Childhood schizophrenia

Childhood schizophrenia (also known as childhood-onset schizophrenia, and very early-onset schizophrenia) is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose.[3] Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments.[1][4][5] Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.[4]

Childhood schizophrenia
Other namesChildhood type schizophrenia; schizophrenia, childhood type; childhood-onset schizophrenia (COS); very early-onset schizophrenia (VEOS); schizophrenic syndrome of childhood
SpecialtyChild psychiatry (EU), Child and adolescent psychiatry (USA), clinical psychology
SymptomsHallucinations, delusions, disorganized behavior or catatonia, negative symptoms (i.e., avolition or reduced affect display)[1]
Usual onsetBefore the age of 13 years
TypesEpisodic-progredient/shiftlike childhood schizophrenia (malignant, paranoid and slow-progressive sub-types), continuous childhood schizophrenia, recurrent childhood schizophrenia (the rarest form – 5 % of all cases)[2]
Differential diagnosisMajor depressive disorder or bipolar disorder with psychotic or catatonic features, brief psychotic disorder, delusional disorder, obsessive–compulsive disorder and body dysmorphic disorder, autism spectrum disorder or communication disorders, other mental disorders associated with a psychotic episode
MedicationAntipsychotics
Frequency1⁄5 of all forms of psychosis of the schizophrenia spectrum;[2] 1.66:1000 among children (0–14 years)[2]

The disorder presents symptoms such as auditory and visual hallucinations, strange thoughts or feelings, and abnormal behavior, profoundly impacting the child's ability to function and sustain normal interpersonal relationships. Delusions are often not systematized and vague.[6] Among the psychotic symptoms seen in childhood schizophrenia non-verbal auditory hallucinations are the most common, and include noises such as shots, knocks, bangs. Other symptoms can include irritability, searching for imaginary objects, or low performance. It typically presents after the age of seven.[7] About 50% of young children diagnosed with schizophrenia experience severe neuropsychiatric symptoms.[8] Studies have demonstrated that diagnostic criteria are similar to those of adult schizophrenia.[9][10] Neither DSM-5 nor ICD-11 list "childhood schizophrenia" as a separate diagnosis. Diagnosis is based on behavior observed by caretakers and, in some cases depending on age, self reports.

Classification of mental disorders

Diagnostic and Statistical Manual of Mental Disorders
DSM-III. American Psychiatric Association against childhood schizophrenia.

Childhood schizophrenia was not directly added to the DSM until 1968, when it was added to the DSM-II,[11] which set forth diagnostic criteria similar to that of adult schizophrenia.[12] "Schizophrenia, childhood type" was a DSM-II diagnosis with diagnostic code 295.8,[11] equivalent to "schizophrenic reaction, childhood type" (code 000-x28) in DSM-I (1952).[11] "Schizophrenia, childhood type" was successfully removed from the DSM-III (1980), and in the Appendix C they wrote: "there is currently no way of predicting which children will develop Schizophrenia as adults". Instead of childhood schizophrenia they proposed to use of "infantile autism" (299.0x) and "childhood onset pervasive developmental disorder" (299.9x).[13]

In the DSM-III-R (1987), DSM-IV (1994), DSM-IV-TR (2000), DSM-5 (2013) there is no "childhood schizophrenia". The rationale for this approach was that, since the clinical pictures of adult schizophrenia and childhood schizophrenia are identical, childhood schizophrenia should not be a separate disorder.[14] However, the section in schizophrenia's Development and Course in DSM-5, includes references to childhood-onset schizophrenia.[1]

International Classification of Diseases

In the International Classification of Diseases 8th revision (ICD-8, 1967) there was a category (295.8) "Other" in the schizophrenia section (295). "Other" includes: atypical forms of schizophrenia, infantile autism, schizophrenia, childhood type, NOS (Not Otherwise Specified), schizophrenia of specified type not classifiable under 295.0–295.7, schizophreniform attack or psychosis.

Unspecified psychoses with origin specific to childhood (code 299.9) in the International Classification of Diseases 9th revision (ICD-9) includes "child psychosis NOS", "schizophrenia, childhood type NOS" and "schizophrenic syndrome of childhood NOS".[15]

"Childhood type schizophrenia" available in the Soviet adopted version of the ICD-9 (code 299.91) and the Russian adopted version of the 10th revision ICD-10 (code F20.8xx3)[16] and the U.S. adopted the 10th revision ICD-10 (code F20.9x6) classified "schizophrenia, unspecified".[17]

Signs and symptoms
Main article: Schizophrenia
See also: Basic symptoms of schizophrenia

Schizophrenia is a mental disorder that is expressed in abnormal mental functions, a loss of one's sense of identity and self, a compromised perception of reality, and disturbed behavior.

The signs and symptoms of childhood schizophrenia are similar to those of adult-onset schizophrenia. Some of the earliest signs that a young child may develop schizophrenia are lags in language and motor development. Some children engage in activities such as flapping the arms or rocking, and may appear anxious, confused, or disruptive on a regular basis. Children may experience hallucinations, but these are often difficult to differentiate from just normal imagination or child play. Visual hallucinations are more commonly found in children than in adults.[1] It is often difficult for children to describe their hallucinations or delusions, making very early-onset[18] schizophrenia especially difficult to diagnose in the earliest stages. The cognitive abilities of children with schizophrenia may also often be lacking, with 20% of patients showing borderline or full intellectual disability.[19]

Negative symptoms include apathy, avolition, alogia, anhedonia, asociality, and blunted emotional affect.

  • Apathy is an overall lack of interest or enjoyment, which relates to the negative symptom of blunted emotional affect.
  • Blunted emotional affect includes a lack of facial expressions, lack of intonation while speaking, and little eye contact. If you are speaking to someone who has blunted emotional affect, it would be difficult to determine their feelings using their facial expressions and tone.
  • Avolition is experienced when they child shows few goal-focused behaviors and choices, and a lack of interest in goal-related activities, including personal hygiene.[20]
  • Alogia can be seen when people use few words and lack fluency while speaking.
  • Anhedonia relates to an inability to find pleasure in activities that one previously found enjoyable, as well as the inability to remember previous enjoyable memories.[21]
  • Asociality is a symptom seen when a person has no interest in socializing with others.[22]

These negative symptoms can severely impact children's and adolescents' abilities to function in school and in other public settings.

Very early-onset schizophrenia refers to onset before the age of thirteen. The prodromal phase, which precedes psychotic symptoms, is characterized by deterioration in school performance, social withdrawal, disorganized or unusual behavior, a decreased ability to perform daily activities, a deterioration in self-care skills, bizarre hygiene and eating behaviors, changes in affect, a lack of impulse control, hostility and aggression, and lethargy.[19]

Auditory hallucinations are the most common of the positive symptoms in children. Auditory hallucinations may include voices that are conversing with each other or voices that are speaking directly to the children themselves. Many children with auditory hallucinations believe that if they do not listen to the voices, the voices will harm them or someone else. Tactile and visual hallucinations seem relatively rare. Children often attribute the hallucinatory voices to a variety of beings, including family members or other people, evil forces ("the Devil", "a witch", "a spirit"), animals, characters from horror movies (Bloody Mary, Freddy Krueger) and less clearly recognizable sources ("bad things," "the whispers").[10] Command auditory hallucinations (also known as imperative hallucinations) were common and experienced by more than half of the group in a study at Bellevue Hospital Center's Children's Psychiatric Inpatient Unit.[10] Voices repeat: "Kill somebody!", "Kill her, kill her!".[10] Delusions are reported in more than half of children with schizophrenia, but they are usually less complex than those of adults.[10] Delusions are often connected with hallucinatory experiences.[10] In one study, delusions were characterized as persecutory for the most part, but some children reported delusions of control.[10] Many said they were being tortured by the beings causing their visual and auditory hallucinations, some thought disobeying their voices would cause them harm.[10]

Some degree of thought disorder was observed in a test group of children at Bellevue Hospital. They displayed illogicality, tangentiality (a serious disturbance in the associative thought process), and loosening of associations.[23]

Negative symptoms include apathy, avolition, and blunted emotional affect.

Pathogenesis

There is no known single cause or causes of schizophrenia, however, it is a heritable disorder.

Several environmental factors, including perinatal complications and prenatal maternal infections may contribute to the etiology of schizophrenia.[9] Prenatal rubella or influenza infections are associated with childhood-onset schizophrenia.[24] Severity or frequency of prenatal infections may also contribute to earlier onset of symptoms by means of congenital brain malformations, reduction or impairment of cognitive function, and psychological disorders.[25][24] It is believed that prenatal exposure to rubella modifies the developmental course during childhood, increasing the risk for childhood schizophrenia.[24] Genetic predisposition is an important factor as well; familial mental illness is more frequently reported for childhood-onset schizophrenic patients.[26] While it is hard to detect, there are relatives who are more-likely to be diagnosed with schizophrenia if they are children of individuals who have this disorder. "First degree relatives" are found to have the highest chance of being diagnosed with schizophrenia. Children of individuals with schizophrenia have a 8.2% chance of having schizophrenia while the general population is at an 0.86% chance of having this disorder.[27] These results indicate that genes play a big role in one developing schizophrenia.

Genetic

There is "considerable overlap" in the genetics of childhood-onset and adult-onset schizophrenia, but in childhood-onset schizophrenia there is a higher number of "rare allelic variants".[28] There have been several genes indicated in children diagnosed with schizophrenia that include: neuregulin, dysbindin, D-amino acid oxidase, proline dehydrogenase, catechol-Omethyltransferase, and regulator of G protein signaling. There have also been findings of 5HT2A and dopamine D3 receptor. An important gene for adolescent-onset schizophrenia is the catechol-O-methyltransferase gene, a gene that regulates dopamine.[29] Children with schizophrenia have an increase in genetic deletions or duplication mutations[30] and some have a specific mutation called 22q11 deletion syndrome, which accounts for up to 2% of cases.[31][32]

Neuroanatomical

Neuroimaging studies have found differences between the medicated brains of individuals with schizophrenia and neurotypical brains, though research does not know the cause of the difference.[33] In childhood-onset schizophrenia, there appears to be a more rapid loss of cerebral grey matter during adolescence.[33][34] Studies have reported that adverse childhood experiences (ACEs) are the most preventable cause of the development of psychiatric disorders such as schizophrenia. ACEs have the potential to impact on the structure and function of the brain; structural changes revealed have been related to stress. Findings also report that different areas of the brain are affected by different types of maltreatment.[35]

Diagnosis

In 2013, the American Psychiatric Association released the fifth edition of the DSM (DSM-5). According to the manual, to be diagnosed with schizophrenia, two diagnostic criteria have to be met over much of the time of a period of at least one month, with a significant impact on social or occupational functioning for at least six months. The DSM diagnostic criteria outlines that the person has to be experiencing either delusions, hallucinations, or disorganized speech. In other words, an individual does not have to be experiencing delusions or hallucinations to receive a diagnosis of schizophrenia. A second symptom could be negative symptoms, or severely disorganized or catatonic behavior.[36] Only two symptoms are required for a diagnosis of schizophrenia, resulting in different presentations for the same disorder.[36]

In practice, agreement between the two systems is high.[37] The DSM-5 criteria puts more emphasis on social or occupational dysfunction than the ICD-10.[38] The ICD-10, on the other hand, puts more emphasis on first-rank symptoms.[39][40] The current proposal for the ICD-11 criteria for schizophrenia recommends adding self-disorder as a symptom.[41]

Changes made

Both manuals have adopted the chapter heading of Schizophrenia spectrum and other psychotic disorders; ICD modifying this as Schizophrenia spectrum and other primary psychotic disorders.[42] The definition of schizophrenia remains essentially the same as that specified by the 2000 text revised DSM-IV (DSM-IV-TR). However, with the publication of DSM-5, the APA removed all sub-classifications of schizophrenia.[42] ICD-11 has also removed subtypes. The removed subtype from both, of catatonic has been relisted in ICD-11 as a psychomotor disturbance that may be present in schizophrenia.[42]

Another major change was to remove the importance previously given to Schneider's first-rank symptoms.[43] DSM-5 still uses the listing of schizophreniform disorder but ICD-11 no longer includes it.[42] DSM-5 also recommends that a better distinction be made between a current condition of schizophrenia and its historical progress, to achieve a clearer overall characterization.[43]

A dimensional assessment has been included in DSM-5 covering eight dimensions of symptoms to be rated (using the Scale to Assess the Severity of Symptom Dimensions) – these include the five diagnostic criteria plus cognitive impairments, mania, and depression.[42] This can add relevant information for the individual in regard to treatment, prognosis, and functional outcome; it also enables the response to treatment to be more accurately described.[42][44]

Two of the negative symptoms – avolition and diminished emotional expression – have been given more prominence in both manuals.[42]

First rank symptoms

First-rank symptoms are psychotic symptoms that are particularly characteristic of schizophrenia, which were put forward by Kurt Schneider in 1959.[45] Their reliability for the diagnosis of schizophrenia has been questioned since then.[46] A 2015 systematic review investigated the diagnostic accuracy of first rank symptoms:

First rank symptoms for schizophrenia[47]
Summary
These studies were of limited quality. Results show correct identification of people with schizophrenia in about 75–95% of the cases although it is recommended to consult an additional specialist. The sensitivity of FRS was about 60%, so it can help diagnosis and, when applied with care, mistakes can be avoided. In lower resource settings, when more sophisticated methods are not available, first rank symptoms can be very valuable.[47]

The same criteria are used to diagnose children and adults.[9][10] Diagnosis is based on reports by parents or caretakers, teachers, school officials, and others close to the child.

A professional who believes a child has schizophrenia usually conducts a series of tests to rule out other causes of behavior, and pinpoint a diagnosis. Three different types of study are performed: physical, laboratory, and psychological. Physical exams usually cover the basic assessments, including but not limited to; height, weight, blood pressure, and checking all vital signs to make sure the child is healthy.[48] Laboratory tests include electroencephalogram EEG screening and brain imaging scans. Blood tests are used to rule out alcohol or drug effects,[48] and thyroid hormone levels are tested to rule out hyper- or hypothyroidism. A psychologist or psychiatrist talks to a child about their thoughts, feelings, and behavior patterns. They also inquire about the severity of the symptoms, and the effects they have on the child's daily life. They may also discuss thoughts of suicide or self-harm in these one-on-one sessions.[48] Some symptoms that may be looked at are early language delays, early motor development delays, and school problems.[48]

Many people with childhood schizophrenia are initially misdiagnosed as having pervasive developmental disorders (autism spectrum disorder, for example).[5]

Age of first episode of psychosis

Childhood schizophrenia manifests before the age of 13 and is also known as very early-onset. Onset before the age of 18 is known as early-onset schizophrenia, and is rare; very early-onset is even rarer.[49]

Differential diagnosis

The onset of childhood schizophrenia usually follows a period of normal, or near normal, development.[50] Strange interests, unusual beliefs, and social impairment can be prodromal symptoms of childhood schizophrenia, but can also be signs of autism spectrum disorder.[50] Hallucinations and delusions are typical for schizophrenia, but not features of autism spectrum disorder.[50] In children hallucinations must be separated from typical childhood fantasies.[50] Since childhood disintegrative disorder (CDD) has a very similar set of symptoms and high comorbidity it can be misdiagnosed as childhood schizophrenia, which can lead to prescribing ineffective medications.[51]

Childhood schizophrenia can be difficult to diagnosis simply because of how many disorders mimic the symptoms of CS. Though it can be difficult, that is why it is important to examine the whole mental state of the child at that time. Individuals who experience disorders such as major depressive disorder, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, delusional disorder and schizotypal personality disorder have all been known to exhibit similar symptoms to children who have been diagnosed with CS.[52]

The three most common disorders that are difficult to distinguish are bipolar disorder (BD), autism spectrum disorder (ASD), and attention deficit hyperactive disorder (ADHD). BD, ASD, and ADHD overlap with symptom patterns in CS [52] but a few distinguishing factors helps differentiate the disorders. Understanding these differences is crucial to diagnosing the child.

Individuals with bipolar disorder and childhood schizophrenia can both present psychotic symptoms such as hallucinations, delusions, and disorganized behaviors.[52] A distinguishing feature in childhood schizophrenia, the hallucination, aren't taking place during a 'depressive or manic' episode as it would for an individual diagnosed with bipolar disorder. An individual with bipolar disorder has both low and high moods while one with CS, exhibits elements of depression.[52]

Autism spectrum disorder share many features that are present in CS such as disorganized speech, social deficits, and extremely bizarre and repetitive behaviors.[52] A hallmark of CS and distinguishing factor is when hallucinations last longer than one month. Should this occur, further examinations are necessary to determine if the child has ASD or CS.

Unlike the previous two disorders, ADHD and CS have fewer commonalities.[52] Both individuals who have been diagnosed with CS and ADHD may appear to exhibit a poor attention span and disorganization. "Psychotic episodes are absent in ADHD, a distinct difference from CS".

It is important to understand that children diagnosed with childhood schizophrenia have higher rates of comorbidity, so exploring all resources is necessary to properly diagnose the child.[52]

Prevention
Further information: Early intervention in psychosis

Research efforts are focusing on prevention in identifying early signs from relatives with associated disorders similar to schizophrenia and those with prenatal and birth complications. Prevention has been an ongoing challenge because early signs of the disorder are similar to those of other disorders. Also, some of the schizophrenic-related symptoms are often found in children without schizophrenia or any other diagnosable disorder.[53]

Treatment

Current methods in treating early-onset schizophrenia follow a similar approach to the treatment of adult schizophrenia. Although methods of treatment for childhood schizophrenia are largely understudied, the use of antipsychotic medicine is normally the primary line of treatment in addressing signs in childhood schizophrenia diagnoses. Contemporary practices of schizophrenia treatment are multidisciplinary, recuperation oriented, and consist of medications, with psychosocial interventions that include familial support systems.[54] However, research has shown that atypical antipsychotics may be preferable because they cause less short-term side effects.[55] When weighing treatment options, it is necessary to consider the adverse effects, such as metabolic syndrome,[56] of various medications used to treat schizophrenia and the potential implications of these effects on development.[57] A 2013 systematic review compared the efficacy of atypical antipsychotics versus typical antipsychotics for adolescents:

Atypical compared with typical antipsychotics (only short term)[58]
Summary
There is not any convincing evidence suggesting that atypical antipsychotic medications are superior to the older typical medications for the treatment of adolescents with psychosis. However, atypical antipsychotic medications may be more acceptable because fewer symptomatic adverse effects are seen in the short term. Little evidence is available to support the superiority of one atypical antipsychotic medication over another.[58]

Madaan et al. wrote that studies report efficacy of typical neuroleptics such as thioridazine, thiothixene, loxapine and haloperidol, high incidence of side effects such as extrapyramidal symptoms, akathisia, dystonias, sedation, elevated prolactin, tardive dyskinesia.[59]

Prognosis

A very-early diagnosis of schizophrenia leads to a worse prognosis than other psychotic disorders.[60] The primary area that children with schizophrenia must adapt to is their social surroundings. It has been found, however, that very early-onset schizophrenia carried a more severe prognosis than later-onset schizophrenia. Regardless of treatment, children diagnosed with schizophrenia at an early age have diminished social skills, such as educational and vocational abilities.[61]

The grey matter in the cerebral cortex of the brain shrinks over time in people with schizophrenia; the question of whether antipsychotic medication exacerbates or causes this has been controversial. A 2015 meta-analysis found that there is a positive correlation between the cumulative amount of first generation antipsychotics taken by people with schizophrenia and the amount of grey matter loss, and a negative correlation with the cumulative amount of second-generation antipsychotics taken.[62][63]

Epidemiology

Schizophrenia disorders in children are rare.[7] Boys are twice as likely to be diagnosed with childhood schizophrenia.[64] There is often a disproportionately large number of males with childhood schizophrenia, because the age of onset of the disorder is earlier in males than females by about 5 years.[5] Clinicians have been and still are reluctant to diagnose schizophrenia early on, primarily due to the stigma attached to it.[53]

While very early-onset schizophrenia is a rare event, with prevalence of about 1:10,000, early-onset schizophrenia manifests more often, with an estimated prevalence of 0.5%.[59]

History

Until the late nineteenth century, children were often diagnosed with psychosis like schizophrenia, but instead were said to have "pubescent" or "developmental" insanity. Through the 1950s, childhood psychosis began to become more and more common, and psychiatrists began to take a deeper look into the issue.[12]

Sante De Sanctis first wrote about child psychoses, in 1905. He called the condition "dementia praecocissima" (Latin, "very premature madness"), by analogy to the term then used for schizophrenia, "dementia praecox" (Latin, "premature madness).[65] De Sanctis characterized the condition by the presence of catatonia.[66] Philip Bromberg thinks that "dementia praecocissima" is in some cases indistinguishable from childhood schizophrenia; Leo Kanner believed that "dementia praecocissima" encompassed a number of pathological conditions.[66]

Theodor Heller discovered a new syndrome dementia infantilis (Latin, "infantile madness") in 1909 which was named Heller syndrome.[67] In ICD-11 Heller syndrome is classed as an autism spectrum subtype.[68]

In 1909, Julius Raecke reported on ten cases of catatonia in children at the Psychiatric and Neurological Hospital of Kiel University, where he worked. He described symptoms similar to those previously recorded by Dr. Karl Ludwig Kahlbaum, including "stereotypies and bizarre urges, impulsive motor eruptions and blind apathy."[67] He also reported refusal to eat, stupor with mutism, uncleanliness, indications of waxy flexibility and unmotivated eccentricity, and childish behavior.[67]

A 1913 paper by Karl Pönitz, "Contribution to the Recognition of Early Catatonia",[69] recounts a case study of a boy who manifested "typical catatonia" from the age of twelve, characterizing him as showing a "clear picture of schizophrenia."[67]

Before 1980 the literature on "childhood schizophrenia" often described a "heterogeneous mixture" of different disorders, such as autism, "symbiotic psychosis" or psychotic disorder other than schizophrenia, pervasive developmental disorders and dementia infantilis.

References
  1. Diagnostic and statistical manual of mental disorders : DSM-5 (5th ed.). American Psychiatric Association. 2013. pp. 99–104. ISBN 9780890425541.
  2. Tiganov AS, Snezhnevsky AV, Orlovskaya DD (1999). "Шизофрения в детском и подростковом возрасте" [Schizophrenia in childhood and adolescence]. In Tiganov AS (ed.). Руководство по психиатрии в 2 томах [Textbook of Psychiatry in 2 volumes] (in Russian). Vol. 1. Moscow: "Медицина" = ["Medicine"]. pp. 472–488. ISBN 5-225-02676-1. // Research of childhood schizophrenia types by The Mental Health Research Center (MHRC) (Russia)
  3. Diagnostic and statistical manual of mental disorders : DSM-5 (5th ed.). American Psychiatric Association. 2013. pp. 102–103. ISBN 9780890425541.
  4. Kendhari J, Shankar R, Young-Walker L (July 2016). "A Review of Childhood-Onset Schizophrenia". Focus. 14 (3): 328–332. doi:10.1176/appi.focus.20160007. PMC 6526799. PMID 31975813.
  5. Ritsner MS, ed. (2011). Handbook of Schizophrenia Spectrum Disorders, Vol. II. Dordrecht, Heidelberg, London, New York: Springer Science+Business Media. pp. 195–205. doi:10.1007/978-94-007-0831-0. ISBN 978-94-007-0830-3.
  6. Bettes BA, Walker E (July 1987). "Positive and negative symptoms in psychotic and other psychiatrically disturbed children". Journal of Child Psychology and Psychiatry, and Allied Disciplines. Wiley-Blackwell. 28 (4): 555–68. doi:10.1111/j.1469-7610.1987.tb00223.x. PMID 3654807.
  7. Baribeau DA, Anagnostou E (December 2013). "A comparison of neuroimaging findings in childhood onset schizophrenia and autism spectrum disorder: a review of the literature". Frontiers in Psychiatry. 4: 175. doi:10.3389/fpsyt.2013.00175. PMC 3869044. PMID 24391605.
  8. Lambert LT (April–June 2001). "Identification and management of schizophrenia in childhood". Journal of Child and Adolescent Psychiatric Nursing. 14 (2): 73–80. doi:10.1111/j.1744-6171.2001.tb00295.x. PMID 11883626.
  9. Nicolson R, Rapoport JL (November 1999). "Childhood-onset schizophrenia: rare but worth studying". Biological Psychiatry. Elsevier BV. 46 (10): 1418–28. doi:10.1016/s0006-3223(99)00231-0. PMID 10578456. S2CID 45154449.
  10. Spencer EK, Campbell M (1994). "Children with schizophrenia: diagnosis, phenomenology, and pharmacotherapy". Schizophrenia Bulletin. 20 (4): 713–25. doi:10.1093/schbul/20.4.713. PMID 7701278.
  11. American Psychiatric Association (1968). Diagnostic and Statistical Manual of Mental Disorders, 2nd Edition. Washington, D. C. p. 35. doi:10.1176/appi.books.9780890420355.dsm-ii (inactive 31 July 2022). ISBN 978-0-89042-035-5.{{cite book}}: CS1 maint: DOI inactive as of July 2022 (link)
  12. Remschmidt HE, Schulz E, Martin M, Warnke A, Trott GE (1994). "Childhood-onset schizophrenia: history of the concept and recent studies". Schizophrenia Bulletin. 20 (4): 727–45. doi:10.1093/schbul/20.4.727. PMID 7701279.
  13. American Psychiatric Association (1980). "Appendix C: Annotated Comparative Listing of DSM-II and DSM-lll". Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). Washington, DC: American Psychiatric Publishing. p. 375.
  14. Spitzer RL, Cantwell DP (1980). "The DSM-III classification of the psychiatric disorders of infancy, childhood, and adolescence". Journal of the American Academy of Child Psychiatry. Elsevier BV. 19 (3): 356–70. doi:10.1016/s0002-7138(09)61059-1. PMID 6157706.
  15. Manual of the international statistical classification of diseases injuries and causes of death (PDF). Geneva: World Health Organization. 1977. p. 190.
  16. "ICD-10. Schizophrenia, schizotypal and delusional disorders (F20—F29)" (in Russian). Retrieved 3 December 2017.
  17. "The ICD-10 Classification of Mental and Behavioral Disorders" (PDF). World Health Organization. p. 83. Archived (PDF) from the original on 2004-10-17.
  18. Jardri, Renaud (2014). "From Phenomenology to Neurophysiological Understanding of Hallucinations in Children and Adolescents". Schizophrenia Bulletin. 40: S221–S232. doi:10.1093/schbul/sbu029. PMC 4141307. PMID 24936083.
  19. Masi G, Mucci M, Pari C (2006). "Children with schizophrenia: clinical picture and pharmacological treatment". CNS Drugs. 20 (10): 841–66. doi:10.2165/00023210-200620100-00005. PMID 16999454. S2CID 41966134.
  20. Strauss, Gregory P.; Horan, William P.; Kirkpatrick, Brian; Fischer, Bernard A.; Keller, William R.; Miski, Pinar; Buchanan, Robert W.; Green, Michael F.; Carpenter, William T. (2013-06-01). "Deconstructing negative symptoms of schizophrenia: Avolition–apathy and diminished expression clusters predict clinical presentation and functional outcome". Journal of Psychiatric Research. 47 (6): 783–790. doi:10.1016/j.jpsychires.2013.01.015. ISSN 0022-3956. PMC 3686506. PMID 23453820.
  21. Gee, Dylan G. (2019-04-10). "Demystifying anhedonia in childhood with large-scale networks". Science Translational Medicine. 11 (487): eaax1723. doi:10.1126/scitranslmed.aax1723. S2CID 111256918.
  22. Gray, Susan W. (2016). Psychopathology : a competency-based assessment model for social workers (4th ed.). Boston, MA: Cengage Learning. ISBN 978-1-305-10193-7. OCLC 945782115.
  23. "Action and Thought: in-Patient Treatment of Severe Personality Disorders Within A Psychotherapeutic Milieu", Personality Disorder and Serious Offending, CRC Press, pp. 181–189, 2006-03-31, doi:10.1201/b13290-23, ISBN 978-0-429-25273-0, retrieved 2021-07-02
  24. Brown, Alan S. (2011-01-01). "The environment and susceptibility to schizophrenia". Progress in Neurobiology. 93 (1): 23–58. doi:10.1016/j.pneurobio.2010.09.003. ISSN 0301-0082. PMC 3521525. PMID 20955757.
  25. Nicolson R, Rapoport JL (November 1999). "Childhood-onset schizophrenia: rare but worth studying". Biological Psychiatry. Elsevier BV. 46 (10): 1418–28. doi:10.1016/s0006-3223(99)00231-0. PMID 10578456. S2CID 45154449.
  26. Kallmann FJ, Roth B (February 1956). "Genetic aspects of preadolescent schizophrenia". The American Journal of Psychiatry. American Psychiatric Publishing. 112 (8): 599–606. doi:10.1176/ajp.112.8.599. PMID 13292546.
  27. Zahari, Zalina; Teh, Lay Kek; Ismail, Rusli; Razali, Salleh Mohd (August 2011). "Influence of DRD2 polymorphisms on the clinical outcomes of patients with schizophrenia". Psychiatric Genetics. 21 (4): 183–189. doi:10.1097/ypg.0b013e3283437250. ISSN 0955-8829. PMID 21206399. S2CID 42218254.
  28. Asarnow RF, Forsyth JK (October 2013). "Genetics of childhood-onset schizophrenia". Child and Adolescent Psychiatric Clinics of North America. 22 (4): 675–87. doi:10.1016/j.chc.2013.06.004. PMC 4364758. PMID 24012080.
  29. Godar SC, Bortolato M (2014). "Gene-sex interactions in schizophrenia: focus on dopamine neurotransmission". Frontiers in Behavioral Neuroscience. 8: 71. doi:10.3389/fnbeh.2014.00071. PMC 3944784. PMID 24639636.
  30. Squarcione, Chiaras; Torti, Maria Chiara; Fabio, Fabio Di; Biondi, Massimo (2013-12-04). "22q11 deletion syndrome: a review of the neuropsychiatric features and their neurobiological basis". Neuropsychiatric Disease and Treatment. 9: 1873–1884. doi:10.2147/ndt.s52188. PMC 3862513. PMID 24353423. Retrieved 2021-07-02.
  31. Squarcione C, Torti MC, Di Fabio F, Biondi M (2013). "22q11 deletion syndrome: a review of the neuropsychiatric features and their neurobiological basis". Neuropsychiatric Disease and Treatment. 9: 1873–84. doi:10.2147/NDT.S52188. PMC 3862513. PMID 24353423.
  32. Giusti-Rodríguez P, Sullivan PF (November 2013). "The genomics of schizophrenia: update and implications". The Journal of Clinical Investigation. 123 (11): 4557–63. doi:10.1172/JCI66031. PMC 3809776. PMID 24177465.
  33. Brent BK, Thermenos HW, Keshavan MS, Seidman LJ (October 2013). "Gray matter alterations in schizophrenia high-risk youth and early-onset schizophrenia: a review of structural MRI findings". Child and Adolescent Psychiatric Clinics of North America. 22 (4): 689–714. doi:10.1016/j.chc.2013.06.003. PMC 3767930. PMID 24012081.
  34. Shaw P, Gogtay N, Rapoport J (June 2010). "Childhood psychiatric disorders as anomalies in neurodevelopmental trajectories". Human Brain Mapping. Wiley-Blackwell. 31 (6): 917–25. doi:10.1002/hbm.21028. PMC 6870870. PMID 20496382. S2CID 18033463.
  35. Teicher MH, Samson JA (March 2016). "Annual Research Review: Enduring neurobiological effects of childhood abuse and neglect". Journal of Child Psychology and Psychiatry, and Allied Disciplines. 57 (3): 241–66. doi:10.1111/jcpp.12507. PMC 4760853. PMID 26831814.
  36. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington: American Psychiatric Publishing. ISBN 978-0-89042-555-8.
  37. Jakobsen KD, Frederiksen JN, Hansen T, Jansson LB, Parnas J, Werge T (2005). "Reliability of clinical ICD-10 schizophrenia diagnoses". Nordic Journal of Psychiatry. 59 (3): 209–12. doi:10.1080/08039480510027698. PMID 16195122. S2CID 24590483.
  38. Tandon R, Gaebel W, Barch DM, Bustillo J, Gur RE, Heckers S, et al. (October 2013). "Definition and description of schizophrenia in the DSM-5". Schizophrenia Research. 150 (1): 3–10. doi:10.1016/j.schres.2013.05.028. PMID 23800613. S2CID 17314600.
  39. American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 5–25. ISBN 978-0-89042-555-8.
  40. "The ICD-10 Classification of Mental and Behavioural Disorders" (PDF). World Health Organization. p. 26. Archived (PDF) from the original on 2016-06-18. Retrieved 2022-04-09.
  41. Heinz A, Voss M, Lawrie SM, Mishara A, Bauer M, Gallinat J, et al. (September 2016). "Shall we really say goodbye to first rank symptoms?". European Psychiatry. 37: 8–13. doi:10.1016/j.eurpsy.2016.04.010. PMID 27429167. S2CID 13761854.
  42. Biedermann F, Fleischhacker WW (August 2016). "Psychotic disorders in DSM-5 and ICD-11". CNS Spectrums. 21 (4): 349–54. doi:10.1017/S1092852916000316. PMID 27418328. S2CID 24728447.
  43. Tandon R, Gaebel W, Barch DM, et al. (October 2013). "Definition and description of schizophrenia in the DSM-5". Schizophrenia Research. 150 (1): 3–10. doi:10.1016/j.schres.2013.05.028. PMID 23800613. S2CID 17314600.
  44. Barch DM, Bustillo J, Gaebel W, et al. (October 2013). "Logic and justification for dimensional assessment of symptoms and related clinical phenomena in psychosis: relevance to DSM-5". Schizophrenia Research. 150 (1): 15–20. doi:10.1016/j.schres.2013.04.027. PMID 23706415. S2CID 10052003.
  45. Schneider, K. Clinical Psychopathology. New York: Grune and Stratton. 1959.
  46. Bertelsen A (2002). "Schizophrenia and related disorders: experience with current diagnostic systems". Psychopathology. 35 (2–3): 89–93. doi:10.1159/000065125. PMID 12145490. S2CID 41076230.
  47. Soares-Weiser K, Maayan N, Bergman H, Davenport C, Kirkham AJ, Grabowski S, Adams CE (January 2015). "First rank symptoms for schizophrenia". The Cochrane Database of Systematic Reviews. 1: CD010653. doi:10.1002/14651858.CD010653.pub2. PMC 7079421. PMID 25879096. Archived from the original on 2021-03-03. Retrieved 2022-04-09.
  48. "Childhood schizophrenia: Tests and diagnosis". Mayo Clinic. 17 December 2010.
  49. Hayes, D; Kyriakopoulos, M (August 2018). "Dilemmas in the treatment of early-onset first-episode psychosis". Therapeutic Advances in Psychopharmacology. 8 (8): 231–239. doi:10.1177/2045125318765725. PMC 6058451. PMID 30065814.
  50. American Psychiatric Association (2013). "Autism Spectrum Disorder. 299.00 (F84.0). Differential Diagnosis". Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Arlington, VA: American Psychiatric Publishing. p. 58. doi:10.1176/appi.books.9780890425596. hdl:2027.42/138395. ISBN 978-0-89042-559-6.
  51. Sawant, Neena Sanjiv; Parkar, Shubhangi; Kulkarni, Prathamesh (2014-08-30). "Childhood disintegrative disorder misdiagnosed as childhood-onset schizophrenia". South African Journal of Psychiatry. 20 (3): 2. doi:10.4102/sajpsychiatry.v20i3.518. ISSN 2078-6786.
  52. Bartlett, Jennifer (2014-01-01). "Childhood-onset schizophrenia: what do we really know?". Health Psychology and Behavioral Medicine. 2 (1): 735–747. doi:10.1080/21642850.2014.927738. ISSN 2164-2850. PMC 4345999. PMID 25750815.
  53. Wicks-Nelson R, Israel AC (2009). "Pervasive developmental disorders and schizophrenia". In Jewell L (ed.). Abnormal child and adolescent psychology. Upper Saddle River, NJ: Prentice Hall Higher Education. pp. 327–359. ISBN 978-0-13-235978-8.
  54. Chan, Vivien (April 26, 2017). "Schizophrenia and Psychosis". Child and Adolescent Psychiatric Clinics of North America. 26 (2): 341–366. doi:10.1016/j.chc.2016.12.014. PMID 28314460.
  55. Kumar, Ajit; Datta, Soumitra S; Wright, Stephen D; Furtado, Vivek A; Russell, Paul S (2013-10-15). "Atypical antipsychotics for psychosis in adolescents". Cochrane Database of Systematic Reviews (10): CD009582. doi:10.1002/14651858.cd009582.pub2. ISSN 1465-1858. PMID 24129841.
  56. DE HERT, MARC; SCHREURS, VINCENT; VANCAMPFORT, DAVY; VAN WINKEL, RUUD (February 2009). "Metabolic syndrome in people with schizophrenia: a review". World Psychiatry. 8 (1): 15–22. doi:10.1002/j.2051-5545.2009.tb00199.x. ISSN 1723-8617. PMC 2656262. PMID 19293950.
  57. Cohen D, Bonnot O, Bodeau N, Consoli A, Laurent C (June 2012). "Adverse effects of second-generation antipsychotics in children and adolescents: a Bayesian meta-analysis". Journal of Clinical Psychopharmacology. 32 (3): 309–16. doi:10.1097/JCP.0b013e3182549259. PMID 22544019. S2CID 5920580.
  58. Kumar A, Datta SS, Wright SD, Furtado VA, Russell PS (October 2013). "Atypical antipsychotics for psychosis in adolescents". The Cochrane Database of Systematic Reviews. 10 (10): CD009582. doi:10.1002/14651858.CD009582.pub2. PMID 24129841.
  59. Madaan V, Dvir Y, Wilson DR (August 2008). "Child and adolescent schizophrenia: pharmacological approaches". Expert Opinion on Pharmacotherapy. Informa Healthcare. 9 (12): 2053–68. doi:10.1517/14656566.9.12.2053. PMID 18671461. S2CID 71397213.
  60. Clemmensen L, Vernal DL, Steinhausen HC (September 2012). "A systematic review of the long-term outcome of early onset schizophrenia". BMC Psychiatry. 12: 150. doi:10.1186/1471-244X-12-150. PMC 3521197. PMID 22992395.
  61. Bartlett, Jennifer (January 1, 2014). "Childhood-onset schizophrenia: what do we really know?". Health Psychology and Behavioral Medicine. 2 (1): 735–747. doi:10.1080/21642850.2014.927738. ISSN 2164-2850. PMC 4345999. PMID 25750815.
  62. Vita A, De Peri L, Deste G, Barlati S, Sacchetti E (September 2015). "The Effect of Antipsychotic Treatment on Cortical Gray Matter Changes in Schizophrenia: Does the Class Matter? A Meta-analysis and Meta-regression of Longitudinal Magnetic Resonance Imaging Studies". Biological Psychiatry. 78 (6): 403–12. doi:10.1016/j.biopsych.2015.02.008. hdl:11379/458510. PMID 25802081. S2CID 27008041.
  63. Navari S, Dazzan P (November 2009). "Do antipsychotic drugs affect brain structure? A systematic and critical review of MRI findings". Psychological Medicine. 39 (11): 1763–77. doi:10.1017/S0033291709005315. PMID 19338710. S2CID 4919922.
  64. Gonthier M, Lyon MA (22 July 2004). "Childhood-Onset Schizophrenia: An Overview". Psychology in the Schools. 41 (7): 803–811. doi:10.1002/pits.20013.
  65. Richard Noll (2009). The Encyclopedia of Schizophrenia and Other Psychotic Disorders. Infobase Publishing. p. 131. ISBN 978-0-8160-7508-9.
  66. Robert Jean Campbell (2009). Campbell's Psychiatric Dictionary. Oxford University Press. pp. 265–266. ISBN 978-0-19-534159-1.
  67. Dirk Marcel Dhossche (2006). Catatonia in Autism Spectrum Disorders. Elsevier. pp. 4–5. ISBN 978-0-08-046338-4.
  68. "ICD-11 - Mortality and Morbidity Statistics". icd.who.int. Retrieved 27 November 2020.
  69. Leonhard K (1995). Classification of Endogeneous Psychoses and their Differentiated Etiology (2nd ed.). Springer Science & Business Media. p. 335. ISBN 3-211-83259-9. Retrieved 25 September 2018.

Further reading
  • Tiffin PA, Welsh P (November 2013). "Practitioner review: schizophrenia spectrum disorders and the at-risk mental state for psychosis in children and adolescents--evidence-based management approaches". Journal of Child Psychology and Psychiatry, and Allied Disciplines. 54 (11): 1155–75. doi:10.1111/jcpp.12136. PMID 24102356.
This article is issued from Wikipedia. The text is licensed under Creative Commons - Attribution - Sharealike. Additional terms may apply for the media files.