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Childhood schizophrenia: diagnostic and treatment challenges

Author/s
Rochelle Caplan
Citation
Issue 1 Summer 2011
CEPiP.2011.1.55-64
Abstract

This paper describes the developmental challenges involved in confirming the diagnostic criteria of schizophrenia in children, the disorders that should be included in the differential diagnosis of this disorder, and how to differentiate their symptoms from those of schizophrenia. It then reviews the psychopharmacological treatment of early-onset schizophrenia focusing mainly on the short-term and long-term adverse effects of first- and second-generation neuroleptics. The diagnostic challenges, together with the adverse effects of neuroleptics, emphasize the importance of accurate diagnosis and medical monitoring of children with schizophrenia.

Keywords:schizophrenia, early-onset, psychosis, diagnosis, neuroleptics, adverse effects

Cite as: Cutting Edge Psychiatry in Practice 2011, 1(1):55-64; https://doi.org/10.65031/jmkt3113

References

  1. Nicolson R, Lenane M, Singaracharlu S, Malaspina D, Giedd JN, Hamburger SD, Gochman P, Bedwell J, Thaker GK, Fernandez T, Wudarsky M, Hommer DW, Rapoport JL. Premorbid speech and language impairments in childhood-onset schizophrenia: Association with risk factors. Am J Psychiatry 2000;157:794-800. https://doi.org/10.1176/appi.ajp.157.5.794
  2. Green W, Campbell M, Hardesty AS, Grega DM, Padron-Gayol M, Shell J, Erlenmeyer-Kimling L. A comparison of schizophrenic and autistic children. J Am Acad Child Psychiatry 1984;23:399-409. https://doi.org/10.1016/s0002-7138(09)60317-4
  3. Kolvin I. Studies in the childhood psychoses: Diagnostic criteria and classification. Br J Psychiatry 1971;118:381-4. https://doi.org/10.1192/bjp.118.545.381
  4. McKenna K, Gordon CT, Lenane M, Kaysen D, Fahey K, Rapoport JL. Looking for Childhood-Onset Schizophrenia: The First 71 Cases Screened. J Am Child Adolesc Psychiatry 1994;33:636-44. https://doi.org/10.1097/00004583-199406000-00003
  5. Russell AT, Bott L, Sammons C. The phenomenology of schizophrenia occurring in childhood. J Am Child Adolesc Psychiatry 1989;28:399-407. https://doi.org/10.1097/00004583-198905000-00017
  6. Kumra S, Charles Schulz S. Editorial: Research progress in early-onset schizophrenia. Schizophr Bull 2008;34:15-7. https://doi.org/10.1093/schbul/sbm123
  7. Caplan R, Guthrie D, Komo S, Tang B, Asarnow R. Thought disorder in childhood schizophrenia: Replication and update of concept. J Am Acad Child Adolesc Psychiatry 2000;39:771-8. https://doi.org/10.1097/00004583-200006000-00016
  8. Carlisle L, McClellan J. Psychopharmacology of schizophrenia in children and adolescents. Pediatr Clin North Am 2011;58:205-18.
  9. Giedd JN, Rapoport JL. Structural MRI of Pediatric Brain Development: What Have We Learned and Where Are We Going? Neuron;67:728-34. https://doi.org/10.1016/j.neuron.2010.08.040
  10. Walsh T, McClellan JM, McCarthy SE, Addington AM, Pierce SB, Cooper GM, et al. Rare structural variants disrupt multiple genes in neurodevelopmental pathways in schizophrenia. Science 2008;320:539-43.        
  11. Trionfi G, Reese E. A good story: Children with imaginary companions create richer narratives. Child Dev 2009;80:1301-13. https://doi.org/10.1111/j.1467-8624.2009.01333.x
  12. Caplan R. Discourse deficits in children with schizophrenia spectrum disorder. . In: Beichtman JH, Cohen N, Konstantareas M, Tannock R, editors. Language, Learning, and Behavior Disorders. Cambridge Cambridge University Press; 1996. p. 156-77.                 
  13. Devlin NM, Connor D, Harley M, Cannon M. The prevalence of psychtoic symptoms in children and adolescents in clinical settings: A systematic review. Schizophr Res 2011;117:196-. https://doi.org/10.1016/j.schres.2010.02.259
  14. Tillman R, Geller B, Klages T, Corrigan M, Bolhofner K, Zimerman B. Psychotic phenomena in 257 young children and adolescents with bipolar I disorder: delusions and hallucinations (benign and pathological). Bipolar Disord 2008;10:45-55. https://doi.org/10.1111/j.1399-5618.2008.00480.x
  15. Ulloa RE, Birmaher B, Axelson D, Williamson D.E, Brent D.A, Ryan N.D, Bridge J, Baugher M. Psychosis in a pediatric mood and anxiety disorders clinic: phenomenology and correlates. J Am Acad Child Adolesc Psychiatry 2000;39:337-45. https://doi.org/10.1097/00004583-200003000-00016
  16. Caetano SC, Olvera R.L, Hunter K, Hatch J.P, Najt P, Bowden C, Pliszka S, Soares J.C. Association of psychosis with suicidality in pediatric bipolar I, II and bipolar NOS patients. J Affect Disord 2006;91:33-7. https://doi.org/10.1016/j.jad.2005.12.008
  17. Hornstein NL, Putnam F.W. Clinical phenomenology of child and adolescent dissociative disorders. J Am Acad Child Adolesc Psychiatry 1992:1077-85. https://doi.org/10.1097/00004583-199211000-00013
  18. Kanner AM, Dunn DW. Diagnosis and management of depression and psychosis in children and adolescents with epilepsy. J Child Neurol 2004;19:S65-S72. https://doi.org/10.1177/088307380401900108
  19. Caplan R, Shields WD, Mori L, Yudovin S. Middle childhood onset of interictal psychosis. J Am Acad Child Adolesc Psychiatry 1991;30:893-6. https://doi.org/10.1097/00004583-199111000-00005
  20. Krishnakumar P, Jayakrishnan MP, Beegum MN, Riyaz A. Acute disseminated encephalomyelitis presenting as acute psychotic disorder. Indian Pediatr 2008;45:999-1001. https://doi.org/10.4103/0019-5545.91913
  21. Caplan R, Tanguay PE, Szekely AG. Subacute sclerosing panencephalitis presenting as childhood psychosis. J Am Acad Child Adolesc Psychiatry 1987;26:440-3. https://doi.org/10.1097/00004583-198705000-00029
  22. Stuart FA, Segal TY, Keady S. Adverse psychological effects of corticosteroids in children and adolescents. Arch Dis Child 2005;90:500-6.
  23. Besag FM. Behavioural effects of the newer antiepileptic drugs: an update. Expert Opin Drug Saf 2004;3:1-8. https://doi.org/10.1517/14740338.3.1.1
  24. Mosholder AD, Gelperin K, Hammad TA, Phelan K, Johann-Liang R. Hallucinations and other psychotic symptoms associated with the use of attention-deficit/hyperactivity disorder drugs in children. Pediatrics 2009;123:611-6. https://doi.org/10.1542/peds.2008-0185
  25. McClellan J, McCurry C, Snell J, DuBose A. Early-onset psychotic disorders: Course and outcome over a 2-year period. J Am Child Adolesc Psychiatry 1999;38:1380-8. https://doi.org/10.1097/00004583-199911000-00012
  26. Leeson VC, Harrison I, Ron MA, Barnes TRE, Joyce EM. The effect of cannabis use and cognitive reserve on age at onset and psychosis outcomes in first-episode schizophrenia. Schizophr Bull 2011. https://doi.org/10.1093/schbul/sbq153
  27. Miller TJ, McGlashan TH, Rosen JL, Cadenhead K, Ventura J, McFarlane W, Perkins DO, Pearlson GD, Woods SW. Prodromal assessment with the structured interview for prodromal syndromes and the scale of prodromal symptoms: Predictive validity, interrater reliability, and training to reliability. Schizophr Bull 2003;29:703-15. https://doi.org/10.1093/oxfordjournals.schbul.a007040
  28. Cannon TD, Cadenhead K, Cornblatt B, Woods SW, Addington J, Walker E, Seidman LJ, Perkins D, Tsuang M, McGlashan T, Heinssen R. Prediction of psychosis in youth at high clinical risk: A multisite longitudinal study in North America. Arch Gen Psychiatry 2008;65:28-37. https://doi.org/10.1001/archgenpsychiatry.2007.3
  29. Haas M, Unis AS, Armenteros J, Copenhaver MD, Quiroz JA, Kushner SF. A 6-Week, Randomized, Double-Blind, Placebo-Controlled Study of the Efficacy and Safety of Risperidone in Adolescents with Schizophrenia. J Child Adolesc Psychopharmacol 2009;19:611-21. https://doi.org/10.1089/cap.2008.0144
  30. Kryzhanovskaya L, Schulz SC, McDougle C, Frazier J, Dittmann R, Robertson-Plouch C, Bauer T, Xu W, Wang W, Carlson J, Tohen M. Olanzapine cersus placebo in adolescents with schizophrenia: A 6-week, randomized, double-blind, placebo-controlled trial. J Am Child Adolesc Psychiatry 2009;48:60-70. https://doi.org/10.1097/chi.0b013e3181900404
  31. Findling RL, Robb A, Nyilas M, Forbes RA, Jin N, Ivanova S, Marcus R, McQuade RD, Iwamoto T, Carson WH. A multiple-center, randomized, double-blind, placebo-controlled study of oral aripiprazole for treatment of adolescents with schizophrenia. Am J Psychiatry 2008;165:1432-41. https://doi.org/10.1176/appi.ajp.2008.07061035
  32. Kumra S, Frazier JA, Jacobsen LK, McKenna K, Gordon CT, Lenane MC, Hamburger SD, Smith AK, Albus KE, Alaghband-Rad J, Rapoport JL. Childhood-Onset schizophrenia: A double-blind clozapine-haloperidol comparison. Arch Gen Psychiatry 1996;53:1090-7. https://doi.org/10.1016/s0165-1781(97)03062-x
  33. Shaw P, Sporn A, Gogtay N, Overman GP, Greenstein D, Gochman P, Tossell JW, Lenane M, Rapoport JL. Childhood-onset schizophrenia: A double-blind, randomized clozapine-olanzapine comparison. Arch Gen Psychiatry 2006;63:721-30. https://doi.org/10.1001/archpsyc.63.7.721
  34. Sikich L, Frazier JA, McClellan J, Findling RL, Vitiello B, Ritz L, Ambler D, et al.. Double-blind comparison of first- and second-generation antipsychotics in early-onset schizophrenia and schizo-affective disorder: Findings from the treatment of early-onset schizophrenia spectrum disorders (TEOSS) study. Am J Psychiatry 2008;165:1420-31. https://doi.org/10.1176/appi.ajp.2008.08050756
  35. De Hert M, Dekker JM, Wood D, Kahl KG, Holt RIG, Moller HJ. Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). Eur Psychiatry 2009;24:412-24. https://doi.org/10.1016/j.eurpsy.2009.01.005
  36. Correll CU, Kratochvil CJ. Antipsychotic use in children and adolescents: Minimizing adverse effects to maximize outcomes. J Am Child Adolesc Psychiatry 2008;47:9-20. https://doi.org/10.1097/chi.0b013e31815b5cb1
  37. Correll CU, Manu P, Olshanskiy V, Napolitano B, Kane JM, Malhotra AK. Cardiometabolic Risk of Second-Generation Antipsychotic Medications During First-Time Use in Children and Adolescents. JAMA 2009;302:1765-73. https://doi.org/10.1001/jama.2009.1549
  38. McIntyre RS, Jerrell JM. Metabolic and Cardiovascular Adverse Events Associated With Antipsychotic Treatment in Children and Adolescents. Arch Pediatr Adolesc Med 2008;162:929-35. https://doi.org/10.1001/archpedi.162.10.929
  39. Roke Y, van Harten PN, Boot AM, Buitelaar JK. Antipsychotic medication in children and adolescents: A descriptive review of the effects on prolactin level and associated side effects. J Child Adolesc Psychopharmacol 2009;19:403-14. https://doi.org/10.1089/cap.2008.0120
  40. Correll CU, Kane JM. One-year incidence rates of tardive dyskinesia in children and adolescents treated with second-generation antipsychotics: A systematic review. J Child Adolesc Psychopharmacol 2007;17:647-56. https://doi.org/10.1089/cap.2006.0117
  41. Silva RR, Munoz DM, Alpert M, Perlmutter IR, Diaz J. Neuroleptic malignant syndrome in children and adolescents. J Am Child Adolesc Psychiatry 1999;38:187-94. https://doi.org/10.4324/9780203449523-24
  42. Neuhut R, Lindenmayer J, Silva R. Neuroleptic malignant syndrome in children and adolescents on atypical antipsychotic aedication: A review. J Child Adolesc Psychopharmacol 2009;19:415-22. https://doi.org/10.1089/cap.2008.0130