GROUP MEMBERS:
  • Alexa Frink z3476780
  • James Cumming z3437894
  • Bronte Doyle z3415683
  • Hannah Michael z3417800

JOBS:
  • Alexa: Intro and symptoms/onset of the disease
  • James: Analysis and causes
  • Bronte: Analysis and treatment
  • Hannah: Effects on life of patient/carers and lifestyle changes/coping
  • Everyone: Research and appendix

DEADLINES:
  • First draft ready by 5 September and due 9 September 10am
  • Review Comments due by 16 September 10am
  • Final Project ready by 20 September for 23 September

MEETINGS:
Monday 5/8/2013 2pm-3pm
  • Researched topic: 20/20 segment on ABC News 'Inside the World of Childhood Schizophrenia'. Source: Youtube
  • Previewed 2010 example and subsequently delegated jobs
  • Discussed availability to meet again and plan draft: Thursday 15/8/2013


Looks like a good topic.
Make sure to have some coverage over the special issues of schizophrenia diagnosed in early childhood, versus the more common adolescent-onset.

Approved.





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Online Media Item

INTRODUCTION


Childhood Schizophrenia is an intriguing and complex disease of the mind. The 20/20 episode from ABC News, “Inside the World of Childhood Schizophrenia”, which we found on YouTube documents the life and day to day difficulties of Jani Schofield and Rebecca Stansen, children living with this devastating disease. This topic interested us because it is amazing to think that while our brains function normally on a day-to-day basis, the brains of some people may be invaded by hallucinations and delusions that they cannot separate from reality. We were astounded at the idea that Jani could imagine a pet rat hitting her and claim to actually feel this pain within her brain. Becoming intrigued with the mental disorder we chose this YouTube video so that we could do more research on the disease. It is of great interest to understand the processes that lead someone to have a whole different world within their mind, separate from reality and which only they can see and understand.


NEUROSCIENTIFIC CONTEXT




Symptoms and Onset


Childhood schizophrenia is a mental disorder with onset in the early years of life and affects less than 1 in 10,000 children (Khurana et al., 2007) (adult schizophrenia affects 1 in 100) (National Alliance on Mental Illness, 2010). The disease leads to degradation of the mind and well-being of the patient. The symptoms of Schizophrenia may be difficult to pinpoint in children because a parent may not yet know what is “normal” for their child and therefore may be unsure if the ways in which they act are out of the ordinary. Also, children have imaginary friends, making it difficult to determine if the child simply has a vivid imagination or if their mind may actually be haunted by voices and visions triggered by the disease (Mayo Clinic (a), 2010). Irrational behavior could be attributed to crankiness in a child and the disease could go on undiagnosed.
Though diagnoses may be more difficult in children, early diagnosis can come from signs such as listlessness, learning deficits early in life, abnormal motor behaviors such as moving the arms about for no reason, above average sensitivity to light and movement, delayed onset of crawling, then walking, fixations, and language and speech deficits or delays. As the child ages past the infant years, and moves into early childhood, they begin to display more common symptoms of schizophrenia. A child may be easily aggravated or upset, have unusual habits and strange, illogical, thinking patterns, perform poorly in school and social settings, and be withdrawn (Boston Children's Hospital). A child with schizophrenia may display emotions that are not appropriate for the situation, or show complete lack of emotion. They may experience hallucinations in which they see or hear things that do not exist, such as voices, characters, or “friends” living within their mind. Delusions are also common and lead a child to believe things that are not based on reality but are actually based on the ideas created in their mind (Boston Children's Hospital).



Causes and Risk factors


It is unclear what the exact cause of schizophrenia is, however, a combination of genetics, physical, psychological and environmental factors are thought to contribute to the development of the disease (Smith 2006).

It is believed that schizophrenia has a strong genetic component. That is, the inheritance of an imbalance of naturally occurring chemicals in the brain. These chemicals, called neurotransmitters, include glutamate and dopamine (Harms 2012). High levels of dopamine in the brain have been associated with psychotic symptoms such as hallucinations and paranoia. Postmortem studies have illustrated that those with schizophrenia do not necessarily have more dopamine receptors, but are far more sensitive to dopamine. Also, too many dopamine receptors can negate the effects of glutamate, which correlates with autopsy studies demonstrating low levels of glutamate in the brains of schizorphreics (Veague 2009).This imbalance of neurotransmitters suggests that the cause of schizophrenia lies within the brain.

Additionally, neuroimaging studies have illustrated that those with schizophrenia have differences in their brain structure (Smith 2006). These findings highlight a reduction of gray matter density found within the medial and lateral temporal lobe (Stephen et al. 2008).

external image COS_map.jpg

Figure 1: Neuroimaging of brain structure in Schizophrenics (Thompson et al., 2001)

Inheritance of genes from both parents can lead to schizophrenia. There is an increasing correlation between development of the disease and affected family members. If a parent has the disorder, the child has approximately 10 to 15 percent chance of developing it. If a sibling is schizophrenic, a newborn has a 7 to 8 percent chance of developing the disease as well (DeMaso 2010).

Environmental stressors that affect the mother during pregnancy are also thought to contribute to the onset of the schizophrenia and increase the risk of the child developing the disease (Hawkes 2010). Alcohol and drug abuse (such as cannabis), particularly during the first and second trimesters of pregnancy, and exposure to a virus or infection such as rubella can increase a child's prospect of developing the disease as well. Poor nutritional health and extreme stress (such as bereavement) on the mother during pregnancy also plays a role.

Prenatal and perinatal complications increase the risk of a child developing schizophrenia. Good prenatal health consisting of a healthy diet, limited use of medications and no use of alcohol or drugs lowers the risk of a child being born with, or acquiring the disease. Perinatal issues such as distress in the newborn or induction of labor due to complications can increase the risk of schizophrenia that the child faces (C.N. Rutt and D.R. Offord, 1971).



Tests and Diagnosis

Schizophrenia is an amorphous condition that will often take more than 6 months to diagnose as it requires multiple evaluations of physical and psychological states to meet the Diagnostic and Statistical Manual of Mental Disorders criteria. It is a chronic, lifelong condition requiring continual treatment, even when symptoms appear to be absent. Overlapping symptoms with other conditions such as bipolar disorder, depression and substance abuse contribute to the longevity of diagnosis. Medications, psychotherapy and social and academic skills training are applied individually or in combination to treat childhood schizophrenia.

Criteria to Classify a Patient:
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria, to classify a patient (adult or child) as schizophrenic, two of the following must be present:
  • Delusions
  • Hallucinations
  • Disorganized speech
  • Disorganized/catatonic behaviour
  • Lack of emotion
  • Social withdrawal
  • Inability to carry out routine daily tasks (bathing, dressing)
  • Failure to achieve expected level of academic, social or work performance

These signs must persist for 6 or so months in order to exclude other mental health disorders (Nordqvist, C. 2010).

Physical Examinations:
Physical examinations include:
  • Examination of height, weight, eye movements, heart rate, blood pressure and temperature to look for any developmental issues and any unusual, repeated or uncontrollable movements.
  • Blood count to check for alcohol and drugs as well as thyroid function, since the prevalence of thyroid abnormalities correlate with chronic schizophrenia (Othman SS et al. 1994).
  • Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scan to look for abnormalities or lesions in the brain.
  • Electroencephalography (EEG) to read brain function.

Psychological Examinations:
Psychological examinations usually delve into the child’s condition in terms of how often and when they might experience episodes, when symptoms started, their severity and whether or not they have thoughts of self harming or harming others. Questionnaires are also used to evaluate emotional state, moods, anxieties and possible psychosis. Examining school reports can also indicate the child’s concentration abilities and academic performance (Nordqvist, C. 2010).



Treatment


Adult and childhood schizophrenia are similarly diagnosed and treated with the exception of some medications and psychological testing approaches.

Medications include atypical antipsychotics such as Risperidone and Aripiprazole and typical antipsychotics such as Clozapine, which are only used if other treatments do not work. These medications work by blocking the effect of dopamine and treat hallucinations, lack of emotion, motivation problems and delusions. Atypical antipsychotics are tried first as they may not present the dangerous side effects in children that typical antipsychotics can over a long term. Serious side effects may include weight gain, diabetes, high cholesterol and movement disorders (Mayo Clinic (b), 2010). Antipsychotics are often not recommended for pediatric use due the intensity of such side effects.

Psychotherapy, another treatment option, helps a child to understand and cope with their condition. Target issues include understanding what makes them feel positive vs anxious, identifying their feelings in a given context, coping with difficult situations and overcoming the stigma associated with the disease (Mayo Clinic (b), 2010).

Hospitalization is a dramatic resort when symptoms become too severe and threaten the child’s safety and the safety of others. The setting can be ideal for rapid control of sleep, hygiene and nutrition that can be monitored by health professionals (Mayo Clinic (b), 2010).



Effects of living with Childhood Schizophrenia


On Patient:
Living with childhood schizophrenia is not an easy task. Throughout their lives patients will suffer physically, mentally and emotionally. They will struggle to sufficiently complete simple tasks on their own, developing and maintaining relationships and developing into a self-reliant individual. They constantly have to rely on their care givers. Children diagnosed with schizophrenia require adjustments to their daily lives to help them manage. Education programs are often altered for smaller classrooms with experienced teachers as well as changes to the level of academic work due to associated symptoms. A common behaviour expressed in a child with schizophrenia is the tendency to withdraw from friends and family. Therefore, social difficulties are experienced and result in the individual becoming isolated, which can interfere with development and family life (Brady and McCain, 2004). With educational and social difficulties, functioning efficiently in a broader society as a confident self-reliant individual can be very difficult (World Health Organisation, 1998).

On Caregivers:
Although those diagnosed are severely affected, they are not the only ones who suffer. Family and close friends are often the primary care givers and they too suffer emotional, social and financial consequences. Caring for an individual with childhood schizophrenia places immense stress on families economically due to treatment and support required. Caring is essentially a full-time job and may cause a family member to quit their job, leading to further financial difficulties. The uncertainty of the disease and the behaviours that result cause immense emotional stress and often carers are unable to focus on their own needs and those of other family members. Emotional stresses such as these may also put a significant strain on marital and sibling relationships. This is seen in the video as the Schofield family is forced to live in two separate apartments to prevent their daughter from harming her younger brother.

Lifestyle and Coping:

Living with childhood schizophrenia requires both patients and care givers to alter their lifestyles to accommodate to the needs of the child and to help cope with the effects of the illness. While professional treatment is necessary there are certain lifestyle adjustments that families can undertake to help ease difficulties. Carers must ensure that medication is taken as directed even if the individual seems to be having a “good day”. If medication is not taken, or taken irregularly, symptoms are likely to return.

Since medications often have negative side effects such as weight gain and increased cholesterol levels, a balanced lifestyle with a healthy diet and regular exercise is a priority to reduce health risks. Since coping with an illness as serious and demanding as childhood schizophrenia places immense pressure on all, there are numerous support groups and professional help available for families to help them understand and learn about schizophrenia to make their lives a little easier. Knowing that others are dealing with the same challenges help people to cope and help to foster the best environment for their child and family.




ANALYSIS


The media item comes from the ABC television news magazine, "20/20". Their presentation concerning childhood schizophrenia is heavily dramatised, focusing mainly on the repercussions that the disease has on the families; the families of Jani Schofield and Rebecca Stansen in particular.

The clip is targeted at the general public with emphasis on parents of young children, especially those who face the hardships of raising children with disorders. Though the video consists of an accurate portrayal of schizophrenia, because of its target it does not use extensive scientific language or explanations. Instead, it opts for an easy to understand format of information presentation through the use of everyday words in the description of a case study.

The video seemed to consist of factual information about the disease with a dramatic insight into the effects of the disorder on the family. Whilst footage of Jani from birth to her current age demonstrated symptoms such as being unsettled and constantly crying as a baby to rapid and fidgety movements and hallucinations as a child, the condition was not fully described in terms of causes, diagnoses, treatments, effects on social behaviours and academic performance. Rather, it showed the hardships faced by the Schofield family, the danger to her younger brother Bodie and the drastic living separation the family has had to undertake to protect him. In order to appeal to the emotional interests of the audience, footage of the family fighting, Jani's outbursts at her brother and the separated housing was included.

Furthermore, the story of another child, Rebecca Stansen, suffering from paranoid schizophrenia was included to show the true, horrifying extent of psychosis in children. This segment showed the implications of schizophrenia on the child more so than the family. Here, the child shows an understanding of her condition and directly announces 'I hate being Rebecca'. It is then mentioned by a narrator that she had attempted to harm herself on numerous occasions. However, focus returned back to the family in terms of financial hardships and the stress of hospital visits.



APPENDIX


After forming our group, we brainstormed a range of topics that we thought would be interesting and enlightening for both us to research and our peers to read. It was agreed that we wanted to research a disease that had not been covered in the lectures and as a result we unanimously decided upon the topic of childhood schizophrenia.

Our search then began to find an online media item that encapsulated our chosen topic and Alexa found a captivating YouTube video depicting the life of a young girl living with childhood schizophrenia and the effects of the disease on both her and her family. From this point we then discussed the specific aspects we thought should be covered in order to provide a detailed and informative analysis of our topic/media item. Once these aspects were chosen, the work for the different areas was distributed evenly between the group members.

When searching for relevant and reliable sources we decided to start broad and use Google as a general search engine to gain background information. After developing a better understanding we then utilised more specific search databases such as Google Scholar and the UNSW Library Database. All sources chosen were first inspected for their reliability - we examined what organisations the information was coming from and avoided sources that we could not connect to reliable and well-known organisations.

The feedback that was received by the group was thoroughly analysed and utilised upon revision. Comments for separating "symptoms" and "onset" into two different sections were strongly considered, however it was decided to keep them together in one section since they work together in the way that a child's symptoms progress and expand with age and the disease has multiple stages of onset as further symptoms arise. One reviewer also suggested that we add information to the symptoms section dealing with the fact that multiple schizophrenia symptoms are similar to those of certain learning disorders. Though this is true, we felt this was better addressed in our "diagnosis" section so we left it there.

It was also suggested that specific sections on the page could be incorporated under the same headings as they related well together and helped enhance the fluidity of the page ("Effects of Living with Childhood Schizophrenia" and "Lifestyle and Coping"). Our group agreed with this suggestion. Additionally, the "Complications" subheading was removed due to repetition of information and portions that had not been mentioned were placed under "Treatment".

In the "causes and risk factors" section, our group added some facts on prevention, as our reviewers suggested. We then added some additional analysis and talked about how though the video was factual, it was not presented in a scientific manner, largely because of the audience it was aimed at.

Generally, the essay was re-read, revised and sometimes re-worded to aid in clarity and elimination of "choppy-ness" in our sentences, in accordance to our reviewers suggestions.



REFERENCES


Bauer, W., & Bauer, J. L. 1982,‘Adolescent schizophrenia’, Adolescence, Vol.17, No.67, pp. 685 – 693

Brady, N., McCain, G. 29/11/2004, ‘Living with Schizophrenia: A Family Perspective’, OJIN: The Online Journal of Issues in Nursing, Vol. 10 No. 1.

DeMaso, D 2010, Schizophrenia Overview, The Children's Hospital Corporation, accessed 5th September 2013, <http://www.childrenshospital.org/az/Site1561/mainpageS1561P0.html>

Fadden G., Bebbington P., Kuipers L. (1987). ‘The burden of care: The impact of functional psychiatric illness on the patient’s family’. British Journal of Psychiatry, Vol. 150, pp.285-292.

Hawkes, E 2010, The Causes of Schizophrenia, accessed 4th September 2013, <http://www.schizophrenia.com/about.html>

Janca A., Kastrup M., Katschnig H., Lopez Ibor jr. J.J., Mezzich J.E., Sartorius N. (1996). ‘The World Health Organization Short Disability Assessment Schedule (WHO DAS-S): a tool for the assessment of difficulties in selected areas of functioning of patients with mental disorders’. Social Psychiatry and Psychiatric Epidemiology, Vol.31, No.6, pp. 349-354.

Staff, Mayo Clinic. "Childhood Schizophrenia." Mayo Clinic. Mayo Foundation for Medical Education and Research, 17 Dec. 2010. Web. 01 Sept. 2013. <http://www.mayoclinic.com/health/childhood-schizophrenia/DS00868/DSECTION=tests%2Dand%2Ddiagnosis>

Staff, Mayo Clinic. "Childhood Schizophrenia." Mayo Clinic. Mayo Foundation for Medical Education and Research, 17 Dec. 2010. Web. 01 Sept. 2013. <http://www.mayoclinic.com/health/childhood-schizophrenia/DS00868/DSECTION=symptoms>
(Mayo Clinic (a), 2010)

Staff, Mayo Clinic. "Childhood Schizophrenia." Mayo Clinic. Mayo Foundation for Medical Education and Research, 17 Dec. 2010. Web. 01 Sept. 2013. <http://www.mayoclinic.com/health/childhood-schizophrenia/DS00868/DSECTION=treatments-and-drugs>
(Mayo Clinic (b), 2010)

Khurana, Anita, Arastou Aminzadeh, Jeff Bostic, and Caroly Pataki. "Childhood-Onset Schizophrenia: Diagnostic and Treatment Challenges." Psychiatric Times. N.p., 1 Feb. 2007. Web. 9 Aug. 2013. <http://www.psychiatrictimes.com/schizophrenia/childhood-onset-schizophrenia-diagnostic-and-treatment-challenges>.

National Alliance on Mental Illness, 2010, ‘Early Onset Schizophrenia’, National Alliance on Mental Illness, http://www.nami.org/Template.cfm?Section=By_Illness&template=/ContentManagement/ContentDisplay.cfm&ContentID=103175 Accessed 22/8/13

National Institute of Mental Health, 2009, ‘Schizophrenia’, National Institute of Mental Health http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml#part6 Accessed 29/8/13

Nordqvist, C. 2010, ‘What is Childhood Schizophrenia? What causes Childhood Schizophrenia?’, Medical News Today, http://www.medicalnewstoday.com/articles/192104.php Accessed 29/8/13

Othman SS, Abdul Kadir K, Hassan J, Hong GK, Singh BB, Raman N, 1994, 'High Prevalence of Thyroid Function Test Abnormalities In Chronic Schizophrenia',Aust N Z J Psychiatry, Vol 4, pp. 620-624

Smith, B 2006, What Causes Schizophrenia?, Liviant LLC, accessed 5th September 2013, <http://psychcentral.com/lib/what-causes-schizophrenia/000715>

Veague, H 2009, Schizophrenia and Neurotransmitters, David Davtyan, accessed 6th September 2013, <http://www.health.am/psy/more/schizophrenia-and-neurotransmitters/>

World Health Organisation. 1998, ‘Schizophrenia and Public Health’, Nations For Mental Health: Schizophrenia and Public Health http://www.who.int/mental_health/media/en/55.pdf Accessed 29/8/13


Staff, Mayo Clinic. "Childhood Schizophrenia." Mayo Clinic. Mayo Foundation for Medical Education and Research, 17 Dec. 2010. Web. 01 Sept. 2013. <http://www.mayoclinic.com/health/childhood-schizophrenia/DS00868/DSECTION=causes>.

Thompson, P. M., Vidal, C., Giedd, J. N., Gochman, P., Blumenthal, J., Nicolson R., Toga, A & Rapoport, J. 2001, Neuroimaging of brain structure in Schizophrenics, accessed 8th September 2013, < http://www.ncbi.nlm.nih.gov/pmc/articles/PMC58784/ >

"Childhood Schizophrenia Ans Bipolar Disorder." Schizophrenia. Schizophrenia.com, n.d. Web. 29 Aug. 2013. <http://www.schizophrenia.com/ami/diagnosis/kidbipol.html>.

"Schizophrenia." Early Onset Schizophrenia. Boston Children's Hospital, n.d. Web. 28 Aug. 2013. <http://www.childrenshospital.org/az/Site1561/mainpageS1561P1.html>.

Rutt, C.N., and D.R. Offord. "Prenatal and Perinatal Complications in Schizophrenics and Their Siblings." Ovid: Welcome to OvidSP. Wolters Kluwer Health, n.d. Web. 20 Sept. 2013. <http://ovidsp.tx.ovid.com/sp-3.10.0b/ovidweb.cgi?WebLinkFrameset=1>.