Childhood-Onset Schizophrenia Workup

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

Laboratory studies are performed as part of an assessment for the differential diagnosis of schizophrenia. Toxicology screens may be needed if substance abuse is suggested. Liver function studies, copper, and ceruloplasmin are part of the workup for Wilson disease. Obtain porphobilinogen levels for porphyria. Human immunodeficiency virus (HIV) titers, Venereal Disease Research Laboratory (VDRL) testing, or heavy metal screening may also be needed.

If the child has mental retardation or dysmorphic features, include a karyotype in the genetic assessment. One example is the 22q11 deletion syndrome, or velocardiofacial syndrome. [40] Other preliminary reports suggest 5q involvement.


MRI or CT scanning

Neuroimaging with magnetic resonance imaging (MRI) or computed tomography (CT) scanning (if MRI is not available) should be part of the evaluation of new-onset psychosis. MRI helps to exclude certain organic causes of psychosis. Demyelination is observed in the child with leukodystrophy. Atrophy is observed in some children with neuronal ceroid lipofuscinosis. Ventricular enlargement and gray matter loss are consistent with, but not diagnostic of, childhood-onset schizophrenia.



Perform electroencephalography (EEG) if episodic symptoms or signs are present in the evaluation of a child with psychosis. In children who receive clozapine, obtain an EEG because of the increased risk of seizures associated with clozapine.



Obtain an electrocardiogram (ECG) before starting a low-potency antipsychotic as well as before starting medication and as part of follow-up care of a child who receives pimozide.



Neuropathologic studies are available for persons with later-onset schizophrenia but not for children with schizophrenia. Postmortem studies have demonstrated reduced volume of the hippocampus. Gliosis has not been found, suggesting that no active inflammatory process occurs.


Psychologic Testing

Initially, a baseline diagnostic framework is formed by the recommended Mental Status Examination. Structured or semistructured interviews are beneficial for the initial assessment and monitoring symptoms during follow-up care.

Other standard instruments include the following:

  • Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) [32]

  • Brief psychiatric rating scale (BPRS)

  • Positive and Negative Syndrome Scale (PANSS)

Projective tests, such as the Rorschach, may be helpful in eliciting further symptoms. The Thematic Apperception Test may also be helpful in eliciting additional information. However, diagnosis is confirmed by comprehensive clinical assessment.

Psychologic testing of cognitive function is essential for treatment planning.