Very Early-Onset Schizophrenia in a Six-Year-Old Boy
APA definition of Schizophrenia:
Schizophrenia is a serious mental illness characterized by incoherent or illogical thoughts,
bizarre behaviour and speech, and delusions or hallucinations, such as hearing voices.
Case Study:
"Kyle" is a boy who was 6 years old and had a history of mild developmental delay,
presenting with disorganized behaviour, hallucinations, and developmental regression for one
month. At age 3 months, he started following objects that his parents couldn't see. At age 7
months, he started visual fixating on unseen objects and would "open his eyes really wide, get
really excited, flap his arms, and tense his legs," his mother reports. He did not start walking
until age 20 months and was sent to early intervention for gross motor delay. At age 3, he
started speaking to a person his parents could not see, which made them think that he had an
imaginary friend. When he learned to read at age 5, he would exclaim, "Stop mom! The
words are talking back! " This may indicate a sensation of auditory hallucinations. He was
retained in kindergarten because of poor attention but was socially interactive without grossly
abnormal behaviour. Subsequently, one month before admission, he began to have frank
hallucinations and marked social withdrawal. He would often whisper to himself incoherently
and was so internally absorbed that he could not always follow commands. His family history
was significant for 1) schizophrenia in his maternal cousin, two paternal cousins, and his
paternal great grandmother; 2) bipolar disorder in two paternal cousins; and 3) autism in a
paternal cousin and a paternal great aunt. His paediatrician conducted an initial workup,
which consisted of routine lab examination and a head CT, both of which were normal.
The paediatrician admitted the patient to our hospital. The child was found on initial
assessment to be thin and younger than reported age. According to his mother, he was eating
only occasionally, leading to marked weight loss and failure to thrive (body mass index=14.5,
weight below 10th percentile; height below 3rd percentile). His behaviour was characterized
by stereotyped puckering of lips, repetitive blinking, and minimal eye contact. The boy was
muttering to himself, and under interrogation, his language was impoverished and disjointed.
His affect was blunted and occasionally guarded. He reported visual hallucinations of "people
in [his] eyes" who were "following [him] everywhere," "Shavonni, James, and Jack," and
were "black with yellow teeth and green eyes." The mother of the child endorsed that he had
a past history of paranoid delusions that people were pursuing him or stealing his food.
He stated passive suicidal ideation, indicating, "God said it's time for me to come to heaven,"
as well as homicidal ideation against a vague target, stating "I'm going to cut you up; I'm
going to kill you." He did not demonstrate violent or self-injurious behaviour. The patient
underwent a complete medical workup, such as MRI of the brain, lumbar puncture (with
oligoclonal bands, myelin basic protein, paraneoplastic, and N-methyl-D-aspartate receptor
antibody studies), EEG, rheumatologic screen (with antinuclear antibody, C-reactive protein,
erythrocyte sedimentation rate, ceruloplasmin, celiac, and thyroid studies), metabolic screen
(with lactate, pyruvate, acylcarnitine, urine organic acid, and plasma amino acid studies),
urine drug screen, and heavy metal panel, all of which were normal. The consulting
psychiatrist withheld starting antipsychotic medication in view of the patient's age and began
clonazepam for agitation management. Due to the patient's unusually early presentation,
potential lifetime symptoms, and robust family history of mental illness, he was referred for
genetic testing.
Symptoms
Schizophrenia involves a range of problems in how people think, feel and behave. Symptoms
may include
Delusions
Hallucinations
Disorganized speech and thinking
Extremely disorganized or unusual motor behaviour
Negative symptoms
Treatment
A lifelong approach for medication and therapy is required to lower the symptoms. It can not
be completely cured but it can be eased with proper guidance.
Diagnosis
Diagnosis of the disease can be done by tests and screenings, physical exam and mental
health evaluations.
Psychosocial Interventions
Individual therapy
Social Skills training
Family Therapy
