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Early Onset Schizophrenia (EOS)
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Transcript of Early Onset Schizophrenia (EOS)
8/8/2019 Early Onset Schizophrenia (EOS)
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EARLY ONSET
SCHIZOPHRENIA (EOS)
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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.
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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´.
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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.
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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.
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CLASSIFICATION Contd.
According to Bender (1947)
First 2 years Pseudodefective Type
3 ± 5 years Pseudoneurotic Type
10 ± 11 years Pseudopsychotic Type
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ETIOLOGY
Inadequate stimulation from the mother
Unrelieved tension
State of frozen balance between aggressiveand libidinal drives.
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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.
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ETIOLOGY Contd.
Three primary mechanisms responsible are: -
Genetics
Neuro-
developmental
insults
Viral exposure
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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.
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N eurodevelopmental Factors
Obstetric complications
Minor physical irregularities
Disruption of neural development during
the 2nd trimester.
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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.
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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:
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SYMPTOMS Contd.
Hearing voices or
experiencing other
sensory events that aren't
real (hallucinations)
Holding untrue beliefs
about reality (delusions) Disorganized thinking
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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
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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
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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.
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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)
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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.
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EARLY WARNING SIGNS FOR
CHILDHOOD-ONSET SCHZ. trouble telling dreams from reality
seeing things and hearing voices which are not
real
confused thinking
vivid and bizarre thoughts and ideas
extreme moodiness odd behavior
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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.
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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
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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
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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
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DIFFERENTIAL DIAGNOSIS
Contd.
Substance abuse disorders (particularly
cocaine and methamphetamine)
Delusional disorders
Medical disorders that affect the brain
Personality disorders
Autism spectrum disorders
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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.
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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
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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.
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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.
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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.
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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
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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
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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
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NURSES ROLE
NURSING MANAGEMENT CONSIST
FOLLOWING AREAS
Family therapy
Individual therapy
Medication management
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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.
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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.
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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.
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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
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