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Introduction

Schizophrenia is characterized by the distorted thinking associated with delusions and hallucinations. Schizophrenia may have a gradual onset, with symptoms of withdrawal and disordered language evident over time, or it can have a sudden onset in adolescence. Evidence suggests that schizophrenia is due to an inherited biochemical abnormality in the brain. Treatment includes medication, such as neuroleptics, to alleviate the painful and intrusive thoughts, and structured programs and education for the youngster and family to improve daily functioning.

Real Life Stories

At age 16, Dwayne was keeping to himself more and more, until one day he emerged from his room with duct tape around his arms and legs, explaining that it was a force field to protect him from the Martian rays streaming into his room at night.

Eighteen-year-old Jennie had been the pride and joy of her family. Intent on pursuing a career in medicine, she was well on her way with a straight A average. At first her parents were puzzled when she earned failing grades her first year in college, but when she came home obsessed with thoughts about being poisoned by the cafeteria staff, they knew something was wrong.

Both Dwayne and Jennie have schizophrenia.

What are the symptoms?

Schizophrenia is one of the most baffling, troubling, and potentially dangerous of the mental disorders because it seems so unbelievable. When a person has schizophrenia (psychosis), his brain is not processing information in the usual way, making it impossible for him to control his thinking or behavior. In the most severe stage, a person with schizophrenia has difficulty telling the difference between fantasy and reality and has thoughts of hurting himself or someone else. The main symptoms include:

Positive symptoms including delusions, which are ideas which may seem real but are not based in reality. For example, someone may think she is being singled out by the government to join an elite military force or is convinced the answers to a television game show are secretly being sent to her through the cable wires. Hallucinations, another positive symptom, occur when a person sees, hears, or feels things that are not there. Hallucinations can seem so real to people with schizophrenia that they act in bizarre ways and do things that look strange to those around them.

Negative symptoms refer to the absence of normal function. For example, teens may become distant, withdrawn, uninvolved with life, want to be alone, and have no energy for people or activities.

Disorganized speech is evident in people with schizophrenia who often talk in a rapid but disjointed way. They either do not make sense or change topics so frequently that they are difficult to understand.

Disorganized or catatonic behavior, such as suddenly becoming violent or walking around confused, or sitting and staring as if immobilized, may reflect a person's disordered thinking.

Who is likely to have it?

Schizophrenia is rare in children under the age of 12, but affects about 1% of the population in the United States. About one million people are being treated for schizophrenia on an outpatient basis. Of those, 15% will kill themselves. In childhood the gender distribution of schizophrenia is marginally weighted toward boys, but by adolescence the female/male ratio is just about even.

Some youngsters diagnosed with schizophrenia have been described by their parents as not quite like other kids when they were younger. They may have been quiet, seeming to be off in their own world, but they functioned adequately on a day-to-day basis. Although the break from reality may have seemed to be sudden, it is likely that the youngsters showed signs of emotional and physical decline before the actual defining episode. For others, the onset of the disorder can be more sudden and swift, occurring unpredictably after an uneventful, possibly successful, early life.

Why does it happen?

As with many other psychiatric disorders, youngsters with schizophrenia most likely inherited a biochemical abnormality or irregularity in their brains that makes them think and act in these different ways. The brains of adults with schizophrenia look different than the brains of people who do not have the disorder, and there is also evidence showing that their brains have too much of the chemical dopamine. If a parent or sibling has schizophrenia, a youngster has a ten times greater chance of having schizophrenia than a person who does not have the disorder in the immediate family. In addition, there is a 50% concordance rate for identical twins compared to a 10% rate for fraternal twins. It is important to understand that a person would not be diagnosed with schizophrenia if the bizarre or unusual behavior was due to a physical illness or drug abuse.

How is it treated?

Youngsters diagnosed with this disorder should get help as soon as possible. The sooner treatment starts, the better chance the individual will respond to medication, get back on track and learn how to manage the disorder. Without early, proper treatment, youngsters will be more difficult to treat, may have gotten into difficulty with the law, or tried to help themselves inappropriately by abusing alcohol or drugs. A treatment plan may include:

Medication Neuroleptics is the term used to refer to the specialized drugs used to treat schizophrenia. Neuroleptics are the first line of defense in treatment and are necessary to keep the delusions and hallucinations at bay. An encouraging 80% of the youngsters who receive medication after their first break will respond, but that figure keeps dropping for each episode that the individual is untreated.

Maintenance Once the right medication is established, the key to maintaining a realistic view of the world is to keep taking the medication even when the symptoms subside. One of the biggest threats to the person with schizophrenia is recurrence of the most difficult symptoms due to noncompliance with the prescribed medication.

Multidisciplinary treatment may include individual and family therapy aimed at psychoeducation about the disorder, its cause, the warning signs, and the need for medication. Special forms of living arrangements and vocational and educational programs are often required throughout life. These programs provide social skills and life skills training to help these youngsters make realistic choices about their future.

Questions & answers

Is it my fault my child has schizophrenia?

No. Contrary to old ways of thinking, we now know that schizophrenia cannot be prevented or caused by bad parenting. It has been proven that there is a genetic predisposition to schizophrenia. Parents should not blame themselves for not spotting the problem and preventing it, because it can run in families without parents being aware of it. Normal behavior has a wide range, and it is only over a period of time and with professional help, that an accurate diagnosis is made. Some of the warning signs include problems negotiating routine developmental tasks, social isolation and ostracism by peers. Keep in mind that often the disease presents itself with full force in the teen years.

How long does an episode of schizophrenia last?

Schizophrenia is a disease, and in many ways it is like diabetes or asthma in that there is no cure; rather it must be managed throughout life. Depending on the compliance with, and response to, treatment the symptoms can get better or worse.

Does my child have to take medication or are there any alternatives?

Medication, called psychopharmacological management, is the most effective treatment to ameliorate the most severe symptoms of the disorder, such as delusions, hallucinations or behavior disturbances. It is likely that medication will be necessary at various points throughout a person's life. Physicians are now better able to tailor medications and adjust dosages according to an individual's specific symptoms, thus minimizing side effects such as fatigue and dry mouth. The advent of newer medications has allowed more individuals to live in the community rather than in isolation.

The introduction of neuroleptics, or antipsychotic medications, has greatly improved the day-to-day functioning of individuals with schizophrenia. Thus they are able to gain the most benefit from such non-pharmacological treatments as cognitive behavioral therapy or vocational training.

Besides medication, are there other forms of treatment?

A variety of treatment programs exist for youngsters with schizophrenia, ranging from inpatient hospital settings to outpatient independent living facilities and day treatment centers. The younger child may require a program that includes special education to address particular language and learning needs. The older child or teen will need a program that addresses peer relationships, social skills training, and education about warning signs and management of the disorder.

What can help me parent a child with schizophrenia?

It is important for parents to realize that when their youngsters have delusions or hallucinations they experience them as real. Therefore, it is unproductive to try and talk them out of it. It certain can be frustrating to be unable to get someone to recognize reality. A better approach would be to listen to them, be supportive and get professional help immediately to assess the need for medication to keep them safe. Psychotherapy for the youngster as well as for the whole family is helpful for managing the stress that schizophrenia can cause in the whole household.

About the Authors

Robin F. Goodman, Ph.D., is a clinical psychologist specializing in bereavement issues.