pediatrics
Schizophrenia in Children and Adolescents
Introduction
Schizophrenia is the presence of hallucinations and delusions causing considerable psychosocial dysfunction and lasting≥6 months. (See also Schizophrenia in adults.) Onset of schizophrenia is typically from mid-adolescence to the mid-30s, with a peak age of onset in the 20s. Features in adolescents and young adults are similar. Schizophrenia in prepubertal children (childhood-onset schizophrenia), in which symptoms similar to those of the adolescent/young adult-onset form develop before age 13, is extremely rare ( General references ). Although the first episode usually occurs in young adults, some contributory neurodevelopmental events and experiences occur earlier (eg, during the perinatal period). Theseperinatal risk factorsinclude the following: Genetic disorders (particularly those that increase risk of childhood onset) Exposure to certain drugs or substances (eg, cannabis) during a vulnerable period Prenatal undernutrition Labor complications, hypoxia, perinatal infection, placental abruption or insufficiency Childhood brain injury Other risk factors, which occur later (eg, illicit drug use later in adolescence), may then trigger the onset of schizophrenia. Manifestations of childhood-onset schizophrenia are usually similar to those in adolescents and adults, but delusions and visual hallucinations (which may be more common among children) may be less elaborate. Additional characteristics also help distinguish childhood-onset schizophrenia from the adolescent/young adult form ( General references ): More severe symptoms A strong family history Increased prevalence of genetic abnormalities, developmental abnormalities (eg, pervasive developmental disorder, intellectual disability), and motor abnormalities Increased prevalence of premorbid social difficulties Insidious onset Cognitive deterioration Neuroanatomic changes (progressive loss of cortical gray matter volume, increase in ventricular volume) Sudden-onset psychosis in young children should always be treated as a medical emergency with a thorough medical assessment to search for a physiologic cause of the mental status change; these causes include ( General references ) the following: Therapeutic drugs (eg, stimulants, corticosteroids, anticholinergics) Recreational drugs (eg, cannabis) Central nervous system (CNS) disorders, including infection (viral, bacterial, parasitic), tumors, demyelinating diseases, injury, seizures, or migraines -aspartate] receptor encephalitis [ General references ], SLE) Endocrinopathies (eg, hyperthyroidism, hypocortisolemia) Sleep disorders Metabolic disorders (porphyria, Wilson disease,GM2gangliosidosis) Lysosomal storage diseases Nutritional deficiencies (magnesium and vitamins A, D, B1, B3, B12) Chromosomal abnormalities (22.11q, XXY, XO, fragile X, Prader-Willi, Fahr's Dis) COVID-19 ( General references ) Recent research indicates that there is an increased risk of developing certain psychotic disorders (namely, Bipolar Disorder in Children and Adolescents and schizophrenia) among adolescents who use cannabis products containing tetrahydrocannabinol (THC; There are several reports of psychoses in adolescents with symptomatic ( General references ) and asymptomatic ( Treatment of schizophrenia in children and adolescents is complex, with variable outcomes, and referral to a child and adolescent psychiatrist is strongly recommended. 