Psychosis in Children & Adolescents

Question 1

What is child psychosis?

Answer 1

Children under 12 yrs who experience psychotic symptoms described as:

• disorganisation/ gross disturbance of thought form or speech, thought content or behaviour (-ve symptoms)
• extreme negativism
• hallucinations & delusions (organic/ medical/neurological conditions ruled out)

Question 2

What are the disorders in which psychotic symptoms may be present? (5)

Answer 2

• schizophrenia
• schizoaffective disorders
• depression
• bipolar disorder
• severe anxiety

Question 3

What are the most common psychotic disorders and when is the peak onset?

Answer 3

• Schizophrenia & bipolar disorder

- Adolescence

Question 4

Problem: distinguishing true psychotic phenomena from…

Answer 4

• nonpsychotic idiosyncratic thinking
• perceptions caused by developmental delays
• exposure to disturbing and traumatic events
• overactive and vivid imaginations

Question 5

What are the known causes of schizophrenia?

Answer 5

• genetic factors (through family, twin & adoption studies)
• environmental exposures
  - paternal age
  - in utero exposure to
  maternal famine

Question 6

What are the signs of a psychotic disorder? (9)

Answer 6

• changes in behaviour
• social withdrawal
• loss of energy or motivation & increased apathy
• probs with memory and concentration
• deterioration in work or study
• lack of attention to personal hygeine
• confused speech or difficulty communicationg
• suspiciousness
• sleep/ appetite disturbances

Question 7

What is early-onset schizophrenia? And what characterizes it?

Answer 7

Schizophrenia with onset prior to 18 years of age

- hallucinations and delusions which can result in incoherent speech and problems in behaviour

Question 8

What is schizophrenia with onset between ages 13 and 18?

Answer 8

Adolescent-onset schizophrenia

Question 9

What are other symptoms of children with schizophrenia?

Answer 9

• social isolation
• poor self-care
• blunted affect

Question 10

What is ‘blunted affect’?

Answer 10

a reduction in the intensity of an individual’s emotional response

e.g. giving a detailed account of an emotionally charged memory but show no emotions

Question 11

What is Schizoaffective disorder?

Diagnosis?

Answer 11

A disorder characterized by both:

• symptoms of mood disorders (mania + depression) and
• symptoms of schizophrenia (hallucinations + delusions)

For at least 2 weeks during course of illness: no mood symptoms and only psychotic symptoms

Question 12

What is the difference between schizoaffective disorder and bipolar disorder?

Answer 12

Schizoaffective disorder is a mood disorder combined with separate psychotic symptoms not associated to mania & depression
Bipolar disorder is strictly a mood disorder (psychotic symtoms occur DURING manic/ depressive episodes)

Question 13

What is schizophreniform disorder?

Answer 13

symptoms of schizophrenia of short duration (1-6 months)

generally evolves into either schizophrenia or schizoaffective disorder

Question 14

What is Delusional disorder?

Age of onset?

Answer 14

Characterized by delusions (fixed, false beliefs) which have occurred for one month or longer

• 18-80 with mean onset 34-35 therefore not likely seen in children and younger adolescents

Question 15

What is the difference between Delusional disorder and Schizophrenia?

Answer 15

In delusional disorder:

• no deterioration in most areas of functioning
• behaviour typically not odd or bizarre

Question 16

What is Brief Psychotic Disorder? (2)

Age of onset?

Answer 16

• psychotic symptoms for at least 1 day - 1 month
• eventual full return to prior levels of functioning
• most commonly late 20’s/ early 30’s but can occur in children

Question 17

What is Delirium?

Answer 17

A neuropsychiatric condition associated with an acute confusional state secondary to a medical condition/ medications

Question 18

What are the psyciahtric differential diagnosis for schizophrenia (7)

Answer 18

1. psychotic disorder due to a general medical condition
2. bipolar disorder
3. MDD with psychotic features
4. Schizoaffective disorder
5. PTSD
6. OCD
7. Pervasive developmental disorders

Question 19

What are the psychosocial differential diagnosis for schizophrenia? (4)

Answer 19

1. Abuse
2. Traumatic stress
3. Chaotic family environments
4. Medical Disorders

Question 20

What medical treatment is usually prescribed for schizophrenia? (3)

Answer 20

Anti-psychotics:

• aripiprazole
• quetiapine
• risperidone

Question 21

What are the interventions for patients with schizophrenia? (2)

And for youth? (8)

Answer 21

• interventions for biopsychosocial stressors and developmental stages associated with the illness
• referral to child psychiatrist

1- comprehensive community programmes
2- medications
3- psychotherapy
4- case management
5- family support
6- vocational and rehabilitative assistance
7- specialized educational programs
8- inpatient treatment and/or residential treatment

Question 22

Issues important to assess: (3)

Answer 22

1- risk factors for psychosis

  a. family history
  b. other psychiatric disorders
  c. substance abuse
  d. trauma
  e. psychosocial adversity 2. functional impairment 3. medical and family history

Question 23

What are some important diagnostic issues? (3)

Answer 23

1. Misdiagnosis of primary psychotic symptoms is a concern bcoz children often have difficulty describing psychotic symptoms therefore
2. some psychotic symptoms may be transient - there is a high prevalence of psychotic symptoms in child psychiatric disorders other than in early onset of schizophrenia
3. it is v. imp to recognize Early-Onset of Schizophrenia otherwise it would slow the implementation of appropriate treatment and worsen long term prognosis