Early Onset Schizophrenia (EOS)

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EARLY ONSET

SCHIZOPHRENIA (EOS)

INTRODUCTION

Schizophrenia is the term , which impliessplitting or breaking up of the mind or

personality or more specifically the ³Ego´. The child¶s ego is in the process of

development, and accordingly the egocannot split, till it forms.

This term in children cannot really occur till late childhood/puberty, by which time,Ego formation has generally occurred.

DEFINITION

³Early onset Schizophrenia, with an onset

prior to age 18, is a serious, often

debilitating disorder characterized by

deficits in affect, cognition, and the ability

to relate socially with others´.

EPIDEMIOLOGY

Childhood schizophrenia affects anestimated one in 40,000 children under the

age of 13. During early teen years, the rate of onset of

schizophrenia in the general population begins to increase, and the peak rates of onset lie between the ages of 15 and 30.

In males the onset of schizophrenia is atthe younger end of this range, while onset

in females is usually at the older end.

CLASSIFICATION

According to Age of Onset

0 ± 30 mths Kanner¶s Early Infantile Autism

30 mths ± 6 yrs Early Onset Childhood Sch.

6 yrs ± puberty Late Onset Childhood Sch.

CLASSIFICATION Contd.

According to Bender (1947)

First 2 years Pseudodefective Type

3 ± 5 years Pseudoneurotic Type

10 ± 11 years Pseudopsychotic Type

ETIOLOGY

Inadequate stimulation from the mother

Unrelieved tension

State of frozen balance between aggressiveand libidinal drives.

ETIOLOGY Contd.

Fetal anoxia and psychological trauma.

Ungratified infant impulses became

repressed and then fused with anxiety.

Double bind attitude ± consisted of superficial warmth combined with severe

coldness and rejection of the mother whichmade the infant ³want to escape´.

Avoidance of eye to eye contact anddeficient touching.

ETIOLOGY Contd.

Three primary mechanisms responsible are: -

Genetics

Neuro-

developmental

insults

Viral exposure

Genetic factors

Owen et al. have estimated a heritability rate of

approximately 80%. Lifetime risk of developing schizophrenia is

approximately 10 times higher in first-degree

biologic relatives.

N eurodevelopmental Factors

Obstetric complications

Minor physical irregularities

Disruption of neural development during

the 2nd trimester.

P sychological factors

These factors does not cause schizophrenia,

chronic interpersonal stress within thefamily has been found to influence the

onset and exacerbation of acute psychotic

episodes and relapse rates.

SYMPTOMS

A child or adolescent with schizophrenia

may experience severe deterioration in the

ability to function in social, personal and

regular daily activities. Signs and

symptoms of the disease, which are known

collectively as psychosis, include:

SYMPTOMS Contd.

Hearing voices or

experiencing other

sensory events that aren't

real (hallucinations)

Holding untrue beliefs

about reality (delusions) Disorganized thinking

SYMPTOMS Contd.

Grossly disorganized, irrational behavior

Physical immobility

Excessive mobility with no

purpose

Absent or inappropriate

emotional expression Little verbal communication with other people

Inability to initiate plans

SYMPTOMS Contd.

In childhood schizophrenia early signs of the

disease may include: -

social withdrawal disruptive behaviors

academic problems

speech or language problems

other developmental delays

SYMPTOMS Contd.

In adolescents, schizophrenia may begin gradually,

but the sudden appearance of psychotic

symptoms and deterioration in hygiene and

functioning is more common in this age group

than in younger children.

DSM-IV-TR CRITERIA

Atleast two of the following are needed for a

diagnosis of schizophrenia: -

Delusions

Hallucinations

Disorganized speech

Grossly disorganized or catatonic behavior Negative symptoms (affective flattening, alogia,

avolition)

DSM-IV-TR CRITERIA

Delusions are bizarre.

Hallucinations consist of a voice keeping a

running commentary on the client¶s behaviour or thoughts or two or more voices are conversing

with each other.

The disturbance must persist for at least 6 months

including 1 month of active psychotic symptoms.

EARLY WARNING SIGNS FOR

CHILDHOOD-ONSET SCHZ. trouble telling dreams from reality

seeing things and hearing voices which are not

confused thinking

vivid and bizarre thoughts and ideas

extreme moodiness odd behavior

EARLY WARNING SIGNS FOR

CHILDHOOD-ONSET SCHZ.

ideas that people are "out to get them"

behaving like a younger child

severe anxiety and fearfulness

confusing television with reality

severe problems in making and keepingfriends.

DIAGNOSIS

A complete diagnostic workup will

include:

A complete medical, social and family

history

Interviews with child and parents or

guardians to assess possible psychoticsymptoms, changes in behavior and the

possibility of other psychiatric disorders

DIAGNOSIS Contd.

Tests to assess cognitive skills and

functional abilities in daily life

A review of school records or other input

from school personnel

Blood and brain-imaging tests to rule out

other medical conditions

DIFFERENTIAL DIAGNOSIS

Bipolar disorder

Schizoaffective disorder, a condition with

some manifestations of both schizophrenia

and a mood disorder

Severe anxiety disorders

Severe major depression with psychotic

features

Post-traumatic stress disorder

DIFFERENTIAL DIAGNOSIS

Contd.

Substance abuse disorders (particularly

cocaine and methamphetamine)

Delusional disorders

Medical disorders that affect the brain

Personality disorders

Autism spectrum disorders

TREATMENT

First line: -

Atypical antipsychotics ± Olanzapine, Risperidone,

quetiapine, aripiprazole, ziprasidone.

Second line: -

Typical antipsychotics ± haloperidol, thiothixene,

chlorpromazine, trifluperazine, molindone.Considered for treatment resistant patients: -

Clozapine, ECT.

TREATMENT Contd.

Other medications such as antidepressants, mood

stabilizers, and/or benzodiazepines can be used to

manage mood and anxiety symptomatology.

PSYCHOSOCIAL INTERVENTIONS

Psychoeducation Family therapy

Cognitive Behavior Therapy

P sychoeducation

Helpful for the patient and the family to learn how to

cope better with effects of illness.

Enhance long term outcome.Ongoing education about the illness, treatment

options, social skill training, relapse prevention,

basic life skills training and problem solving

strategies.Educating family to increase their understanding

about their child¶s illness, treatment options, short

and long term prognosis.

Family Therapy

Educating the family about Schizophrenia

and the medications used to treat the

disorder.

Improving problem solving.

Increasing communication skills

These decrease relapse rates.

C ognitive Behavior Therapy ( C BT)

Focuses on challenging and testing key beliefs

associated with hallucinations and delusions.

Teaches problem solving skills.

Enhances coping strategies

Increases medication adherence.

OTHER INTERVENTIONS

Ongoing, age-appropriate education about thedisease and treatment options for both the child

and family members, including siblings Social skills and basic life skills training at

home, school and in the community

Psychotherapy for child and parents or

guardians that focuses on coping strategies, problem-solving skills, and awareness of symptoms and the circumstances that may prompt or exacerbate them

OTHER INTERVENTIONS Contd.

Special educational programs that address

learning and developmental needs

Day programs or at-home services for childrenwho can't attend school for an entire day

Hospitalization when psychotic behaviors aren't

well-managed by drug treatment or when

behaviors, particularly paranoid delusions or

hallucinations, present a danger to the child or

others

PROGNOSIS

The outcome for children with schizophrenia

varies greatly and some individuals function

well with medication. Earlier onset is often associated with a poorer

outcome when it interferes with attending

school and completing an education

NURSES ROLE

NURSING MANAGEMENT CONSIST

FOLLOWING AREAS

Family therapy

Individual therapy

Medication management

NURSES ROLE Contd.

Family therapy

To clear the channels of communication & to

lower the emotional tone of family interaction.- support the parents.

- don¶t blame parents for their child¶s disorder

- help parents to separate from their child toallow them the space to develop.

NURSES ROLE Contd.

Individual psychotherapy

- nurses assist in individual psychotherapy

- encourage child to attend and followseparation from parents

- support the child through bad times during the

therapy.

- manage acting-out which follows the

conscious discovery of conflicts.

NURSES ROLE Contd.

Medication management

- Gives medication to children.

- Ensures that they have taken the medicine rather than storing it or throwing it away.

- Evaluate/Observe response to medicines.

- Assess side effects.- Administration of emergency drugs to control

behaviour as prescribed.

BIBLIOGRAPHY

Wilkinson Teresa R. (1983) ³Child &

Adolescent Psychiatric Nursing´, Blackwell

Scientific Publications, Melbourne, Pp: 151-152

www.yahoo.com

www.google .com

Cheng K. ³Child and adolescent Psychiatry´,

Lippincott Williams Company

Early Onset Schizophrenia (EOS)

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