Espectro de la esquizofrenia en niños y adolescentes / Schizophrenia spectrum in children and adolescents

RESUMEN

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ABSTRACT

Abstract Introduction: Schizophrenia commonly appears during adolescence or early adulthood, when young people change their habits and start a new social life. Stigma about this disease delays its diagnosis and treatment. While avoiding medical treatment, neuronal losses may occur and the disease may worsen. Schizophrenia may be sending signals to the person, but she or he may not have noticed them. However, mood alterations could already be happening. Schizophrenia is toxic to the brain and with the passage of time, more neuronal losses may occur, which diminish the performance of the brain. Fragmentary thinking affects cognitive processes that may affect behavior and emotions. An early diagnosis makes it possible for medications and therapies to combat the symptoms and brain damage, hence, increasing the quality of life of the patient. Development All recent studies have found that schizophrenia appears in the families of patients with schizophrenia in early adulthood (EIA), unlike the families of community controls. Adoption and twin studies suggest that genetic factors greatly increase the risk of developing schizophrenia. The diagnosis is based on overt changes in his or her behavior and interrupted thinking in the examination of the mental state. Cognitive delays are common in early-onset schizophrenia. There are deficits in memory, executive functioning, attention and global deficiencies. Children who subsequently develop schizophrenia often have premorbid problems with verbal reasoning, working memory, attention and processing speed. Cognitive impairment usually occurs at the onset of the disease. Premorbid abnormalities are evident in mthe majority of young people who develop schizophrenia. Common premorbid difficulties include social isolation, behavioral disorders, academic difficulties, speech and language problems, and cognitive delays. Because schizophrenia in young people often has an insidious onset, the gradual development of psychotic symptoms in a child with premorbid language delays and social isolation may be difficult to recognize. The diagnosis, according to the Diagnostic Manual of Mental Disorders (DSM 5), should include two or more of the following symptoms delusions, hallucinations, disorganized speech, very disorganized or catatonic behavior, negative symptoms. Discussion: The majority of children who report having hallucinations do not meet the criteria for schizophrenia. Normative childhood experiences, including overactive imagination and vivid fantasies, can be misinterpreted as psychosis. Distinguishing formal thought disorder from developmental disorders that affect speech and language function can be a challenge for the clinician. Several environmental risk factors have been associated with the development of schizophrenia but the use of new methods for the detection of genes and anatomical alterations opens the door for the development of new theories. Neuroimaging studies are still limited and cannot yet provide information on brain activity at the molecular level. The relatively small sample sizes, few longitudinal studies and scant population studies in the field remain our only direct access to the living brain. Conclusions: Further studies in schizophrenia beginning in childhood will give us the opportunity to understand it better and will help develop new theories and lines of research regarding neurodevelopmental abnormalities. Unfortunately, the follow-up of a significant number of patients with this disease is difficult since the cases are scarce. Another complication for this kind of studies is the difficulty in making a diagnosis due to the superimposed symptoms with other mental disorders. It will always be of great importance to maintain a good relationship with parents and caregivers, bearing in mind that stigma and discrimination are often associated with the use of mental health services. We must be respectful and sensitive to gender, sexual orientation, disability, socioeconomic status, age and other background information of the patients to achieve a greater attachment to the therapy and improve prognosis. Currently, the origin of schizophrenia is uncertain, and we still do not have a specific study for its diagnosis, therefore, adequate staff training will continue to be the key in this scenario.