“One in a million”: A case of a very early onset schizophrenia

Abstract

Introduction: Very early onset schizophrenia (VEOS), psychosis prior to age 13, is rare with an incidence of less than 0.04%. Its clinical presentation, course, and outcome differ from early onset (ages 13–18) and adult onset (ages 18 and up) schizophrenia. It is associated with poor response to treatment, poorer prognosis, and multiple hospitalizations. Early identification and intervention has shown to improve overall functioning. Case Report: We present a case of a 12-year-old female with significant family history of psychosis, admitted due to physical and verbal aggression, sexual inappropriateness, destruction of property, response to internal stimuli, decline in functioning, and 10 month history of social isolation. She responded to risperidone treatment. The patient was discharged to partial hospitalization program but could not tolerate the group setting resulting in discharge to outpatient services. Psychosocial supports were put in place to help with environmental and family dynamics to improve outcome. Conclusion: As per a recent study, one-third of children and adolescents with psychosis initially present with negative symptoms. It has also been reported that 30% of those with negative symptoms develop treatment failure with antipsychotics. Given these statistics and the treatment challenges of this case, it was imperative to provide additional psychosocial supports to the patients and families, to improve overall functioning and long-term prognosis.

Lack of Resources for Aftercare for Children With Psychosis: A System’s Failure

“…VEOS is a rare psychiatric illness with an incidence of less than 0.04% [8]. Patients with VEOS face significant barriers to receiving the care that they require as they get older.…”

“…They found that acute onset of symptoms, higher IQ, fewer negative symptoms at the onset of the illness, and right medication adherence were all associated with remission and better outcomes for their patients [9]. The need to provide psychosocial supports to patients with VEOS and their families are essential for overall improvement in functioning [8]. One hurdle is that many patients do not achieve a level of functioning to live and work independently, and they often require very long-term treatment.…”