CHAPTER 24
Schizophrenia
Childhood-onset and adolescent-onset schizophrenia are pretty similar to
adult-onset schizophrenia – but are rarer and generally more severe.
Epidemiology
Roughly one in a thousand 12–17-year-olds have experienced a psychotic
disorder. Approximately half of these psychotic disorders are schizophre-
nia, while most of the rest are linked to depression, mania or drugs.
Although schizophrenia can occur in children as young as 7, onset is
very uncommon before puberty and becomes increasingly common as
adolescence progresses, peaking in early adult life. Though males are
generally more vulnerable to early-onset schizophrenia, the sex ratio is
reversed in the 11–14 age band, perhaps because girls are much more
likely than boys to be postpubertal at this age.
Characteristic features
The features of schizophrenia are often divided intopositiveandnegative
symptoms. This terminology is potentially confusing since it could imply
that positive symptoms are good and negative symptoms are bad. In fact,
‘positive’ refer to thepresenceof symptoms that should not normally be
there (for example, hallucinations, delusions, thought disorder, motor
abnormalities), while ‘negative’ refers to areductionin characteristics that
should normally be there (for example, less speech, sociability, emotional
involvement or motivation to do things).
Multivariate analyses suggest that the two-way distinction between pos-
itive and negative symptoms should perhaps be replaced by a three-way
distinction between negative symptoms, reality distortion (hallucinations
and delusions), and disorganisation (thought disorder, bizarre behaviour,
inappropriate affect).
Child and Adolescent Psychiatry, Third Edition. Robert Goodman and Stephen Scott.
©c2012 Robert Goodman and Stephen Scott. Published 2012 by John Wiley & Sons, Ltd.
193