Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Childhood-Onset Schizophrenia Differential Diagnoses

  • Author: Annemarie K Loth, MD; Chief Editor: Caroly Pataki, MD  more...
 
Updated: Sep 03, 2014
 
 

Diagnostic Considerations

The diagnosis of schizophrenia requires the exclusion of mood disorders with psychotic features (bipolar disorder), substance-induced psychotic disorder, and psychosis due to a medical condition. The following conditions should be considered when evaluating a child or adolescent with suspected schizophrenia:

  • Psychosis secondary to epilepsy; psychosis not otherwise specified; and psychosis, single episode
  • Neurodegenerative disorders
  • Multidimensionally impaired syndrome (not a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV] diagnosis), characterized by emotional lability, distractibility, poor social skills, brief hallucinations, and trouble distinguishing fact from fiction
  • Central nervous system (CNS) tumor
  • Progressive organic CNS disorder (eg, sclerosing panencephalitis)
  • Schizoaffective disorder

Chromosomal disorder: 22q11 deletion syndrome

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Annemarie K Loth, MD Fellow in Child and Adolescent Psychiatry, Indiana University School of Medicine

Annemarie K Loth, MD is a member of the following medical societies: American Psychiatric Association, Indiana Psychiatric Society

Disclosure: Nothing to disclose.

Coauthor(s)

David W Dunn, MD Program Director, Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Neurology, Indiana University School of Medicine

David W Dunn, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Neurology, American Epilepsy Society, American Psychiatric Association, Child Neurology Society

Disclosure: Received research grant from: Eli Lilly<br/>Honorarium for grant review committee for Department of Defense.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Acknowledgements

Angelo P Giardino, MD, PhD Clinical Associate Professor, Department of Pediatrics, Baylor College of Medicine; Medical Director, Texas Children's Health Plan, Inc

Angelo P Giardino, MD, PhD is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Professional Society on the Abuse of Children, Harris County Medical Society, Helfer Society, and International Society for Prevention of Child Abuse and Neglect

Disclosure: Bayer Honoraria Review panel membership; Pfizer Grant/research funds Independent contractor; MedImmune Honoraria Review panel membership

Raj K Kalapatapu, MD Fellow, Addiction Psychiatry, Columbia University College of Physicians and Surgeons

Raj K Kalapatapu, MD is a member of the following medical societies: American Academy of Addiction Psychiatry, American Academy of Child and Adolescent Psychiatry, American Association for Geriatric Psychiatry, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References
  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: APA; 1994.

  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). 4th ed. Washington, DC: APA; 2000.

  3. Polanczyk G, Moffitt TE, Arseneault L, et al. Etiological and clinical features of childhood psychotic symptoms: results from a birth cohort. Arch Gen Psychiatry. 2010 Apr. 67(4):328-38. [Medline].

  4. Asarnow RF, Nuechterlein KH, Fogelson D, Subotnik KL, Payne DA, Russell AT, et al. Schizophrenia and schizophrenia-spectrum personality disorders in the first-degree relatives of children with schizophrenia: the UCLA family study. Arch Gen Psychiatry. 2001 Jun. 58(6):581-8. [Medline].

  5. Keshavan MS, Diwadkar VA, Montrose DM, Stanley JA, Pettegrew JW. Premorbid characterization in schizophrenia: the Pittsburgh High Risk Study. World Psychiatry. 2004 Oct. 3(3):163-8. [Medline]. [Full Text].

  6. Gogtay N, Sporn A, Clasen LS, Greenstein D, Giedd JN, Lenane M, et al. Structural brain MRI abnormalities in healthy siblings of patients with childhood-onset schizophrenia. Am J Psychiatry. 2003 Mar. 160(3):569-71. [Medline].

  7. Addington AM, Rapoport JL. The genetics of childhood-onset schizophrenia: when madness strikes the prepubescent. Curr Psychiatry Rep. 2009 Apr. 11(2):156-61. [Medline]. [Full Text].

  8. Addington AM, Gornick M, Duckworth J, et al. GAD1 (2q31.1), which encodes glutamic acid decarboxylase (GAD67), is associated with childhood-onset schizophrenia and cortical gray matter volume loss. Mol Psychiatry. 2005 Jun. 10(6):581-8. [Medline].

  9. Walsh T, McClellan JM, McCarthy SE, et al. Rare structural variants disrupt multiple genes in neurodevelopmental pathways in schizophrenia. Science. 2008 Apr 25. 320(5875):539-43. [Medline].

  10. Weinberger DR, McClure RK. Neurotoxicity, neuroplasticity, and magnetic resonance imaging morphometry: what is happening in the schizophrenic brain?. Arch Gen Psychiatry. 2002 Jun. 59(6):553-8. [Medline].

  11. Rapoport JL, Giedd JN, Blumenthal J, Hamburger S, Jeffries N, Fernandez T, et al. Progressive cortical change during adolescence in childhood-onset schizophrenia. A longitudinal magnetic resonance imaging study. Arch Gen Psychiatry. 1999 Jul. 56(7):649-54. [Medline].

  12. Rapoport JL, Addington AM, Frangou S, Psych MR. The neurodevelopmental model of schizophrenia: update 2005. Mol Psychiatry. 2005 May. 10(5):434-49. [Medline].

  13. Gogtay N, Vyas NS, Testa R, Wood SJ, Pantelis C. Age of onset of schizophrenia: perspectives from structural neuroimaging studies. Schizophr Bull. 2011 May. 37(3):504-13. [Medline]. [Full Text].

  14. Mattai AA, Weisinger B, Greenstein D, et al. Normalization of cortical gray matter deficits in nonpsychotic siblings of patients with childhood-onset schizophrenia. J Am Acad Child Adolesc Psychiatry. 2011 Jul. 50(7):697-704. [Medline].

  15. Johnstone EC, Lawrie SM, Cosway R. What does the Edinburgh high-risk study tell us about schizophrenia?. Am J Med Genet. 2002 Dec 8. 114(8):906-12. [Medline].

  16. Steen RG, Mull C, McClure R, Hamer RM, Lieberman JA. Brain volume in first-episode schizophrenia: systematic review and meta-analysis of magnetic resonance imaging studies. Br J Psychiatry. 2006 Jun. 188:510-8. [Medline].

  17. Mattai A, Hosanagar A, Weisinger B, et al. Hippocampal volume development in healthy siblings of childhood-onset schizophrenia patients. Am J Psychiatry. 2011 Apr. 168(4):427-35. [Medline].

  18. Greenstein D, Lerch J, Shaw P, Clasen L, Giedd J, Gochman P, et al. Childhood onset schizophrenia: cortical brain abnormalities as young adults. J Child Psychol Psychiatry. 2006 Oct. 47(10):1003-12. [Medline].

  19. Gogtay N, Rapoport JL. Childhood-onset schizophrenia: insights from neuroimaging studies. J Am Acad Child Adolesc Psychiatry. 2008 Oct. 47(10):1120-4. [Medline].

  20. Degenhardt L, Hall W. Is cannabis use a contributory cause of psychosis?. Can J Psychiatry. 2006 Aug. 51(9):556-65. [Medline].

  21. Sevy S, Robinson DG, Napolitano B, et al. Are cannabis use disorders associated with an earlier age at onset of psychosis? A study in first episode schizophrenia. Schizophr Res. 2010 Jul. 120(1-3):101-7. [Medline]. [Full Text].

  22. Harley M, Kelleher I, Clarke M, et al. Cannabis use and childhood trauma interact additively to increase the risk of psychotic symptoms in adolescence. Psychol Med. 2010 Oct. 40(10):1627-34. [Medline].

  23. Kumra S, Robinson P, Tambyraja R, et al. Parietal lobe volume deficits in adolescents with schizophrenia and adolescents with cannabis use disorders. J Am Acad Child Adolesc Psychiatry. 2012 Feb. 51(2):171-80. [Medline].

  24. Arseneault L, Cannon M, Fisher HL, Polanczyk G, Moffitt TE, Caspi A. Childhood trauma and children's emerging psychotic symptoms: A genetically sensitive longitudinal cohort study. Am J Psychiatry. 2011 Jan. 168(1):65-72. [Medline].

  25. Schreier A, Wolke D, Thomas K, et al. Prospective study of peer victimization in childhood and psychotic symptoms in a nonclinical population at age 12 years. Arch Gen Psychiatry. 2009 May. 66(5):527-36. [Medline].

  26. Dalman C, Allebeck P, Gunnell D, et al. Infections in the CNS during childhood and the risk of subsequent psychotic illness: a cohort study of more than one million Swedish subjects. Am J Psychiatry. 2008 Jan. 165(1):59-65. [Medline].

  27. Clinton SM, Haroutunian V, Davis KL, Meador-Woodruff JH. Altered transcript expression of NMDA receptor-associated postsynaptic proteins in the thalamus of subjects with schizophrenia. Am J Psychiatry. 2003 Jun. 160(6):1100-9. [Medline].

  28. Kirkbride JB, Fearon P, Morgan C, Dazzan P, Morgan K, Tarrant J, et al. Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes: findings from the 3-center AeSOP study. Arch Gen Psychiatry. 2006 Mar. 63(3):250-8. [Medline].

  29. Ballageer T, Malla A, Manchanda R, Takhar J, Haricharan R. Is adolescent-onset first-episode psychosis different from adult onset?. J Am Acad Child Adolesc Psychiatry. 2005 Aug. 44(8):782-9. [Medline].

  30. Mattai AA, Tossell J, Greenstein DK, Addington A, Clasen LS, Gornick MC, et al. Sleep disturbances in childhood-onset schizophrenia. Schizophr Res. 2006 Sep. 86(1-3):123-9. [Medline].

  31. David CN, Greenstein D, Clasen L, et al. Childhood onset schizophrenia: high rate of visual hallucinations. J Am Acad Child Adolesc Psychiatry. 2011 Jul. 50(7):681-686.e3. [Medline]. [Full Text].

  32. Caplan R, Guthrie D, Fish B, Tanguay PE, David-Lando G. The Kiddie Formal Thought Disorder Rating Scale: clinical assessment, reliability, and validity. J Am Acad Child Adolesc Psychiatry. 1989 May. 28(3):408-16. [Medline].

  33. Caplan R, Guthrie D, Tang B, Komo S, Asarnow RF. Thought disorder in childhood schizophrenia: replication and update of concept. J Am Acad Child Adolesc Psychiatry. 2000 Jun. 39(6):771-8. [Medline].

  34. Caplan R, Siddarth P, Bailey CE, Lanphier EK, Gurbani S, Donald Shields W, et al. Thought disorder: A developmental disability in pediatric epilepsy. Epilepsy Behav. 2006 Jun. 8(4):726-35. [Medline].

  35. Bearden CE, Wu KN, Caplan R, Cannon TD. Thought disorder and communication deviance as predictors of outcome in youth at clinical high risk for psychosis. J Am Acad Child Adolesc Psychiatry. 2011 Jul. 50(7):669-80. [Medline]. [Full Text].

  36. Gochman PA, Greenstein D, Sporn A, Gogtay N, Keller B, Shaw P, et al. IQ stabilization in childhood-onset schizophrenia. Schizophr Res. 2005 Sep 15. 77(2-3):271-7. [Medline].

  37. Kendall T, Tyrer P, Whittington C, Taylor C. Assessment and management of psychosis with coexisting substance misuse: summary of NICE guidance. BMJ. 2011 Mar 23. 342:d1351. [Medline].

  38. Karp BI, Garvey M, Jacobsen LK, Frazier JA, Hamburger SD, Bedwell JS, et al. Abnormal neurologic maturation in adolescents with early-onset schizophrenia. Am J Psychiatry. 2001 Jan. 158(1):118-22. [Medline].

  39. Erlenmeyer-Kimling L, Hans S, Ingraham L, Marcus J, Wynne L, Rehman A, et al. Handedness in children of schizophrenic parents: data from three high-risk studies. Behav Genet. 2005 May. 35(3):351-8. [Medline].

  40. Bassett AS, Chow EW, AbdelMalik P, Gheorghiu M, Husted J, Weksberg R. The schizophrenia phenotype in 22q11 deletion syndrome. Am J Psychiatry. 2003 Sep. 160(9):1580-6. [Medline].

  41. Amminger GP, Schäfer MR, Papageorgiou K, Klier CM, Cotton SM, Harrigan SM, et al. Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Arch Gen Psychiatry. 2010 Feb. 67(2):146-54. [Medline].

  42. Correll CU, Manu P, Olshanskiy V, Napolitano B, Kane JM, Malhotra AK. Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents. JAMA. 2009 Oct 28. 302(16):1765-73. [Medline]. [Full Text].

  43. Howland RH. Update on newer antipsychotic drugs. J Psychosoc Nurs Ment Health Serv. 2011 Apr. 49(4):13-5. [Medline].

  44. Fusar-Poli P, Valmaggia L, McGuire P. Can antidepressants prevent psychosis?. Lancet. 2007 Nov 24. 370(9601):1746-8. [Medline].

  45. Grcevich SJ, Findling RL, Rowane WA, Friedman L, Schulz SC. Risperidone in the treatment of children and adolescents with schizophrenia: a retrospective study. J Child Adolesc Psychopharmacol. 1996 Winter. 6(4):251-7. [Medline].

  46. McGorry PD, Yung AR, Phillips LJ, Yuen HP, Francey S, Cosgrave EM, et al. Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms. Arch Gen Psychiatry. 2002 Oct. 59(10):921-8. [Medline].

  47. Armenteros JL, Davies M. Antipsychotics in early onset Schizophrenia: Systematic review and meta-analysis. Eur Child Adolesc Psychiatry. 2006 Mar. 15(3):141-8. [Medline].

  48. Spencer EK, Kafantaris V, Padron-Gayol MV, Rosenberg CR, Campbell M. Haloperidol in schizophrenic children: early findings from a study in progress. Psychopharmacol Bull. 1992. 28(2):183-6. [Medline].

  49. Correll CU, Kratochvil CJ, March JS. Developments in pediatric psychopharmacology: focus on stimulants, antidepressants, and antipsychotics. J Clin Psychiatry. 2011 May. 72(5):655-70. [Medline].

  50. Findling RL, Robb A, Nyilas M, et al. A multiple-center, randomized, double-blind, placebo-controlled study of oral aripiprazole for treatment of adolescents with schizophrenia. Am J Psychiatry. 2008 Nov. 165(11):1432-41. [Medline].

  51. Kryzhanovskaya L, Schulz SC, McDougle C, et al. Olanzapine versus placebo in adolescents with schizophrenia: a 6-week, randomized, double-blind, placebo-controlled trial. J Am Acad Child Adolesc Psychiatry. 2009 Jan. 48(1):60-70. [Medline].

  52. Findling RL, Kline K, Mckenna K, et al. Efficacy and safety of quetiapine in adolescents with schizophrenia: a 6-week, double-blind, randomized, placebo-controlled trial. Presented at: 55th Annual Meeting of the American Academy of Child and Adolescent Psychiatry. Chicago, IL: October 28 to November 2, 2008.

  53. Singh V, Vijapurkar U, Robb A, et al. Efficacy, safety and tolerability of paliperidone ER in adolescent patients with schizophrenia. Poster presented at: 65th Annual Meeting of the Society of Biological Psychiatry. New Orleans, LA: May 20–22, 2010.

  54. Haas M, Unis AS, Armenteros J, Copenhaver MD, Quiroz JA, Kushner SF. A 6-week, randomized, double-blind, placebo-controlled study of the efficacy and safety of risperidone in adolescents with schizophrenia. J Child Adolesc Psychopharmacol. 2009 Dec. 19(6):611-21. [Medline].

  55. Haas M, Eerdekens M, Kushner S, et al. Efficacy, safety and tolerability of two dosing regimens in adolescent schizophrenia: double-blind study. Br J Psychiatry. 2009 Feb. 194(2):158-64. [Medline].

  56. Pandina G, Kushner S, Singer J, et al. Comparison of two risperidone dose ranges in adolescents with schizophrenia. Poster presentation, 54th Annual Meeting of the American Academy of Child and Adolescent Psychiatry. Boston, Massachusetts: 2007.

  57. Singh V, Vijapurkar U, Robb A, et al. Efficacy, safety and tolerability of paliperidone ER in adolescent patients with schizophrenia. Poster presented at: 65th Annual Meeting of the Society of Biological Psychiatry. New Orleans, LA: May 20-22, 2010.

  58. Findling R, Cavus I, Pappadopulos E, et al. Efficacy and safety of ziprasidone in adolescents with schizophrenia. Presented at: 2nd Biannual Meeting of the Schizophrenia International Research Society (SIRS). Venice, Italy: April 10-14, 2010.

  59. ClinicalTrials.gov. Safety and tolerability of ziprasidone in adolescents with schizophrenia. Updated December 2, 2011. Available at http://clinicaltrials.gov/ct2/show/NCT00265382. Accessed: January 12, 2012.

  60. Sikich L, Hamer RM, Bashford RA, Sheitman BB, Lieberman JA. A pilot study of risperidone, olanzapine, and haloperidol in psychotic youth: a double-blind, randomized, 8-week trial. Neuropsychopharmacology. 2004 Jan. 29(1):133-45. [Medline].

  61. Arango C, Robles O, Parellada M, et al. Olanzapine compared to quetiapine in adolescents with a first psychotic episode. Eur Child Adolesc Psychiatry. 2009 Jul. 18(7):418-28. [Medline].

  62. Kumra S, Frazier JA, Jacobsen LK, et al. Childhood-onset schizophrenia. A double-blind clozapine-haloperidol comparison. Arch Gen Psychiatry. 1996 Dec. 53(12):1090-7. [Medline].

  63. Shaw P, Sporn A, Gogtay N, et al. Childhood-onset schizophrenia: A double-blind, randomized clozapine-olanzapine comparison. Arch Gen Psychiatry. 2006 Jul. 63(7):721-30. [Medline].

  64. Kumra S, Kranzler H, Gerbino-Rosen G, et al. Clozapine and "high-dose" olanzapine in refractory early-onset schizophrenia: a 12-week randomized and double-blind comparison. Biol Psychiatry. 2008 Mar 1. 63(5):524-9. [Medline].

  65. Sikich L, Frazier JA, McClellan J, et al. Double-blind comparison of first- and second-generation antipsychotics in early-onset schizophrenia and schizo-affective disorder: findings from the treatment of early-onset schizophrenia spectrum disorders (TEOSS) study. Am J Psychiatry. 2008 Nov. 165(11):1420-31. [Medline].

  66. Correll CU, Penzner JB, Parikh UH, et al. Recognizing and monitoring adverse events of second-generation antipsychotics in children and adolescents. Child Adolesc Psychiatr Clin N Am. 2006 Jan. 15(1):177-206. [Medline].

Previous
Next
 
Childhood schizophrenia. Early and late gray matter deficits in schizophrenia. Areas of gray matter loss, shown in red and yellow, spread from back-to-front (right to left) over 5 years in composite MRI scan data from 12 teens with childhood-onset schizophrenia, beginning at age 14 (left). Red and yellow denotes areas of greater loss. Source: Paul Thompson, MD, UCLA, Laboratory of Neuroimaging. NIMH media file.
Childhood schizophrenia. Rate of gray matter loss. Composite MRI scan data showing areas of gray matter loss over 5 years, comparing 12 normal teens (left) and 12 teens with childhood-onset schizophrenia. Red and yellow denotes areas of greater loss. Front of brain is at left. Source: Paul Thompson, MD, UCLA, Laboratory of Neuroimaging. NIMH media file.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.