For example, schizophrenia typically appears around the 20s, but is rare in childhood. Why is it so rare to see in childhood?
In: Biology
I feel during childhood, the brain is still developing, and many of the brain functions that are involved in these disorders aren’t fully active yet. As they grow up, their brains undergo changes and this changes can sometimes trigger the onset of mental disorders if someone is genetically predisposed of it.
I think it’s more because it’s too hard to recognize because kids are kids. They typically already have a small emotional temperament and seem to be in their own world so you can’t just say they’re bipolar or have psychosis because it’s just as likely they’re just kids. I think that’s why autism at least back in the day was hard to get diagnosed because some kids are just shy and don’t like to be around others.
There’s something called the stress-diathesis model where stressful events trigger these conditions to manifest. So you can have the genetic makeup for schizophrenia but only stressful events trigger it to manifest. So theoretically most children don’t experience enough stressful events for these conditions to pop up. That’s something I learned in undergrad years ago, not sure if it holds up now. I’m certain brain development plays a role too, but I’m not sure how off the top of my head. I will say I did work with one child (a 4 year old) that was in the process of being diagnosed with schizophrenia and it was absolutely awful and sad to see him scared of his own hallucinations and acting out aggressively.
I have a side question. In middle school I had an angry demonic sounding voice in my head telling me horrible things like nobody liked me, and i should kms. It went away eventually. Can schizophrenia show up and then leave?
Schizophrenia is related to a lack of synaptic pruning, which is where connections are cut in the brain. This is a process that goes through stages as you age up until about 24, it can go longer depending on the person. When people say your brain isn’t mature until 24, this is what they are talking about. Late teenage years to early twenties, this process moves farther from basic processes like seeing (ends at 6) and moves to the prefrontal cortex. This is a part of your brain responsible for personality, critical thinking, inpulse control among many other things.
So as this process moves brain regions as you age, a disorder of this process will only show its full effects after it ends.
(I am definitely not doing the best at explaining the biology. I am not a professional in this subject. I had two exes in my late teens and early twenties who were affected by these disorders and I’ve read a lot about them trying to understand what happened. My ex in highschool developed schizophrenia over senior year into freshman year. It was very confusing watching him change and not knowing what was happening. He had not had any symptoms of it that I noticed before. We’d been friends since 13. He was homeless and terrified and paranoid of everyone by 21. His parents couldn’t help him. My other ex developed bipolar. That was a lot slower. She committed suicide at 23. She also refused help.)
Actually, they more commonly present in adulthood, not at adolescence. There are always exceptions, mind you.
The actual root cause of many psychiatric disorders isn’t completely understood, and potentially there are a number of factors that come into play, but it is very important to know that, contrary to what many people think, the brain is never truly static in terms of development. There are several periods of development where the brain changes/develops significantly, with puberty being a big one, and some things get pretty much ‘set’ at certain points, but there is always a degree of neuroplasticity, just less post-puberty. There are numerous things that can alter a person’s neurological functioning in adulthood, including injuries, illnesses, and substance misuse. All of those can result in symptoms of psychosis and other symptoms superficially similar to schizophrenia.
There are a lot of different conditions, not just psychiatric ones, that are something you are ‘born with’ but don’t develop until later on, and this includes things like certain types of arthritis. What causes these conditions to present at a certain point varies from condition to condition, and can be influenced by environmental factors and normal age-related changes such as hormone levels and even just stress.
There are certain developmental milestones that are “scheduled” to occur at specific times.
Everything for toddlers typically lines up for them to start speaking intelligibly at around 2 to 3 years old. Sometimes those factors “fail to launch” and sometimes you end up with an autistic child. They are normal babies until this stage, but the necessary changes go awry.
Because the brain is “scheduled” to make specific changes within specific time frames, when these changes go awry, diseases like schizophrenia or other mental diseases can occur. I have a schizophrenic parent, so was very relieved when I reached a milestone year and could consider myself likely safe from this occurring.
There are also other diseases that can typically occur within a specific age group, such as MS that typically manifests between one’s 20s and early 40s. So far, research has not isolated what the exact reason for this. It is theorized that it can be triggered by a stressor that occurs within that time frame, but still no idea why these years tend to bracket one’s susceptibility.
I think schizophrenia and bipolar might have two very different answers here. The answers people are giving for schizophrenia are likely not the answers you’d see for bipolar.
For many bipolar people, looking back, they can see the beginnings of things. Bipolar also looks very different in small kids, and often they get a host of various diagnosis before settling on bipolar in teens/early 20’s. I know I was caught as having a mood disorder at 7, ended up hospitalized and on strong meds not long after, but wasn’t formally diagnosed until 14.
Vs schizophrenia which is a very not there/there thing, with a fairly short onset window. You rarely look back on their mental health history and go “oh, yeah, that makes sense” a decade back into their life. Each condition is just going to be different.
Schizophrenia and bipolar are both diseases of the brain, due to chemical male up. They are influenced by genetics (if family members have either disease), environment (trauma/stress), and substances (high THC or mushroom trip that trigger first episode).
Children cannot be diagnosed due to guiding bodies – ICD internationally and in US, the DSM. This is due to the fact that 1) children may have perceptual disturbances ( hallucinations) that are normal- imaginary friends, reactions to trauma, maladaptive coping skills. 2) there was a time that bipolar could be diagnosed with kids, and it was grossly inappropriately diagnosed. Usually due to parent struggling to enforce boundaries, etc, not coping with mood swings or teenage years- and then the child being inappropriately medicated/sedated on drugs that have serious side effects
Of note- the medications for both bipolar and schizophrenia are severely lacking. They are not all that effective and have serious side effects, even for adults.
There are a variety of differential diagnoses to consider- schizophrenia, schizophreniform, schizotypal, schizoaffective disorder depression type, schizoaffective disorder bipolar type, major depressive disorder with psychotic features, bipolar II, bipolar I. All of these need to be teased out with time, and part of criteria is the brain is more fully developed.
There is also a prodromal phase to psychotic disorders- usually a year or so of odd behavior before something mentioned above triggers a first episode.
These are considered major mental illness with serious impairment of daily functioning.
I have more but lmk if any questions. I am very passionate about these diagnoses and the people that have them- usually incredibly resilient and lovely people.
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