Speaking of Schizophrenia... Does This Sound Like It?

Factual Questions
1

I saw the other thread on Schizophrenia, and decided to start my own thread rather than hijack.

I read with interest that schizophrenia generally starts in adolecence or adulthood, because the girl I know has been “funny” since infancy. She’s only one day younger than me, and she’s my mother’s friend’s daughter. My mother says it’s like she didn’t want to be born, her mother’s labor kept starting and stopping. Eventually, she was born, but she wasn’t like other babies. She didn’t laugh, or even smile. She didn’t talk much right up until she started school. Left alone with other children her age, she would punch and kick and hit them, around age 2. When she did start school, she had trouble making and keeping friends. The girls who did befriend her had a lot to put up with, and I remember an incident where she drove away all her friends by dousing them in fruit juice, despite them screaming for her to stop. Yet she got angry at them for not finding it as funny as she did.

She had a terrible temper, and would scream and bite pieces out of her furniture. She was always paranoid, and was convinced that everyone was watching her. She would stare at people to see if they were looking at her, and cause a fuss when they did glance her way. She hated people to look at her. She couldn’t ever hold down a conversation because she would either talk too much or too little. Somedays you can’t get her to speak, others she’ll just come out with a stream of unrelated questions that she won’t give you a chance to answer.

When we were twelve, we ended up in the same school, and class, for the first time ever. Naturally I made friends with her because she had no other friends and she was my mother’s friend’s daughter. She seemed happy to hang around with me and my other friends, and they all accepted her, but she eventually drove us all away. She was as skinny as a rake handle, and would make comments like “I’m going home tonight to pig out so I can get fat like you guys”, and then she’d laugh and say she didn’t mean it. We didn’t appreciate it. Her behaviour got worse, and in the end we stopped being friends with her.

One day in class, my friends and I were sitting together laughing. She was on the other side of the room. We weren’t facing her, talking about her, or anything. Suddenly she stood up, came across the room to me, screamed “Stop laughing at me”, picked up my pen and stabbed me in the leg with it. I went to my year level co-ordinator and demanded that I be transferred away from her. Since I had friends in the class and she didn’t, they transferred her into a different class.

She started skipping classes, but unlike other kids who would skip classes they didn’t like, or skip to go do some other activity, she would just skip classes, and walk around the school, alone. I recall watching her from the window one day, walking around in the pouring rain. She was soaked through. In those conditions, other people would go to class just to keep out of the weather. She didn’t seem to think like that. She would stand in the rain and be miserable instead of going to school and doing activities that she seemed to like.

As an adult (she’s now 25), she still has no friends and her mother has to watch her like a child. At times she goes into a state where she’s unable to care for herself, and her mother has to wash her hair for her and help her dress. When she’s not on medication, she sees “dirty” women and angels of death and all kinds of horrifying things. On the medication, she’s like a zombie. She smokes, and her mother has to ration her cigarettes or she’ll just sit and smoke until they are all gone. She is completely unable to take care of herself. She still either talks too much or not at all, and she makes me uneasy. She stares at me with a sly little smile on her face. Having been on the receiving end of her temper many times, I am afraid of her because she can be violent. I fear for her mother, and for mine.

Does this sound like schitzophreia, or something else? I’ve wondered if she’s autistic because she can’t seem to relate to others, and I guess it’s possible that she’s both, but I know nothing about schitzophrenia.

2

In my unprofessional eyes, that sounds more like autism. However, there are many people who could guess better than I, so let’s see what they have to say.

3

Sorry, too many possibilities to consider, without enough supporting information, for me to stick my neck out and guess. Could be schizophrenia, autism, or other thought/extreme personality disorders. But she’s certainly troubled, and I expect your best move would be just to stay away, protect yourself, and do her no harm.

On a related note, Schizophrenia is often described as coming on in the 20’s or 30’s, but with hindsight, unusual behavior can be noted well into the pre-adolescent era.

QtM

4

I have seen a lot of schizophrenics. Despite their reputation, they tend to be very shy and are more rarely aggressive than the average person.

Schizophrenia often has its onset in the adolescent years s a brief psychotic disorder or signs of manic-depression. The hallmark is a progressive loss of function over time. But this person never seems to have functioned well. This is very unlikely to be schizophrenia.

Doesn’t sound like autism to me either. Psychiatry is very subtle and impossible to do over the web, nevertheless, this sounds most like a severe personality disorder – possibly schizoid or schizotypal, but more likely anti-social or borderline personality disorder. But who knows? Even good psychiatrists don’t always presume to definitively diagnose a personality disorder on one visit since they have common features and they are treated quite differently.

But no. Not schizophrenia. Not in a two year old.

5

Yeah, she’s been diagnosed schizophrenic, but from the little I know of it I think they’re missing something.

Another thing I forgot - don’t know if it means anything, but a number of her relatives have suicided. Mum hints that those people were a little funny too.

The violence as a child - I was really the only one who knew about this, and only because I have exceptionally early memories. My mother believes me because she remembers I would always start crying at their house for no apparent reason - the reason was that as soon as the mothers walked out of the room, the little girl would lay into me. She’d stop when I was crying and the mothers were coming back, and she’d just stand there, silent. I was so young that I didn’t have the language to explain why I was upset (I have a lot of memories of being too young to explain things!).

I also think they left out a lot of stuff when talking to psych doctors because they’re afraid. The girl was first referred to a psych specialist when she was 12, but her mother stopped her seeing him - the reason given was that he wanted the girl to stay in a hospital and be evaluated for two weeks, and the mother said she didn’t want her daughter to go through that. They were already talking schizophrenia then. They also said she had the maturity of an 8 year old at 12.

Qadgop, thanks for the advice. Things are civilized and friendly between us these days, because I rarely have to see her. Rather than being angry at her I try to feel compassion because she’s sick, but I don’t ever trust her.

6

IANAMD, but I read the medical records of many persons with mental problems and have read some on the topic. I agree with Dr. Paprika that schizophrenia is not the correct diagnosis, or at least not the only one, and she definitely has a severe antisocial personality disorder, along with a paranoid personality disorder. Schizophrenia is not manifested until the late teens. It is, however, familial, and others in her family have had similar problems. But so is bipolar disorder.

You say that her family has not completely discussed her problems with the therapists. Troublesome also is that she was diagnosed with schizophrenia at age 12. I have never seen one diagnosed with that disorder so early in life.

7

It just doesn’t make any sense that there is an actual age “threshold” or “window” in which schizophrenia appears. I believe it is only a virtual threshold based on the majority of cases studied - which still may not include a significant number (if any) pre-adolescent children. And so, it goes into the textbooks as if written in stone.

Maybe the majority of experts have only been permitted to observe is teens and up. It is possible child psychiatrists may not even get to see these patients for various reasons like parents relying on the pediatrician saying “it’s this, or that…don’t worry, the child will outgrow it”. Also, many parents may be highly reluctant to concede to bringing their children to a child mental health experts. Likewise, these records would be treated in greater confidence in the sense that the professionals may meet great resistance in getting rights to publish any findings w/o violating the rights of their patients. Lastly, misdiagnoses by child psychiatrists trained to think in the same mold may perpetuate the myth.

In the very least, I’d wager it’s no leap of faith to say there are children diagnosed as “schizoid”, an early stage along the pathway to schizophrenia. I’m no expert, but I bet I can find references for case studies of schizophrenic tendencies in children.

WAGging IMHO,

  • Jinx
8

Just wanted to add that maybe the professionals have yet to agree on what defines schizophrenia in pre-teen children…when it could be easily mistaken for so many other disorders. And, the younger the child, the harder it would be to run any such test with reliable results. The child would have to be observed over a course of time just to develop a “baseline” for that child to compare against “the norm” defined by the general population for the same age group.

I mean, heck, just think of the nature of a normal 2 yr old. They can be stubborn, quiet, and shy…does this mean they’re catatonic? autistic? bored? ,or maybe just a little sleepy that day?

Oh, any such (long-term) study should be double-blind, by the way, so we reduce the chance of doctors seeing only what they want to see…

  • Jinx
9

IANAP, but it sounds like there are some elements ofAntisocial Personality Disorder. The hallucinations you describe suggest schizophrenia as well. Maybe she has both?

10

I agree that there are no good childhood criteria for schizophrenia. But I do not think it is a matter of clinicians seeing what they want to see. There is no good chemical or imaging test for schizophrenia in adults, why would there be in kids? Given such a difficult and devastating diagnosis, it is only reasonable to exclude less serious disorders which can be confuse for schizophrenia. Most schizophrenics seem to function reasonably well in childhood and a common characteristic of the disease is often a gradual decrease from good levels of functioning in school and job performance to worsening levels.

It is true children vary a great deal, but when you see a lot of children you certainly do get an idea of what is relatively normal, and scales like the Denver go into fair detail about red flags in behaviour (and other spheres). Children themselves are not diagnosed as “schizoid” or “anti-social” or “schizophrenic”; more general terms like “conduct disorder” (e.g.) are used since it is accepted that much remains to be learned about early psychosis.

11

“Conduct disorder” is the diagnosis made of children. When they become adults, many of them show all the signs of antisocial personality disorder.

DSM-IV (decided to look it up) states: “the onset of shcizophrenia typically occurs between the late teens and the mid 30s, with onset prior to adolescence rare (although cases with age at onset of 5 or 6 years have been reported)…The first degree biological relatives of individuals with schizophrneia have a risk for schizophrenia that is about 10 times greater than that of the general population…The characteristic symptoms of schizophenia involve a range of cognitive and emotional dysfunctions that include perception, inferential thinking, language and communiction, behavioral monitoring, affect, fluency and productivity of thought and speech, hedonic capacity, volition nad drive, and attention…the diagnosis involves a constellation of signs and symptoms assoicated with impaired occupational or social functioning.”

So it may be that she is schizophrenic. Taking a look at paranoid personality disorder, we find: “The essential feature of a paranoid personality disorder is a pattern of pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent. This pattern begins by early adulthood and is present in a variety of contexts… There is some evidence for an increased prevalence of paranoid personality disorder in relatives of probands with chronic schizophrenia and for a more specific familial relationship with delusional disorder, persecutory type.”

So it may be that she has that also. However, a personality disorder does not involve a psychosis (losing contact with reality: delusions or hallucinations). This young lady appears to have delusions. But maybe not, merely unreasonable suspicions of others, which does not amount to delusions. Taking a look at antisocial personality disorder we find: “The essential feature of antisocial personality disorder is a pervasie pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood…[D]eceit and manipulation are central features…For this diagnosis to be given, the individual must be at least 18 years and must hae had a history of some symptoms of conduct disorder before age 15…Antisocial personality diosrder is more common among the first-degree biological relatives of those with the disorder than among the general population.”

So it may be that she now has antisocial personality disorder and previously had conduct disorder. along with schizophrenia vs. paranoid personality disorder.

Looking up delusional disorder, we find that this diagnosis is notgiven to one who has ever had a sumptom presentation that met Criterion A for Schizophrenia. This individual has met that, so we can eliminate that disgnosis.

To sum up, it appears that she has schizophrenia and antisocial and antisocial personality disorders.

12

It’s obvious I got tired of typing near the end of the prior post.

13

Agree with Dr Paprika and barbitu8- antisocial personality features seem to be the strongest manifestations of her disorder- consider the possibility that her schizophrenic features may be a side effect of her meds? I would think of fetal alcohol syndrome or other prenatal drug exposure as a possible cause of severe social problems from the earliest age. Severe abuse as a child might explain the features seen in childhood- but I wouldn’t expect the lifelong disability to the degree you are describing.

14

I would suggest Asberger’s Syndrome, which is thought to be a “mild” form of autism and is characterized by a persistent lack of (or mis-learning of) ordinary social skills–such as how to read another person’s expression, how to play, how to react to humor, etc. Asbergers can quickly become socially isolated, for obvious reasons; the resultant frustration could lead to rages and tantrums.

15

Well, you can have more than one disease. The fact that she made it so far is amazing. Must have been with your assitance
cazzle.

16

Psychotic features are commonly drug-induced. They are also often related to depression or mania. The fact she hallucinates, if she indeed does, in no way implies this has to be schizophrenia. Someone may of course have several diseases… but is much more likely to have fewer diseases that encompass their symptoms rather than many individual ones. In psychiatry, multiple diagnoses may include a mood disorder and personal disorders, but this is a result of using a “cookbook” like DSM-IV which cannot otherwise accurately describe complex presentations.

17

Psychotic features are commonly drug-induced. They are also often related to depression or mania. The fact she hallucinates, if she indeed does, in no way implies this has to be schizophrenia. Someone may of course have several diseases… but is much more likely to have fewer diseases that encompass their symptoms rather than many individual ones. In psychiatry, multiple diagnoses may include a mood disorder and personal disorders, but this is a result of using a “cookbook” like DSM-IV which cannot otherwise accurately describe complex presentations.

Child abuse often does have lifelong sequelae… usually these are related to anxiety. Asperger’s is not usually associated with aggression.

18

Thank you all for your feedback. It’s been very interesting.

For the record, she wasn’t diagnosed schizophrenic at age 12, but her mother was told that she might be schizophrenic, and that they’d like to keep her in for observation and further testing, which her mother refused.

We’ve thrown around that idea that she was molested, but it would have had to have been in infancy because her problems started that early. I know that her mother is not a drinker, so fetal alcohol syndrome is out. Her father is an alcoholic, but a gentle one, and his problem with drink have only become bad within a couple of years. When she was a child he drank, but was only on the path to alcoholism. She also has two well adjusted, normal brothers - one older, one younger. Her mother is highly strung but is a devoted parent.

DireStraits suggests the medication could cause some of her symptoms - unlikely. She’s only been medicated during the last four years. I’ve been observing her behaviour my entire life - we were born a day apart, and our mothers were in the same room at the hospital. We lived in the same street. The only thing that seperated us was school because she went to the primary school down the road and I went to my father’s old primary school.

Scott Dickerson suggests Asperger’s Syndrome. While what you described sounded fairly accurate, I did a websearch, and found the symptoms don’t really fit that well. She had delayed speech, never had an exceptional vocab, isn’t brilliant, is unable to hold down a job (let alone have a fabulous career), can’t focus on one area of interest, and is less eccentric and more obviously disturbed. She develops obsessions of people, especially those who have been nice to her. She can’t stand people to look at her and as a baby would scream the place down if people looked her way. She constantly watches people to see if they are staring, and if they glance her way she gets distressed because she sees that as confirmation that they’re watching her. She doesn’t understand that by staring at people, she makes them look at her. She’s never really been what I would call Compulsive-Obsessive, even though she has some compulsions (staring) and some obsessions.

All your suggestions have been great. I hope that someday, she will be diagnosed, medicated and able to live a fairly normal and independent life, for her sake and for her mother’s.

19

No. What cazzle describes in NO way resembles Aspergers Syndrome.

TBH I’m reminded of the blind committee examining the elephant.

20

OK. Just read Cazzle’s post about Aspergers. It is possible for AS to be co-morbid with other dx’es. I know a child dx’ed with bi-polar and Aspergers FE. What you now describe cazzle does sound a bit closer to some symptoms of Aspergers. There’s a myth creeping around that every kid with Aspergers is gifted or brilliant. That’s actually not true. IMO there’s a lot of misdiagnosis of gifted kids with Aspergers (esp in Australia) but it is perfectly possible to be Aspergers and be thick as a plank. Some kids with delayed speech still get dx’ed with Aspergers although that shouldn’t happen.