Kate Hergott's List: Schizophrenia Research Essay

• The next time we saw her was at 25 weeks. The obstetrician commented on how Jani was face on to the ultrasound, as if she could hear it, hear us, which we were told was unusual. Typically, we were told, the fetus often hides, but Jani was right there. Her eyes were open. We watched her blink.

   
• She was awake even then, and she would stay awake. She moved constantly, so much so that when on Memorial Day, 2002 Susan did not feel her move for 90 minutes, she panicked and

  broke down; terrified that Jani had died inside. She cried with relief when Jani finally moved. She had just been asleep.
• Ninety minutes after birth, lying swaddled in Susan’s arms, her eyes were open and she seemed to follow me and the camcorder around the room, although the nurse assured us newborn babies couldn’t focus.
• While the other newborns screamed and cried, Jani seemed content.
• On the seventh day of her life, Jani awoke, but this time she did not go back to sleep.
• She screamed. Constantly
• At three weeks old, she was sleeping a total of three to four hours a day.
• From that point on, Jani would sleep in bursts of twenty to thirty minutes at a time, 24 hours a day.
• It became pointless to put Jani down when she fell asleep because she would wake up again minutes later. People gave us all sorts of advice. We were told to ‘let her cry it out.’ We tried that once. One hour later, Jani was still screaming, so we picked her up and never did that again.
• I dropped out of college because I couldn’t function, let alone study.
• One day, Susan was holding a screaming Jani and had to go out to get the mail. When she went outside, Jani stopped screaming. When she went back inside, Jani started again.
• A few more times experimenting with going outside and Susan had figured out what our pediatrician could not; the only thing that stopped Jani from screaming was stimulation.
• We learned that the more stimulation Jani got, the happier she was. Taking Jani to the mall and letting her see the crowds bought us quiet, if not sleep. Unlike most other babies, it was impossible to over stimulate her. She was not afraid of large crowds. In fact, she thrived on them

• We took her to the mall, to play areas, the zoo on the weekend days when it was the most crowded, Ikea. We squeezed ourselves into crowded elevators.

   
• And we did without each other, because by now the only time Susan and I saw each other was to hand Jani off after our “shift” was done.
• At five months, Jani would press whatever button on a toy you told her to push. She began to talk at 8 months. At 13 months she knew the alphabet and her numbers to ten. By 18 months, she was speaking in grammatically correct full sentences.
• Shortly before her third birthday, Jani started to play with “Low,” an imaginary cat. Kids have imaginary friends all the time, so we thought nothing of it. She would say “Come on, Low! Let’s go play!” and run across the room. She talked with “Low” all the time.
• By this time Jani could count to one thousand, so we didn’t find it strange when another imaginary friend appeared named “400”, who Jani described as an orange tabby cat.
• But then Jani began to change. She started changing her name, often several times a day. She became Wednesday, then Hot Dog, then Blue Eyed Tree Frog.
• But we were growing uneasy now because when somebody called Jani by her name, she would scream in a rage at them: I’M NOT JANUARY! She started to withdraw from the other kids she had once loved playing with, spending more of her time alone with her imaginary friends. The happy, smiling girl started to fade, replaced by one who seemed angry at everything and everybody.
• By four years old, people were starting to suggest that Jani might be autistic or have Asperger’s Syndrome. So we had her tested. She didn’t, but she did have a 146 IQ. Once again, we thought that Jani was just brilliant, if a little eccentric. She loved to learn. Whatever you cared to teach her, she would learn and she could retain anything. She learned the periodic table (her favorite element is Tungsten). She learned about evolution. She loved science and math. We started making plans to put her in a gifted school.
• Jani was starting to scream at people. A high-pitched, excruciating and ear-shattering scream when she didn’t get what she wanted. And what did she want? She wanted to work. She would run behind the counters of stores and restaurants, laughing, saying she was sixteen and wanted to work.
• By now, Low and 400 had been joined by hundreds of other imaginary friends, who she normally named after numbers or days of the week. She refused to play with other kids, calling them “thirteens” and saying she was an “eighteen.” Her number kept climbing, into the hundreds and eventually into the thousands. She said she wanted other kids “like her.” We tried to find them, but no matter how smart or verbal the other child was, Jani would always come up with an excuse as to why she couldn’t play with them.

• the violence began.

   

  It began right around the time Susan got pregnant. Due to her pregnancy, she was unable to take Jani all over the city for 12-14 hours a day anymore. I had finished my graduate degree and was working. At first it just seemed like Jani was throwing a severe tantrum, except that she hit at us with closed fists, kicked us, scratched and bit until she drew blood.
• These rages would come out of nowhere and pass just as quickly. Jani would go from sweet and loving to violent and back to sweet and loving within fifteen minutes.
• Whenever Bodhi would cry, Jani would become violent, but it wasn’t an emotional rage. Her voice went flat and her demeanor remained calm. She would attack us, saying “I am hitting you, Mommy (or Daddy). I’m not hitting Bodhi.”
• we sought out a therapist, who upon seeing Jani once and her unprovoked violence sent us to a psychiatrist. The psychiatrist suspected bipolar and put her on medication, but it had no affect.
• By this time we could no longer travel anywhere as a family. We had to take two cars to prevent Jani from screaming at Bodhi when he would cry. One parent took Jani and one took Bodhi. While driving, Jani would unbuckle herself and reach up and shift the car into neutral on the freeway. She took off her shoes and threw them at us while we drove.
• We were referred to a neurologist, but Jani could not sit still for the EEG. The neurologist suspected ADHD, so we tried medications for that, but these only made Jani worse, making her high, followed by a violent emotional crash. Medication after medication was tried. None of them worked and most caused side effects, so we would quickly pull her off even though the psychiatrist wanted to keep upping the doses. We went to therapist after therapist. Each told us something different. Most told us we just needed to be “stricter” with Jani.
• By February 2008 the violence was so bad that we tried to get her hospitalized, but every hospital we called told us they either could not take a child so young or that they had no beds available. After a day of constant hitting and kicking, in desperation, Susan took Jani to BHC Alhambra in Rosemead, CA, the only child psychiatric inpatient hospital that our insurance would accept. But even they would not take her until Susan called Jani “January” and the admissions person saw Jani attack Susan.
• ani wasn’t stabilizing. The staff at Alhambra kept telling us she was fine, yet by the end of the second week, Jani was spending most of her time in the “time out room” fast asleep after being injected with Thorazine. The staff told us nothing. We were terrified for Jani’s safety. She was rooming with a girl who had a history of fondling.  The other kids would tell us that Jani would climb the curtains and jump off furniture, which the staff would deny, yet they never gave us a straight answer about why Jani needed constant PRN shots of Thorazine.

• We visited Jani everyday in the hospital, taking Bodhi with us because we had no family in the area to watch him. Jani refused to brush her teeth, hair, or take a bath or shower on her own, so we had to do to make sure it was done. We alternated this, but on the night when it was my turn to give Jani a shower one of the nurses found this strange.

   

  Later that night the Department of Child and Family Services knocked on our door with two Sheriff’s Deputies.  A staff member of BHC Alhambra had accused me of molestation. Jani had not confirmed the accusation, so I was simply asked to cooperate with their investigation and allow Jani to be examined, which of course I did. The investigation was closed, the accusation ruled unfounded.

   

  I wished, and still wish, the cause of Jani’s behavior had been that simple. The worst part of it was not the lack of sleep, the people thinking we were raising a brat, the screaming, the random violence, or even being suspected of being a child abuser. The worst part was the fear that we were losing our daughter forever, losing the bright and happy child she had been, and we were powerless to stop it.
• On Monday, January 12th, 2009, paramedics were called to the school when Jani was brought to the nurse’s office, drooling and unable to speak. It turned out she had developed Dystonia, which is when the muscles in her body begin to lock up. It is a side affect of Haldol, which she had been prescribed after going into a protracted psychotic state for three weeks, where she spent almost all her time in her imaginary world, interacting with us only to eat.
• During that time, she tried to jump out of her second story bedroom window.  By this time, her psychiatrist, having seen her for more than a year, had come to believe that Jani’s psychosis was not caused by her emotional state (bipolar) but that her emotional state was caused by near constant psychosis. Her diagnosis was now psychosis NOS (not otherwise specified)
• Jani had finally confessed to us that 400 the Cat would scratch her unless she hit and that the rats were afraid of Bodhi and wanted her to hit him to drive him away. It was becoming clear that Jani did not control her imagination. It controlled her. What we thought were just hundreds of imaginary friends were actually command hallucinations. A year before, during her first hospitalization at BHC Alhambra, Jani had tried to tell the doctor and staff that the rats and cats were real to her, but they refused to believe her, because of the idea that five year old’s don’t have a firm grasp on reality anyway. But Jani knew. But they wouldn’t listen to her.

• Jani had been getting better on the Haldol. The violence had stopped and she seemed more like her happy self. But we had no choice but to lower the Haldol because of the side effects. Still, Jani seemed fine when I dropped her off at school on Friday, January 16th, 2009.

   

  About an hour into class, she started screaming that she wanted to see Bodhi. She then ran from the classroom and through the halls, trying to throw herself THROUGH doors and windows. In a panic, the school staff corralled her into the assistant principal’s office and called the police.  The deputy who responded called the Psychiatric Emergency Team who came and evaluated Jani and took her to UCLA.

   
• Jani spent the better part of six months at UCLA. They have said that she is the most “complex” case they have ever seen.
• They performed every test at their disposal, or at least the ones Jani would cooperate with.  They ruled out autism. They ruled out Asperger’s. They even ruled out bipolar as their tests, just like the school tests, had shown that Jani had no consistent external “triggers.” They suspected schizophrenia, which does exist in our family history, on both sides, but were reluctant to make the diagnosis. 
• After three months with little improvement, UCLA diagnosed Jani with child onset schizophrenia. When in a psychotic state, no one could reach Jani. She would bite the furniture until her mouth bled because she said it made her teeth feel better. She hit her head against the wall. She tried to jump out the window at UCLA.

• 300 mg of Thorazine stopped all this. It did not drug Jani into a stupor. Rather, it made her social. On Thorazine, she would play with the other kids. On Thorazine, she stopped talking and playing with people and animals that weren’t there. On Thorazine she stopped kicking the hospital dog and staff who she loved (and us).

   

  But that dose of Thorazine came at a terrible cost. It put her into Dystonia, and because she freed from the psychosis, she was terrified. We held her as she screamed in terror that she couldn’t swallow.
• Jani only needs to hit once, only once, so that the voices in her head will stop screaming at her and 400 will stop scratching her and Wednesday will stop biting her. She experiences hallucinations in four of her five senses.
• When we are out of the hospital, Jani will rip off her clothes in public if she spills even just a drop of liquid on herself. She will laugh and suddenly bolt into traffic because she sees “80” or another hallucination in the street waving for her to come. She will tell people to be careful of Wednesday because she bites. When I tell her Wednesday can’t hurt other people, she tells me “yes, she can. She can hurt them in their head.”
• Today, Jani is on Clozaril, the most powerful anti-psychotic yet invented, which is reserved for only the most serious cases of schizophrenia that have not responded to other medications. It is illegal to give Clozaril unless there are weekly blood tests to check for the destruction of white blood cells. So far, Jani is not having any side effects. So far, the psychosis seems to be abating. Jani still sees the hallucinations, but they do not dominate her life so much. Yet, Clozaril has no sedative effect on her
• The prognosis for child onset schizophrenia is worse than that of adolescent or adult onset schizophrenia. This is because the adolescent or adult has had more time to develop cognitively and emotionally before the psychosis started to eat away at them.
• Jani has a 50/50 chance of living to adulthood. Her intelligence makes her risk of suicide higher. However, having a loving and supportive family makes her risk lower.
• Child onset schizophrenia is extremely rare, appearing in only .01% of the population.

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• Jani was face on to the ultrasound, as if she could hear it, hear us, which we were told was unusual. Typically, we were told, the fetus often hides, but Jani was right there. Her eyes were open. We watched her blink.
• She was awake even then, and she would stay awake. She moved constantly, so much so that when on Memorial Day, 2002 Susan did not feel her move for 90 minutes, she panicked and broke down; terrified that Jani had died inside. She cried with relief when Jani finally moved. She had just been asleep.
• Ninety minutes after birth, lying swaddled in Susan’s arms, her eyes were open and she seemed to follow me and the camcorder around the room, although the nurse assured us newborn babies couldn’t focus.
• While the other newborns screamed and cried, Jani seemed content.
• On the seventh day of her life, Jani awoke, but this time she did not go back to sleep. She screamed. Constantly. We fed her. We changed her. We held her. We played with her. Nothing worked.

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   "Child-onset schizophrenia is 20 to 30 times more severe than adult-onset schizophrenia," says Dr. Nitin Gogtay, a neurologist at the National Institute of Mental Health who helps direct the children's study, the largest such study in the world on the illness.

• About 1% of adults have schizophrenia; most become ill in their late teens or 20s. Approximately one in 10 will commit suicide.
• Doctors and other mental health experts don't fully understand the disease, which has no cure. Jani's extreme early onset has left them almost helpless. The rate of onset in children 13 and under is about one in 30,000 to 50,000. In a national study of 110 children, only one was diagnosed as young as age 6.
• "Child-onset schizophrenia is 20 to 30 times more severe than adult-onset schizophrenia," says Dr. Nitin Gogtay, a neurologist at the National Institute of Mental Health who helps direct the children's study, the largest such study in the world on the illness.
• "Ninety-five percent of the time they are awake these kids are actively hallucinating," Gogtay says. "I don't think I've seen anything more devastating in all of medicine."

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• Although many cases of schizophrenia begin in the teen or early adult years, children as young as 5 years old can develop schizophrenia.
• Childhood symptoms of schizophrenia before age 12 are unc

  ommon, affecting only three in every 1,000 children, according to Mental Health America (2010).
• • Delusions (incorrect perceptions and beliefs about reality)
   
  • Distortion of reality
   
  • Dramatic personality and mood changes
   
  • General confusion
   
  • Hallucinations (perceiving visions and/or sounds without a physical stimulus)
   
  • Paranoia
   
  • Withdrawal.
• Although researchers are still investigating the exact causes of schizophrenia, most experts agree that the condition arises from a combination of genetic and environmental causes.
• Schizophrenia in childhood causes different symptoms than in adult schizophrenia
• • Delays in the ability to learn language
   
  • Difficulty with academic achievement
   
  • Distraction
   
  • Extreme moodiness
   
  • High anxiety levels
   
  • Impaired motor skills
   
  • Nearly constant fear
   
  • Socialization issues, such as problems maintaining friendships
   
  • Symptoms of pervasive developmental disorder (frequent rocking back and forth, arm flapping, etc.)
   
  • Uneven motor development (odd crawling behavior, etc.).
• Schizophrenia in childhood tends to develop and intensify over many years, as opposed to schizophrenia in adults, which is usually marked by a dramatic, easily identifiable onset of symptoms.
• Because of its wide range of symptoms, this condition is difficult to diagnose, especially in children with schizophrenia. Children may have a hard time describing their feelings and fears, and adults often dismiss symptoms of schizophrenia in childhood as common behavior.
• Childhood symptoms are usually treated with antipsychotic medication and therapy. Early treatment is key to helping affected kids learn how to live healthy, productive lives.

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• Some research shows as high as 90% of children who go on to have early onset schizophrenia have some abnormalities before the positive symptoms of the disorder (hallucinations, delusions, disorganized speech or behavior) emerge
• Halluciations have been consistently found in most children with schizophrenia. This is often accompanied by what's known as ‘flattened affect'. Children with flattened affect tend not to have emotional reactivity and don't show a lot of emotion on their face. Children who are psychotic tend to show signs of a thought disorder, meaning their manner of speaking suggests that their thinking isn't well organized or coherent.

• Most children with schizophrenia show delays in language and other functions long before their psychotic symptoms (hallucinations, delusions, and disordered thinking) appear, usually at age seven or later. In the first years of life, about 30% of these children have temporary symptoms of developmental disorder, such as rocking, posturing and arm flapping.

• Early warning signs of childhood schizophrenia include: 

   • trouble discerning dreams from reality
   • seeing things and hearing voives that are not real
   • confused thinking
   • vivid and bizarre thoughts and ideas
   • extreeme moodiness
   • peculiar behaviour
   • concept that people are "out to get them"
   • behaving younger than they are
   • severe anxiety and fearfulness
   • confusing televisionor movies with reality
   • severe problems in making and keeping friends.
• Children may begin talking about strange fears and ideas. They may start to cling to parents or say things that do not make sense. Children who used to enjoy relationships with others may become more shy or withdrawn and seem to be in their own world. Children with schizophrenia experience difficulty in managing everyday life. In common with their adult counterparts, children with schizophrenia are at an increased risk of suicide.
• Misdiagnosis of schizophrenia in children is all too common. Schizophrenia is often confused with autism but is distinguished from it by the persistence of hallucinations and delusions for at least 6 months, and a later age of onset - 7 years or older. Autism is usually diagnosed by age 3. Schizophrenia is also different to a brief psychosis which can be seen in people with depression, personality and dissociative disorders in children. Adolescents with bipolar disorder sometimes have acute onset of manic episodes that may be mistaken for schizophrenia. Children who have been victims of abuse may sometimes claim to hear voices of- or see visions of- the abuser.
• Children tend to be harder to treat and have worse prognosis than adult-onset schizophrenia patients. These children need individual care plans involving a combination of medication, individual therapy, family therapy and specialised programmes (for example, help at school or during activities).

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• People with schizophrenia may have perceptions of reality that are strikingly different from the reality seen and shared by others around them. Living in a world distorted by hallucinations and delusions,   individuals with schizophrenia may feel frightened, anxious, and confused.
• Hallucinations are disturbances of perception that are common in people suffering from schizophrenia. Hallucinations are perceptions that occur without connection to an appropriate source. Although hallucinations   can occur in any sensory form – auditory (sound), visual (sight), tactile (touch), gustatory (taste), and olfactory (smell) – hearing voices that other people do not hear is the most common type of hallucination in   schizophrenia. Voices may describe the patient's activities, carry on a conversation, warn of impending dangers, or even issue orders to the individual. Illusions, on the other hand, occur when a sensory stimulus is   present but is incorrectly interpreted by the individual.
• Delusions are false personal beliefs that are not subject to reason or contradictory evidence and are not explained by a person's usual cultural concepts. Delusions may take on different themes. For example,   patients suffering from paranoid-type symptoms – roughly one-third of people with schizophrenia – often have delusions of persecution, or false and irrational beliefs that they are being cheated, harassed, poisoned,   or conspired against. These patients may believe that they, or a member of the family or someone close to them, are the focus of this persecution. In addition, delusions of grandeur, in which a person may believe he   or she is a famous or important figure, may occur in schizophrenia. Sometimes the delusions experienced by people with schizophrenia are quite bizarre; for instance, believing that a neighbor is controlling their   behavior with magnetic waves; that people on television are directing special messages to them; or that their thoughts are being broadcast aloud to others.
• Schizophrenia often affects a person's ability to "think straight." Thoughts may come and go rapidly; the person may not be able to concentrate on one thought for very long and may be easily distracted, unable to   focus attention. People with schizophrenia may not be able to sort out what is relevant and what is not relevant to a situation. The person may be unable to connect thoughts into logical sequences, with thoughts   becoming disorganized and fragmented. This lack of logical continuity of thought, termed "thought disorder," can make conversation very difficult and may contribute to social isolation. If people cannot make sense   of what an individual is saying, they are likely to become uncomfortable and tend to leave that person alone.
• People with schizophrenia often show "blunted" or "flat" affect. This refers to a severe reduction in emotional expressiveness. A person with schizophrenia may not show the signs of normal emotion, perhaps may   speak in a monotonous voice, have diminished facial expressions, and appear extremely apathetic. The person may withdraw socially, avoiding contact with others; and when forced to interact, he or she may have   nothing to say, reflecting "impoverished thought." Motivation can be greatly decreased, as can interest in or enjoyment of life. In some severe cases, a person can spend entire days doing nothing at all, even   neglecting basic hygiene. These problems with emotional expression and motivation, which may be extremely troubling to family members and friends, are symptoms of schizophrenia – not character flaws or personal   weaknesses.

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• While schizophrenia sometimes begins as an acute psychotic episode in   young adults, it emerges gradually in children, often preceded by developmental   disturbances, such as lags in motor and speech/language development. Such   problems tend to be associated with more pronounced brain abnormalities.
• Children   with schizophrenia often see or hear things that don't really exist, and   harbor paranoid and bizarre beliefs. For example, they may think people   are plotting against them or can read their minds. Other symptoms of the   disorder include problems paying attention, impaired memory and reasoning,   speech impairments, inappropriate, or flattened, expression of emotion,   poor social skills, and depressed mood. Such children may laugh at a sad   event, make poor eye contact, and show little body language or facial   expression.
• The newer   generation "atypical" antipsychotics, such as olanzapine and clozapine,   may also help improve motivation and emotional expressiveness in some   patients. They also have a lower likelihood of producing disorders of   movement, including tardive dyskinesia, than the other antipsychotic drugs   such as haloperidol. However, even with these newer medications, there   are side effects, including excess weight gain that can increase risk   of other health problems.
• Children with schizophrenia and their families can also benefit from supportive   counseling, psychotherapies and social skills training aimed at helping   them cope with the illness. They likely require special education and/or   other accommodations to succeed in the classroom.
• Although it's unclear whether schizophrenia has a single or multiple   underlying causes, evidence suggests that it is a neurodevelopmental disease   likely involving a genetic predisposition, a prenatal insult to the developing   brain and stressful life events. The role of genetics has long been established;   the risk of schizophrenia rises from 1 percent with no family history   of the illness, to 10 percent if a first degree relative has it, to 50   percent if an identical twin has it. Prenatal insults may include viral   infections, such as maternal influenza in the second trimester, starvation,   lack of oxygen at birth, and untreated blood type incompatibility.
• Studies   find that children share with adults many of the same abnormal brain structural,   physiological and neuropsychological features associated with schizophrenia.⁶ The   children seem to have more severe cases than adults, with more pronounced   neurological abnormalities. This makes childhood onset schizophrenia potentially   one of the clearest windows available for research into a still obscure   illness process.
• In addition to studies of brain structural abnormalities, researchers   are also examining a group of measures associated with genetic risk for   schizophrenia. Early onset cases of illness have recently proven crucial   in the discovery of genes linked to other genetically complex disorders   like breast cancer, Alzheimer's and Crohn's diseases.³ Hence,   children with schizophrenia and their families may play an important role   in deciphering schizophrenia's molecular roots. Evidence suggests that   the rate of genetically-linked abnormalities is twice as high in children   as in adults with the illness.

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•    

  Schizophrenia is a chronic, severe, and disabling brain disease. Schizophrenia is found all over the world. The severity of the symptoms and the long-lasting, chronic pattern of schizophrenia often results in   disability, and many individuals need ongoing assistance to manage the most basic functions of independent living.

• Antipsychotic medications have been available since the mid-1950s. They have greatly improved the outlook for individual patients. These medications reduce the psychotic symptoms of schizophrenia and usually allow   the patient to function more effectively and appropriately. Antipsychotic drugs are the best treatment now available, but they do not "cure" schizophrenia or ensure that there will be no further psychotic episodes.
• The large majority of people with schizophrenia show substantial improvement when treated with antipsychotic drugs. Some patients, however, are not helped very much by the medications and a few do not seem to need   them.
• A number of new antipsychotic drugs (the so-called "atypical antipsychotics") have been introduced since 1990. The first of these, clozapine (Clozaril®), has been shown to be more effective than other   antipsychotics, although the possibility of severe side effects – in particular, a condition called agranulocytosis (loss of the white blood cells that fight infection) – requires that patients be monitored with   blood tests every one or two weeks.
• Antipsychotic drugs are often very effective in treating certain symptoms of schizophrenia, particularly hallucinations and delusions; unfortunately, the drugs may not be as helpful with other symptoms, such as   reduced motivation and emotional expressiveness. Indeed, the older antipsychotics (which also went by the name of "neuroleptics"), medicines like haloperidol (Haldol®) or chlorpromazine (Thorazine®), may   even produce side effects that resemble the more difficult to treat symptoms.
• Patients and families sometimes become worried about the antipsychotic medications used to treat schizophrenia. In addition to concern about side effects, they may worry that such drugs could lead to addiction.   However, antipsychotic medications do not produce a "high" (euphoria) or addictive behavior in people who take them.
• Antipsychotic medications reduce the risk of future psychotic episodes in patients who have recovered from an acute episode. Even with continued drug treatment, some people who have recovered will suffer relapses.   Far higher relapse rates are seen when medication is discontinued. In most cases, it would not be accurate to say that continued drug treatment "prevents" relapses; rather, it reduces their intensity and frequency.   The treatment of severe psychotic symptoms generally requires higher dosages than those used for maintenance treatment. If symptoms reappear on a lower dosage, a temporary increase in dosage may prevent a full-blown   relapse.
• Some antipsychotic medications, including haloperidol (Haldol®),   fluphenazine (Prolixin®), perphenazine (Trilafon®) and others, are available in long-acting injectable forms that eliminate the need to take pills every day. A major goal of current research on treatments   for schizophrenia is to develop a wider variety of long-acting antipsychotics, especially the newer agents with milder side effects, which can be delivered through injection.
• Antipsychotic drugs, like virtually all medications, have unwanted effects along with their beneficial effects. During the early phases of drug treatment, patients may be troubled by side effects such as   drowsiness, restlessness, muscle spasms, tremor, dry mouth, or blurring of vision.
• The long-term side effects of antipsychotic drugs may pose a considerably more serious problem. Tardive dyskinesia (TD) is a disorder characterized by involuntary movements most often affecting the mouth, lips,   and tongue, and sometimes the trunk or other parts of the body such as arms and legs. It occurs in about 15 to 20 percent of patients who have been receiving the older, "typical" antipsychotic drugs for many years,   but TD can also develop in patients who have been treated with these drugs for shorter periods of time.

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• There is no known single cause of schizophrenia. Many diseases, such as heart disease, result from an interplay of genetic, behavioral and other factors, and this may be the case for schizophrenia as well. Scientists do not yet understand all of the factors necessary to produce schizophrenia, but all the tools of modern biomedical research are being used to search for genes, critical moments in brain development, and other factors that may lead to the illness.
• It has long been known that schizophrenia runs in families. People who have a close relative with schizophrenia are more likely to develop the disorder than are people who have no relatives with the illness. For example, a monozygotic (identical) twin of a person with schizophrenia has the highest risk -- 40 to 50 percent -- of developing the illness. A child whose parent has schizophrenia has about a 10 percent chance. By comparison, the risk of schizophrenia in the general population is about 1 percent.
• Scientists are studying genetic factors in schizophrenia. It appears likely that multiple genes are involved in creating a predisposition to develop the disorder. In addition, factors such as prenatal difficulties like intrauterine starvation or viral infections, perinatal complications, and various nonspecific stressors, seem to influence the development of schizophrenia. However, it is not yet understood how the genetic predisposition is transmitted, and it cannot yet be accurately predicted whether a given person will or will not develop the disorder.
• Many studies of people with schizophrenia have found abnormalities in brain structure (for example, enlargement of the fluid-filled cavities, called the ventricles, in the interior of the brain, and decreased size of certain brain regions) or function (for example, decreased metabolic activity in certain brain regions).

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• Today the leading theory of why people get schizophrenia is that it is a result of a genetic predisposition combined with an environmental exposures and / or stresses during pregnancy or childhood that contribute to, or trigger, the disorder. Already researchers have identified several of the key genes - that   when damaged - seem to create a predisposition, or increased risk, for schizophrenia. The genes, in combination with suspected environmental factors - are believed to be the factors that result in schizophrenia. These genes that seem to cause increased risk of schizophrenia include the DISC1,   Dysbindin,   Neuregulin and G72 genes, but it has been estimated that up a dozen or more genes could be involved in schizophrenia risk. See our Schizophrenia Genetics news for the latest information in this fast-moving area.

• The Prevalance Rate for schizophrenia is approximately 1.1% of the   population over the age of 18 (source: NIMH)   or, in other words, at any one time as many as 51 million people worldwide   suffer from schizophrenia, including;

   
   
  • 6 to 12 million people in China (a rough estimate based on the population)
   
  • 4.3 to 8.7 million people in India (a rough estimate based on the population)
   
  • 2.2 million people in USA
   
  • 285,000 people in Australia
   
  • Over 280,000 people in Canada
   
  • Over 250,000 diagnosed cases in Britain
• Anti-psychotic medications are the generally recommended treatment   for schizophrenia. If medication for schizophrenia is discontinued,   the relapse rate is about 80 percent within 2 years. With continued   drug treatment, only about 40 percent of recovered patients will suffer   relapses.( Source: NIMH)

• After 10 years, of the people diagnosed with schizophrenia:

   
   
  • 25% Completely Recover
   
  • 25% Much Improved, relatively independent
   
  • 25% Improved, but require extensive support network
   
  • 15% Hospitalized, unimproved
   
  • 10% Dead (Mostly Suicide)

• After 30 years, of the people diagnosed with schizophrenia:

   
   
  • 25% Completely Recover
   
  • 35% Much Improved, relatively independent
   
  • 15% Improved, but require extensive support network
   
  • 10% Hospitalized, unimproved
   
  • 15% Dead (Mostly Suicide)
• People with the condition have a 50 times higher risk of attempting   suicide than the general population; the risk of suicide is very serious   in people with schizophrenia. Suicide is the number one cause of premature   death among people with schizophrenia, with an estimated 10 percent   to 13 percent killing themselves and approximately 40% attempting suicide   at least once (and as much as 60% of males attempting suicide). The   extreme depression and psychoses that can result due to lack of treatment   are the usual causes. These suicides rates can be compared to the general   population, which is somewhere around 0.01%. (source: Treatment   Advocacy Center and other sources)

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• Suicide is a major cause of death among patients with schizophrenia. Research indicates that at least 5–13% of schizophrenic patients die by suicide, and it is likely that the higher end of range is the most accurate estimate. There is almost total agreement that the schizophrenic patient who is more likely to commit suicide is young, male, white and never married, with good premorbid function, post-psychotic depression and a history of substance abuse and suicide attempts.
• Suicidal schizophrenics usually fear further mental deterioration, and they experience either excessive treatment dependence or loss of faith in treatment. Awareness of illness has been reported as a major issue among suicidal schizophrenic patients, yet some researchers argue that insight into the illness does not increase suicide risk.
• Suicide attempts, which often result in death from suicide at a later time, are common among patients with schizophrenia; about 20–40% of these patients do make suicide attempts
• There is almost total agreement that the schizophrenic patient who is more likely to commit suicide is young, male, white, and never married, with good premorbid function, post-psychotic depression and a history of substance abuse and suicide attempts. Hopelessness, social isolation, hospitalization, deteriorating health with a high level of premorbid functioning, recent loss or rejection, limited external support, and family stress or instability are important risk factors in schizophrenic individuals who commit suicide.
• Compared with suicide attempts among persons without schizophrenia, attempts among those with schizophrenia are serious and typically require medical attention. Suicidal intent is generally strong, and the majority of those who attempt suicide have made multiple attempts. In addition, the methods used to attempt suicide are considered more lethal than those used by suicidal persons in the general population.
• Great caution is required during the period after hospital discharge because patients with schizophrenia usually experience hopelessness and demoralization during this time. For these patients, discharge often means losing the hospital environment and the people who in some way have become central in their life. The number of psychiatric admissions, which are usually higher among patients who have attempted suicide, may be indicative of a severe relapsing illness.
• Suicide was correlated with psychomotor agitation and restlessness [30,94] and a fear of mental disintegration, if present, predicts suicide with an odds ratio of 12.1 [30]. Akathisia is manifested subjectively in an unbearable feeling of inner tension and restlessness, and subjective awareness of akathisia is also associated with higher suicidality. Findings from a study devoted to this topic demonstrated that, among patients with akathisia, there was a greater likehood of suicidal behavior than among those without akathisia

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• Most of us have heard of schizophrenia, but we don’t know exactly what it is (it’s not split personality!), or how to recognize it, or even when it’s most likely to show its first signs.  The fact is, schizophrenia generally does strike young people, rather than adults; but it doesn’t usually appear in children before they reach their teens.  But when it does, it’s even more devastating than in an older child, and you need to get expert help immediately.
• Schizophrenia is a severe, chronic, and disabling brain disease that affects approximately 1 percent of the world's population,. Contrary to the popular misconception, people with schizophrenia do not have a "split" personality.  Rather, they experience severe mental disturbances in which normal thoughts, speech, and behavior are disrupted.  Schizophrenia researchers generally believe the illness is caused by a combination of genetic and environmental factors, and that, in people with a genetic predisposition, the likelihood of schizophrenic episodes can be increased or triggered by the use of street drugs, including marijuana.
• Most people who develop schizophrenia exhibit the first symptoms of the disease in their teens or early twenties.  However, a much smaller percentage develop symptoms before age 13, sometimes as early as age 7.  When a child develops psychiatric symptoms before he or she turns 13, it is called Childhood-Onset Schizophrenia. 
• These children also show greater evidence of abnormal brain development, including loss of gray matter in the brain.  Early diagnosis and medical treatment are important. Schizophrenia is a life-long disease that can be controlled but not cured.  Childhood-onset schizophrenia is generally more difficult to treat than is schizophrenia that comes on later in life, and doctors at the National Institute of Mental Health say that in general, the children tend to become, and often stay, more severely ill than is the case with adolescent-onset schizophrenia..
• Positive symptoms, including unusual thoughts or perceptions that include hallucinations (disturbances of sensory perception, such as "seeing things" or "hearing things"), delusions (false beliefs, such as the belief that people are reading their thoughts or plotting against them,) and thought disorder (one mother described it as though the child had "a blender running in his brain").  Disorganization of thought is sometimes listed under the category of "cognitive symptoms," below.
• Negative symptoms, including a loss or a decrease in the ability to initiate plans, speak, or interact with others (there may be a withdrawal from interaction), emotional flatness or lack of expression, speech that is brief and devoid of content, or an inability to find pleasure in everyday life. ("Negative" does not refer to a person's attitude but to a lack of certain characteristics that should be there.)  These symptoms are harder to recognize as part of the disorder and can be mistaken for laziness or depression.
• Cognitive symptoms (or cognitive deficits), including problems with attention, certain types of memory, and the executive functions that allow us to plan and organize our everyday lives. Cognitive deficits can also be difficult to recognize as part of the disorder but are the most disabling in terms of leading a normal life.
• "The symptoms and behavior of children and adolescents with schizophrenia may differ from that of adults with this illness.  The following symptoms and behaviors can occur in children or adolescents with schizophrenia:
   
   
  • seeing things and hearing voices which are not real (hallucinations),
   
  • odd and eccentric behavior, and/or speech,
   
  • unusual or bizarre thoughts and ideas,                                    
   
  • confusing television and dreams [with] reality,
   
  • confused thinking,
   
  • extreme moodiness,
   
  • ideas that people are "out to get them," or talking about them, (paranoia)
   
  • severe anxiety and fearfulness,
   
  • difficulty relating to peers, and keeping friends.         
   
  • withdrawn and increased isolation,
   
  • decline in personal hygiene
   
   The behavior of children with schizophrenia may change slowly over time.  For example, children who used to enjoy relationships with others may start to become more shy or withdrawn and seem to be in their own world.  Sometimes youngsters will begin talking about strange fears and ideas.  They may start to cling to parents or say things which do not make sense.  These early symptoms and problems may first be noticed by the child's school teachers."
• In the first years of life, about 30% of these children have temporary symptoms of developmental disorder, such as rocking, posturing and arm flapping.... The schizophrenic psychosis (hallucinations, delusions and sense of unreality) develops gradually in children, without the sudden psychotic break that sometimes occurs in adolescents and adults."
• (Source: NARSAD-The Mental Health Research Association-see resource information below)
    "Treatment is aimed at reducing symptoms and preventing psychotic relapses and is believed to be most effective when begun early in the course of the illness. Schizophrenia is usually treated with antipsychotic medication. Once acute symptoms have lessened, a combination of medicine and psychosocial/rehabilitation interventions can be beneficial. Because schizophrenia is a chronic condition, disease management is a life-long process."

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• Pediatric schizophrenia (also known as childhood onset schizophrenia)^[1] is a type of mental disorder that is characterized by degeneration of thinking, motor, and emotional processes in children and young adults under the age of 17. Patients are unable to distinguish between what is real and what is not. The disease is illustrated by symptoms such as auditory and visual hallucinations, strange thoughts/feelings, and abnormal behavior therefore profoundly impacting the child’s ability to function and sustain normal interpersonal relationships.
• Genetics play a large part in patients with schizophrenia, with higher rates found in children of schizophrenics. There is no known cure but childhood schizophrenia is controllable with the help of the proper fusion of behavioral therapies and medications.

• P

  hysical exams alone cannot completely diagnose schizophrenia, but they do help rule out other diseases that can be causing the behavior. Doctors may run tests on the brain to see if any abnormalities exist. Some tests include EEG exams and brain imaging scans. Blood tests are used to rule out alcohol or drug effects being a factor.

   
• A psychologist or psychiatrist will talk to a child about their thoughts, feelings and behavior patterns and ask about how severe the symptoms are and the effect they have on daily life. Thoughts of suicide or self-harm may also be discussed in these one-on-one exams. School records may be requested and questioners are used to assess anxiety and mood. All will be evaluated on an age appropriate level.

• Environmental causes will be described as any factor that is not genetic or hereditary (any macro-factor). Some possible environmental risk factors comprise of:

   
   
  • Disturbed family/ interpersonal problems
   
  • Being from a low-class household/poverty
   
  • Inadequate social resources
   
   

  These alone do not cause schizophrenia. There needs to be some kind of genetic predisposition coupled with these factors.

• The link between genetics and schizophrenia is seemingly strong. Many believe that changes in neo-natal development cause the disorder while others believe it is hereditary, but neither have concrete support. If neither parent has the disorder there is a 1% chance that a child will develop it but the chances increase to 10% if one parent has schizophrenia. Possible genetic causes may be:

   
   
  • Family history of the disorder
   
  • Exposure to viruses in the womb
   
  • Prenatal malnutrition
   
  • Certain drugs
   
  • Stressful situation early in life
• Childhood schizophrenia is chronic and children with schizophrenia require permanent treatment.^[3] Treatment is the same for all forms of schizophrenia. However, because childhood is such a molding period, treatment can be a challenge.

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• Once the schizophrenic child is over age six, they may begin hallucinating. What is heard as auditory hallucinations are bangs, clangs, loud scrapes, explosions, door slamming, and whispering voices.
• Their visual hallucinations appear like dark streaks or wiggling snakes, rolling balls, or a dark background with streaks of light appearing against it. They will appear to talk, smile or converse at something or someone unseen—described as children who are "inner-directed".
• The child who is a schizophrenia has been viewed as putting his/her hands over their ears while remarking that someone was speaking to them in their head. Because this thing, person or persons are unseen by the parents, teachers or doctors, what the child sees as a very real situation is actually unreal.
• The schizophrenia child is convinced that every gesture they see, every posture of surrounding people, animals and things—both real and unreal combined with their every look and noise---has severe significance that will do them harm, based on what they are hearing from their "inner voices" or sensing with their distorted reality.

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• Schizophrenia is a mental disorder characterized by a delusional perception or expression of real life situations. The disorder may cause distortion of the fives senses, like the sense of touch, smell, taste, hearing and sight. However, schizophrenia is popularly known to cause hallucinations, delusions and paranoia. Though there is no way for a laboratory test to determine the schizophrenic condition, studies suggest that genetics, neurobiology and the psychological and social developments in a person contribute to schizophrenia.
• There are no specific reasons that trigger or cause schizophrenia in children. However, studies suggest that genetics may be blamed for this disorder. Early neurodevelopment increases the risk of schizophrenia. A freak study, shows that babies born in winter or spring, in the northern hemisphere, are likely to develop schizophrenia. Also prenatal exposure to infections, makes the fetus susceptible to schizophrenia in later life. Social adversity, racial discrimination, broken families and traumatized childhood can also cause schizophrenia. Often, children from broken homes, with poor education, take recourse in excessive drug abuse. The narcotic substances have a clear connection with the mental disorder.