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Psychosis (Schizophrenia)
Schizophrenia and other psychotic disorders are medical illnesses that result in strange or bizarre thinking, perceptions (sight, sound), behaviors, and emotions. Psychosis is a brain-based condition that is made better or worse by environmental factors – like drug use and stress. Children and youth who experience psychosis often say “something is not quite right” or can’t tell if something is real or not real. It is an uncommon psychiatric illness in young children and is hard to recognize in its early phases.
The appearance of symptoms of psychosis before age 12 is rare (less than one-sixtieth as common as the adult-onset type), but studying these cases is important for understanding this disorder. For those who might develop psychotic disorders or schizophrenia as adults (adult-onset), it is not uncommon for them to start experiencing early warning signs during puberty or adolescence. The period of time when an adolescent experiences the early warning signs of psychosis is called prodrome. During this time, youth recognize that their experiences (hearing or seeing things that are not there) are strange or concerning. They may not easily admit these problems unless asked. Being aware of the early warning signs and offering support is crucial.
Childhood-onset – Most children with schizophrenia show delays in language and other functions long before their psychotic symptoms (hallucinations, delusions, and disordered thinking) appear. In the first years of life, about 30% of these children have transient symptoms of pervasive developmental disorder, such as rocking, posturing, and arm flapping. Childhood-onset of psychosis may present with poor motor development, such as unusual crawling, and children may be more anxious and disruptive compared to those with later onset.
It is especially important to pay attention to sudden changes in thoughts and behaviors. Keep in mind that the onset of several of the symptoms below, and not just any one change, indicates a problem that should be assessed. The symptoms below should not be due to recent substance use or another medical condition.
Early Warning Signs:
•Feeling like their brain is not working
•Feeling like their mind or eyes are playing tricks on them
•Seeing things and hearing voices that are not real
•Hearing knocking, tapping, clicking or their named being called
•Confused thoughts
•Vivid and bizarre thoughts and ideas
•Sudden and bizarre changes in emotions
•Peculiar behavior that seem unusual
•Increased sensitivity to light, sounds, smells or touch
•Concept that people are “out to get them”
•Fearfulness or suspicion that isn’t warranted
•Withdrawal from others
•Severe problems in making and keeping friends
•Difficulty speaking, writing, focusing or managing simple tasks
Symptoms and causes
Symptoms
Schizophrenia involves a range of problems with thinking, behavior or emotions. Signs and symptoms may vary, but usually involve delusions, hallucinations or disorganized speech, and reflect an impaired ability to function. The effect can be disabling.
Schizophrenia symptoms generally start in the mid- to late 20s. It’s uncommon for children to be diagnosed with schizophrenia. Early-onset schizophrenia occurs before age 18. Very early-onset schizophrenia in children younger than age 13 is extremely rare.
Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always be present. Schizophrenia can be difficult to recognize in the early phases.
Early signs and symptoms
The earliest indications of childhood schizophrenia may include developmental problems, such as:
•Language delays
•Late or unusual crawling
•Late walking
•Other abnormal motor behaviors — for example, rocking or arm flapping
Some of these signs and symptoms are also common in children with pervasive developmental disorders, such as autism spectrum disorder. So ruling out these developmental disorders is one of the first steps in diagnosis.
Symptoms in teenagers
Schizophrenia symptoms in teenagers are similar to those in adults, but the condition may be more difficult to recognize in this age group. This may be in part because some of the early symptoms of schizophrenia in teenagers are common for typical development during teen years, such as:
•Withdrawal from friends and family
•A drop in performance at school
•Trouble sleeping
•Irritability or depressed mood
•Lack of motivation
•Strange behavior
•Substance use
Compared with schizophrenia symptoms in adults, teens may be:
•Less likely to have delusions
•More likely to have visual hallucinations
Later signs and symptoms
As children with schizophrenia age, more typical signs and symptoms of the disorder begin to appear. Signs and symptoms may include:
•These are false beliefs that are not based in reality. For example, you think that you’re being harmed or harassed; that certain gestures or comments are directed at you; that you have exceptional ability or fame; that another person is in love with you; or that a major catastrophe is about to occur. Delusions occur in most people with schizophrenia.
•These usually involve seeing or hearing things that don’t exist. Yet for the person with schizophrenia, hallucinations have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination.
•Disorganized thinking.Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can’t be understood, sometimes known as word salad.
•Extremely disorganized or abnormal motor behavior.This may show in several ways, from childlike silliness to unpredictable agitation. Behavior is not focused on a goal, which makes it hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.
•Negative symptoms.This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion ― doesn’t make eye contact, doesn’t change facial expressions, speaks in a monotone, or doesn’t add hand or head movements that normally occur when speaking. Also, the person may have reduced ability to engage in activities, such as a loss of interest in everyday activities, social withdrawal or lack ability to experience pleasure.