Psychosis (schizophrenia) in Children and Adolescents

What is schizophrenia?

According to the Child Mind Institute (CMI), there are fewer more frightening or challenging psychiatric conditions for a family to face than psychosis, an extreme mental state in which impaired thinking and emotions cause a person to lose contact with reality. This could mean hearing or seeing things that are not there (hallucinations) or believing things that are not true (delusions). Jody L. Brown, M.D. and D. Alan Bagley, M.D. at the Department of Psychiatry, Division of Child & Adolescent Psychiatry, the University of Arkansas for Medical Sciences, one of the leading schizophrenia specialists in the nation, stated that there is a prevalence of mental health concerns in pediatric populations, and shared some facts:

  • A) 10% to 11% of children have both a mental health disorder and functional impairment.
  • B) 20% of children receive care for their mental health problems.
  • C) Psychotic disorders are rare in children but are usually more severe if present.
  • D) Transient psychotic phenomena can occur in healthy and mildly disturbed children.
  • E) Most children with hallucinations do not have schizophrenia.
  • F) Youth with schizophrenia often have a family history of the disorder.
  • G) Psychotic symptoms such as hallucinations and delusions may be present in a number of disorders including schizophrenia, schizoaffective disorders, and more common disorders such as depression, bipolar disorder, and anxiety disorders such as post-traumatic stress disorder (PTSD).
  • H) Half of the adults in the U.S. with a mental health disorder have symptoms by 14 years old.
  • I) 5% of adults with schizophrenia report onset of psychosis before 15 years old.

The illness most often associated with psychosis (schizophrenia) usually does not show up until very late adolescence or early adulthood. Recently, however, experts in the field have been working to identify high-risk kids who show symptoms that could serve as early warning signs of psychosis, and several academic centers have been set up to focus on this crucial period when it may be possible to change the trajectory of mental illness.

Not all the kids who are identified with what experts call “prodromal” symptoms will progress, or “convert” to full-blown psychotic illness. But the early intervention has been shown to improve outcomes for those who do. And since psychotic symptoms cause disruption across a teenager’s life, from school to friendships to family, researchers are hoping quick action can prevent impairment and prolong typical functioning. Some of the approaches that show promise in delaying the onset of psychosis or mitigating symptoms include fairly simple lifestyle changes like stress reduction and sleep hygiene, and managing co-occurring disorders like anxiety. The key: identifying at-risk kids earlier when these low-impact measures are still effective.

What are “prodromal” symptoms?

Prodromal symptoms are “attenuated” or weak symptoms of psychosis. Moreover, “they are a warning sign,” says Dr. Christoph Correll, the medical director of the Recognition and Prevention Program (RAP) at Zucker Hillside Hospital in Queens, NY, which specializes in diagnosing and treating early symptoms of mental illness in teenagers and young adults. “These signs can happen in people who don’t go on to develop psychosis—but if we follow these people who are in the risk state based on these watered-down versions, one-third will probably go on to develop psychosis. That’s a lot more than in the general population.”
Prodromal symptoms occur on a spectrum from very mild to severe and can include:

  • Withdrawing from friends and family/feeling suspicious of others
  • Changes in sleeping or eating patterns
  • Less concern with appearance, clothes, or hygiene
  • Difficulty organizing thoughts or speech
  • Loss of usual interest in activities or of motivation and energy
  • Development of unusual ideas or behaviors
  • Unusual perceptions, such as visions or hearing voices (or even seeing shadows)
  • Feeling like things are unreal
  • Change in personality
  • Feelings of grandiosity (i.e., the belief to have a superpower)

In some cases, these symptoms represent the early stages of a disorder, and will eventually convert. In others, the symptoms actually fade or remain mild. Dr. Tiziano Colibazzi is a psychiatrist at Columbia Presbyterian’s COPE clinic (Center for Prevention and Evaluation), which was established to research and treat prodromal symptoms. “We can identify a group of people that are at clinically high risk,” says Dr. Colibazzi. “What we can’t do is narrow that group down further to identify the 30 percent who will convert.”

schizophrenia specialists in Orange County, Ca

An evaluation is the first step

The right treatment for prodromal symptoms depends entirely on how severe they are when they are diagnosed. The first step is a proper and complete diagnosis by a mental health professional with experience in assessing psychotic illness. If you see marked changes in motivation, thinking, and/or behavior in your child, the first place to start is with the child’s pediatrician to rule out a medical illness. Substance use also needs to be ruled out as the cause of any behavior changes in adolescents. After that, you may want to have your child evaluated by a qualified psychiatrist or psychologist. This in itself might be a multi-step process.
“You can’t just look at the kid once and get a bit of a history and then know what’s going on,” says Dr. Correll. “Kids develop; symptoms develop. And the trajectory—how things change, get better or worse, what other symptoms add on to it—will be highly informative in telling us something about the prognosis, what we expect to happen.”
One aid to predicting the evolution and severity of symptoms, notes Dr. Colibazzi, is the patient’s ability to doubt his symptoms. If your child retains the self-awareness to know that it’s his or her mind that is playing tricks on him/her, it’s an indication that symptoms are still in the very early stages. As symptoms become more severe, the patient’s beliefs (whether paranoid, grandiose or hallucinatory) become increasingly difficult to challenge.

Lifestyle and mental health options

Psychotic symptoms and illnesses have been shown to vary quite a bit depending on the environment—the health of our bodies, our interpersonal relationships, our mindsets. As with any illness, but particularly important in at-risk youth, healthy living is key. Regardless of the severity of prodromal symptoms, Dr. Correll says that your child’s outcome can be improved by making sure your kid sticks to a routine that includes:

  • Eating well
  • Getting regular exercise
  • Adhering to a regular sleep schedule
  • Reducing stress as much as possible
  • Staying away from drugs—particularly marijuana, which can interact with prodromal symptoms and increase the risk for psychosis significantly

In addition, don’t forget to address depression and anxiety. According to Dr. Correll, “adults who eventually developed schizophrenia identified a three to five year period during which they experienced depression or anxiety before developing the prodromal symptoms of psychosis and then developed full-blown psychosis.” “So treating the depression early,” he says, “might actually interrupt the progression from depression to psychosis in some patients.”

Treatment for prodromal psychotic symptoms

Dr. Correll recommends trying several approaches. Mild symptoms call for more low-key treatments including:

  • Psycho-education: teaching both the kid and the family more about the symptoms and the illness.
  • Therapy, particularly cognitive-behavioral therapy (CBT): “CBT can be good to change one’s thinking patterns,” says Correll, “and also to address developing self-esteem. We have to be careful that kids with a psychiatric diagnosis don’t self-stigmatize and get into a hopeless or negative mode where they feel they can’t achieve.”
  • Lifestyle adjustments: Assessing whether the current school environment is best for the child. Perhaps a therapeutic social group to help the child cope.
  • Reducing Stress: Stress is often a trigger for symptoms, so reducing stress in these kids’ lives is crucial and may prevent or delay conversion to psychotic illness.
  • Understanding prodromal symptoms and monitoring kids who are at high risk for psychotic illness mean that parents can do more for their kids than wait for symptoms to get worse or merely hope for the best. Early monitoring and intervention can give high-risk kids an advantage, which researchers hope will eventually change the odds when it comes to psychotic illness. “The duration of untreated psychosis does actually seem to affect the course of the illness,” Dr. Colibazzi says. The longer the illness goes untreated, the greater the chance that it will cause serious disruption in all areas of the patient’s life. “So it is reasonable to think that just the following someone very closely and treating them very early, as soon as they develop symptoms, would be helpful.”

This article is provided by Dr. Ralph Kueche (Child Psychologist). Dr. Kuechle is a Child and Adolescent Clinical Psychologist who specializes in treating children and their families who may be struggling with mood and behavioral issues. Contact us if you’re looking for schizophrenia specialists in Orange County, Ca. Learn more about Dr. Kuechle.