Schizophrenia has many clinical variants, which are differentiated by the number of symptoms and the rate of progression. The more dangerous are the continuous current ones, as they cause a disintegration of the personality sooner or later. Juvenile malignant schizophrenia is one such type. It develops early and rapidly, leading to a severe schizophrenic disorder.
There is no diagnosis of juvenile schizophrenia in the International Classification of Diseases. So doctors conventionally designate the psychopathology which develops in adolescence. Sometimes it is called juvenile. If we talk about the nature of the course, as a rule, this type of schizophrenia becomes malignant. It means that it is characterized by a high level of progredient nature, which corresponds to a gradual and rapid increase in symptoms.
Often such schizophrenia manifests at the age of 14-15. This age is considered the riskiest. However, it can also develop at the age of 10 and at 18-19 years old. In the majority of cases, the patients are boys. In girls, this psychopathology is revealed 4-5 times less often. -In general, the prevalence of juvenile schizophrenia of the malignant type is 5-6% of the total number of schizophrenic patients.
Juvenile malignant schizophrenia may end 2-3 years after manifestation with a severe schizophrenic disorder.
In general, it is possible to allocate five features of juvenile schizophrenia which distinguish it from other types of psychopathology:
- Early Manifestation. The disease begins mostly in adolescence, less often before age 12 or after age 17-18.
- Negative symptoms are manifested before the first psychosis. The rapid development of the disease does not always allow treatment to begin in time.
- Syndromal incompleteness at the time of the disease’s debut. It means that the clinical picture consists of signs belonging to different syndromes.
- Resistance to therapy. Medications and other therapies do not produce the desired effect, so schizophrenia continues to progress.
- The presence of a simplex syndrome in which the adolescent acquires traits previously uncharacteristic of him. He suddenly becomes rude and withdrawn. Forgets the basic rules of hygiene.
The disease always begins with negative symptoms, after which a period of aggravation begins. The type of juvenile malignant schizophrenia determines the set of symptoms. There are four in total – simple, hebephrenic, paranoid, and catatonic.
Before the manifestation of simple schizophrenia, the adolescent suddenly becomes lethargic and lacks initiative. Energy potential is markedly reduced, clearly demonstrated by the marks he receives at school. At first, parents and teachers attribute it to overwork, but later it becomes clear that the child cannot cope due to cognitive impairment. He does not understand the material given.
The teenager’s motivation disappears. He begins to wander the streets vagrant and refuses to wash or brush his teeth. His social circle shrinks. He contacts only his loved ones, but more out of necessity than desire.
Can distinguish the following negative signs of simple juvenile malignant schizophrenia:
- Decreased ability to process information;
- Inability to form new skills;
- withdrawal, emotional coldness;
- lack of motivation, abulia, apathy, chronic fatigue;
- sexual disinhibition;
- Primitive reasoning, detachment from reality.
There may be occasional positive symptoms that suggest an active mental apparatus. These include:
- Mild elation of mood, combined with irritation;
- sexual promiscuity, promiscuity;
- a propensity for alcohol, drugs, and vagrancy;
- delusional disorders and hallucinations;
- Catatonic syndrome – brief stiffness in one posture.
A simplex syndrome is also observed. All of these signs may be unexpressed for some time. But the presence of several of them already causes a visit to a psychotherapist. Such symptoms are especially striking when the child is completely different – exemplary, obedient, an excellent student, etc.
Hebephrenic schizophrenia is named after the ancient Greek goddess of youth, Geba. Patients developing this type of disorder behave overly childishly goofy manner. In contrast to the simple type of the disease described above, there are more productive symptoms in this case. As a rule, we are talking about delusions of persecution, auditory hallucinations, mental automatism, and movement disorder.
The main symptoms that occur in juvenile malignant hebephrenic schizophrenia are:
- Fake, goofy, clownish behavior;
- Constant clowning and absurd protests;
- Insularity, combined with rudeness;
- Frequent use of foul language in speech;
- Auto-aggression manifested in self-hatred;
- Delusional utterances that do not match facial expressions.
Somatic symptoms such as fever, increased body temperature, change of skin color, etc., are also possible. But they usually go away without therapeutic help.
Hallucinations in this form of schizophrenia do not lead to hallucinosis, and delusions remain ridiculous and unsystematic.
There are two types of hebephrenic malignant schizophrenia – delusional and catatonic. In the first case, delusions predominate but are superficial. In the second, there are motor disorders, but, as a rule, short-term. The patient is excessively excited, sometimes falls into a stupor, but periodically makes senseless impulsive movements.
A key symptom of catatonic juvenile malignant schizophrenia is movement disorders. There is no dementia when the patient is in a stupor but still sees hallucinations. The so-called lucid catatonia characterizes this pathology, also called pure or transparent. It means that when the patient falls into a stupor, he has negative symptoms rather than productive ones.
- Inadequate, goofy behavior;
- sudden mood swings;
- Alternating stupor and agitation;
- Negative symptoms.
Sometimes the teenager stiffens for a long time in an exaggerated pose or swings and waves his hands. In such a condition, they may shout out strange words or, on the contrary, fall silent, refusing to answer questions.
There is also a tendency to repeat their movements and words after others – echolalia and echopraxia.
In catatonic schizophrenia, the patient can play primitive games, moving objects from one place to another for hours.
As the pathology progresses, the negative symptoms intensify, leading to a delay in mental development.
Paranoid juvenile schizophrenia of the malignant type is similar to adult paranoid. But in the first case, there is simplex syndrome. The following symptoms may also be observed:
- Obsessions and compulsions, compulsive rituals;
- Dysmorphophobia, the belief that you have a horror;
- Delusions of different content;
- Hypochondria – fear of contracting a disease.
Delusions may be associated with delusions of grandeur or reformism, where the patient believes they have discovered something incredible for all humanity. Some patients are convinced that they are adopted children and that their parents are strangers.
In general, delirium is not systematic and is not very persistent. However, as the disease progresses, signs of Kandinsky-Clerambaut syndrome appear. It is also called “possession syndrome.” It seems to the person that his thoughts, actions, and feelings are controlled by someone else.
See Also: What Is Catatonic Schizophrenia?
The main symptoms of this condition are called automatisms:
- Mentism is an influx of thoughts, images, and memories that the person cannot control.
- Ideatorial automatisms. The patient believes that third parties control his thoughts. They put ideas in his head and control them. Sometimes it seems to the person that all his thoughts are available to others.
- Senestopathies. These manifest themselves in somatic symptoms. The patient feels strange bodily ailments or discomfort in the area of the internal organs. Moreover, he is sure that extraneous forces cause these symptoms, for example, aliens.
- Motor automatisms. In this case, we are talking about movements that, as the schizophrenic person believes, are performed not by himself but by someone else. Numbness and paralysis are possible in these situations.
Because of constant dissatisfaction with their appearance, patients insist on plastic surgery. Some of them lose a lot of weight. But regardless of whether they improve their appearance, they remain dissatisfied with it. Often no defects and shortcomings, in reality, do not exist, and they are all contrived.
In most cases, juvenile malignant schizophrenia ends in a persistent schizophrenic disorder, with psychosis ending as early as 2-3 years after manifestation. Suppose the patient develops a simple form of the disease. In that case, they have apathetic dementia if the catatonic or hebephrenic types of the course of the illness lead to foolish and mannered dementia.
The paranoid stage ends with schizophasia, a speech discontinuity in which the patient speaks mostly meaningless words if he does speak. He builds complex sentences, but they do not make any sense.
In general, any schizophrenia that manifests in childhood runs unfavorably. The earlier the signs of the disease appear, the more severe the consequences will be. In almost all cases, dysontogenesis is observed as a mental development disorder or its components.
It varies according to the time of its formation:
- Domestic. Leads to early childhood autism and psychopathy.
- Processual. It begins to manifest as the pathology develops and progresses with it.
- Post-procedural. Causes delays in mental development, which become appreciable already after the end of the acute phase of psychosis.
Remissions in juvenile malignant schizophrenia are rare and short-lived. They are often indistinct. As a rule, some signs and stages are superimposed on others, so it is difficult to distinguish between negative and productive symptoms.
Often parents attribute changes in the child’s behavior to a difficult age or “bad company. Because of this, time that could have gone to treatment is lost.
The schizophrenic disorder makes it very difficult for the person with schizophrenia to continue functioning in society. He has difficulty learning and doing his job. Sometimes he shuts down and doesn’t respond to his surroundings. He becomes indifferent to his fate and the lives of his loved ones.
Diagnosis and Treatment
When schizophrenia is suspected, a person receives referrals for multiple tests – laboratory, instrumental and psychotherapeutic. A child must be monitored for several weeks or months to accurately diagnose and differentiate between malignant schizophrenia and other types of this disorder or other mental illnesses.
Often the disease is detected late when there is an extensive set of symptoms. It is not uncommon for a patient to be involuntarily hospitalized, such as on the street, when he molests passersby or walks around in the nude. Late diagnosis complicates the treatment of an already complicated disease.
In the active phase, the patient is prescribed neuroleptics, and in the negative phase, antidepressants. However, patients often have resistance to drug therapy. They do not help to stop the main symptoms and bring the person into a relatively stable emotional state.
Psychotherapy plays a large role in treatment. The patient attends solo and group therapy sessions. He needs to understand that he is sick and accept himself as such. Relatives of the schizophrenic patient are also consulted and have to learn how to interact with him correctly.
Treatment is lifelong since it is impossible to cure schizophrenia completely. Even if the person manages to go into long-term remission, he will always remain at risk. As medical practice shows, the risk of juvenile malignant schizophrenia is very high.
There are no specific prevention measures for juvenile schizophrenia since the etiology and pathogenesis of the disease are unknown. Doctors only give recommendations that will help reduce the likelihood of an exacerbation. The patient is advised to visit the psychiatrist regularly, give up bad habits, walk outdoors and eat right.
Relatives should learn to identify the onset of an attack at the first symptoms to seek help from the doctor in time. Scientists advise adults to be more responsible in their upbringing since schizophrenia can provoke stress, family conflicts, despotism, and permissiveness. These tips are especially useful for those genetically predisposed to mental disorders.