Schizophrenia

Schizophrenia is a serious brain disorder that distorts the way a person may think or perceive things.  It also may alter their actions, emotions and the way they relate with others.  People with this disorder often have problems functioning in society, at work, school and in relationships.

Schizophrenia is a psychosis in which a person is unable to distinguish what is real and what is not causing a loss of what reality is.  This disorder can cause a person’s personality or behavior to be very strange.

The Northwest Clinical Research Center is conducting a clinical trial for adolescents ages 13-17 who may be dealing with schizophrenia.  If you think your teenager may have schizophrenia, contact our office by completing the questionnaire or calling, to learn more information about our clinical trial.


Questionnaire:


Please let us know which of the following symptoms you’ve noticed your child has experienced:

 Social withdrawal Intense Anxiety Loss of appetite Loss of hygiene Delusions Difficulties processing information Hearing/seeing things that aren’t there Feeling depressed/causing self-harm NONE

Has your child been treated with schizophrenia before?
 Yes No

Is your child currently receiving treatment for schizophrenia?
 Yes No

Does your child have a history of any of the following?

 Seizure Disorder Stroke Head Injury Brain Tumor Cancer NONE

What is your child's gender?
 Male Female

How old is your child?

Parent's Name (First and Last):

Child's Name (First and Last):

Phone:

Email Address:

Is the child a resident of Washington State?

Zip Code:

What is the best time to contact you?

How did you hear about us?
 TV Radio Referral Flyer/Brochure Internet Search Web Advertisement Facebook Previous Patient Parent Map Seattle’s Child School PTA

Please enter any questions or comments in the space below.

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