Schizophrenia is a mental illness that usually starts in the late teens or early 20s. It often begins with what are known as prodromal symptoms: mild symptoms that precede the full-blown disease. These are nonspecific, can mimic normal teen behavior or other psychiatric or medical conditions and are usually recognized only in retrospect. The most important consideration regarding possible prodromal symptoms is differentiating them from other conditions.
Prodromal Symptoms
Prodromal symptoms of schizophrenia include social withdrawal and a decline in functioning in all areas of life. In a teen, this can mean withdrawing from friends and family and a decline in the level of schoolwork. Students who previously received A's might now fail their classes. Hobbies are abandoned. Even simple tasks such as maintaining hygiene become difficult. Instead of moving toward independence, the person becomes more passive and dependent.
Normal Teen Behavior
The prodromal symptoms of schizophrenia are similar in many ways to normal teen behavior. Loss of interest in schoolwork is not unusual in the transition form childhood to adolescence. School becomes a burden and is viewed as an imposition of authority. Teen rebellion can include withdrawal from family and previous activities as the young person searches for his own way in life. Transition to high school can present a shy person, who previously had a close circle of friends, with an unfriendly, even hostile environment, leading to discomfort and withdrawal. The teen often cannot articulate his difficulties well and may have a negative attitude toward everything.
Other Psychiatric Conditions
Withdrawal, a decline in functioning, loss of interest in previous activities and a negative attitude can all indicate the presence of a mood disorder, an emerging personality disorder or post-traumatic stress disorder. A depressed teen will often resist help and will not want to talk about his troubles. Depression is often associated with difficulties at home, and teens usually go to their initial psychiatric evaluations with their parents. It's difficult in this scenario to be open about what's going on. In short, the prodromal symptoms of schizophrenia can be similar to symptoms of other psychiatric conditions.
Medical Conditions
Many medical conditions involve the same symptoms seen in the prodromal phase of schizophrenia. Several neurological degenerative disorders appear for the first time in the adolescent years. Among these are Wilson's disease and adrenoleukodystrophy. In addition, the use of street drugs and the culture surrounding that use can lead to cognitive decline and withdrawal. Seizures are another cause of abnormal behavior. Seizures aren't always obvious; a change in behavior can indicate seizures without the typical convulsions. For all these reasons, an adolescent with new psychiatric symptoms should have a complete medical workup to rule out the underlying medical conditions.
Treatment
There is no consensus about pharmacological treatment of prodromal symptoms. Aside from the diagnostic difficulties detailed above, it is not yet clear whether treatment with antipsychotics will affect the eventual full-blown illness. Treatment should consist of psychotherapy to address the teen's difficulties, the use of educational and occupational resources to keep the teen on track toward a productive adult life, evaluation of the situation at home and at school and changes in those situations if possible.
References
- "The American Journal of Psychiatry"; The Schizophrenia Prodrome; Tonya White et. al.; March 2006
- "Kaplan and Sadock's Comprehensive Textbook of Psychiatry"; Virginia Sadock and Pedro Ruiz, editors; 2009
