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.