Chapter Eleven Severe Deviation in Late Childhood and Adolescence—Schizophrenia

Vocabulary flashcards covering key terms and definitions from the chapter on schizophrenia in late childhood and adolescence.

Schizophrenia

A severe, pervasive psychotic disorder with positive symptoms (delusions, hallucinations), negative symptoms (reduced social/affective functioning), and disorganized thinking or behavior; can start in childhood, adolescence, or adulthood and is often chronic.

Premorbid development

Development before onset of schizophrenia showing early deviations in motor, speech, language, social adjustment, or cognitive functioning.

Prodromal phase

Early phase with subtle or nonspecific signs (e.g., social withdrawal, declining functioning) preceding the acute psychotic episode.

Acute phase

Phase with prominent psychotic symptoms (delusions, hallucinations, disorganized thinking) and marked functional impairment.

Recovery phase

Period after acute psychosis with continued but reduced symptoms and gradual improvement in functioning.

Residual or chronic phase

Phase characterized by enduring symptoms, often negative or subtle, with little or no active psychosis.

Two ages of onset

Onset can be classified as early onset (before 14–15 years) or adolescent onset (14–15 years to young adulthood).

Early onset schizophrenia (EOS)

Schizophrenia beginning in childhood, prior to about age 14–15, often with a poorer prognosis.

Childhood-onset schizophrenia (COS)

Schizophrenia that begins in childhood, typically before adolescence.

Adolescent-onset schizophrenia

Schizophrenia that begins during adolescence, between early teens and young adulthood.

DSM-IV-TR criteria for schizophrenia

Two or more characteristic symptoms (delusions, hallucinations, disorganized speech, disorganized/catatonic behavior, negative symptoms) plus social/occupational dysfunction and duration criteria; exclusions apply for mood disorders or medical conditions.

Positive symptoms

Symptoms presence of abnormal experiences (e.g., delusions, hallucinations, disorganized speech).

Negative symptoms

Absence or reduction of normal functions (e.g., affective flattening, alogia, avolition, reduced social drive).

Disorganized speech

Speech with loose associations, derailment, or incoherence, reflecting thought disorder.

Disorganized behavior

Bizarre or inappropriate behavior, unpredictable agitation, or odd movements.

Hallucinations

Sensory perceptions without external stimuli; most common are auditory in schizophrenia.

Delusions

Firmly held false beliefs not grounded in reality, often persecutory or grandiose.

Catatonic behavior

Motor disturbances ranging from stupor and rigidity to excessive, purposeless activity.

Affective flattening

Reduced expression of emotion in face, voice, and gestures.

Alogia

Poverty of speech or diminished speech output.

Avolition

Lack of motivation or inability to initiate and persist activities.

Social/occupational dysfunction

Impaired performance in work, school, or social roles resulting from schizophrenia.

Paranoid type

Schizophrenia subtype with prominent delusions/hallucinations, often with persecutory content; prognosis typically better but rare in childhood.

Disorganized type

Subtype with disorganized speech/behavior and flat affect; usually poorer prognosis and common in youth.

Catatonic type

Subtype with marked psychomotor disturbances (rigidity, mutism, echolalia, echopraxia).

Undifferentiated type

Schizophrenia subtype lacking clear features of the other defined types.

Residual type

History of schizophrenia with ongoing negative or subtle symptoms but no active psychosis.

Premorbid social and cognitive deficits

Early social withdrawal and cognitive delays that predict later schizophrenia in youth.

Equifinality

Different developmental pathways can lead to the same outcome (schizophrenia).

Neurodevelopmental model

Theory that early CNS abnormalities predispose to schizophrenia, interacting with later factors.

Diathesis-stress model

Vulnerability (diathesis) plus stress increase the likelihood of developing schizophrenia.

Integrative Developmental Model (vulnerability-stress model)

Multifactorial framework where vulnerabilities, stressors, and protective factors interact across development to influence schizophrenia risk.

Vulnerabilities

Enduring genetic, biological, or developmental factors that predispose to schizophrenia.

Stressors

Internal or external pressures that can trigger or worsen schizophrenia in vulnerable individuals.

Protective factors

Environmental or personal characteristics that reduce schizophrenia risk (e.g., intelligence, social skills, support, healthy family dynamics).

Genetic factors

Heritable influences contributing to schizophrenia risk; strong familial transmission noted.

Familial transmission

Increased risk of schizophrenia among relatives of affected individuals, higher with closer genetic relatedness.

Monozygotic twin concordance

Approximately 48% risk of schizophrenia in co-twins of an affected identical twin; higher than dizygotic twins.

Copy number variation (CNV)

Genomic deletions or duplications (e.g., 22q11) associated with schizophrenia risk.

22q11 microdeletion

A CNV strongly linked to childhood-onset schizophrenia and related disorders.

Genetic and environmental interaction

Schizophrenia arises from the combination of genetic vulnerability and adverse environmental factors.

Dopamine hypothesis

Schizophrenia symptoms are related to dopamine system dysregulation; Antipsychotics block dopamine to reduce symptoms.

Glutamate and GABA

Neurotransmitters examined in schizophrenia research; glutamate excitation and GABA inhibition play roles.

HPA axis and cortisol

Stress-related hormonal system; cortisol may exacerbate schizophrenia and influence brain function.

Brain structures affected

Hippocampus, frontal cortex, and left-hemisphere regions commonly implicated in schizophrenia.

Gray matter loss

Reduction in brain gray matter (especially cerebellar/frontal areas) linked to EOS and negative symptoms.

Ventricular enlargement

Expansion of brain ventricles observed in some individuals with schizophrenia.

Cerebral volume changes

Overall brain volume reductions; dynamic changes in gray matter across development in EOS.

Corpus callosum changes

Altered development of the connecting fiber tract between hemispheres seen in EOS.

Neuropsychological deficits

Cognitive impairments (attention, memory, executive function) associated with schizophrenia.

Attention deficits

Difficulties with selective and sustained attention linked to schizophrenia risk and course.

Executive functioning

High-level cognitive processes (planning, flexible thinking, working memory) impaired in schizophrenia.

Memory deficits

Impairments in short-term/long-term memory, with worse delayed recall observed.

Comorbidity in youth

High rates of co-occurring conditions (OCD, ADHD, anxiety, depression, bipolar) in youths with schizophrenia.

Substance use comorbidity

Alcohol, cannabis, and other drugs commonly co-occur with youth schizophrenia and may influence outcomes.

Suicide risk

Elevated risk after first psychotic episode; predictors include past self-harm, longer psychosis duration, and substance use.

Stigma (cultural context)

Cultural perceptions of schizophrenia vary; stigma affects care and outcomes; some cultures tolerate or honor symptoms.

Expressed Emotion (EE)

High criticism/overinvolvement within families linked to higher relapse risk in schizophrenia.

Communication deviance

Unclear, fragmented, or overinclusive family communication patterns associated with schizophrenia risk.

Pseudo-mutuality

Facade of family harmony masking underlying dysfunction; associated with risk factors for schizophrenia.

Treatment approaches (psychopharmacology)

Use of antipsychotic medications (typical and atypical) to treat schizophrenia symptoms.

First-generation antipsychotics

Older antipsychotics (e.g., haloperidol) effective but with higher risk of extrapyramidal side effects.

Second-generation antipsychotics

Newer antipsychotics (e.g., risperidone, olanzapine, aripiprazole) with generally better tolerability but metabolic risks.

Clozapine

Atypical antipsychotic reserved for treatment-resistant cases; risk of agranulocytosis.

Extrapyramidal side effects

Motor side effects (tremor, rigidity, dystonia) often associated with some antipsychotics.

Cognitive-behavioral therapy (CBT)

Therapy focusing on coping with symptoms, challenging delusional beliefs, and improving functioning.

Early intervention programs

Strategies aiming to identify and treat psychosis early to improve prognosis (e.g., RAP, YES, COST initiatives in youth).

Prevalence and incidence in youth

Childhood schizophrenia is rare (roughly 1 in 40,000) but incidence rises through adolescence.

Long-term outcomes

Most youth with schizophrenia show chronic illness with remission in some but persistent impairment in many.

Equity in onset and prognosis

EOS often shows poorer prognosis than adult-onset; early treatment and supportive care can improve outcomes.