[Therapy of childhood schizophrenia]

Due to the multifacet genesis and variability of clinical phenomenology, the therapy of childhood schizophrenia must be multidimensional. Formerly applied techniques like electroshock- and insulin-therapy are now replaced by pharmaco-therapy, primarily with phenothiazines, butyrophenones and chlorprothixens. The dosage depends on age, body weight or body surface. Because of extrapyramidal motor side effects, combinations with anticholinergic drugs may be necessary. Psychopharmaco-therapy alone, however, is insufficient. High emphasis must be placed on psychotherapy and educational guidance and counselling of the psychotic child. Participation in play groups, sports, muscial activities, arts and crafts, and acting helps make it possible to improve communication behaviour and to transform aggressive anxiety defense into stabilized control of emotions and impulses. In addition to successive integration of the psychotic child into small groups, play therapy with the single child is meaningful. In this case, a constant and confidential relation between therapist and child is extremely important and only possible if the therapist attempts to place himself into the magic-animistic phantasies of the psychotic child. He has first to learn the psychotic language of his patient in order to support more reality-oriented behaviour processes of the child's thinking, preceiving and performing later on. In this manner, the magic-omnipotent phantasies can be dissolved and an increasing orientation of the child toward reality can be encouraged. This involves strengthening and support of non-pathological ego-functions and initiation of a new level of ego-functioning. Such an integrated developmental concept can best be realized through play therapy.