Diagnosing Schizophrenia And Bipolar Disorder In Children

My daughter, 14, has been struggling with severe depression, auditory hallucinations and some manic episodes for several months. There are days when she seems to get better, then she has another episode, sometimes within the same day. She is currently taking Depakote, Respirdal and Klonopin (for panic episodes). We have a family history of both schizophrenia and bipolar disorder, but her doctors don’t seem to have a clear diagnosis yet as to which one it is. Does it take a long time to figure this out in children?

You describe severe psychiatric symptoms of depression, auditory hallucinations (“hearing voices”), and manic episodes (agitated, “speedy” thoughts, speech, and behavior) in your teenage daughter. You also mention that there is a family history of both schizophrenia and bipolar disorder, two psychiatric disorders which are known to have a genetic or inherited component.

As you probably know, schizophrenia is characterized by what we call psychotic symptoms, which means a loss of touch with reality, and these symptoms commonly include unusual thoughts, auditory hallucinations, disorganized speech and behavior, and delusions. Bipolar disorder, which used to be called manic-depressive disorder, is characterized by severe, uncontrollable mood swings, often lasting over a period of weeks or months, with debilitating depressive episodes and out-of-control manic episodes.

Schizophrenia is treated with antipsychotic medications — risperidone (Risperidol) is one of the newer ones, and tends to be useful in a large number of patients. Other new antipsychotics are olanzapine (Zyprexa), clozapine (Clozaril), and quetiapine (Seroquel) and ziprasidone (Geodon). Bipolar disorder is treated with mood stabilizing agents — valproic acid (also known as Valproate, divalproex sodium, or Depakote) is such an agent. It works effectively in many patients, and tends to have a minimum of side effects. Other mood stabilizers are lithium, gaba-pentin or Neurontin, carbamezepine or Tegretol), lamotrigine (Lamigdil) and topiramate (Topamax). Klonopin, a benzodiazepine or anti-anxiety agent, can be used in either of these two disorders, especially when the patient experiences a lot of anxiety, panic, or agitation.

Both schizophrenia and bipolar disorder are neurobiological disorders — disorders of the normal functioning of the brain. They both have a genetic component (as I have mentioned), and they are both associated with changes in normal brain chemistry. Schizophrenia is a disorder of the cognitive functioning of the brain (how the brain thinks and processes information), while bipolar disorder results from dysfunction in the mood-regulating parts of the brain. These illnesses are not caused by poor parenting or by bad psychological events, even though we do know that stresses can make their symptoms worse (just like stresses can make the symptoms of any medical illness worse).

What is interesting and complicated about these two serious illnesses is that a patient with schizophrenia can have mood symptoms (usually depression), just like a patient with bipolar disorder can have psychotic symptoms (usually during really bad manic episodes). Especially in a young person who is early in the course of her illness, it can be difficult to sort out exactly which one — schizophrenia or bipolar disorder — is the core illness. In schizophrenia, the “out of touch with reality” symptoms are more enduring, and the mood symptoms come and go; while the opposite is true in bipolar disorder.

There is a third diagnosis, called schizoaffective disorder, which may apply in your daughter’s case. Researchers have identified this as a disorder in which the patient shows both schizophrenia-type symptoms and chronic mood symptoms (“affective” is another word for mood). In schizoaffective disorder, both types of symptoms are present to a consistent degree. As you might guess, schizoaffective disorder is usually treated with a combination of antipsychotic agents, mood-stabilizing agents, and often, antidepressants. Research shows that schizoaffective disorder can appear in families who have a history of either schizophrenia or bipolar disorder, or both.

While your daughter’s physicians are waiting to obtain more information about her course and about her exact diagnosis, it is important that she remain compliant with medications and that she stay away from things which are toxic to the brain (alcohol, drugs, severe stresses). New research evidence suggests that psychotic symptoms and severe mood symptoms are not good for the brain’s overall health — they should be treated immediately and vigorously to help protect the individual from future episodes.

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