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1. Early-onset schizophrenia

epidemiology
- childhood frequency <1/40K
- 13-18yo: increased by 50x
- resembles severe, chronic, treatment-refractory adult scz
- extremely high rate of comorbidity: ADHD, dep, anx
- M>F
etiology
- neurodev
- 80% heritability
- 8x more in 1st deg relatives
dx
- more premorbid social rejection, poor peer rel, academic trouble
- insidious, starts with inappropriate affect or unusual behaviour
- months or years before they meet criteria
- auditory hallucinations are common
  - critical commentary or command
- may lose function or may not reach expected functional level
no lab tests
ddx
- may be manifesting ptsd or neurodev immaturity rather than hallucination or thought d/o
- ASD, BD, dep, drug, organic psychosis
- vs schizotypal: hallucinations, delusions, incoherence
prognosis
- premorbid functioning
- IQ
- age of onset
- response to interventions
- family support
- comorbidities
- accuracy and stability of dx
  - 1/3 later dx with bipolar d/o
tx
- psychoeducation
- pharm
  - 2nd gen antipsychotics
- therapy
- social skills training
- educational placement

epidemiology
- most apparent <3yo
- M>F (4:1)
- no relation to gender conformity
etiology
- genetics: no candidate gene, chromosomal variation is uncommon
- no psychosocial factors
dx
- DSM V
- incongruence between expressed and assigned + self-perception
- specifiers: with disorder of sex dev
ddx
- schizophrenia (delusions), body dysmorphic d/o, transvestic d/o
prognosis
- ~puberty: more anxiety
- not necessarily transgender
  - >50% assigned gender, more extreme dysphoria usually leads to transgender
comorbidities
- depression, anxiety, ASD
- lifetime SI rate 40%
tx
- therapy: family, individual, group
- hormone therapy and surgery

biopsychosocial pathology that results from maternal deprivation, lack of care by caregiver.
comorbidities
- failure to thrive, psychosocial dwarfism, separation anxiety, avoidant personality, depression, delinquency, academic issues, borderline intelligence
normal attachment stages in K&S
stages
- pre-attachment: 8-12w - orient to mothers
- attacahment in the making: 8-12w-6m - attached to one or more persons
- clear-cut attachment: 6-24m - cry when separated
sequence of behaviour in separation >3mo
- protest: crying, calling out, searching for lost person
- despair: lose hope
- detachment: emotionally separates from the mother