Ages of Onset: The onset of schizophrenia peaks in males during the late teens to mid-twenties. It peaks in females at somewhat later ages. Schizophrenia is rare in pre-pubertal children, but it is not rare in teens.

Symptoms/characteristics: Before the onset of full-blown symptoms, recognizable warning signs may be present for months -- or even years. These are called “prodromal” symptoms.

Some Prodromal Characteristics:

• Increasingly withdrawn
• Increasingly disorganized, declining schollwork
• Deterioration in social functioning and/or hygiene
• Emotionally flat at times, outbursts at other times.
• Occasional odd thoughts or beliefs, or bouts of garbled language.

Characteristics of Full-Blown Schizophrenia:

• Delusions (bizarre, strongly-held false beliefs).
• Hallucinations (sensing something that isn’t there). Often auditory, especially voices, but can be visual, tactile, or olfactory.
• Disorganized speech and behavior
• Flat emotions, apathetic, sedentary
• May be paranoid – believing others are conspiring against him/her, implanting thoughts or devices in their brain, etc. May be catatonic, not moving.
• At high risk for suicide.

Brain biology:

• Like heart disease or cancer, schizophrenia has complex genetic and environmental components, not yet well-understood. There are probably many forms and causes with multiple genes involved.
• Environmental component can include maternal malnutrition or illness during pregnancy, birth complications, advanced paternal age, and possibly infectious agents.
• Brain activity has varied patterns, excessive in some areas, weak in others.
• Brain anatomy: Schizophrenia is a disorder of brain development. Abnormalities in cell number, positioning, migration, and connections may be present in several areas. Especially in males, the brain may actually become smaller and lighter, with up to a 10% loss in gray matter.
• Neurotransmitters: Glutamate activity is irregular. Anti-psychotic medications act upon Dopamine.
• Prevalence of Schizophrenia: Roughly one in every 100 people (1%).
• Schizoaffective disorder is the diagnosis when an individual has schizophrenia with a strong component of depression or mania.

Diagnosis involves ruling out other possible causes; for example, brain tumor, medical condition, bipolar disorder, autism, substance abuse. Official criteria are listed in the Diagnostic & Statistic Manual published by the American Psychiatric Association.

Treatment: Prompt treatment leads to better outcomes. A board-certified child psychiatrist should prescribe medication. Psychosocial rehabilitation, family education, and wrap-around community services, including supported education, are all components of treatment.

Myths about schizophrenia

• Myth: People with schizophrenia are violent.
• Fact: People with schizophrenia are more often victims of violence than perpetrators of it. When it does occur, violence often results from substance abuse, just as it does in the general population.
• Myth: Schizophrenia means “split personality.”
• Fact: “Schizophrenia” means the person is not in touch with reality ("split" from reality.)
• Myth: Schizophrenia is not treatable
• Fact: Schizophrenia is highly treatable, although not curable.
• Myth: Schizophrenia results from “schizophrenogenic” mothering.
• Fact: Parenting practices are unrelated to schizophrenia.

Famous people with schizophrenia: John Nash, Nobel Prize winning mathematician; Lionel Aldridge, Super Bowl winning Green Bay Packers defensive end and NBC sportscaster; Peter Green, Fleetwood Mac founder; Zelda Fitzgerald, painter and wife of F. Scott Fitzgerald; Mark Vonnegut, pediatrician and son of writer Kurt Vonnegut.

Classroom applications:

• Anticipate difficulty paying attention, concentrating, planning work, initiating work, following through, making decisions, and reality testing.
• Provide a small, calm, structured classroom, with a teacher who is trained and experienced with psychiatric disorders; with modified assignments, extra supports, and flexible pacing and due dates.
• Educate peers about schizophrenia and how to be supportive and respectful of the student. Student may benefit from having selected school staff and students appointed and trained as "guardian angels" to informally assist the student when needed (with the permission of the student and parent.)
• Prepare for or assist with noisy environments, chaotic or frustrating situations (e.g. hallways, lunch room), unstructured time, and peers who bully or antagonize.
• Make sure transition services are provided to learn and rehearse skills necessary for adult life.
• Make sure social skills training and reinforcement are provided.
• Educate all students about schizophrenia. It is a common, devastating, lifelong illness, yet most health texts do not thoroughly describe warning signs or educate about treatment.
• Develop a crisis plan jointly with parents, student, behavior specialist, and mental health providers.

Advice for parents/care givers:

• Read first-person accounts to gain empathy (e.g. The Quiet Room: A Journey Out of the Torment of Madness by Lori Schiller, Amanda Bennett, Warner Books, 1996; The Eden Express by Mark Vonnegut, Seven Stories Press. 2002.)
• Consult mental health professional immediately if there is talk of suicide or runaway.
• Seek out respite. Get plenty of rest. Join a support group.
• Substance use may be attempted self-medication.
• People with schizophrenia have a high rate of smoking, believed to be self-medication by nicotine. Realize that the smoking and the mental illness may be inter-related.
• About 50 percent of people with schizophrenia lack the ability to know that they are sick. The function of their brain that monitors the appropriateness of their own behavior is broken. They may deny the need for treatment. The book, I am Not Sick I Don't Need Help! (by Xavier Amador & Anna-Lica Johanson, Vida Press, 2000) is helpful in these circumstances.

Book for teachers, teens and parents: Surviving Schizophrenia: A Manual for Families, Consumers, and Providers (4th Edition) by E. Fuller Torrey, Perennial Currents (2001).

Internet sites:

• The Children’s Hospital of Philadelphia, http://www.chop.edu
• Harvard Health Publications, "On the trail of Schizophrenia," March 2005, http://www.health.harvard.edu/newsletters/Harvard_Mental_Health_Letter.htm ($3.95 charge).
• American Academy of Child & Adolescent Psychiatry: http://www.aacap.org/publications/factsfam/schizo.htm

This information is not meant to be all- inclusive but to be used as a quick reference. Sources include the above books for teachers and parents and the recommended web sites