Childhood Psychoses Flashcards
What is psychosis?
Psychosis is a severe disruption of thought, perception, and behavior resulting in a loss of reality testing.
Name some disorders in which psychosis can occur.
Major depressive disorder, bipolar I disorder, schizoaffective disorder, and schizophrenia.
What are positive symptoms of psychosis?
Positive symptoms include delusions, hallucinations, disorganized thinking, and grossly disorganized behavior.
What are negative symptoms of schizophrenia?
Negative symptoms include diminished emotional expression, avolition, alogia, anhedonia, and social withdrawal.
Define delusions.
Delusions are fixed, unchangeable, false beliefs held despite conflicting evidence.
What is the most common type of hallucination in psychosis?
Auditory hallucinations are the most common type.
How can disorganized thinking be identified?
Disorganized thinking is inferred from speech, examining thought process and content, and typically impairs communication.
What distinguishes hallucinations from developmentally normal fantasy in children?
Hallucinations are not under the child’s control and have the full impact of normal perception, unlike controlled fantasy.
What is brief psychotic disorder?
Brief psychotic disorder involves one or more psychotic symptoms for at least 1 day but less than 1 month, with full recovery.
What duration of psychotic symptoms characterizes schizophreniform disorder?
Schizophreniform disorder symptoms persist for at least 1 month but less than 6 months.
What criteria must be met for a diagnosis of schizophrenia?
At least two psychotic symptoms (one must be delusions, hallucinations, or disorganized speech) for at least 1 month, with continuous signs for 6 months.
What are common cognitive deficits in schizophrenia?
Cognitive deficits include impairments in declarative memory, working memory, language, executive functions, and slower processing speed.
What are the most frequent psychotic symptoms in youth with schizophrenia?
Auditory hallucinations (82%), delusions (78%), thought disorder (66%), disorganized behavior (53%), and negative symptoms (50%).
What is a key difference in schizophrenia presentation between children and adults?
Children’s delusions and hallucinations may be less elaborate, with more frequent visual hallucinations and possible overlap with autism or communication disorders.
What are the DSM-5 criteria for a brief psychotic disorder?
Presence of one or more psychotic symptoms (delusions, hallucinations, disorganized speech, grossly disorganized behavior) for at least 1 day but less than 1 month, with eventual return to baseline.
What specifiers exist for brief psychotic disorder?
Specifiers include with marked stressors, without marked stressors, and with postpartum onset.
What are the DSM-5 criteria for schizophreniform disorder?
Two or more psychotic symptoms (one must be delusions, hallucinations, or disorganized speech) for at least 1 month but less than 6 months, ruling out other mood and medical conditions.
What additional criteria must be met for schizophrenia diagnosis in individuals with autism spectrum disorder?
Prominent delusions or hallucinations must be present for at least 1 month, along with other required symptoms of schizophrenia.
What is the percentage of first-onset psychosis attributed to brief psychotic disorder in the United States?
“9%”
Is brief psychotic disorder more common in males or females?
“Females”
How does the incidence of schizophreniform disorders compare to schizophrenia in the United States?
“It is as much as fivefold less than that of schizophrenia.”
What is the lifetime prevalence of schizophrenia?
“Approximately 0.3–0.7%”
What is the male-to-female ratio for schizophrenia?
“1.4:1”
What are common differences in presentation of schizophrenia between males and females?
“Males have poorer premorbid adjustment
What is the incidence of childhood-onset schizophrenia?
“Less than 0.04%”
What is the male-to-female ratio in childhood-onset schizophrenia?
“2:1”
At what age does brief psychotic disorder most often appear?
“Adolescence or early adulthood
What is required for a diagnosis of brief psychotic disorder?
“Full remission within 1 month of onset and gradual return to premorbid level of function.”
What percentage of patients with schizophreniform disorder relapse into schizophrenia or schizoaffective disorder?
“About 65%”
What predicts a better outcome in schizophreniform disorder?
“Abrupt onset
What is the typical age of onset for schizophrenia in males and females?
“Early to mid-20s for males and late 20s for females.”
What are the hallmark phases in schizophrenia assessment?
“Prodrome
What symptoms characterize the prodrome phase of schizophrenia?
“Functional deterioration
What symptoms are most prominent in the acute phase of schizophrenia?
“Positive symptoms and functional deterioration.”
What characterizes the residual phase of schizophrenia?
“Minimal to no positive symptoms but persistent negative symptoms causing impairment.”
What are common features of hallucinations caused by medical illnesses?
“More likely tactile or visual than auditory.”
What autoimmune condition may present with psychosis and neurological symptoms?
“Autoimmune encephalitis caused by anti–NMDA receptor or other autoantibodies.”
What differentiates delirium with psychotic features from primary psychosis?
“Fluctuating levels of consciousness and abnormalities in neurologic exams or vital signs.”
What factors increase suspicion of secondary causes of psychosis?
“Atypical features such as acute onset
What diagnostic criteria suggest possible autoimmune psychosis?
“Abrupt onset of psychosis with symptoms like catatonia
Among youth with schizophrenia, what are the comorbidity rates for posttraumatic stress disorder, ADHD, and substance abuse?
“Approximately 34% for posttraumatic stress disorder
What percentage of children with schizophrenia have intellectual delays?
“At least 10–20%.”
What impairments are commonly observed in children with schizophrenia?
“Impairments in language
What is the estimated co-occurring rate of schizophrenia and autism spectrum disorder (ASD)?
“30–50% of childhood-onset schizophrenia cases are preceded by a diagnosis of ASD.”
What factors predict poor outcomes in youth with schizophrenia?
“Low premorbid functioning
How does schizophrenia affect social and functional outcomes in adulthood?
“Youth with schizophrenia show greater social deficits
What percentage of individuals with schizophrenia die by suicide or accidental death?
“Approximately 5–10%.”
How does life expectancy in individuals with schizophrenia compare to the general population?
“Life expectancy is reduced due to associated medical conditions.”
What are the key genetic factors associated with schizophrenia?
“First-degree relatives have a 5–20 times higher risk; monozygotic twins have a 40–60% concordance rate
What role do rare genetic variants play in schizophrenia?
“Rare variants
What environmental factors contribute to the development of schizophrenia?
“In utero exposure to famine
How does cannabis use in teens relate to the risk of schizophrenia?
“Cannabis use is associated with a higher risk of psychosis
What is the relationship between schizophrenia and expressed emotion within families?
“Expressed emotion in families can influence the onset and exacerbation of episodes
What neuroanatomical abnormalities are seen in schizophrenia?
“Increased lateral ventricle volumes
How are dopamine systems involved in the pathophysiology of schizophrenia?
“The dopamine hypothesis suggests that central dopamine circuits
What are the typical findings on neurologic exam for individuals with schizophrenia?
“Deficits in smooth-pursuit eye movements and autonomic responsivity.”
What are the characteristics of youth at high risk for developing schizophrenia?
“They may have unusual beliefs
How effective are antipsychotic medications in preventing the development of schizophrenia?
“Antipsychotics may delay conversion to psychosis but have no lasting effect after withdrawal and are not broadly recommended.”
What role do antidepressants play in youth at risk for schizophrenia?
“Antidepressants may improve symptoms in adolescents at risk for schizophrenia spectrum disorders.”
How effective are psychologic interventions for youth with early symptoms of schizophrenia?
“Psychological interventions
What is the main concern with screening for schizophrenia spectrum disorders?
“There is a high false-positive rate
What tools are available for screening schizophrenia spectrum disorders in children?
“There are no validated tools for screening schizophrenia spectrum disorders in children or adolescents.”
What common findings are present in children with childhood-onset schizophrenia?
“67% show disturbances in social
What is the importance of family history in diagnosing schizophrenia?
“A thorough family history is key
What is the diagnostic process for schizophrenia in youth?
“A comprehensive diagnostic assessment involves evaluating the persistence
What medical tests are commonly used in the assessment of schizophrenia?
“Routine testing includes blood counts
What is the role of neuroimaging in diagnosing schizophrenia?
“Neuroimaging is used to rule out other conditions but does not establish a diagnosis of schizophrenia.”
What is the role of pharmacotherapy in treating schizophrenia in youth?
“First- and second-generation antipsychotics are effective in reducing psychotic symptoms
What factors influence the choice of antipsychotic medication in treating youth with schizophrenia?
“Factors include FDA approval
What are the risks associated with clozapine treatment?
“Clozapine carries a risk for agranulocytosis and seizures
How does electroconvulsive therapy (ECT) fit into the treatment of schizophrenia?
“ECT may be used in severely impaired adolescents if medications are not effective or cannot be tolerated.”
How are substance/medication-induced psychotic disorders differentiated from primary psychotic disorders?
“They are distinguished by the timing of symptom onset and the presence of substance exposure.”
What is the hallmark feature of substance/medication-induced psychotic disorder?
“Delusions and hallucinations develop within the context of substance or medication exposure.”
What is the prevalence of substance/medication-induced psychotic disorder in individuals with a first episode of psychosis?
“It is estimated that 7–25% of individuals with a first episode of psychosis meet criteria for this diagnosis.”
How is psychosis due to another medical condition diagnosed?
“It is diagnosed through evidence from history
What is the role of anticonvulsant treatment in psychosis associated with epilepsy?
“Anticonvulsants are the primary treatment
What is the primary difference between ictal, interictal, and postictal psychosis in epilepsy?
“Ictal psychosis occurs during nonconvulsive status epilepticus
What is catatonia?
Catatonia is a syndrome characterized by psychomotor features, including decreased purposeful motor activity, decreased engagement in interviews and physical exams, or excessive and peculiar motor activity. Key symptoms are waxy flexibility and bizarre poses, but these may not always be present.
Which conditions can catatonia be associated with in children and adolescents?
Catatonia can be associated with psychotic, affective, drug-related, autoimmune, encephalitic, and neurodevelopmental conditions, including autoimmune encephalitis and autism (autism shutdown syndrome).
What is the most common etiology of catatonia in children?
Autoimmune encephalitis is considered the most common etiology of catatonia in childhood.
What is the pathophysiology of catatonia?
The exact pathophysiology of catatonia is unknown, but neuroanatomic, neuroendocrine, immunologic, and neurotransmitter-based theories have been proposed.
What is the prevalence of catatonia in pediatric populations?
Pediatric prevalence rates range from 0.6–17% in child psychiatric inpatients and up to 17% in medically hospitalized children.
What are the three presentation categories of catatonia?
The three presentation categories of catatonia are stuporous, excited, and malignant.
How does stuporous catatonia present?
Stuporous catatonia is characterized by immobility, mutism, staring, and rigidity.
What characterizes excited catatonia?
Excited catatonia involves prolonged periods of psychomotor agitation.
What is malignant catatonia, and why is it emergent?
Malignant catatonia is characterized by hyperthermia, hypertension, rhabdomyolysis, and psychomotor agitation in addition to psychiatric and motor symptoms. It is an emergent condition.
How can catatonia severity be measured?
The severity of catatonia symptoms can be measured using the Bush-Francis Catatonia Rating Scale, which includes a standardized physical examination and observation of patient behavior.
How is catatonia treated pharmacologically?
Benzodiazepines, especially lorazepam, are the first-line pharmacological treatment for catatonia. A lorazepam challenge test may be used to confirm the diagnosis, where a positive response indicates improvement or resolution of symptoms.
What is the role of antipsychotics in treating catatonia?
The use of antipsychotics in catatonia is controversial, as they are associated with an increased risk of malignant catatonia or neuroleptic malignant syndrome.
What is the role of electroconvulsive therapy (ECT) in treating catatonia?
ECT is used in cases of refractory catatonia, especially when other treatment options are ineffective or cannot be safely administered.
What are the DSM-5 criteria for catatonia due to another medical condition?
The DSM-5 criteria include having at least three symptoms from a list, such as stupor, catalepsy, waxy flexibility, mutism, and others, with evidence that the condition is a direct result of another medical condition, and the disturbance not being better explained by another mental disorder.
Which symptoms are included in the DSM-5 criteria for catatonia?
Symptoms include stupor, catalepsy, waxy flexibility, mutism, negativism, posturing, mannerism, stereotypy, agitation, grimacing, echolalia, and echopraxia.
What is the diagnostic approach to catatonia?
The diagnostic approach involves searching for the underlying cause of catatonia and monitoring its potentially dangerous effects on the body.
Why is morbidity and mortality high in individuals with catatonia?
Morbidity and mortality are high due to the severity of the underlying illnesses that often cause catatonia, especially in cases involving schizophrenia or other serious conditions.
Why is catatonia underdiagnosed in pediatric populations?
Catatonia is often underdiagnosed in pediatric populations, making it difficult to accurately determine prevalence rates.
What are hallucinations?
Hallucinations are perceptions that occur in the absence of identifiable external stimuli.
What are nondiagnostic hallucinations?
Nondiagnostic hallucinations are those that are part of normal human experience, such as hearing footsteps, knocking, or one’s name being called.
What are hypnogogic and hypnopompic hallucinations?
Hypnogogic hallucinations occur as one transitions into sleep, and hypnopompic hallucinations occur as one wakes up. These types of hallucinations carry no psychopathologic implications.
Why might children experience hallucinations?
In younger children, hallucinations may reflect a developmentally appropriate blurring between fantasy and reality, especially concerning dreams and imaginary friends.
What is the first clinical task when evaluating a child who reports hallucinations?
The first clinical task is to differentiate hallucinations associated with severe mental illness from those caused by other factors, such as developmental or environmental influences.
What are acute phobic hallucinations?
Acute phobic hallucinations are benign, common in preschool children, often visual or tactile, and last 10-60 minutes. They often occur at night and involve fears such as bugs or snakes crawling on the child.
What is the typical course of acute phobic hallucinations?
These hallucinations can last 1-3 days, gradually abating over 1-2 weeks, with the child being frightened but showing no other abnormal findings on examination.
What is the difference between nonpsychotic hallucinations and psychotic hallucinations?
Nonpsychotic hallucinations occur without other symptoms of psychosis, often in response to severe stress, developmental issues, or cultural beliefs, whereas psychotic hallucinations are associated with more severe mental illness.
How might trauma-related hallucinations present in children?
Trauma-related hallucinations are often associated with posttraumatic stress disorder (PTSD) and may represent flashbacks to traumatic events.
What role do cultural beliefs play in childhood hallucinations?
Cultural beliefs in mysticism or other supernatural phenomena may contribute to nonpsychotic hallucinations in children, influencing how they interpret their experiences.
What type of hallucinations are associated with depression in children?
Auditory hallucinations involving voices invoking suicide are often associated with depression in children.
How are disruptive behavior disorders related to hallucinations in children?
Auditory hallucinations of voices telling children to do ‘bad things’ may be associated with disruptive behavior disorders, often in an unconscious attempt to distance from undesirable behaviors.
What is the significance of the content of a child’s hallucinations?
The content of the hallucinations is important for understanding the underlying psychopathology or developmental issues, such as trauma, depression, or behavior disorders.
What is the treatment approach for children with nonpsychotic hallucinations?
Treatment often involves disorder-specific psychotherapy, such as cognitive-behavioral therapy (CBT) to help the child understand the origin of the hallucinations and develop coping strategies for stressful situations.
How might CBT be useful for older children and adolescents with hallucinations?
Cognitive-behavioral therapy can help older children and adolescents understand the origin of their hallucinations and develop coping strategies for dealing with stressful situations.
