Symptoms of schizophrenia in adolescents: diversity and expressiveness

Adolescence is a period of life when the formation of a person’s character traits occurs.
The child’s psyche at this moment is unstable and vulnerable. Modern teenagers are distinguished by their penchant for maximalism, demonstrative protest, and oppositional behavior. During adolescence, human emotions are very changeable and fickle. It is for this reason that some adolescents begin to develop primary mental disorders. Schizophrenia is one of the pathologies that rapidly develops at this stage.

For many, this mental disorder is associated with such unpleasant manifestations as:

• madness;
• antisocial behavior;
• maladjustment in society;
• insulation;
• no future.

To some extent this is true. Late diagnosed or advanced schizophrenia can lead to serious consequences. Fortunately, these are isolated cases.

Modern methods of diagnosing and treating mental disorders help patients lead a normal lifestyle without losing its quality.

The main task of parents of a teenager is to understand the reason for the change in behavior and seek help in time.

Causes of teenage schizophrenia

The main factor in the development of this mental disorder is heredity. Scientists have identified a number of genes that convey a predisposition to schizophrenia. But this is far from the only source of the disease.

Psychiatrists argue that there are also a number of biological and psychosocial prerequisites. Most often there are several triggers. The most common causes of schizophrenia in adolescents:

• parental divorce;
• frequent quarrels in the family;
• severe stress;
• any type of violence – physical, psychological, sexual;
• taking a large dose of alcohol or drugs for the first time;
• traumatic brain injury.

Statistics show that boys are diagnosed with schizophrenia twice as often as girls at the same age. The reason for this pattern is unknown.

First manifestations

The initial signs of schizophrenia in a teenager can be noticed in childhood. But they are irregular and expressed sporadically, so parents attribute them to some individual character traits, fatigue or moodiness. Besides, it’s hardly anyone’s pleasure to suspect their own child has a mental disorder.

It will not be difficult to see changes in a child’s behavior if he led an energetic lifestyle: he studied well, actively communicated with friends, was interested in sports or other hobby activities. But suddenly some event occurs that radically changes his life. He ceases to be interested in studies, he does not find common topics for conversation with friends, he refuses to play sports or previously loved activities.

The teenager withdraws into himself, his behavior becomes unpredictable. The mood can change in the opposite direction in seconds.

The reason for visiting a psychiatrist should be the following, repeatedly occurring symptoms:

1. Progressive ridiculous ideas and strange reasoning.
2. Changes in the logic of thinking, transformation of speech.
3. Craving for absurd fantasies, absurd philosophizing.
4. Emotional alienation even from close people, absence or inconsistency of reaction to current events.
5. Atypical and absurd use of words and expressions in conversation.
6. Irritability for no apparent reason, deceit, manifestation of causeless aggression.
7. Inactivity, apathy, lack of any initiative and interest in life.
8. Tendency to alienate, categorical refusal to go out, neglect of personal hygiene, sloppiness, carelessness in clothing.
9. Unusual phobias and fears, eating disorders, strange hobbies or accumulation of unnecessary things.
10. Consumption of alcohol, drugs, tendency to vagrancy.
11. Talk about suicide.

A rather characteristic manifestation of a mental disorder should be noted ostentatious hostility towards parents or one of them who was especially close.

Continuous schizophrenia is characterized by a continuous, chronic course. The range of its clinical variants in terms of degree of progression is extremely wide - from juvenile malignant schizophrenia to sluggish schizophrenia, manifested mainly by disorders of a neurosis-like nature. Between these extreme variants of continuous schizophrenia, the middle place is occupied by paranoid schizophrenia, characterized by an average degree of progression.

With continuous schizophrenia, exacerbations and weakening of the process are observed, spontaneous or drug stabilization is often observed, but remissions are not typical for this form of the disease.

Malignant juvenile schizophrenia

Juvenile schizophrenia with a malignant course occurs, as a rule, in adolescence and young adulthood and is characterized by a pronounced progression, manifested by a rapid increase in negative symptoms and the formation of severe forms of defective (final) states. The psychopathological features of malignant juvenile schizophrenia are as follows: the disease begins with negative symptoms, then positive psychopathological disorders develop, characterized by extreme polymorphism and lack of development. This form of schizophrenia is resistant to treatment.

The prevalence of malignant juvenile schizophrenia is about 5-6% of the total patient population, with boys getting sick 4-5 times more often than girls. Some psychiatrists note that this disease often occurs in fairly gifted, capable young people who are the pride of their family and school; other researchers emphasize the smoothness of character traits - obedience, seriousness, diligence, lack of interest in children's fun and noisy games; Still others pay attention to the poverty of mental activity, emotional reactions, the absence of traits of youthful negativism, reflection and opposition characteristic of puberty. In more rare cases, before the appearance of obvious signs of the disease, symptoms of changes in mental development (dysontogenesis) are observed in the form of delayed mental development and motor skills, passivity, periodically occurring disinhibition, and fears of varying content. Thus, the premorbid population of patients with juvenile malignant schizophrenia has some characteristics and is quite diverse.

The disease usually begins gradually with a reduction in energy potential and the appearance of signs of emotional deficiency or with a picture of a distorted pubertal crisis. The reduction in energy potential is manifested by a progressive decline in productivity: young people who previously studied well begin to experience difficulties in perceiving new information, thinking disorders are observed, and the inability to concentrate attention; patients sit for hours preparing homework, rereading the same material many times. If at first teachers and relatives associate a decline in academic performance with objective reasons (most often with overwork), then later intellectual failure becomes obvious. Previous interests are lost, friendships are severed. Characteristic is the emergence of special interests - in problems of philosophy, the universe, nuclear physics, religion, i.e., in those areas of science and spiritual life with which the patient was not previously familiar and in which he showed no interest. This phenomenon is called “metaphysical intoxication.” Patients sit for days at a time reading books, without understanding or grasping the essence of the problem; Often a visit to the library takes on the character of a stereotype; ordered books remain open for hours on the same page; when asked about the meaning of what is read, unintelligible answers follow. Relationships with loved ones deteriorate sharply, patients become more and more indifferent to them, to the joys and sorrows of the family. In direct communication with loved ones they can be irritable, brutal and sometimes rude. Patients avoid their friends and sometimes flatly refuse to meet with them, become indifferent to themselves, do not take care of their appearance, are unkempt, sloppy, and categorically refuse basic hygiene procedures. Over time, inactivity increases: patients do nothing all day long, wander aimlessly around the apartment or lie in bed.

The described increasing personality changes, characteristic of simple schizophrenia and the initial period of other variants of juvenile malignant schizophrenia, are called “simplex syndrome”.

Against the background of increasing personality changes, rudimentary positive psychopathological disorders arise: short-term states of elevated and depressed mood, manifested not so much by changes in affect, but by psychopathic equivalents; Desire disorders in the form of sexual promiscuity and a tendency towards alcoholism (the latter is especially characteristic of periods of high mood and dysphoria), a desire for vagrancy (more typical for subdepression). Episodes of hallucinatory and delusional disorders also occur: most often these are calls, transient ideas of relationship and persecution; catatonic disorders are manifested by short-term freezes and individual impulsive actions.

The described symptoms are characteristic of the course of simple schizophrenia, characterized by a predominance of increasing negative disorders and rudimentary positive symptoms.

Three other variants of the course of juvenile malignant schizophrenia - hebephrenic, paranoid and catatonic, like simple schizophrenia, also begin with negative disorders (“simplex syndrome”). Their differences are determined by the picture of manifest psychosis, which does not occur in simple schizophrenia.

Features of hebephrenia as an independent nosological form are described by H. Hecker (1871) and G.V. Darshkevich.

In hebephrenic schizophrenia, against the background of negative disorders characteristic of the initial period of the disease, an acute psychotic state occurs - changeable and polymorphic. The psychopathological picture of psychosis in these cases consists of delusions of persecution, influence, hallucinations and pseudohallucinations, phenomena of mental automatism, catatonic disorders in the form of agitation, and short-term substuporous episodes. These disorders are distinguished by their rudimentary nature: delusional ideas do not form a system, hallucinations do not acquire the character of hallucinosis, catatonic disorders do not reach the level of stupor or catatonic excitement. There are two variants of hebephrenic schizophrenia - delusional and catatonic [Morozova T.N., 1957].

In the picture of polymorphic psychosis in hebephrenic schizophrenia, signs of somatic distress may develop: short-term episodes of rising body temperature, feverish appearance of patients, and often icteric skin color. These conditions are short-lived and resolve without any therapeutic intervention.

In the catatonic variant of schizophrenia, or “lucid catatonia,” against the background of the described simplex syndrome, a psychotic state acutely arises with a picture of substupor, interrupted by impulsive or hebephrenic excitation. These catatonic states are not accompanied by oneiric stupefaction (hence the name lucid catatonia, as opposed to oneiric catatonia).

At the same time, individual delusional disorders may be observed that do not tend to be systematized - pseudohallucinations, phenomena of mental automatism. These symptoms are unstable, and the corresponding disorders occur sporadically.

The fourth variant of juvenile malignant schizophrenia - early-onset paranoid schizophrenia (juvenile paranoid schizophrenia) in its development has much in common with paranoid schizophrenia that occurs in adulthood, i.e. it is characterized by a similar developmental stereotype. However, with juvenile schizophrenia, a number of features are also noted: the disease begins with simplex syndrome, is characterized by a wide variety of manifestations of the initial period, the appearance of catatonic symptoms at the advanced stages of the course of delusional chronic psychosis.

In the initial period of juvenile paranoid schizophrenia, positive disorders are most often represented by obsessions with the rapid development of rituals and the transformation of the latter into motor obsessions, psychopathic phenomena, interpretive delusions, characterized by little systematization and a “naive” system of evidence. The most common delusion of dysmorphomania is manifested by patients’ conviction of the imperfection of their appearance or pathology of physiological functions. Patients often insist on cosmetic surgery, threatening medical workers if they refuse to perform it. Sometimes patients try to eliminate cosmetic imperfections themselves. Delusions of a different origin are also typical, for example in the form of the patient’s conviction that he is being raised by strangers, while his real parents occupy a high position in society. The plot of delusion can also be hypochondriacal delirium with the conviction that patients have one or another serious illness - cancer, syphilis, tuberculosis. At the same time, the evidence provided by patients of their illness usually has nothing in common with the actual clinical picture of these diseases. And finally, delusions of reformism may develop: patients create concepts for reorganizing the world around them, the education system, etc., while the main provisions of the “reforms” are distinguished not only by naivety, but also by the lack of elementary logic.

After the initial period has passed, Kandinsky-Clerambault syndrome (mastery syndrome) develops, i.e., manifest psychosis. The mastery syndrome that dominates his picture is characterized by pronounced polymorphism, and in it, along with mental automatisms, pseudohallucinations and various types of delusional disorders are observed. A feature of this stage of the disease, as well as the following stage of paraphrenia (most often pseudohallucinatory), is the occurrence of fragmentary catatonic disorders in the form of episodes of substupor or agitation. It should be emphasized that these stages are layered on top of each other, creating a complex clinical picture of the disease. Over a relatively short period of time (2-3 years), malignant juvenile schizophrenia in most cases ends in severe types of final states: apathetic dementia (with simple schizophrenia), “foolish”, “muttering”, “mannered” dementia (with its hebephrenic and catatonic variants), phenomena of speech discontinuity in the form of schizophasia in paranoid schizophrenia.

Symptoms

The signs of schizophrenia in adolescents are not very different from its manifestations in adults. Most often this is the same delusion, hallucinations, personality disorder.

One can observe rudimentary delusional distortions of thinking in the form of various fears and phobias. They are intrusive and literally pursue the patient. Among them are:

1. Fear of other people's parents. The child begins to suspect his own parents that they are not his own. He is afraid of them, does not make contact, and refuses to eat.
2. Fear of contamination, which is often accompanied by compulsive hand washing. The teenager does this at every opportunity, regardless of his location.
3. Fear of open space – agoraphobia. The patient wants to hide somewhere, to become invisible.

Attention should be paid to the adequacy of the child’s reaction. It happens that to a situation that should make a person sad or upset, he reacts with a fit of laughter and feigned fun. The most common emotional disorders are:

• fenced off;
• isolation;
• absence of any manifestations of emotions, monotonous reaction to events happening around;
• loss of interest in previously favorite activities.

On the part of motor disorders, there may be repeated stereotypical movements, freezing in some unnatural positions, poor posture, strange gait, etc. Sometimes the angularity and awkwardness of movements can be attributed to adolescence or the accelerated growth of a teenager. But this pattern only works if the child has only these manifestations and they do not get worse over time.

MAIN FEATURES

For a long period, childhood schizophrenic disorder was considered as a separate, independent type of disease that is not associated with its adult form. Modern researchers have come to a consensus that pathology that begins to develop at a young age transforms into a similar disorder in an adult, but with a more severe form.

Possible signs of the onset of a schizophrenic process that should be reported to a child psychiatrist are:

• unusual fantasies that are particularly stable. These may be “friends” that are not visible to others who come to the child, or his identification with a specific character. For example, a baby can pretend to be a cat, take food only from a cat’s bowl, sleep in the most inappropriate places for a person;
• inexplicable fear. In this case, the child finds it difficult to answer what exactly he is afraid of, or, conversely, confidently and clearly points to the “monsters” that scare him and their locations;
• The level of everyday and social behavior sharply deteriorates. The patient stops taking care of himself and prefers a solitary pastime. At the same time, academic performance in educational institutions suddenly declines. The behavior of a schizophrenic begins to correspond not to actual, but to earlier age development;
• during a conversation, a schizophrenic often interrupts the conversation, begins to fearfully look around, or listen to something. At the same time, he often loses the thread of the conversation, his speech becomes incoherent and devoid of meaning. In particularly advanced cases, there is a breakdown of speech;
• causeless aggression, cruel attitude towards others is replaced by apathy and indifference. Emotions often arise that do not correspond to the situation - instead of crying, the patient begins to laugh hysterically, and vice versa;
• in the drawings of a schizophrenic, bright, contrasting colors begin to appear that do not correspond to reality - blue grass, green sun, etc. The dominance of black color in the images indicates a concomitant depressive disorder. The subjects of the drawings are often frightening - these are creatures with huge, bulging eyes, terrifying fangs, severed limbs, etc.

This mental disorder is quite rare before the age of 11-12; obvious symptoms of the disease often become more active in adolescence.

It is easier to diagnose mental disorders in children who are predisposed to the disease. Along with a normal level of intelligence, their adaptability to practical activities suffers; for example, they cannot perform ordinary self-care activities. Their behavior is characterized by the following features:

• they ignore activities that require active movement and prefer to play quiet games;
• selectivity in communication with peers;
• do not have the ability to stand up for themselves;
• in early childhood they often whine for no apparent reason;
• When a conflict or problematic situation arises, such a schizotype tries not to give away his emotional reaction, but withdraws into himself and closes down.

Stages of the disorder

Whatever the causes of schizophrenia in adolescents, it begins slowly and imperceptibly. One of the first manifestations is a feeling of internal discomfort. It has no reason, but keeps a person in constant stress and tension.

The following stages of development of the disorder and the measures taken should be highlighted:

1. Prodromal. At this stage of the disease, adolescents are characterized by problems associated with concentration, sleep disturbances, and difficulties at school. Making a diagnosis of schizophrenia at this stage is impossible; the goal of the diagnostic process is to form specific risk groups and carry out specific prevention.
2. Spicy. Productive symptoms predominate: hallucinations, delusions, disorders of formal thinking, strange psychotic behavior. The most specific are auditory hallucinations. They occur in 80% of patients aged 12 to 18 years.
3. Response to treatment and reduction of symptoms of the disease. The goal of therapy at this stage is to monitor and correct side effects of therapy and achieve remission.
4. Maturing remission. There are residual positive and negative symptoms of schizophrenia associated with side effects of therapy. At this stage, stable remission is achieved, factors that may cause a relapse are eliminated, a commitment to long-term maintenance therapy is formed, and social functioning is restored.
5. Recovery. At this level, monitoring of compliance with the maintenance therapy regimen, social support, and relapse prevention are carried out.
6. Chronic. The progression of this stage indicates the teenager’s resistance to the treatment methods used. Deactualization and partial reduction of positive symptoms occur, but social isolation, apathy and abulia persist. Negative symptoms cause a child's low level of social functioning.

Schizophrenia affects the most subtle layers of a teenager’s psyche and manifests itself in the sphere of self-awareness and perception of the surrounding reality.

Signs of schizophrenia in children and adolescents

There are negative and positive symptoms of the disease.

Positive

Among them are the following symptoms:

1. Hallucinations. The child hears voices in his head, sees images, objects and creatures that, in fact, do not exist.
2. Excessive aggressiveness and psychomotor agitation. Such children show increased activity, restlessness, excitability and emotionality. They are prone to various provocations: they start fights, show cruelty towards relatives, as well as strangers.
3. Protest reactions. The child turns out to listen to his parents, often throws tantrums, falls to the floor and screams in protest. It’s hard to get him to do anything: eat, get dressed or wash.

Negative

Signs of a disease that sharply kill something in the child’s behavior and character:

1. A mood disorder, which is accompanied by depression, apathy, lethargy, complete indifference to everything that happens, irritability and tearfulness. At an advanced stage, the child is prone to suicidal actions. Due to depression of the central nervous system, his motivation and concentration suffer.
2. Impaired communication skills. The need for communication disappears, the child becomes withdrawn, silent, and avoids communication with family and peers in every possible way.

Features of the course of the disease

Schizophrenia in adolescents has very similar symptoms to the adult type of the disease. However, when started early, it has a more malignant course, especially in males.

During puberty, a person’s sexual sphere is finally formed, and the perception of one’s own gender identity is formed. Sexual activity is usually limited to intense self-gratification, and the teenager does not particularly hide this fact.

There is an opinion that schizophrenics are dangerous to society; this theory is greatly exaggerated. A person suffering from a mental disorder is much more dangerous to himself than to others. If he finds himself in a criminal situation, it is most likely as a victim. The tendency to aggression can manifest itself only in the acute period under the influence of hallucinations.

Diagnostics

Where to turn first if there is a suspicion that a teenager has a worsening mental disorder? The initial examination can be carried out by any of the following specialists:

• psychologist;
• psychiatrist;
• neurologist;
• neuropsychologist;
• speech pathologist

Having studied the symptoms, the doctor refers the patient for further examination to identify concomitant somatic disorders.

Parents must be involved in the process of fighting the disease. For effective interaction between a doctor and a teenager, one should remember the specificity of adolescence, as well as the individual characteristics of the patient.

The doctor's task:

• show a tolerant attitude towards the child, recognize the naturalness of his anxiety, tension and suspicion, express understanding about the teenager’s reluctance to communicate with a psychiatrist;
• take into account possible obstacles to a teenager’s perception of information, in particular due to the presence of verbal hallucinations and severe impairments in the concentration function of attention;
• always listen carefully to the patient, take seriously any information provided, ask about details, using the terms he uses;
• maintain an optimal distance with the child, taking into account his needs for personal space, for example, do not mind if it is easier for the patient to talk to you while playing, walking around the office;
• demonstrate a desire to help;
• Explain in detail to the child and parents what the procedure for assessing the child’s condition will be;
• collect information gradually, as trust is formed on the part of the child and his parents;
• introduce the teenager and his parents to specialists who will participate in the implementation of psychosocial intervention.

A specialist who provides qualified psychiatric care to a child with schizophrenia must take into account the stage of its development, the severity and mechanisms of disorders of adaptive behavior, the presence of special educational problems, and the situation in the family context.