eMedicine Specialties > Pediatrics: Developmental and Behavioral > Medical Topics

Schizophrenia and Other Psychoses: Follow-up

Author: Rajkumar K Kalapatapu, MD, Fellow in Child/Adolescent Psychiatry, Department of Psychiatry, Indiana University School of Medicine
Coauthor(s): David W Dunn, MD, Program Director, Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Neurology, Indiana University
Contributor Information and Disclosures

Updated: Mar 10, 2008

Follow-up

Further Inpatient Care

  • Acute inpatient care is necessary for persons with behaviors dangerous to self or others.
  • The child with schizophrenia who is severely impaired may need day treatment programs or hospitalization until the child is stabilized and not considered a danger to self or others.

Further Outpatient Care

The frequency of regular outpatient visits is determined by the presence of continuing symptoms.

  • Many children with schizophrenia have a residual phase with predominantly negative symptoms that can be socially disabling.
  • During residual phase or remission, monitor the child with schizophrenia for recurrence of positive symptoms (eg, hallucinations, delusions) that may signal a relapse or worsening of negative symptoms.
  • Monitor for any new symptoms or episodes of mania. Approximately 15-20% of children with an initial diagnosis of schizophrenia may be found later to have bipolar disorder, schizoaffective disorder, or one of the disorders listed in the differential diagnosis (see Differentials).

Inpatient & Outpatient Medications

Repeating assessment for medication adverse effects using standard measures is essential.

  • The abnormal involuntary movement scale (AIMS) is one such standard measure.
  • Possibly one third of children on antipsychotics develop withdrawal dyskinesias.
  • Recommendations for monitoring adults on atypical antipsychotics include checking the following:
    • Weight at baseline; 4, 8, and 12 weeks; and then quarterly
    • Blood pressure at baseline, 12 weeks, and annually
    • Fasting plasma glucose level at baseline, 12 weeks, and annually
    • Fasting lipid profile at baseline, 12 weeks, and every 5 years
  • Similar recommendations are not yet available for children and adolescents, but careful monitoring of weight, blood pressure, and glucose and lipids levels seems warranted.

Deterrence/Prevention

Treatment prior to emergence of psychosis is under investigation.

  • In very preliminary work, first-degree relatives of patients with schizophrenia who had suggestive symptoms and neuropsychological deficits received risperidone with a subsequent reduction in suggestive symptoms and improvement in attention and working memory.26 In a randomized controlled trial that compared risperidone and cognitive behavior therapy with intervention for symptoms in individuals at very high risk for schizophrenia, fewer people in the active treatment group progressed to a first episode of psychosis.27
  • This preliminary finding raises the possibility that children with prodromal symptoms of schizophrenia can be treated prior to emergence of psychosis.
  • Further study is required before such therapy can be recommended.

Complications

  • Suicide is a major complication of schizophrenia. Approximately 10% of adults with schizophrenia commit suicide.
  • Violence is a potential problem, particularly for the adolescent with paranoid ideation.
  • Other complications arise from poor self-care, impulsivity leading to injury or sexually acquired diseases, and substance abuse.
  • Adults with schizophrenia may not receive adequate medical care.

Prognosis

  • The prognosis for childhood-onset schizophrenia and adolescent-onset schizophrenia is worse than that observed in adult-onset schizophrenia.
  • As adults, these children experience the following:
    • Fewer close social relationships
    • Less academic achievement
    • More unemployment
    • Less capacity for independent living
  • Patients with an onset prior to adolescence and those with an insidious onset appear to have a worse response to medication and a worse prognosis.

Patient Education

  • Psychoeducation is essential for families of children with schizophrenia. They need to know symptoms of the disorder, natural history, and adverse effects of medication.
  • Once children with schizophrenia are in remission, teach them to self-monitor for signs of possible relapse. Inform these children about possible adverse effects of medication.
  • For excellent patient education resources, visit eMedicine's Mental Health and Behavior Center. Also, see eMedicine's patient education article Schizophrenia.

Miscellaneous

Medicolegal Pitfalls

  • Failure to adequately inform the child and family about potential drug adverse effects such as tardive dyskinesia and the metabolic syndrome
  • Failure to warn and to protect if suicide is a risk
  • Failure to warn and to protect when aggressive or homicidal behavior is a risk
 


More on Schizophrenia and Other Psychoses

Overview: Schizophrenia and Other Psychoses
Differential Diagnoses & Workup: Schizophrenia and Other Psychoses
Treatment & Medication: Schizophrenia and Other Psychoses
Follow-up: Schizophrenia and Other Psychoses
Multimedia: Schizophrenia and Other Psychoses
References
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Further Reading

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Keywords

earlier-onset schizophrenia, EOS, very earlier-onset schizophrenia, VEOS, childhood-onset schizophrenia, childhood schizophrenia, dementia praecox, hallucinations, delusions, schizophrenic disorder, mental illness, mental disorder, dopamine, autism, psychotic disorder, schizophreniform psychosis, speech and language delays, inattention, aggression, rage, pervasive developmental disorder, PDD, attention deficit hyperactivity disorder, ADHD, internalizing disorders, bipolar disorder, depression, anxiety disorder, disorganized speech, catatonia, auditory hallucination, visual hallucination

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Contributor Information and Disclosures

Author

Rajkumar K Kalapatapu, MD, Fellow in Child/Adolescent Psychiatry, Department of Psychiatry, Indiana University School of Medicine
Rajkumar K Kalapatapu, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Medical Association, and American Psychiatric Association
Disclosure: Nothing to disclose.

Coauthor(s)

David W Dunn, MD, Program Director, Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Neurology, Indiana University
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, and Child Neurology Society
Disclosure: McNeil Honoraria Speaking and teaching; Lilly Grant/research funds Other; Novartis Grant/research funds Other; Shire Grant/research funds Other

Medical Editor

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: Ambulatory Pediatric Association, American Academy of Pediatrics, and American Professional Society on the Abuse of Children
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine.com, Inc
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry, Department of Psychiatry and Biobehavioral Sciences, Division Chair of Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck 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, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

CME Editor

Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School
Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry
Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry, Department of Psychiatry and Biobehavioral Sciences, Division Chair of Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck 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, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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