Psychiatry and Clinical Psychopharmacology

Childhood schizophrenia: early signs, diagnosis and therapeutics of the prodromal phase of childhood schizophrenia

Psychiatry and Clinical Psychopharmacology 2014; 24: Supplement S34-S35
Read: 613 Published: 18 February 2021

Schizophrenia disrupts social and family relationships, resulting severe educational and occupational impairment, lost productivity, unemployment, physical illness, and premature mortality. Among people at “ultra high risk” of psychosis, about 22% to 40% is in transition within 12 months. Interventions that delay or prevent transition to psychosis from this prodromal syndrome could be clinically and economically important. The common symptoms in the prodromal psychotic phase are; reduced concentration and attention, reduced drive and motivation, anergy, anhedonia, depressed mood, sleep disturbance, anxiety, social withdrawal, suspiciousness, deterioration in role functioning, irritability, suicidal ideas, somatic complaints, change in motility, change in sense of self, others or world, perceptual abnormalities, mood swings, day dreaming, somatic anxiety findings, obsessive-compulsive symptoms, sexual orientation difficulties, metaphysical occupations and overvalued ideas. In the period of adolescence, it is difficult to determine these symptoms as prodromal signs of a developing psychosis as a result of the peculiar behavioral characteristics of this period. Family education and psychoeducation must be well balanced and must be individualized as alerting the family and the patient may cause negative outcomes and increase the stress of the family and the patient. Above all, it is impossible to know whether the patient will experience full symptom psychosis. Intense family therapy and psychoeducation may cause significant stress leading detrimental effect on family function or atypical antipsychotic treatment may cause serious metabolic-cardiac side effects in a patient who will never experience psychotic disorder. Individualized assessment and individualized treatment is essential considering the risk-benefit analysis. Although the treatment of the prepsychotic adolescents aims to prevent transition to psychosis, it may also improve the symptoms of the prepsychotic adolescents and leads to improvement in functionality. Even if the patient will not experience full symptom psychosis, these prodromal sign and symptoms may continue for a long time and may cause serious burden on the academic, familial, occupational functionality. Treatments in the prepsychotic and prodromal phase should prevent transition to schizophrenia but also should aim to treat the present symptoms. Low doses of atypical antipsychotics, SSRI’s, mirtazapine, benzodiazepines, antihistaminics and lithium come into prominence in the symptomatic treatment of prodromal phase. Although perospirone, aripiprazole, amisulpride, risperidone, and olanzapine have been found to be effective in treating the symptoms of the prepsychosis, it is controversial that whether second generation antipsychotics prevents transition to psychosis. In the first decade of the new millennium, SSRIs come forward for the prevention of schizophrenia in prepsychotic individuals, however in the recent years there has been little research on that possibility. As it is impossible to estimate the length of the treatment, aripiprazole and ziprasidone may be more reliable for the treatment of prepsychotic symptoms due to their low metabolic side effect profile. As a result although there is no proven treatment for individuals in the prodromal phase of psychosis, CBT, Psychoeducation, Family education, low doses of atypical antipsychotics, SSRI’s (especially şuvoxamine), Mirtazapine, omega-3 fatty acids, may have little benefit on the symptoms of prepsychosis.

EISSN 2475-0581