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Stigma and Children with Schizophrenia in School

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Journal of Pharmacy and Pharmacology 2 (2014) 152-156
D DAVID PUBLISHING

Stigma and Children with Schizophrenia in School

Kourkouta Lambrini1, Rarra Aikaterini2 and Fradelos Evangelos3

1. Department of Nursing, Alexander Technological Educational Institute, Thessaloniki, GR 574 00, Greece
2. 9th Primary School of Athens, GR 11527, Greece
3. 3rd Psychiatric Department, State Mental Hospital of Attica “Daphni”, Athens, GR 12462, Greece

Received: November 28, 2013 / Accepted: January 08, 2014 / Published: March 31, 2014.

Abstract: The most stigmatized among all diseases are mental illness such as schizophrenia, both for the children themselves and for
their families. The present study aims in the recording of the problems and needs of children with schizophrenia at school and
identification of actions that contribute to addressing their problems; The material of study consists of recent articles concerning the
subject that were found mainly in the Medline electronic database, the HEAL-Link (Hellenic Academic Libraries Link) and in the
Google Scholar search engine; The school community, due to the weakness of understanding the thoughts and behavior of
schizophrenic children, in conjunction with the stress of thought of this mental illness, are shaping the development of social stigma.
The co-operation of mental health educators and school organizations in general is required in order to improve attitudes towards these
children and students should be aware of an open world, without prejudice. The alienation of children with schizophrenia from the
school community becomes a barrier to contact and collaboration with their peers. With proper education about mentally ill children
teachers can remove the stigma from them.

Key words: Schizophrenia, stigma, children, school.

1. Introduction of the mental disorders that affect even children is

schizophrenia. The term “childhood schizophrenia” is
Mental disorders occur in people in all countries,
first described by Potter 1933 and Lutz 1936 [4].
societies and in all ethnic groups’ regardless
Schizophrenia usually occurs for the first time in late
socio-economic order. The prevalence is estimated to
adolescence, however, in relatively rare cases can
be 10% for adults, and it is estimated that about
occur in childhood [5, 6].
20%-25% percent of the population will suffer by a
The purpose of this study is to indicate problems
mental disorders at least once in their lifetime [1]. In
and needs of children that are suffering from
Greece, mental disorders are frequent. Epidemiological
schizophrenia in school and to identify the measures
studies that have been carried out in the general
that help to overcome their problems and promote
population show that 14%-16% of Greeks suffer from a
their health in general.
psychiatric disorder, with more frequent anxiety
The material of study consists of recent articles
disorder. In a study that was conducted by the World
concerning the subject, theses articles were found
Health Organization, in which Greece participated, it
mainly in the Medline electronic database, the
was found that 22% of those visiting primary health
HEAL-Link (Hellenic Academic Libraries Link) and
care are suffering from a psychiatric disorder during
in the Google Scholar search engine. The search was
the last month and the importance of prevention of
conducted using the key words: schizophrenia,
them is given by the psychiatric community [2, 3] One
children and school.
Corresponding author: Kourkouta Lambrini, professor,
research fields: history of nursing, ethics & deontology. E-mail:
laku1964@yahoo.gr.
 Stigma and Children with Schizophrenia in School
2. Epidemiology and Prognosis of
Childhoods Schizophrenia
Epidemiological data on childhood schizophrenia
are limited. The inclusion of data from clinical and
population studies suggests that childhood
schizophrenia shows prevalence point: < 1/10.000 and
a ratio boys: girls about 2:1 [7].
The higher the level of functionality of the children
is before the schizophrenia, the better the prognosis of
childhood schizophrenia. The age of initiation (the
smaller age has the worst route), as well as the support
for the child from the family environment and the
level of functionality recovery after treatment of the
initial episode are an important basis for the
prognosis [5]. In children with developmental
disorder, learning disability or behavior disorder
usually the prognosis is very poor [8]. Other sings that
indicate a poor prognosis for childhood schizophrenia
are the following [9]:
The co-existence of both organic disorders and
childhood psychosis;
The absence of speech in children older than 5
years;
Pathological environment, for example, parents and
siblings are suffering from mental disorders or bad
communication of them.
3. Clinical Picture of Childhood
Schizophrenia
The clinical picture of a child that suffers from
schizophrenia is similar to that of adults and it is
characterized by hallucinations, delusions, altered
structure of thought and negative symptoms [10].
Acoustic hallucinations can include voices with
persecutory content, voices conversing with each
other, voices commenting on the child and giving
orders. Often these voices are of parents, brothers or
relatives. The child may be experiencing these
subjectively events as foreign outside of his control, or
even frightening [11].
At the beginning of schooling the cognitive
153
disorders of the child are begging to show. The
attention deficit disorder, impaired perception as well
memory lapses are observed. Thus school failure is
frequent. Aggression and lack of self-control are
commonly characterized as behavioral disorders [12].
Children with schizophrenia, which exhibit bizarre,
unpredictable and often aggressive behavior, surprise
his peers, neighbors and relatives, because they cannot
explain and understand this behavior [5].
4. Treatment of Childhood Schizophrenia
Regarding the treatment, it should not be forgotten
that the treatment in this case is a multidimensional
process. Professionals should also implement a
personalized treatment program, where they should
take into consideration the intensity, severity of
symptoms, from acute or non-onset, the child’s age
and the level of functionality of the family [9].
In children, usually adolescents with acute onset
and severe symptoms hospitalization in specialized
pediatric context are required. Adversely when the
onset of the disease is progressive and children exhibit
altered behavior, the suitable treatment for them is the
day hospital. This provides long-lasting special
education and the child is not removed from the
family environment [13, 14]. Pharmacotherapy is
currently the main therapeutic method for treatment of
childhood schizophrenia. More specifically,
antipsychotic drugs are prescribed for the treatment of
the symptoms. Commonly, dopamine antagonists as
risperidone (risperdal) with antagonistic activity at
both 2 serotonin receptors (5-HT2) and on two types
of receptors for dopamine (D2) and aripiprazole
(abilify) are prescribed. However, side effects during
use must be taken under consideration. Side effects
can include weight gain, diabetes and high cholesterol
and, more rarely, movement disorders [5, 15]. Usually,
proper use of medication is reducing the risk of relapse,
and readmission to the hospital. Another treatment
method in childhood schizophrenia is psychotherapy
(psychoanalysis and supportive), which helps the child
154 Stigma and Children with Schizophrenia in School
understand the reality and adapt as well as possible in
daily life [7].
Psychotherapy also helps in parent-child interaction,
in that it makes them aware of appropriate practices in
providing care. This can change the way in which the
child behaves towards to the parents, the way in which
the parent explains the child’s behavior and determine
the parenting role and behavior towards the child [16].
Moreover, social activities and social skills training
are important. Educational interventions in school and
special education are important, too [7, 16]. The family
and educational interventions are of particular
importance in childhood schizophrenia, mainly in
cases that psychotic symptoms and severe deficits in
various aspects of development are coexisting.
5. School Community and Children with
Schizophrenia
The classroom which includes the teacher and
students is a team with bidirectional relationship.
According to the expectations that the teacher has on
school performance and behavior in each one of his
student shapes the perception about him. Therefore, a
child has poor school performance would be treated
with ignorance and rejection [17].
In addition children that are suffering by
schizophrenia have to deal with a double test during
school age. On the one hand they struggle with the
symptoms of the disease and in the other hand suffer
because of discrimination from the myths, stereotypes
and prejudices associated with mental illness [8]. In
cases of childhood schizophrenia the child initially
shows signs of attention deficit, perception and
memory lapses during school, also they exhibit
aggression which leads to school failure and expulsion
from the school , limited contact with its classmates,
isolation and finally the child creates a negative image
for himself. Studies also show that schizophrenic
children begin to complain that they hear to the
comment or see something that other students and the
teacher do not see or hear its speech becomes
incoherent and generally decays. This leads to negative
implications both in the relationship with teachers and
classmates [18]. Moreover, teachers often are not able
to understand the mental and emotional needs of their
students and their personal problems. There for
conflicts, learning difficulties and frustrations are
created and experienced by the child on a daily basis [17].
In such type of behaviors teachers should be patient
and supportive; they should have the adequate
knowledge on child psychology to help on the
development of their specific personality and to
improve their capabilities and skills so that they live
together in the school community [18]. Students with
these disorders usually “underestimated” in school.
Generally in school societies children tend to create
groups with common codes, such as dressing,
behavior, language and interests. When a child
displays behavior different from the other children
then classmates and peers will try to isolate it, alienate
it and to mock it. Besides, it is also known that
children are strict and harsh judges and many times
they can use verbal or non verbal group violence
against “different” children. In such cases it is not
difficult for these children to be stigmatized [12].
Stigma, stereotypes and prejudices about mental
illness is one of the major problems, both for the
children themselves and for their families [19]. Stigma
has a negative impact on the course of mental illness,
increasing the difficulties that these children and their
families face in their efforts to be reintegrated into
society. Simply put, stigma is a sign of humiliation,
disgrace and shame.
The stereotype of the stigmatization of the mentally
ill begins to develop in the early years of childhood.
Negative attitudes are marked in kindergarten and
they shall remain in adulthood [20]. The violent
behavior, that is quite often shown by these children,
which violates all commonly accepted rules of
behavior, frightens, repels and scares both peers and
other society members. This behavior of society
makes the child feel isolated, threatened, alienated and
 Stigma and Children with Schizophrenia in School
as a result his behavior becomes aggressive [21]. As
for the child usually feelings of social isolation are
created, negative beliefs about them, as feelings of
low self-esteem, thereby feelings of frustration,
disappointment, shame and introspection are also
developed. Eventually the children are led to
marginalization and exclusion. Also negative and
derogatory characterizations are attributed to the child;
it is mocked at and sometimes deceived in a violent
way [22].
Media are also key players to the renovation of
society; shape the development of social stigma. They
claim that the mentally ill are different from other
people, strange and eccentric. They also describe
schizophrenia as synonymous to violence and
aggression, thus creating feelings of horror, panic,
predisposing negative the society [23].
The mental health professionals should then seize
every opportunity to participate in discussions in the
media so they could participate in the restoration of
the image distortion that occurs to children with
schizophrenia from the media, especially in the school
environment [24].
6. Conclusions
The treatment of schizophrenia in children is based
on a multidimensional treatment plan, which apart
from medication is also based on family, social and
educational interventions mainly at school [7]. Also
the alienation of children with schizophrenia at school
by teachers and classmates feeds the already existing
prejudices and becomes an obstacle to the contact,
acquaintance and cooperation of those children with
both their teachers and their peers [9]. With proper
knowledge and education by the health professionals,
to teachers and students of schools and the direct
contact and personal transaction with schizophrenic
children is possible to bring out the change.
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