Assign 17 Reaidy Oct. 30

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Assignment 17: Pre-Class Summary on Readings on Schizophrenia Perla H. Reaidy Department of Educational Psychology, The University of Texas at Austin EDP 383C: Developmental Psychopathology Dr. J. Mark Eddy October 30, 2023

Disorder/Topic Schizophrenia, as defined by the DSM-V, is a severe mental disorder characterized by a range of symptoms, including hallucinations, delusions, disorganized thinking, and impaired emotional responses. These symptoms often lead to significant disturbances in thought, perception, and behavior, impacting a person's ability to function in daily life. Schizophrenia typically emerges in late adolescence or early adulthood and requires ongoing treatment and support. Takeaways Assessment Schizophrenia is a complex neurodevelopmental disorder characterized by disruptions in cognition, perception, affect, and sociality, and typically presents in late adolescence or early adulthood, affecting around 21 million people worldwide, leading to substantial long-term morbidity, mortality, and increased risk of suicide, substance abuse, and other health problems. Early-onset schizophrenia, diagnosed using the same criteria as in adults, requires at least two of five core symptoms, such as delusions, hallucinations, disorganized speech, grossly disorganized behavior, and negative symptoms, with these symptoms persisting for at least 1 month and impacting daily functioning. When assessing psychotic symptoms in youth, standardized rating scales like the Positive and Negative Syndrome Scale are valuable tools for evaluating the severity of key symptoms. These scales, including SAPS and SANS, help clinicians measure positive and negative symptoms, and general psychopathology in patients with early-onset schizophrenia, providing an objective assessment to guide diagnosis and treatment planning. Assessing psychotic symptoms in individuals with ASD presents challenges due to

symptom overlaps between ASD and schizophrenia, such as social and emotional reciprocity, restricted interests, and perseverative idiosyncratic beliefs seen in ASD can resemble symptoms of social withdrawal and disordered thinking in schizophrenia, making it crucial to differentiate between them. Furthermore, the goal of education and treatment should involve patient and family preferences, addressing comorbid conditions, cultural considerations, and long-term monitoring for symptoms, functioning, and medication adherence to ensure better outcomes for individuals with early-onset schizophrenia. Treatment Schizophrenia is a severe and chronic neurodevelopmental disorder characterized by disruptions in cognition, perception, affect, and social relatedness. Schizophrenia has substantial public health and societal costs due to its long-term morbidity and increased risk of suicide and health problems, especially in those diagnosed at an early age. Antipsychotic medications are well-established for treating schizophrenia in both youth and adults, however, there isn't strong evidence supporting the superiority of one medication over another, and many patients discontinue their medication due to various factors like lack of efficacy or side effects. Psychosocial treatments and adjunctive medications are also part of the comprehensive approach to managing schizophrenia in both youth and adults. The treatment of Early-Onset Schizophrenia involves a combination of antipsychotic medication, psychotherapeutic interventions, and supportive strategies. The choice of which antipsychotic medication to use is influenced by various factors, including FDA approval, side- effect profiles, patient and family preferences, and clinician familiarity. Additionally, regular monitoring of medication effects and potential side effects is essential for managing EOS effectively.

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Article 1 The prevalence of self-reported psychotic-like experiences in childhood varies significantly depending on the method of assessment and criteria used, with up to 60% reporting such experiences in broadly-defined questionnaires but only around 5% in narrowly-defined interviews. PLEs in non-clinical samples are associated with an increased risk of psychotic disorders, but their predictive value is low, and they are also linked to the onset of other psychiatric conditions. Many risk factors for schizophrenia are associated with PLEs, but the associations are often non-specific and not of great effect size. Analyzing trajectories of change in PLEs over time can be a valuable approach for understanding their development and implications. Such trajectories may reveal distinct groups of individuals with varying patterns of PLEs and potentially offer insights into future outcomes and intervention strategies. Article 2 Schizophrenia is a severe disorder that affects around 1% of the global population, and while its exact causes and pathogenesis is not completely understood, the neurodevelopmental model is the most widely accepted hypothesis for its origin. This model suggests that altered brain development in schizophrenia may result from abnormal gene expression crucial for neurodevelopment, and this can interact with prenatal and perinatal environmental factors to increase the risk of developing schizophrenia. Early neurodevelopmental anomalies may interact with typical brain maturation processes during childhood and adolescence, resulting in various developmental disruptions. Childhood-onset schizophrenia is a rare condition, but it provides valuable neurodevelopmental

data, contributing to a better understanding of schizophrenia at all ages. Impairments in social skills and lower IQ scores evident before the age of 6 years may serve as early indicators of developmental trajectories that could lead to impairments in social cognition and the eventual emergence of schizophrenia. Motor coordination issues and enuresis may also be associated with a genetic risk for developing the illness, however, further research is needed to confirm these findings and understand the relationship between neurocognition, social competence, and negative symptoms in early-onset psychosis. Article 3 The neurodevelopmental hypothesis of schizophrenia has evolved significantly over the years, from initially focusing on genetic and early neural factors to incorporating ideas about synaptic pruning in adolescence and later considering factors like childhood adversity, urban living, migration, and cannabis use as important risk factors. The hypothesis has matured into the Developmental Risk Factor Model, which suggests that schizophrenia is not a discrete disease entity but rather a severe end of a broader multidimensional psychosis spectrum, with varying degrees of subclinical psychotic symptoms. It emphasizes the importance of intervening early in the developmental cascade to prevent psychosis. The role of dopamine in the onset of psychosis, particularly in the striatum, has been a key focus of research, with increased dopamine synthesis capacity observed in individuals with psychotic disorders. Factors like early developmental disruption, stress, and genetic variants affecting dopamine pathways have been linked to schizophrenia risk. Article 4 Early onset of illness in diseases, including schizophrenia, can provide valuable insights

into the understanding of the disease. It may reveal more striking genetic and environmental influences, differing pathophysiologies, and distinct mechanisms of illness compared to later onset cases. Studies of childhood-onset schizophrenia have demonstrated clinical and biological continuity with adult-onset schizophrenia. This suggests that childhood-onset schizophrenia may offer important clues about the etiology of the disorder and the role of genetic factors. While genetic and environmental factors play a role in the development of childhood- onset schizophrenia, genetic factors appear to be particularly significant, as patients with this condition have more significant premorbid abnormalities and a greater history of schizophrenia spectrum disorders in their first-degree relatives. Genetic studies of these patients may be especially informative for uncovering the genes involved in the etiology of schizophrenia. References American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5) , 5th Edition. American Psychiatric Press. Murray, Bhavsar, V., Tripoli, G., & Howes, O. (2017). 30 Years on: How the

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Neurodevelopmental Hypothesis of Schizophrenia Morphed Into the Developmental Risk Factor Model of Psychosis. Schizophrenia Bulletin, 43(6), 1190–1196. https://doi.org/10.1093/schbul/sbx121 Nicolson, & Rapoport, J. L. (1999). Childhood-onset schizophrenia: rare but worth studying. Biological Psychiatry, 46(10), 1418–1428. https://doi.org/10.1016/S0006- 3223(99)00231-0 Petruzzelli, Margari, L., Craig, F., Campa, M. G., Martinelli, D., Pastore, A., Simone, M., & Margari, F. (2015). Markers of neurodevelopmental impairments in early-onset psychosis. Neuropsychiatric Disease and Treatment, 11, 1793–1798. https://doi.org/10.2147/NDT.S83904 Prinstein, M. J., Youngstrom, E. A., Mash, E. J., & Barkley, R. A. (Ed.) (2021). Treatment of disorders in childhood and adolescence , 4th Edition. The Guilford Press. Thapar, Heron, J., Jones, R. B., Owen, M. J., Lewis, G., & Zammit, S. (2012). Trajectories of change in self-reported psychotic-like experiences in childhood and adolescence. Schizophrenia Research, 140(1), 104–109. https://doi.org/10.1016/j.schres.2012.06.024 Youngstrom, E. A., Prinstein, M. J., Mash, E. J., & Barkley, R. A. (Eds.) (2020). Assessment of disorders in childhood and adolescence , 5th Edition. The Guilford Press.

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