Overview

The onset of a schizophrenic illness during childhood or adolescence often seems disastrous for the patient and the family. Management of the acute phase of the psychosis presents a true psychiatric emergency, usually requiring the services of a multidisciplinary team on an inpatient unit. A developmentally appropriate therapeutic milieu, i.e., one providing a school-based and structured program in the company of peers, is preferred to placing the patient on an adult inpatient service.

Optimal management requires the successful differentiation of schizophrenia from a number of other psychotic and nonpsychotic disorders with similar presentations, but this may be extremely difficult in the acute situation, and it is important to reassess the initial diagnostic formulation in light of the course of the illness and treatment response.

Some of the diagnostic difficulties arise from the current noseology. First, schizophrenia is spoken of as a unitary disorder, when it is more likely to be a conglomerate of various phenomenologically related syndromes, each having a different and complex etiologic pathway. Secondly, diagnostic criteria developed for adults have been applied across the life cycle, with only minor allowances made for developmental influences on the presentation of the important symptoms. Thirdly, there continues to be debate and uncertainty about the delineation of early-onset schizophrenia, schizotypal personality disorder, and the higher functioning pervasive developmental disorders (PDDs). Final clarification of these issues awaits an understanding of etiologies.