#early onset schizophrenia

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Chapter 3 of Schizophrenia, Third Edition: Child and adolescent schizophrenia

Although it's rare before the age of 10, childhood and adolescent schizophrenia does happen. Things like clinical severity, impact on development, and poor prognosis calls for a need of early detection, prompt diagnosis, and effective treatment. Childhood/adolescent onset schizophrenia is associated with poor premorbid functioning and early developmental delays, which is particularly striking for people with onset before adolescence. Similar impairments have been reported in adult-onset cases but are more common in child/adolescent-onset cases. These premorbid impairments may be a risk, or a precursor to psychosis. Diagnoses like anxiety, depression, ADHD, and autism may precede the diagnosis of schizophrenia in children and adolescents.

People who develop schizophrenia typically go through a prodromal phase characterized by a marked decline in functioning. Things like social withdrawal, decline in school performance, and uncharacteristic and odd behavior begin on average a year before the onset of psychotic symptoms. In retrospect things like non-specific behavioral changes were frequently early negative symptoms well before positive symptoms showed. Prodromal symptoms may also include odd ideas, eccentric interests, changes in affect, unusual experiences, and bizarre perceptual experiences. While these are characteristic of schizotypal personality disorder, in a schizophrenic prodrome there is usually a progression to a more severe dysfunction.

Child and adolescent-onset schizophrenia is characteristically chronic, with only a minority of cases making a full recovery. If full recovery does occur it is most likely in the first three months, and Hollis (1999) found that 12% of cases of schizophrenia only reached full remission. A Maudsley study found that those who were psychotic after 6 months have a 15% chance of full remission, while over half of cases who made a full recovery had active psychotic symptoms for less than 3 months. This indicates that observation past 6 months adds little new information, and the course over the first 6 months is the best predictor of remission.

A number of long-term follow-up studies of child and adolescent-onset schizophrenia all describe a chronic, unremitting long-term course with severely impaired functioning in adult life. Roughly one-fifth of cases in most studies have a good outcome while at the other extreme one-third are severely impaired. After the first few years of the illness there is little evidence of further progressive decline. Third, child and adolescent-onset schizophrenia has a worse outcome than adult-onset schizophrenia and affective psychoses. Social functioning is also very impaired in early onset schizophrenia. These findings confirm childhood schizophrenia is at an extreme end of a continuum of severity.

Cognitive symptoms of schizophrenia are increasingly being acknowledged as core features of the disorder. The degree of cognitive impairment is greater in child and adolescent-onset than adult-onset cases, which raises several questions. Are cognitive deficits specific or general - are some areas more affected? Which deficits precede psychosis and could be causal, and which are consequences of psychosis? Is it specific to schizophrenia or is it common between other developmental and psychotic disorders? Are cognitive impairments progressive or static after the onset of psychosis?

In summary of the findings: sensorimoter skills, associative memory, and simple language abilities are preserved in children with schizophrenia. Bigger decifits include tasks that require sustained and focused attention, flexible switching of cognitive set, high-information processing speed, and suppression of prepotent responses. These cognitive processes are executive functions, necessary for organizing goal-directed behavior.

Assessing a child or adolescent with schizophrenia should include detailed history, mental state and physical examination, and laboratory tests. Usually physical exams include a full blood count and biochemistry, including liver and thyroid function and a drug screen. Progressive structural brain changes indicate value in getting an MRI. Antipsychotics stay a cornerstone of treatment of schizophrenia but treatment should take a multimodal approach including pharmacotherapy, family and individual counselling, education about the illness, and provision to meet social/educational needs.

[fencesandfrogs]

My god what a night

[ghostlyschizophrenic]

looking back on my childhood objectively and with the insight of knowing what my schizoaffective psychosis symptoms are, i realize that most people weren’t just constantly terrified of everything growing up. they didn’t develop multiple UTIs from holding their pee at night because they thought someone was waiting in the bathroom to kill them. they didn’t calculate all the ways they could hide in their room if someone broke into the house and went over these steps in their heads for hours every night. they didn’t lose sleep over the feeling of bugs crawling around inside their bodies. they didn’t have this terror in their lives before they even hit double digits and by the gods am i sad for young me that he had to deal with it

[little-paper-ghost-child]

Hhh have to go to the psychosis clinic tomorrow what if they hate usssss

Like yeah mental health is weird and stuff but whyyyy

The closer it gets the more scary it is

We don’t really want to go

They might get mad and say we made it up

Or get mad and say we have to get admited

Dunno man it’s scary

Being 14 will be cool after this though

Hopefully

We’ve been through enough already

Sorry this is kinda venty haha

[pictureday2005]

currently loading up the queue! im trying to clear out all the flickr stuff ive saved so i can free up space on my phone !! thanks for being patient, its been a rough few months and im not Thrilled about my birthday tomorrow lol. thankfully i at least have the attention span to reload the queue! 💙🌈🌧️

[tabbytiger]

Also I’m not even depressed or su***dal.

I’ve just been bored and uninterested in doing anything even eating. I’ve just been skipping meals for a day or two because I’m bored and or when I take a bite of something I immediately lose interest and I just ignore the hunger pangs.

I’ve spent entire days, DAYS, lying in bed in the same position bc I had no energy or motivation to move or get up. Even trying to sit up or at least go to a different room has been difficult. And this specifically have been happening since at least last November, BEFORE I got on adderall.

Even WITH adderall its not doing anything for me other than I think triggering pyschosis bc its a side effect.

I’ve been trembling the past few days too. The dude at the dmv that takes the finger print had to hold my finger down for me bc I couldn’t hold it still 😭 he asked me to redo it like 3 times before finally just grabbing my hand.

If this keeps happening I’mma need them to take me off adderall bc its actively making my psychosis act up. Like I’ve been thinking of lying in my bathtub in the dark at night during an episode because I feel so unsafe in my own bedroom and house. And normal coping methods I usually do are not doing anything. I haven’t used the fucking ‘lock myself in my bathroom and curl up in a fetal position while rocking back and forth’ strategy since elementary school. Except its gonna be in my pc room cuz thats the only fucking door down here with a lock that requires a key to open 😭. If I ask for a lock on my bedroom door my parents are going to call me insane and ridiculous and to stop being paranoid 🥴. Like girl I’m trying thats why I need a lock.

I can’t keep passing out from panic and stress and not remembering falling asleep bro.

[cicidraws]

it always bothers me that peoples first question is if someone does drugs, when the person has done alot of research on something, like space, or patterns in the world, or whatever else like that. or even jsut experimental art. like Not All People Gotta Do Drugs to explore things in the world.

[toesuckler]

honestly my second hand embarrassment got better the more i stopped trying to push through it. the more i simply fucked off rather than try to endure it

[lesboylycan]

reading up on prodromal schizophrenia just to refresh knowledge and we just looked at one thing and said ". that was sixth grade."

we exited prodromal and went into active stage when we were in ninth grade. shitman.

"If you're vulnerable, the start of symptoms may be set off by a change in your environment or your body." <- sixth grade was the start of middle school, and that combined with the increased workload and the loss of friends may be culpable for setting off schizophrenia prodrome

man

[granhairdo]

i’d be curious to calculate the average age of death in my family a certain amount of generations back. it can’t be good.

[shititskat]

Look. Look. I can imagine that getting a group of schizophrenics together to run some tests on them is hard. That makes sense. But I would also like to put my foot down about accepting research with small sample sizes. Especially when that research is being given to me by my psychiatrist and GP telling me to look into getting tested for Parkinson’s, and the DAMN SAMPLE SIZE IS ONLY 100 PEOPLE??!!!!!

[gray-gray-gray-gray]

Let's Talk About The Overlap Between Autism, ADHD, and Schizophrenia

I've been wanting to make a graph like this for awhile, about the overlap between these three disorders. Tagging @auschizm because it's highly related to that blog :D

Text transcribed below the cut because it's long!

Title: Can We Talk About The Overlap Between... AUTISM, ADHD, AND SCHIZOPHRENIA?

Description: You always hear people talking about AuDHD, but schizophrenia has the same if not more overlap with these disorders, and it's not talked about!

Let's start boosting schizophrenic people's voices. There's more to the disorder than just psychosis!

Graph based on my personal experience with schizophrenia, my experiences with autistic and ADHD communities, and the words of people with AuDHD themselves.

Made by @gray-gray-gray-gray on tumblr.

Schizophrenia Only

Typical age of onset between 15 and 54 years old

Before the onset/ first psychotic break, there is a "prodrome" where you have a drop in functioning

Reoccuring episodes of psychosis (Hallucinations, delusions, paranoia, etc)

Likely had less noticeable or covert symptoms pre-onset

Often daydreaming, 'in their own world', hyper-self-reflective, 'space cadet'

Autism Only

Need for familiarty & routine

Sudden disruptions to routine are highly distressing

ADHD Only

Craves new experiences & novelty

Autism & ADHD (AuDHD)

Interest-based nervous system (meaning attention & focus is activated based on personal interest, not how important something is)

Onset in very early childhood -- before age 12

Autism & Schizophrenia (Auschizm)

Self-soothing via repetitive behavior

Higher rates of catatonic symptoms

Social withdrawal or exclusion

Difficulties filtering speech

Flat affect

Alogia

Concrete and/or literal thinking

Higher rates of personality disorders, dissociative disorders, and trauma

Internally oriented behavior

Difficulties wording what they

want to say correctly & disorganized speech

Difficulties with insight into what is part of the disorder and what is neurotypial

ADHD & Schizophrenia (SchizoDHD)

Impulsivity & hard to sit still

Difficulties regulating attention & focus, also causing social cue difficulties

Difficulty keeping a daily routine

Jumping around or out of sequence speech

Forgetfulness

Failing to reach a clear end goal or point in speech

Less coherent progression from start to finish in stories

General difficulties with thinking clearly

Drawing blanks / losing train of thought often

Difficulties finding motivation to do things

Lots of energy some days, no energy other days

Troubles multitasking

Planning poorly or not at all

All Three

Stimming

Echolalia, echopraxia

Executive dysfunction

Sensory issues & overload

Emotional dysregulation

Interconnected/webbed thought

ND communication (infodumping, connecting ideas, shared interest bonding)

Increased risk of victimization

Hyperfixations

Higher rates of depression, anxiety, OCD, BFRBS, bipolar, suicidality, sleep issues, eating disorders, and substance abuse

Eye contact differences

Difficulties switching tasks

Masking

Hyperfocusing

Restlessness

Prone to boredom

Memory issues

Social situation difficulties

Time blindness

Difficulties with school, learning, and following tasks

Chronic disorder

RSD

Anhedonia

Alexithymia

Interoceptive difficulties

[youbutstupid]

Morgan: I’m predisposed to having a good time ;)

Reid: I’m predisposed to paranoid schizophrenia and early onset Alzheimer’s

Morgan:

Reid: but yeah let’s have a good time

[schizodiaries]

World Schizophrenia Day was a couple months ago (May 24th), and I had intended to publish this post on that day but I couldn’t finish it in time, so consider this a belated Schizophrenia Day post, or perhaps this can be a Disability Pride Month post!

I want to send positive energies to all people on the schizophrenia spectrum, but I want to give a special shoutout to those who don’t get enough recognition, or are often forgotten in our community:

Early onset schizophrenics, or those who are diagnosed as children or teens.

People with schizotypal personality disorder, delusional disorder, schizoaffective disorder, or schizophreniform disorder.

The schizophrenics who are considered gravely disabled and therefore cannot live independently or care for themselves on their own.

Homeless schizophrenics, especially those without access to mental health treatment.

The schizophrenic people throughout history who never got the chance to be diagnosed or treated.

Schizophrenics part of other marginalized groups, like schizophrenic people of color and queer schizophrenics.

The schizophrenics who have to be institutionalized long term and don’t currently have access to the outside world.

Schizospec people who also live with physical disabilities.

The “crazy” or “scary” schizophrenics- those who talk to themselves, behave aggressively, act unpredictably, or have unusual beliefs.

People who were misdiagnosed with schizophrenia, but turned out to have a different illness, and vice versa.

People who have schizospec disorders alongside other mental disorders, like autism, DID, personality disorders, mood disorders, and so on.

Schizospec people who are not “out,” who have to mask and appear neurotypical, whether it’s for safety or other reasons.

Unmedicated schizophrenics, whether by choice or reasons out of their control.

The schizophrenic survivors of abuse at the hands of their family, partners, or medical staff.

Schizophrenic victims of police brutality.

The schizophrenics that we lost to suicide.

And there are still so many more of us. (If you feel like I left anyone out, feel free to respond to this post with any additions you have.)

Happy World Schizophrenia Day / Disability Pride Month to all of you, from one schizospec to another. The world is a more beautiful place with you in it. I hope there will come a day when we don’t have to be ashamed of who we are. And I hope we can all find it within ourselves to not only survive, but thrive, in a world that likes to demonize us. So let’s all be here for one another, and remember you are never alone. I have so much gratitude the schizospec community for teaching me how to love and accept myself, and I wish the same for all of us. I love you, I see you, and I hope you can live happy and fulfilling lives, schizophrenia and all 🩷

[five-thousand-loaves-of-bread]

what is (chronic) autistic catatonia?

// why specify “autistic” catatonia? //

catatonia most common associate with schizophrenia, but increase realize also happen in things like bipolar & depression.

if look at some of typical catatonia diagnostic criteria in DSM 5 (but in easier words): catalepsy & waxy flexibility, grimacing (hold same stiff facial movement), mutism, echolalia, echopraxia (copy movement), exaggerated mannerisms, stereotypies/repetitive movements, etc… wait! some of these things happen in autism!!! (like 7 out of total 12 can be seen in autism)

this is why important to know how recognize catatonia in autism. because overlap.

catatonia in schizophrenia most common start fast and get worse fast. but chronic autistic catatonia typically slow onset and slow but visible deterioration. (always have exceptions though)

not know a lot about schizophrenia catatonia, so this post largely focus on autism. everything below, when say “catatonia” or “autistic catatonia,” mean chronic autistic catatonia with deterioration.

// before move on— //

sometimes professionals do connect autistic shutdown with/as catatonia or catatonia episode or catatonia-like episode to draw connection. this not talk about that. this about chronic ones with deterioration. personally for community identity purpose i don’t enjoy (already have term for shutdown). but personal opinion aside, again this about the temporary vs long term all the time. if experience temporary shutdown, remember to leave space for and not same as those of us deal with chronic autistic catatonia.

important to distinguish from autism because autism and catatonia share many symptoms. (for example, physical stimming or “stereotypies” is autism diagnostic criteria AND catatonia criteria). autistic catatonia should only be suspected IF have new symptoms OR change in type & pattern of old symptoms. cannot. stress. this. enough. again. it not about IF you have these symptoms it’s about WHEN and HOW and CHANGE. it's about NEW.

and. please do not diagnose self based on one tumblr post. yes even if i do extensive research and cite sources and have lived experience. many many many disorders look similar. am all here for educated self diagnosis because medical system inequitable BUT am also sick of every time write this a bunch people comment “oh never heard this this is so me.” one tumblr post not educated self dx. it not a cool new thing to add to carrd to hoard as much medical label as can, it miserable it makes my life hell it not a joke it not cool. not every autistic have chronic catatonia, not every shutdown means chronic catatonia, even if you autistic and see these signs, may be separate unrelated disorder altogether, like Infectious, metabolic, endocrinological, neurological, autoimmune diseases, all can see catatonia (Dhossche et al, 2006). some of you all will read this and truly think this is answer been looking for so long—great! still, please do more research.

// chronic autistic catatonia with deterioration and breakdown //

the key defining symptoms of chronic autistic catatonia is gradual lose functioning and difficulty with voluntary movements (shah, 2019, p21). “gradual lose functioning” will come with regression in independence & ADLs & quality of life. it usually gradual, chronic, and complex. but can vary in severity. some need prompts on some day & some situations, while others need prompt and even physical assistance for almost everything.

how common? have seen statistic estimate from 10% - 20% of autistic people adolescents & above experience chronic autistic catatonia.

typical onset for autistic catatonia is adolescence. some study samples is 15-19, some as early as 13. some professionals think this autistic catatonia may be a reason for many autism late regression (Ghaziuddin, 2021).

can happen regardless of gender, IQ (yes shitty), “autism severity/functioning labels” (is what most studies use, so i keep, but yes have issues, probably also mean happens regardless of autism level 1/2/3 and support needs before catatonia, but need more research to confirm since these thing don’t equal eachother).

// primary symptoms //

from book "Catatonia, Shutdown and Breakdown in Autism: A Psycho-Ecological Approach" by dr amitta shah, recommend read at least first two chapter and appendix.

1. Increased slowness

often first sign but not always

periods of inactivity or immobility between actions which appears as slowness, e.g walking, responses (verbal & body), self care, mealtime, etc

2. Movement difficulties (freezing and getting stuck)

difficult initiate/start movement

freeze or become "stuck" in middle of activity for few seconds to minutes

hesitate & "to and fro" movements

difficulty cross threshold/transitions like door way

difficulty stop action/movement once started

affect speech content, fluency, & volume

eat & drink difficult (like movement for fork & knife, chewing and swallowing, etc)

spend long time in one place

(new) ritualistic behaviors

3. Movement abnormalities

repetitive movements like in tourette's & parkinsons

e.g. sudden jerky movement, tremors, involuntary movements, blinking, grimacing, unusual & uncomfortable postures, locked in postures, increase in repetitive movements, etc.

4. Prompt dependence

may not be able to do some or any movement/activity, unable to move from one place to another, unable to change posture, etc without external/outside prompt

5. Passivity and apparent lack of motivation

look unmotivated & unwilling to do stuff, include activities used to like, probably because can't do voluntary action or have trouble with request and make decison.

6. Posturing

classic catatonia symptom of being stuck in one posture, sometimes for hours

7. Periods of shutdown

8. Catatonic excitement

episodic & short lasting

e.g. uncontrollable & frenzied movement and vocalizations, sensory/perceptual distortions, aggressive & destructive outbursts that not like self

9. Fluctuations of difficulty

e.g. some days better can do more need less prompt! other days worse. sometimes emergency can act as almost like a prompt! but fluctuate doesn't mean difficulty voluntary

// secondary difficulties //

Social withdrawal and communication problems

Decline in self-help skills

Incontinence

‘Challenging’ behavior

Mobility and muscle wastage

Physical problems

Breakdown

// autism breakdown //

can be in addition to autistic catatonia. can look like autism is getting worse, even though autism by itself not progressive disorder!

i also call this autism late regression. separate between autistic catatonia & this not very clear, not enough research.

1. exacerbation of autism

1a. increased social withdrawl, isolation, avoidance of social situations

1b. increased communication difficulties

1c. increased repetitive and ritualistic behavior

2. decrease in tolerance & resilience

easily disturbed, irratable, angry

3. increase in "challenging" behaviors

e.g. self injurious behaviors

4. decrease in concentration & focus

5. decrease in engagement & enjoyment

// treatment //

for catatonia (autistic or not), typical treatment is lorazepam and/or ECT.

specific to catatonia in autism, Dhossche et al. (2006) separate it to mild/moderate/severe and give recommend treatment according to that (do not come here and argue about severity labels, because fuck! mild depression and severe depression of course have different suggested treatments and severity important to know. Remember we talk about autistic catatonia).

note: this is one paper! not the only way! yes have problems like most psych/autism papers, just here to give example (of range of symptoms and treatment route!). NOT MEDICAL ADVICE. (not even endorsement)

mild: slight impairment in social & job things without limit efficiency as a whole (essentially still able to function for most part but difficult).

moderate: more obvious struggles in all areas, but ambulatory and don't need acute medical services for feeding or vitals

severe: typically medical emergency, acute stupor, immobility for most of day, bedridden, need other people help feed. also malignant catatonia which can be life-threatening (fever, altered consciousness, stupor, and autonomic instability as evidenced by lability of blood pressure, tachycardia, vasoconstriction, and diaphoresis, whatever any of that means)

the "shaw-wing approach": very brief summary, keep person active and do thing they enjoy, use verbal & gentle physical prompts, have structure & routine.

lorazopem challenge: take 2-4 mg of lorazopem to see changes in next 2-5 minutes. if no change, another 1 mg and reassess

lorazopem trial up to 24 mg. (note difference between challenge & trial)

bilateral ECT, last resort.

mild: "shaw-wing approach" -> 2 week lorazopem trial if no imporvement in 1 month -> if effective, do both, if not, just shaw-wing approach

moderate: depends on prefernece, either shaw-wing alone or shaw-wing and 2 week lorazopem trial -> if not effective, do 2 week lorazopem trial if havent already -> if not, bilateral ECT

severe: lorazepam challenge test -> if not effective, bilateral ECT; -> if lorazopem challange positive, 1 week lorazopem trial -> continue if successful, bilateral ECT if not.

can sound extreme, but rememeber for many severe catatonia (autistic or not), it is medical emergency. can be life-threatening. there's no/not a lot of time.

it possible to make partial recovery, as in get better but not to before catatonia. but overall, many permanently lose previous level of functioning.

references

Dhossche, D. M., Shah, A., & Wing, L. (2006). Blueprints for the assessment, treatment, and future study of Catatonia in autism spectrum disorders. International Review of Neurobiology, 267–284. https://doi.org/10.1016/s0074-7742(05)72016-x

Ghaziuddin, M. (2021). Catatonia: A common cause of late regression in autism. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.674009

Ghaziuddin, M., Quinlan, P., & Ghaziuddin, N. (2005). Catatonia in autism: A distinct subtype? Journal of Intellectual Disability Research, 49(1), 102–105. https://doi.org/10.1111/j.1365-2788.2005.00666.x

Shah, A. (2019). Catatonia, shutdown and breakdown in autism: A psycho-ecological approach. Jessica Kingsley Publishers.

[asurrogateblog]

The Syd Poll

the topic of this poll is one that is frequently avoided in the pink floyd fandom, but inevitably one we all consider – our individual views on what we think caused syd's psychological struggles (and by extension, led to his departure from the band). I think that – at least in this neighborhood of tumblr – this is a conversation we are capable of having in a way that is civil, nuanced, and at least minimally disrespectful to syd.

So, to help facilitate this, here are some ground rules:

let's all assume we have a mutual understanding of the complexities of this. syd could never actually be reduced down to a poll, and all of our viewpoints are limited in various ways

the poll options just serve as just a conversation starter, and responses are not necessarily a statement of absolute beliefs

feel free to discuss as much or as little of your own perspective as you feel comfortable sharing.

in the case that debates break out, please try to assume good intent – and also demonstrate it (unless, for instance, someone is being blatantly insulting beyond a misunderstanding that needs correcting)

please do NOT vote if you are not actually a pink floyd fan with at least basic knowledge about what we're talking about here.

The options I've included below are not meant to be exhaustive, they are simply the "theories" that I have seen most commonly circulated. I have also decided not to include combinations. I'm fairly sure we'd all agree multiple factors were involved. Rather than make the poll too complicated, I ask you to instead select the one that you think is the "most" important to your viewpoint, and clarify further in your tags/comments as you wish.

so. here we go.

READ BEFORE VOTING ^^^^

(note of correction: "late-onset schizophrenia" should just be "schizophrenia". the typical timeline for onset of symptoms is late adolescence/early adulthood, so syd would've been well within that period at the time)