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M05.09.06 Thought Disorders
Thought disorders are a group of mental health conditions that primarily affect a person’s thinking process, impacting how they interpret reality, behave, and communicate. This section will explore some of the common presentations of thought disorders in children and adolescents.
Psychosis
Psychosis is a severe symptom of thought disorders characterized by a disconnect from reality. It can manifest through:
- Hallucinations: Perceiving things that are not there (e.g., hearing voices, seeing visions).
- Delusions: Fixed false beliefs that persist despite evidence to the contrary.
- Disorganized speech: Difficulty forming coherent thoughts or sentences, leading to rambling or illogical speech patterns.
- Disorganized behavior: Erratic, unpredictable, or purposeless actions.
- Catatonia: A state of motor immobility or excessive activity, sometimes accompanied by unusual postures or stereotyped movements.
Classification of Thought Disorders
Thought disorders can be categorized based on symptom presentation and duration (Table 9-3).
Table 9-3. Classification of Thought Disorders in Children and Adolescents
| Diagnosis | Symptoms | Duration of Symptoms | Treatment |
|---|---|---|---|
| Brief Psychotic Disorder | Hallucinations, delusions, disorganized behavior, or speech | >1 day but <1 month | Antipsychotics |
| Schizophreniform Disorder | Hallucinations, delusions, disorganized behavior or speech | >1 month but <6 months | Antipsychotics |
| Schizophrenia | Hallucinations, delusions, disorganized behavior or speech, catatonic symptoms, negative symptoms, marked reduction in level of functioning | >6 months | Antipsychotics |
| Schizoaffective Disorder | Hallucinations, delusions, disorganized behavior, or thinking | Must have at least 2 weeks of psychotic symptoms in the absence of mood symptoms | Antipsychotics and mood stabilizers (bipolar type) or antidepressants (depressed type) |
Schizophrenia
Schizophrenia is a chronic and severe thought disorder affecting approximately 1% of the population. It typically presents in late adolescence or early adulthood, with a higher prevalence in males during late teens and females in their mid-twenties. People with schizophrenia have an increased risk of mortality due to accidents, natural causes, and substance abuse.
Epidemiology:
- Men = Women
- Age of onset: Males (15-25 years), Females (25-35 years)
- Increased mortality rate from accidents and natural causes
- Higher prevalence of winter or early spring births (possible association with prenatal influenza exposure)
- Lifetime substance abuse prevalence > 50%
- Over 90% of schizophrenics smoke (nicotine may have some mitigating effects on symptoms)
Etiology:
The exact cause of schizophrenia is unknown, but several contributing factors are likely involved:
- Genetics: A genetic predisposition is evident, with a higher concordance rate in monozygotic twins compared to dizygotic twins.
- Prenatal factors: Exposure to certain infections (e.g., influenza) during pregnancy may increase risk.
- Neurodevelopmental abnormalities: Brain development issues may play a role.
- Neurochemical imbalances: Dysregulation of neurotransmitters, particularly dopamine, is a potential factor.
- Social and environmental factors: Stressful life events or disadvantaged socioeconomic backgrounds may contribute.
Table 9-4. Biochemical Theories of Schizophrenia
| Neurotransmitter | Change | Effects |
|---|---|---|
| Dopamine | Increase | Positive symptoms (hallucinations, delusions) |
| Serotonin | Increase/Decrease | Both positive and negative symptoms |
| Glutamate | Increase | PCP (glutamate antagonist) can induce schizophrenia-like symptoms |
| Nicotine | Decrease | May improve some cognitive impairments |
| GABA | Decrease | May contribute to positive symptoms |
Neuropathology:
Studies suggest structural and functional abnormalities in specific brain regions in schizophrenia (Table 9-5).
Table 9-5. Schizophrenia-Associated Neuropathology
| Brain Area | Change |
|---|---|
| Ventricles | Increased size |
| Symmetry | Decreased (asymmetry in some brain structures) |
| Limbic System | Decreased activity |
| Prefrontal Cortex | Decreased activity |
| Thalamus | Decreased activity |
| Basal Ganglia and Cerebellum | Increase/decrease in activity |
Additional Points:
- Early diagnosis and intervention are crucial for managing thought disorders and improving long-term outcomes.
- A multidisciplinary approach involving medical professionals, therapists, and social workers is often necessary for effective treatment.
- Family support and education are essential for patients and their caregivers.
Bibliography:
- American Psychiatric Association. (2022). Diagnostic and statistical