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| ESE424 : The Class : Mild Disabilities : Behavioral/Emotional : Schizophrenia | |||||
Schizophrenia
Schizophrenia is the final emotional or behavioral disorder we will explore in this topic. I should note, though, that this is a very low incidence disability. The majority of children in the traditional ED/BD programs in our public schools have conduct disorders, anxiety or depression. Schizophrenia is often not diagnosed until after the age of 7-8 year of age due to the limited developmental levels of children below those ages. Thus, schizophrenia is primarily an e adolescent or adult onset condition.
In this lesson we will cover:
- Definitions and symptoms of schizophrenia
- People with schizophrenia
- Epidemiology of schizophrenia
- Developmental courses and outcomes associated with schizophrenia
- The etiology of schizophrenia
- Treatments for schizophrenia
Definition, Diagnosis, and Symptoms
Childhood schizophrenia, with an onset before the age of 12, as with the conduct disorders we studied earlier, is defined by a complex of symptoms rather than a specific definition. There is some consensus among educators, psychiatrists, and mental health professionals that the essential features of schizophrenia hold across age groups.
Diagnostic Criteria for Schizophrenia, Subtypes, and Associated Features
Delusions are erroneous beliefs the person holds in the fact of realistic contradiction. Delusions may be simple or complex and can take many forms.
Examples of different delusions
Hallucinations are erroneous perceptions that occur in the absence of any identifiable stimuli. Hallucinations may involve hearing, seeing, or smelling things that do not exist. These hallucinations are remarkably consistent across samples of people with schizophrenia
Examples of different hallucinations
Thought disorders are disorders of the form and content of thinking. Thought disorders can be manifested as distortions (the person misperceives what is said), or may be reflected in disorganized speech such as jumping from one topic to another, incoherent or illogical speech, impoverished content, or neoglisms (words that have no meaning to anyone other than the speaker - "flappelwafeen")
Associated features include awkwardness, delayed motor development, poor coordination, and peculiar postures. The person may also show a lack of emotion or inappropriate emotion and may withdraw socially. For 10-20% of the persons with schizophrenia, they have depressed IQ scores. Preliminary data shows that intelligence (IQ) declines slightly during the first few years of psychotic symptoms.
People with schizophrenia
Perhaps the best way to understand schizophrenia is to listen (or read) the stories of those who have this condition. I have identified several stories. Please look through these to get better sense of the disorder.
Struggle with Schizophrenia (with Real Audio segment)
Epidemiology and Outcomes of Schizophrenia
As more research has been conducted, the picture of schizophrenia has improved. We know that schizophrenia
- is a low incidence condition
- is present in approximately 0.2% of children and 1% of adults
- is more frequently identified in males than in females
- in its adult form, is more common in lower socioeconomic levels
- 40% will attempt suicide; 10% will be successful
- 50% will develop substance abuse problems
- 40% receive little or no therapy
- 50% deny they have schizophrenia
- 70% will go off medical interventions and have a relapse within 2 years
Outcomes
Relapse Rates and Long Term Outcomes
Developmental course of childhood schizophrenia
Schizophrenia can occur suddenly or come on gradually and insidiously. Childhood schizophrenia typically has a developmental sequence from nonpsychotic to psychotic symptoms. Children who have an acute onset of schizophrenia appear to have better outcomes than those whose schizophrenia develops slowly over time.
Non-psychotic symptoms - delays or problems with language, motor, sensory, or cognitive abilities; social withdrawal; school problems; an "odd personality." The person may withdraw from social situations (where they had not before)
psychotic symptoms - hallucinations, delusions, disorganized speech or thought. These symptoms are more evident during school years.
themes of hallucinations - in childhood, the themes are more related to the experiences of a child (animals, toys, monsters) and appear to be simple. In adulthood or adolescence, the themes are more complex, elaborate and abstract.
Adult onset schizophrenia is more sudden and occurs during periods of high stress or difficulty.
The Etiology of Schizophrenia
Most of what we have learned about schizophrenia points to three factors: Biological and neurological origins, genetic and inheritance factors, and social and psychological variables.
Biological and neurological origins
Researchers have found structural abnormalities in the brains of some persons with schizophrenia. In these individual's brains, there appears to be a slight enlargement of the ventricles which may be due to an underdevelopment or loss of brain tissue during early developmental periods (the first trimester).
MRIs of the brains of persons with and without schizophrenia (scroll down about 1/4 of the page for the images. Look at the darkened areas in the middle of the brain shown in the bottom row, rightmost image)
Other researchers have found that persons with schizophrenia have reduced volume in the temporal-limbic areas which have a role in emotion, memory, and organization. Other researchers feel that the structural changes that are noted in adult schizophrenic patients progress during childhood as the brain continues to grow and differentiate. MRI scans have also uncovered abnormal neurons in unusual locations of the brains of persons with schizophrenia.
Inheritance
A limited number of studies indicate higher than expected occurrences of schizophrenia in first-degree relatives of children with schizophrenia. The risk for developing schizophrenia increases as the genetic relationship to the person who is manifesting symptoms increases
- 13% chance for the child of a person with schizophrenia
- 2% for a first cousin
Identical twins have a much greater risk than fraternal twins (48% to 17%).
Risk Factors for Schizophrenia
Social and Psycholgical Variables
Life events that are stressful (adverse happenings, demanding situations) have been linked to the onset of schizophrenia in adults. Some researchers take this to indicate an environmental cause of schizophrenia. Most likely, the environmental stressors that trigger the schizophrenia interact with other factors to cause the schizophrenia to manifest itself.
Treatment of Schizophrenia
There are many interventions for schizophrenia, each of which has shown some success in reducing the symptoms of this condition. The most prominent interventions include pharmacotherapy, ethnopsychopharmacology (culturally sensitive pharmacotherapy), and psychosocial treatments.
Interventions for Schizophrenia
Once you have finished you should:
Go on to Activity
5: Case Study
or
Go back to Emotional
and Behavioral Disorders
E-mail Larry Gallagher at Larry.Gallagher@nau.edu
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