“There is no such ‘condition’ as ‘schizophrenia,’ but the label is a social fact and the social fact a political event.” -R.D. Laing

R.D. Laing was a rather famous psychiatrist who actually commissioned a film called Asylum which looked into the mental health ‘hospitals’ like the often heard of Bellevue. If you have time, I encourage you to either google or YouTube R.D. Liang/Asylum and check out some of the film clips–it is incredibly interesting.

On a different note, I cannot help but still wonder about childhood onset schizophrenia. Is it schizophrenia? is it another type of illness? What are the differences in this illness as compared with adult onset (or ‘typical’) schizophrenia? I found very few articles related to childhood-onset schizophrenia, but one in particular I found to be of interest to our discussion. It was a study done in Africa looking at 12 children who had schizophrenia onset at or below the age of 12 (before the onset of puberty). Read through the article (you can search it on PubMed) but I will put the citation and abstract below, which shares some very interesting demographic information about these childhood schizophrenia cases:

Maydell, R.J., van der Walt, C., Roos, J.L., Scribante, J., & Ladikos, A. (2009). Clinical characteristics and premorbid variables in childhood-onset schizophrenia: A descriptive study of twelve cases from a schizophrenia founder population. African Journal of Psychiatry, 12, 144-148.

OBJECTIVE: To analyze clinical and demographic data of childhood-onset (12 years and younger) schizophrenia patients collected for a genetic study in schizophrenia, undertaken nationally in South Africa, using multiple parameters. METHOD: Patients with an onset of schizophrenia at 12 years or younger, were included. From the Diagnostic Interview for Genetic Studies (DIGS), patients’ information and summary report data was tabulated and analyzed. Specific subgroups were further compared. This sub-population of 12 subjects was further compared with a group of the adult sample. RESULTS: Of the 12 patients recruited, prominent results were: male to female ratio of 1:1; all had insidious onset of psychosis; a third had all 3 multidimensional impairment (MDI) symptoms; all patients that received ADHD treatment had ADHD treatment failure; two thirds had milestone delay; 58% had birth complications; a third were predominantly bottle fed; 42% had family history of schizophrenia; a third had family history of other major psychiatric conditions; all patients had at least one non-psychotic deviant behaviour (NPDB); no patient used cannabis; all delusions were paranoid; 92% had school achievement difficulty and a third had treatment resistance. Gender comparison included: earlier onset of psychosis in females; all females had aggression versus a third of males; more females had school achievement difficulty than males; males had more treatment resistance. Patients with MDI, compared to the sample average had: earlier onset of non-psychotic deviant behaviour; lower school drop-out rate; less social difficulty and no treatment resistance. CONCLUSION: The results compare well to previous research on this topic. The new concepts introduced by the present study require further investigation.

We also talked a little bit about the possible genetic component (if it does indeed exist) of schizophrenia, and I found a really interesting article regarding the incidence of genetic ‘predisposition’ in childhood-onset schizophrenia cases. Here is the citation and abstract for you to check out:

Addington, A.M., & Rapoport, J.L. (2009). The genetics of childhood-onset schizophrenia: When madness strikes the prepubescent. Current Psychiatry Reports, 11, 156-161.

Stratification by age at onset has been useful for genetic studies across all of medicine. For the past 20 years, the National Institute of Mental Health has been systematically recruiting patients with onset of schizophrenia before age 13 years. Examination of familial transmission of known candidate risk genes was carried out, and a 10% rate of cytogenetic abnormalities was found. Most recently, high-density, array-based scans for submicroscopic rare copy number variations (CNVs) have suggested that this kind of genetic variation occurs more frequently than expected by chance in childhood-onset schizophrenia (COS) and at a higher rate than observed in adult-onset disorder. Several CNVs and cytogenetic abnormalities associated with COS are also seen in autism and mental retardation. Populations with COS may have more salient genetic influence than adult-onset cases. The relationship of rare CNVs to prepsychotic development is being studied further.

What do you think about this? Perhaps this indicates that childhood schizophrenia may be more genetically based than adult-onset schizophrenia? Perhaps adult-onset is more based on environment and childhood-onset more on predisposition? Do you still think they are the same, or can they be put into distinct categories? I think that it is incredibly interesting, especially considering how rare childhood onset appears to be, and the literature on it is practically non-existant.

Here is another video about childhood schizophrenia. The beginning talks again about Jani, and shows some really interesting clips of when she was a baby, and she looks like she can already see hallucinations. The latter half of the video shows a schizophrenic girl named Rebecca, who is paranoid schizophrenic and pretty violent. Listen to the things she says and also take note of her affect and thoughts.

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6 thoughts on ““There is no such ‘condition’ as ‘schizophrenia,’ but the label is a social fact and the social fact a political event.” -R.D. Laing

  1. Jenn,
    I found the video you posted really interesting. I know how you were saying in class whether or not children can get schizophrenia, but that girl that has paranoia seemed to understand what was going on in her head somewhat and knew that this “man following her” wasn’t supposed to be there, but yet she still does the things he tells her to do anyways. I just find it so bizzarre, and it’s sad that these people know that something is wrong and can differentiate between the two, and yet they still can’t escape the “things” in their head. It’s unfortunate that it is so rare and thus there is no literature on the matter… I think it would be really interesting to look at the genome of these girls and others like them to see if there are any correlations. Also, in adults it appears to be more pertinent to males or that males have more severe cases of schizophrenia. We saw two girls here… I wonder if perhaps that same sexual dimorphism of schizophrenia applies to children, or perhaps that it is the opposite?

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  2. It is true that childhood schizophrenia is different and rare, but many things are rare and sometimes the exception proves the rule. I do hope that the future holds more research with children who have childhood Schizophrenia, but I can see the logistical difficulties in studying such a rare disorder. I think that from these videos we can make a differentiation between childhood Schizophrenia and adolescent/adult Schizophrenia.

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  3. Hi Jenn!

    Like Natasha, I found the video you posted to be of interest. I was intrigued by how much the two girls were affected by their conditions, especially in terms of their predisposition towards violence. Prior to watching the video, I was aware that schizophrenia has been connected with a higher suicide rate, but had never seen much evidence for a link with violence towards others. It was upsetting to see the profound effect that the disorder had on the entire family.

    From my own research of schizophrenia, I would guess that the two are related because of their symptoms, but distinct because of their severity. Childhood schizophrenia is unquestionably more severe, and this effect is likely associated with a higher genetic vulnerability, as you suggest. Then again, perhaps there is something that triggers the onset in childhood, and the fact that the disorder occurs early in brain development leads to the greater deficits in cognitive function. It is certainly a puzzling subject, and one that certainly deserves attention despite it being a rare diagnosis. Furthermore, whether the onset occurs in childhood or adulthood, isolating the true cause (or causes) of schizophrenia will be a big step forward.

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  4. I found the video on those two girls to be really upsetting and disturbing. I had no idea that children could have schizophrenia and it even appeared as though one of the girl’s was having hallucinations as an infant. I believe most of what I have read about schizophrenia has mentioned that it first presents itself during puberty. These young girls and their hallucinations just really made me realize how dangerous this disease can be, not only to others, but the threat it poses to those who are diagnosed with it. The one girl’s desire to hit her baby brother was particularly distressing to me and I wonder if these tendencies towards violence will only increase with age. I was also intrigued by the different visions or hallucinations these girls experienced. I wonder if it is possible to see how the brain operates differently in a child with paranoid schizophrenia versus a child suffering from childhood schizophrenia.

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  5. In class we discussed that the possibility that adult onset schizophrenia is caused by stress. One article says that 58% had birth complications. Although these are not specified, perhaps they put the child under unmanageable amounts of stress. I wonder if this finding coupled with the genetic factors have contributed to a change in the brain during development. Instead of being triggered by the developmental changes in adolescence, these changes are triggered by the many developmental changes that occur after the stressful experiences of their births and during the many developmental changes that occur in early life. If the child did not experience any prenatal or birthing stress then what does this say about the model where stress is a factor in schizophrenia? Or would a correlation (or lack there of) of stress between adults and children not even matter because the diseases are more different than they appear to be when we call them both schizophrenia. It is also surprising that research in this area seems to be just beginning. I wonder if cases have been reported further into the past.

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  6. Childhood Schizophrenia is really interesting especially because of the extent of her hallucinations. Almost seems like her imagination as a child is playing into her hallucinations. This would make sense with the top down processing model of hallucinations. She uses her more vivid imagination as a child to come to rationalizations that most adults would come to.

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