12 is too young for this stuff... right??

I've just spent about a month and a half dealing with probably the most difficult thing I've ever had to deal with, and I'm just now feeling like I'm coming up for air and am trying to make sense of it all. So long story short, my 12 y.o. niece lives with us because of some bad stuff that happened to her when she was with her parents. Her mother has schizophrenia as did her maternal grandmother. I'm trying to figure out if she's in the prodrome period right now, or what's going on. She seems to be getting worse.

Last month, my niece had a "psychotic break" or "suicidal ideations" or needed a "psych eval" or was "depressed" or was "looking for attention" (depending on who you asked) and ended up hospitalized twice, and when she wasn't inpatient was in a partial treatment program. Part of the reason for the breakdown, so says her psychiatrist, was because she opened up to me about some abuse she suffered at about kindergarten age. Her psychiatrist diagnosed her with major depression with psychosis, anxiety, and PTSD due to trauma and abuse.

However she has had hallucinations, visual and auditory (sound and thought) her entire life, since she was a toddler (she remembers laying in her crib (toddler bed?) seeing things), and her psychiatrist admitted he's concerned about that. Plus there's that family history of schizophrenia. It's my gut feeling that yes, she's had some awful trauma and abuse BUT there's something else.

He has her on risperidol and Zoloft and quite honestly I don't think they're working. He keeps upping them both but this past month she's been slipping -- she's gotten so unstable and the littlest thing will set her off. One night my husband yelled at her for looking angry and she ended up in the hospital for five days. Some days her hallucinations will get so bad she almost can't see. In the spring she was more or less okay; now she can't get through a basketball practice without freaking out and biting her tongue and lip until it bleeds.

So.... thoughts? I know it's uncommon for schizophrenia to appear so early, but if she's had psychosis literally her whole life, could it be possible that that one psychotic break she had in July could've set things in motion for a schizophrenic prodrome? And also, I'm afraid of her getting worse. Could she get worse? She told me yesterday that the thought/voices in her head sometimes tell her to hurt other people... that scares the hell out of me.

That's hard , so damn hard, to beat psychosis , it needs experience to be honest. And she is young. However if risperidone is not working , then tell the doctor that you dont want the child overmedicated , and see what he/she will do.

He started her on Ability which didn't do a thing to lessen the hallucinations, then switched to Risperidol. She's okay unless she gets upset/angry/sad, then they get really bad which is how it's been her whole life. Sometimes in school it's so bad she can't see the blackboard through the swirling "static" (as she calls the daytime hallucinations). She wants something, anything to take it away just so she can function.

Is she working with a child/ adolescent psychiatrist specifically? As with any condition, it's important to find the right clinician, and in the case of adolescent mental illness, very important to work with someone experienced treating other children around her age so they have the best knowledge of treatment options.

Getting a second opinion is common practice and maybe something to think about in order to get another assessment of her symptoms and talk about options for both medication and psychotherapeutic support.

She is so young, and it's terrible that she has to go through all of this at a young age. However given the family history that there and the trauma she's experiencing, it sounds like you are doing your best to be supportive and get her the right care. It takes time and be frustrating at times, but trust that you are acting in her best interest.

I think the poster above gave some good advice. Schizophrenia can present very young (think 3 y/o), but it's rare. The course of the condition isn't entirely predictable. Some people do well on the right medication, but she really needs to see a psychiatrist who is skilled in pediatrics to diagnose and treat her.

She does have a team of adolescent/child psychiatrists working with her. One is her primary pdoc and in the partial program she's been in all summer, she sees them all. So the opinion of the three pdocs is, at this point she does not show signs of schizophrenia 1) because she has insight into her condition, 2) she's still very much in touch with reality and 3) she's only 12; and also they all believe her symptoms can be explained by the trauma she went through as a toddler and child, things we know about and things we may never know about.

Not that I want a more serious diagnosis for her, I just feel that there's more to it than depression with psychosis, anxiety and PTSD. However one of her three pdocs would like her to undergo neuropsych testing to give us insight into why the psychosis is happening, and is willing to try something different if the risperidal continues to not be effective.

I do get the feeling, or have even been told outright from some mental health professionals that there's "no such thing" as a child with schizophrenia. It's just my niece trying to manipulate my husband and me. Just this afternoon talking to the psychiatrist I asked about my niece remembering being in her crib having hallucinations, and the doc said, well, a toddler with schizophrenia, that just isn't a thing. I have to wonder, then, if this was before the trauma (assuming we know everything that happened), then what's causing the lifelong psychosis?? No one can answer that yet.