Adolescent-Onset Schizophrenia: Risk Factors, Presentation, and Early Intervention

Schizophrenia emerging before age 18 (adolescent-onset) or 13 (childhood-onset) has distinct features:

• Insidious Onset: Prodromal phase (social withdrawal, declining grades, odd beliefs) often lasts months-years.
• Risk Factors: Family history (10% if 1st-degree relative), COMT, DISC1, NRG1 variants, prenatal infection/hypoxia, childhood trauma, urban upbringing, cannabis use (especially high-THC, early adolescence).
• Presentation: More negative/cognitive symptoms, fewer elaborate delusions than adults. Visual/tactile hallucinations more common.
• Neurodevelopment: Exaggerated synaptic pruning, reduced gray matter, delayed white matter maturation.

Early Intervention is Critical: Coordinated Specialty Care (CSC) programs (low-dose antipsychotics, CBT-p, family education, supported education/employment, case management) reduce duration of untreated psychosis (DUP) and improve long-term functional outcomes. School accommodations (IEP/504) are often needed.