Diagnosing Schizophrenia In Teens
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The teen years can be a difficult period for anyone. As adolescents age, they often go through periods of personal growth and setbacks. However, many teens also struggle with untreated mental health disorders, such as DSM-5 schizophrenia, while attempting to manage a stressful and emotional time during their young lives.
Schizophrenia, in particular, can be difficult to diagnose in teenagers and young adults, especially in its early phases. Whether you are a parent, a teacher, or anyone else who regularly interacts with teenagers, educating yourself on the early warning signs of schizophrenia in a child’s behavior, as well as the later signs once the disorder has manifested, can be beneficial. Recognizing the symptoms of early-onset schizophrenia in the teenagers in your life can help them receive a diagnosis and find the right treatment before their symptoms grow out of control.
Schizophrenia: An overview of the mental illness
Schizophrenia is a serious mental illness that can cause distorted thinking and unusual behavior in patients. Many people with schizophrenia struggle to distinguish between what is real and what isn’t. As a result, their thoughts and views on the world are distorted or inaccurate, and they may exhibit bizarre behavior as a result. In short, many patients with schizophrenia have lost their concept of reality.
An individual can develop schizophrenia at any age; however, the average age of onset tends to be in the mid to late twenties. It is extremely rare for children younger than age twelve to be diagnosed with schizophrenia. However, childhood-onset schizophrenia is not impossible.
Criteria for diagnosing schizophrenia in teens
Schizophrenia falls under the category of psychotic disorders in the Diagnostic and Statistical Manual (DSM-5). In order to receive an official diagnosis of schizophrenia, patients must present two or more symptoms from the following categories:
- Delusions
- Hallucinations
- Negative symptoms
- Disorganized speech
- Disorganized behavior
Healthcare providers may conduct a full examination to recognize schizophrenia, considering a person’s medical history and current symptoms. They may also conduct tests to rule out the presence of another medical condition.
Different types of schizophrenia
In the past, there were five main types of schizophrenia that physicians studied, including the following.
Paranoid
Paranoid schizophrenia is the type most often portrayed in films and TV shows and is the type most people associate with the disorder. Individuals with paranoid schizophrenia often experience psychotic episodes consisting of delusions and hallucinations. Many of them have trouble distinguishing between what is real and what isn’t. This form of the condition can make daily functioning in all areas of life more difficult for an individual.
Catatonic
Individuals with catatonic schizophrenia often exhibit unusual styles or levels of movement. A person with this type can either move erratically or very little. Catatonic states can last from minutes to days.
Undifferentiated
An individual with undifferentiated schizophrenia often exhibits behaviors that fit into two or more categories of schizophrenia. This type of schizophrenia is characterized by a decline in one’s ability to perform regular day-to-day activities. For instance, a person with undifferentiated schizophrenia may choose not to change their clothes or take a shower.
Residual
Residual schizophrenia is diagnosed in those who had schizophrenia in the past but no longer present any symptoms of the disorder. In some cases, these symptoms vary in intensity over time, while others present themselves in a more muted form.
Disorganized or hebephrenic
While this disorder is still recognized by the International Statistical Classification of Diseases and Related Health Problems, hebephrenic schizophrenia is no longer considered an official subtype of schizophrenia. Individuals with hebephrenic schizophrenia were said not to experience hallucinations but still exhibited disorganized behavior and speech. Nowadays, schizophrenia is viewed on a spectrum. In some cases, physicians may use these subtypes to guide their overarching diagnosis of a patient.
Risk factors for developing schizophrenia
Researchers have not yet found a singular cause behind the development of schizophrenia in teenagers. Schizophrenia diagnosed in teens is less common than in young adulthood, but most medical scientists agree that a variety of genetic, psychological, and environmental factors cause schizophrenia. The National Institute of Mental Health (NIMH) notes risk factors that can increase one’s likelihood of developing the condition, such as:
- Having a family history of schizophrenia or other mental health conditions
- Stressful or traumatic life events
- Differences in brain chemistry and structure
- Complications during pregnancy and birth
Experts have long believed that the dysregulation of certain brain chemicals, including neurotransmitters called dopamine, plays a role in certain symptoms of schizophrenia, including psychotic symptoms and cognitive symptoms.
Warning signs of schizophrenia in teens
In some instances, a teen or child’s symptoms of schizophrenia appear without any warning. Other times, the disorder causes a gradual decline in an individual’s normal functioning. There are a variety of early symptoms that parents can look out for, such as:
- Social withdrawal and trouble making or keeping friends
- A deterioration in their child’s personal hygiene
- Hostility or paranoia
- A flat, expressionless gaze
- Depression
- Bizarre ideas or unusual thoughts
- Difficulty concentrating
- Laughing or crying at inappropriate times
- Struggling to pick up on social cues, such as eye contact
- Inability to display emotions such as joy or sadness
- Suicidal thoughts
Suppose your child is displaying significant mood changes, behavior shifts, or other problems that raise concern. In that case, seek early treatment from a family doctor or your child’s pediatrician as soon as possible so that they can receive appropriate medical care. Early intervention for treating schizophrenia at the first sign of a psychotic episode could be key.
Breaking down positive and negative symptoms of schizophrenia
Symptoms of schizophrenia are typically broken down into two categories — positive and negative symptoms. Positive symptoms are characterized by the presence of abnormal thinking and behavior, while negative symptoms refer to the absence of normal mental functioning.
Negative symptoms
Negative symptoms in patients with schizophrenia can include:
Withdrawal or apathy: When making plans with friends or talking to others, people with schizophrenia sometimes withdraw.
Trouble with speech: Also known as alogia, this negative symptom of schizophrenia is characterized by the inability to show one’s feelings when talking, or even talk much at all during a conversation.
An inability to perform basic functions: Individuals with schizophrenia may stop bathing or performing basic hygienic functions.
Affective flattening: A flattening effect is present when someone with schizophrenia talks in a flat tone that lacks emotion or cannot make normal facial expressions in response to events around them.
Inability to stay on task or finish what they started: Some individuals with schizophrenia struggle with their ability to follow through on tasks. Some doctors refer to this symptom as “avolition.”
Positive symptoms
Positive symptoms in schizophrenia patients include:
Hallucinations: Hallucinations occur when an individual sees, smells, hears, or feels stimuli that no one else does. They might start hearing voices in their head or seeing loved ones who are dead. Tactile hallucinations, such as crawling sensations over their body, may also be observed in people living with schizophrenia.
Delusions: Delusions are false beliefs that are held even when there is evidence to the contrary. An example of a delusion is the belief that someone is attempting to manipulate one’s actions through their TV set or that the FBI is targeting them. Individuals might have a religious delusion where they think they are possessed by a demon or a grandiose delusion where they consider themselves to be a significant public figure.
Movement disorders: Some people with schizophrenia appear jumpy while also staying in a catatonic state for extended periods. Others may continue to make the same movements repeatedly.
Inability to organize one’s thoughts and speech: People with schizophrenia may have trouble organizing their thoughts or following what other people are telling them. In some cases, their words come out jumbled when they try to speak. Other individuals may appear zoned out or distracted when people try to talk to them.
Treatment for adolescent schizophrenia
People with schizophrenia often undergo lifelong treatment for their illness — even after their symptoms have subsided. A combination of medication and psychosocial or person-centered therapy is commonly used to treat individuals and help them manage their condition. However, in some cases, clients may enroll in inpatient treatment or be hospitalized.
Antipsychotic medications
Antipsychotic medications are the most commonly prescribed medications for individuals with schizophrenia. Many researchers believe that these antipsychotic medications control symptoms by affecting the dopamine and serotonin levels in their brains. Right now, there are first-generation and second-generation antipsychotics available on the market. However, physicians may prefer prescribing second-generation antipsychotics, as they often pose a lower risk of causing serious side effects in patients.
Some mental health specialists prescribe antipsychotic medications along with a treatment plan for person-centered therapy for their patients. Always consult with a child psychiatrist or another professional trained in adolescent psychiatry before taking any medications.
The BetterHelp platform is not intended to provide any information regarding which medication or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. Do not take any action (including starting, stopping, or changing medications) without consulting a qualified medical professional.
Person-centered therapy and counseling
Psychosocial interventions such as client-centered therapy and mental health counseling have also proven to be effective for individuals when their psychosis recedes. In addition to medication, physicians could encourage their patients to undergo:
One-on-one person-centered therapy: A client-centered therapist can use talk therapy to teach clients how to cope with stress, identify early signs of a relapse, and normalize their thought patterns. This treatment may allow the client to achieve personal growth as they continue with their therapy.
Family therapy: A family-centered approach to therapy is often highly effective in helping a teen or child cope with a diagnosis.
Training in social skills: Social skills training focuses on teaching individuals how to improve their communication skills and their ability to participate in social activities. This person-centered approach to therapy gives them the skills and training to help them improve their social lives and relationships.
Many mental health counselors follow the main components of person-centered therapy when treating their clients. Person-centered therapy aims to treat people with compassion and without judgment. For this reason, many individuals prefer working with physicians who specialize in person-centered therapy.
Hospitalization
During severe crisis periods or relapses, individuals may undergo hospitalization for their symptoms. This step is often taken to ensure their safety and minimize health risks. During their stay, individuals might also undergo treatment such as person-centered therapy or electroconvulsive therapy (ECT).
Electroconvulsive therapy (ECT)
Electroconvulsive therapy (ECT) may be prescribed for those who have not experienced success with medication or therapy. During an ECT session, a medical specialist administers general anesthesia as well as a medication to relax their muscles. They will then attach electrodes that send a controlled electric current to the client’s scalp. Talk to your doctor about the recovery from this procedure and any doubts you may have.
Common misconceptions about schizophrenia
There are a variety of stereotypes and misconceptions attached to people living with schizophrenia. Some people mistake schizophrenia with multiple personality disorder, which is now referred to as dissociative identity disorder (DID), a rare mental illness. Inaccurate media depictions of schizophrenia may contribute to people confusing TV and movie portrayals of the disease, which often portray people with schizophrenia as violent and dangerous. However, actual people with the condition are more likely to be survivors of violent crime than to perpetrate such crimes themselves. To remove the stigma around this mental health disorder, it is important that teens, parents, and teachers educate themselves on the myths that continue to follow it.
Electroconvulsive therapy (ECT)
Electroconvulsive therapy, or ECT, may be prescribed for patients who have not experienced success with drug therapy. During an ECT session, a medical specialist will give the patient general anesthesia as well as a drug to relax their muscles. They will then attach electrodes that send a controlled electric current to the patient’s scalp.
Common misconceptions about schizophrenia
There are a variety of stereotypes and misconceptions attached to patients with schizophrenia. Some people mistake schizophrenia with multiple personality disorder, which is now referred to as dissociative identity disorder, a mental illness that is quite rare. Inaccurate media depictions of schizophrenia may contribute to people confusing TV and movie portrayals of the disease, which often portray people with schizophrenia as violent and dangerous, with actual schizophrenia patients, who are more likely to be victims of violent crime than to perpetrate such crimes themselves. To remove the stigma around this mental health disorder, it is important that teens, parents, and teachers educate themselves on the myths that continue to follow it.
Mental health help for parents
If your teen has recently been diagnosed with schizophrenia, it may take a toll on your mental health as their parent. In this case, it can be beneficial to lean on someone who can help, such as a therapist. You can connect with a professional through an online platform like BetterHelp to search for someone who has experience with teens and schizophrenia to ensure you’re receiving care tailored to your needs.
As a parent, you may have a lot of different responsibilities. Since much of your time may be going toward finding your teen appropriate care, you may perceive that you don’t have enough time to go to therapy sessions. Online therapy allows you to receive care from the comfort of your home. You can talk to your therapist over the phone, through a video chat, or by utilizing an in-app messaging feature.
The effectiveness of online therapy for managing mental health
Online therapy can be an effective tool for managing a variety of mental health disorders. One study assessed the efficacy of an internet-based intervention for people with psychosis. Researchers found that those with schizophrenia who took part in the study experienced significant improvements in social functioning. They also reported a decline in comorbid depressive symptoms, including their severity.
Takeaway
Although schizophrenia is rarely diagnosed in teenagers, looking out for the common signs and symptoms associated with this serious disorder can still be significant. If you have a child who has recently been diagnosed with schizophrenia, their symptoms can have a significant impact on their life and yours. A team of professionals can help your child manage the symptoms associated with this disorder with a treatment plan customized to their needs. Likewise, an online or in-person therapist can work with you, as the parent, to cope with the difficult emotions that may arise from your teen’s diagnosis.
Can a 14-year-old be diagnosed with psychosis?
Schizophrenia can occur at any age. However, it is exceptionally rare for the symptoms of schizophrenia to appear outside of middle or young adulthood. Most cases appear after the age of 12 or before the age of 40. On average, men tend to experience symptom onset in their late teens to early 20s, and women tend to experience symptom onset in their late 20s to early 30s.
Diagnosing schizophrenia in adolescents is often challenging. Many symptoms of schizophrenia appear similar to other conditions, like ADHD or developmental delays, in the early days of the illness. Diagnosis is complicated further by the presence of prodromal symptoms, which are weak symptoms of schizophrenia that appear in the very early days of the illness.
Prodromal symptoms can include withdrawing from friends, changes in sleeping patterns, changes in personality, and grandiose thoughts or delusions. Each of those symptoms could be attributed to a condition other than schizophrenia, and many prodromal symptoms represent behavior that is typical of the average adolescent.
What are the three warning signs of schizophrenia?
Schizophrenia has many warning signs, but three hallmark signs of schizophrenia are the emergence of hallucinations, delusions, or disorganized thoughts. Hallucinations include hearing voices or seeing stimuli that others cannot. Auditory hallucinations are more common than visual hallucinations, but both can occur. The voices heard while hallucinating may be critical or threatening.
Delusions are false beliefs that remain unchanged despite direct evidence against them. One commonly-known delusion is a delusion of grandeur, in which a person has an exaggerated sense of their own significance, authority, or knowledge.
Disorganized thinking is also a hallmark of schizophrenia. People with schizophrenia often struggle to form new memories, organize their thought processes, or complete tasks. Those with schizophrenia are likely to experience a symptom known as anosognosia, or a lack of awareness that they have a mental illness.
At what age can you tell if a child is schizophrenic?
Generally, symptoms of schizophrenia do not appear until after a child has reached the age of 12, and they usually appear much later in adolescence. Still, developing the symptoms of schizophrenia before age 12 is possible, but it is challenging to distinguish schizophrenia in children from other mental health conditions or normal child behavior. For example, a child’s teacher might note when a child engages in imaginative play. They may “see” shapes or people that are not there and “believe” in observably untrue ideas. However, people may misidentify this symptom as imagination, which is common in children. Below are some warning signs common to child-onset schizophrenia:
Reporting that their mind or eyes are playing tricks on them
Hearing knocking, tapping, or clicking
Confusion or expressing strange ideas
Sudden and unusual emotional shifts
Paranoia or a feeling like people are “out to get them”
Unwarranted fear or suspicion
Difficulty speaking, writing, or completing age-appropriate tasks
Each warning sign listed above could apply to a diagnosis other than schizophrenia. It is not possible to tell if a child’s behavior indicates schizophrenia; a licensed professional must perform a complete evaluation to rule out other conditions. Early treatment can often significantly improve the quality of life for many children.
What tests confirm schizophrenia?
There is not one single test to confirm schizophrenia, nor is there an assessment battery that definitively predicts the diagnosis. Schizophrenia must be diagnosed by a licensed professional, usually a psychiatrist, who is familiar with the complexities and nuances of the diagnosis. The individual usually receives a complete medical workup to rule out underlying medical conditions before proceeding to a thorough history, investigation of symptoms, and administration of standard rating scales.
The patient's history evaluates hereditary components, brain development, educational history, and social history. The clinician also deeply examines the patient’s current symptoms. The assessing professional may use standardized rating scales to compare the patient’s responses with responses taken from the schizophrenic population. A detailed cognitive assessment, including intelligence testing, may also be included.
How do you self-diagnose schizophrenia?
Self-diagnosing schizophrenia or other mental health conditions is unadvised and potentially dangerous. Schizophrenia is a serious condition that requires medical treatment to manage. A qualified professional can perform an in-depth evaluation and discern whether an individual’s reported symptoms are due to schizophrenia or another disorder.
Schizophrenia also requires a complex treatment plan to reduce symptoms as much as possible. Even if it were possible for an untrained person to self-diagnose, it is not possible to treat schizophrenia without the guidance of a trained, knowledgeable professional who is familiar with the course of the illness.
Can IQ tests diagnose schizophrenia?
An IQ test alone cannot diagnose schizophrenia. However, IQ tests are often used as part of a comprehensive cognitive assessment, which is often included in schizophrenia evaluations. A cognitive assessment helps rule out mental health conditions besides schizophrenia and gives insight into the individual’s brain function.
Can a 15-year-old have schizophrenia?
There is no cut-off for when schizophrenia can appear. For men, symptom onset usually occurs in the late teens to early 20s. For women, symptoms tend to appear in the late 20s to early 30s. It is exceptionally rare for schizophrenia to begin under the age of 12, but child-onset cases have been known to occur.
Diagnosing schizophrenia can be difficult when it emerges during the teenage years. Many of the features of schizophrenia, like disorganized thought and unusual behavior, can be attributed to other mental health conditions or, in some cases, typical adolescent behavior. Neurotransmitters called dopamine are heavily implicated in the development of schizophrenia as well as adolescent development. Bizarre, thrill-seeking, or otherwise strange behavior is already common in adolescents.
How does schizophrenia start in young people?
Schizophrenia often begins with prodromal symptoms, which are weaker, attenuated versions of the symptoms that may eventually develop in schizophrenia. Prodromal symptoms are typically a warning sign, but they do not guarantee that the person will develop schizophrenia. If prodromal symptoms are noticed, a full evaluation may be conducted to determine the person’s risk of developing schizophrenia.
Researchers are uncertain how many people who develop prodromal symptoms will go on to meet the criteria for a schizophrenia diagnosis. One current estimate suggests that only 20% to 40% of those in a prodromal period will develop schizophrenia within two to four years.
What are the seven early warning signs of schizophrenia?
The warning signs of impending schizophrenia are usually the prodromal symptoms. The early phase of schizophrenia is characterized by weaker symptoms that signal the possible beginnings of the illness. Although prodromal symptoms function as a warning sign, researchers are still uncertain how many people who experience prodromal symptoms will develop schizophrenia. Estimates indicate that 20% to 40% of those who experience a prodrome will go on to meet the criteria for a diagnosis of schizophrenia. Below are a few common prodromal symptoms of schizophrenia:
Social isolation and withdrawal
Declining role function (such as occupational, educational, or family roles)
Emergence of strange or odd behavior changes
Flat or blunted emotional expression
Speech that becomes long-winded, elaborate, or devoid of logical meaning
Strange beliefs that do not seem in alignment with observable reality
A lack of initiative, energy, or willingness to engage in formerly-enjoyed interests
What do kids with schizophrenia see?
Those with schizophrenia experience a variety of hallucinations. However, not all hallucinations are visual. Auditory hallucinations - or hearing sounds that others cannot - are the most common type of hallucination, followed by visual hallucinations. Visual hallucinations vary from person to person, though some common themes appear.
Visual hallucinations vary in complexity. Some people experience vivid scenes that often include family members, religious figures, or animals. Other people experience more disjointed hallucinations, such as seeing incomplete renderings of humans (like an arm or a leg rather than a whole person), abstract shapes, and unidentifiable objects.
Reactions to hallucinations can be met with fear, joy, or indifference. People with schizophrenia may describe hallucinations that represent an imaginary world, such as reporting hallucinations populated with ideas or objects that do not exist in the real world or people who appear in an attenuated or symbolic form.
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