Endogenous are those psychoses in which no organic changes can be found in the brain. In this they differ significantly from organic psychoses which are the result of various observable brain diseases.
The term “endogenous” is intended to emphasize that these psychoses originate from the diseased psychic constitution of man, from the innate disposition of the individual to become mentally ill.
Although it is clear that heredity, ie the “internal factor”, significantly influences the occurrence of these psychoses, today it is considered that the diseased influences of the environment are significant in their origin.
Childhood Schizophrenia: Symptoms and Treatment
There are two endogenous psychoses: schizophrenia and manic-depressive psychosis. These are the most common mental illnesses of adults. They are very rare in childhood.
Schizophrenia is sometimes encountered even before puberty; manic-depressive psychosis occurs in childhood only exceptionally. Lutz says barely 1% of schizophrenia begins before the age of ten. But the onset of the disease is usually difficult to determine exactly, because in most cases it begins gradually, insidiously, without alarming symptoms.
Interestingly, schizophrenia occurs 2-3 times more often in boys than in girls. Some cases of this disease go unrecognized in childhood, ie under other diagnoses – psychoneurosis, mental retardation, dementia – so they are recognized only in adulthood, when they manifest in a very characteristic picture.
Pearson and Katz say that in every special school for mentally retarded children, one can find a number of children who are not mentally retarded but schizophrenic. It is characteristic of children’s schizophrenia that after a few years of more or less normal mental development, the child begins to decline mentally and his personality gradually disintegrates.
The child is increasingly losing contact with the environment and finds it increasingly difficult to adapt to the environment and its requirements. This is followed by increasingly clear symptoms of psychosis.
The child becomes increasingly indifferent, his emotions more superficial, contact with the environment weaker; he leaves society, withdraws into himself, becomes less and less interested in the events around him, is no longer interested in anything, nothing can make him happy or delighted; he becomes very sensitive to every action towards himself, he is irritable, capricious in his reactions, they are less and less in line with the situation in which he finds himself; the mood is increasingly changeable and inadequate, ie without a logical connection with the momentary state.
The moment is listless, apathetic, the hour falls into unreasonable excitement, it is attacked by attacks of unjustified anger. Sometimes the first suspicion of a child’s psychotic development is aroused by his completely unmotivated outbursts: without a clear cause he runs away from home or leaves school, commits theft, sexual outbursts and the like.
In addition, he regularly loses interest in school, his attention weakens, his flow of thought becomes disordered, and his whole behavior is bizarre, unusual, illogical. As the disease progresses, intellectual functions begin to decline.
In a younger child, speech also breaks down, starts beating again, speaks vaguely, incorrectly, or stops speaking altogether. Movements become artificial, unnatural, impulsive or completely stereotypical, facial expressions are inadequate, they fall into unreasonable laughter or crying.
Sometimes he starts urinating in bed, masturbates passionately, suffers from insomnia, lets his chair fall to the floor. Personality breakdown in a child progresses faster and more completely than in adult patients.
The prognosis of the disease is poor, the worse the younger the child was when the schizophrenic process began. Healing cannot be expected. After transient improvements and exacerbations, the disease slowly progresses to chronic adult schizophrenia with hallucinations, delusions, torn, dissociated thinking, and other typical symptoms of adult schizophrenia. Then the patient remains more or less constantly in the hospital.
The occurrence of childhood schizophrenia cannot be prevented because it occurs on the basis of innate psychological intolerance to life loads. However, various negative environmental influences that could be prevented can be found in the life development of schizophrenic children.
So Levy warns of the fact that some schizophrenic children were deprived of maternal love as early as the first year of life. But other children react to life blows that could be the cause of schizophrenia in a much milder way. In many cases of the schizophrenic process in childhood, such negative environmental factors cannot be established that would be sufficiently responsible for the occurrence of such a severe mental illness.
In the treatment of schizophrenia, hospital therapy with biological and chemical agents is used as in adults. A schizophrenic child is occasionally unable to attend school.
His family environment needs to be rehabilitated to the utmost, in order to treat the sick child in the most correct and warm way possible. All emotional upheavals worsen the child’s mental state, so they should be carefully avoided.
In addition, it is necessary for the sick child to be activated as much as possible, to be taught various skills, to be engaged in household chores. He should be subjected to psychotherapeutic treatment from time to time.
Manic-Depressive Psychosis in Children and Adolescents: Manifestation and Treatment
In puberty and adolescence, schizophrenia occurs with a clinical picture of adult schizophrenia. It is much more common there than in childhood. Moreover, adult schizophrenia usually begins in adolescence. The basic psychological change is the gradual emotional alienation from the environment.
Often, the first sign of a schizophrenic process is progressive failure at school, or increasing neglect of studies or employment. The patient becomes more and more lonely, avoids company, does nothing, wanders the streets aimlessly or reads any worthless reading for hours.
In addition, he becomes harsh, silent, irritable, distrustful, increasingly strange in his behavior. He neglects his appearance, he no longer feels responsible for anything, he becomes cold, rude and aggressive towards those closest to him.
Sometimes a young man gets bored, a girl sometimes indulges in prostitution; the patient sometimes commits an offense that he cannot explain. When a sick experience of oneself (depersonalization) and crazy ideas of relationships, persecution, etc. appear, it becomes clear that the young man is not “lazy” or “dissolved and corrupt”, but is a severe mental patient.
In the acute stages of the disease, the patient should undergo hospital treatment. In addition to drug therapy, psychotherapy of schizophrenic youth should be provided.
The basic task is to enable a young man to finish school and to qualify for a profession in the quieter stages of the disease, if possible. The efforts of the psychiatrist should also be supported by the patient’s family.
It is her duty to dismiss any mistrust, fear, and emotional repulsion in relation to the patient. For a schizophrenic young man, the most important thing is that the family accepts him with a certain warmth, that he is treated as a normal man; he should be dealt with, he should be employed, he should be entrusted with various duties, and nothing should show him that he is considered a sick and inferior man.
A schizophrenic young man should not be forced into anything, he should not be persuaded into activities he does not like, he should not be chased into society when he is not in the mood for it.
His whims, unusual actions, strange statements and other manifestations of the disease should be responded to calmly, patiently and benevolently, carefully avoiding any conflict with the patient. He should not be irritated by anything, he should not engage in any quarrel with him, he should not contradict his attitudes and beliefs.
In this way, exacerbations of the disease can be prevented and it can be achieved that the patient is at least somewhat able to live independently.
Manic-depressive psychosis – if it occurs at all before puberty – manifests itself in children with a less clear picture than in adults. In the manic phase of the disease, the child is constantly too cheerful, chatty, excited, constantly on the move.
In the depressive phase, the child is depressed for no reason, silent, inhibited, inactive, constantly uttering the same complaints, worried about his future, blaming only himself, thinking about suicide.
At puberty, depression sometimes occurs in connection with menstruation. Otherwise, in adolescence, the picture of the disease is essentially the same as the picture in childhood, only the symptoms are more pronounced; it is successfully treated with hospital therapy, so it can be completely cured in a few weeks. Sometimes it recurs, appearing periodically.