Background: The peak age of onset of schizophrenia is during late adolescence
and young adulthood. Early onset schizophrenia—that which occurs prior to age 18—is more
likely to be treatment resistant. The management of schizophrenia in the adolescent patient
poses many challenges.
Methods: We present a complex case of a patient diagnosed with schizophrenia when she was
16 years old. The patient initially developed symptoms of depression and obsessions after
stressful life events. The OCD and depressive symptoms remitted partially with medications.
She also had short stature and delayed puberty, possibly related to growth hormone
Results: The patient’s psychotic illness did not respond well to typical and atypical
antipsychotics, but she improved dramatically on clozapine. Treatment was augmented with
estrogens. However, she had persistent cognitive deficits that were quite disabling and
interfered with academic functioning.
Conclusion: The case illustrates how multiple factors – psychosocial and hormonal -- might
have been involved in the development of schizophrenia in this adolescent and the challenges
of treatment resistant schizophrenia. In particular, we discuss the possibility of a link between
delayed puberty and schizophrenia and raise the question of whether growth hormone
deficiency could make adolescents susceptible to early-onset schizophrenia.