A study into children with schizophrenia is giving insights into how it affects the brain, writes SHARI ROAN.
SO RARE is childhood-onset schizophrenia that it has taken researchers at the National Institute of Mental Health (NIMH) in the US 18 years to diagnosis and collect data on 110 children.
“We are trying to understand schizophrenia in a comprehensive way,” says Dr Nitin Gogtay, a researcher with the project.
“We see the illness in a very pure form. At that age, there are no confounding factors, like alcohol or drug abuse. We feel a lot of answers will come out of this study.”
The study, the largest of its kind, already has yielded clues about the disease – the most severe mental illness. Although schizophrenia afflicts about 1 per cent of adults, it occurs in about one of every 30,000-50,000 children aged 13 and under.
The causes of the disease are a mystery, although genes are known to play a role. In young children, a brain injury at or near the time of birth might contribute to its onset.
Brain scans of the children in the study, who are examined every two years, show a specific pattern that involves the loss of grey matter as well as deficits in white matter, Gogtay says.
“Grey matter” contains nerve cell bodies while “white matter” contains filaments that extend from cell bodies to carry messages. By the time these children reach adult age, however, the pattern of matter loss changes and appears as classic adult schizophrenia.
The study also involves comparing the children with their healthy siblings because siblings share 50 per cent of genes.
This research has shown that even healthy siblings, who never have had symptoms of schizophrenia or taken medications for mental illness, have some loss of grey matter in their brains – similar to the afflicted sibling. But by the time the healthy siblings turn 20, their brains appear normal on scans, Gogtay says.
The study also has demonstrated the difficulty of diagnosing a child with schizophrenia. Children are entered into the study based on input from doctors, parents and teachers describing symptoms that suggest schizophrenia.
The children are then admitted to a special ward at NIMH where they remain for weeks or months.
In 30 per cent of cases, children are diagnosed with something other than schizophrenia.
“They have bipolar disorder, depression or severe behavioural problems,” Gogtay says.
“We have followed these children in which we have ruled out schizophrenia, and not one of them has been diagnosed with schizophrenia.”
One unique aspect of the study is that the children are weaned off all medication and are observed for up to three weeks without medication to arrive at a more accurate diagnosis.
Under most US insurance coverage, doctors are not allowed to undertake such a “medication wash-out”.
The treatment of young children with the disease remains puzzling. As for the prognoses, doctors use terms like “guarded” and “painful”.
Like adults, children with schizophrenia have auditory and visual hallucinations, disordered thinking and disruptive behaviour.
“When you’re diagnosed early, one of the best hopes is that the diagnosis is not accurate,” says Dr Louis Kraus, a member of the American Psychiatric Association’s council on children, adolescents and their families, and chief of child psychiatry at Rush Sonia Shankman Orthogenic School in Chicago.
Of the 110 children, only two or three have gone to college, Gogtay says.
The children who tend to do best are those who respond to clozapine, an antipsychotic drug that is considered the “medication of last resort” because of its severe side effects.
The stigma of mental illnesses and the harsh and frightening symptoms of schizophrenia can leave the child and family isolated from relatives, friends, neighbours and even social and health professionals.
“When a child has cancer, everyone is there to cook for you, support you, take care of things,” Kraus says. “When mental illness touches a child, it’s such a difficult process.
“Every concept a parent has of the child growing up, going to school, going to a wedding, is thrown out the window. It’s a real mourning process, and often there are not a lot of people there to help you.” – (Los Angeles Times/Washington Post)