Psychosis in Children and Adolescents
Definitions
- Hallucinations
- Delusions
- Thought disorder
- Impaired reality testing
Prevalence- not common among kids (1%); most present in young adulthood
Symptoms
1. Hallucinations- no sensory input
Organic, psychiatric, and medical conditions
Most common + Sx on schizophrenia (80% of childhood schizophrenia; AUDITORY is most common)
RARE/poorly formed before age 7
Different from and illusion because in an illusion there is sensory input- you see something but interpret it wrong
More ELABORATE in OLDER children
Adolescents similar to adults
Mood congruent
Can be associated with *depression, dissociative disorder, and conduct disorders
2. Delusions
Says, “the police are after me,” so ask how do you know?
Present in 60% of childhood schizophrenia
ncreasing complexity with age
Common in effective psychosis psychotic symptoms related to mood disorder
3. Thought Disorder
Difficult to screen fantasy from reality
Loose association (most common TD) and flight of ideas (seen in mania)
Transiently seen in dissociative disorders
May see in normal kids under age 7
Poverty of speech
Frequency unclear
Several forms
Rating scales are available
4. Affective Disturbances
Negative symptom
Flat affect is common
May see in
Depression
Anxiety
Antisocials
Borderlines
Premorbid Features
Social Withdrawal- if the child is timid before the diagnosis of the onset of schizophrenia then they have a worse prognosis
Poor school performance and peer relationships
Variable onset
- Insidious- gradual, starts as a little odd and gradually gets worse
- Acute- Normal BOOM Psychotic
- Insidious with acute episode- Premorbid BOOM Psychotic
History of ADHD or a conduct disorder- it is unusual for ADHD to change to schizo
Neuro-developmental abnormalities- slowing, seizures
Etiology
- Biologic Factors
- Neurologic findings – soft neurological signs; mild; not enough to point towards a lesion
- EEG
- Family history- HIGH rate in parents of kids who have schizo that starts in childhoos
- Processing deficits and poor attention
- Genetic link
- Family Characteristics
- Communication patterns
- High expressed emotion- schizo kids have a very hard time with drama queens in the fam
- Environmental Factors
- Event may precipitate an episode
- Lower SES (“downward drift”)
Diagnostic Studies
- Biologic
- No biological marker
- Careful medical evaluation- H&P
- Psychological
- No assocoation with MR
- Look for learning disabilities to help with school placement
- Projective testing- non-specific stimulation; Roreschak test, drawing and interpreting, etc
Differential Diagnosis
- Schizophrenia
- Duration- + symptoms for at least 6 months
- Impairment- social/occupational failure; school work declines
- Rare in childhood (before puberty)
- Mood Disorders
- Easily confused with bipolar early on
- More common
- Premorbid function is better
- Flat affect may come later
- Stronger family history (including depression and substance abuse)
- Other Psychiatric Disorders
- Borderline personality- transient (cut on themselves, etc)
- Dissociative disorders- increased mood symptoms and inappropriate sexual behavior, irritability
- Autism- social isolation; no hallucinations and delusions
- Organic Conditions
- EEG/imaging
- Delerium- fluctuation in level of consciousness
- Seizure disorders- may have other CNS symptoms associated with it
- Intoxication- illegal drugs or cross-reactivity of another drug
Treatment
- Medication
- Typical neuroleptics (haldol)- problem: kids increase their susceptibility and tarditive diskinesia
- Newer agents- suggested so patients but over the counter
- Psychosocial
- Development- growth/social skills
- Family- Education
- Social Skills
- School – learning disability
Outcome
- Early onset is WORSE
- Good prognostic factors:
- Higher EQ
- Normal EEG
- Mood symptoms – bipolar > schizo
- Acute onset- better prognosis
- Family history of mood disorders
Tags: Antisocials, anxiety, Borderline personality, Delusions, depression, hallucinations, schizo kids, schizophrenia, Social withdrawal
