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Psychotic Disorders in Children (Management (Medical Cause: Find and Treat…
Psychotic Disorders in Children
Prevalence
Childhood -onset schizophrenia: 1 in 10 000
Definition
Same as Adult: Loss of Reality testing,abnormal mental functioning and alteredl mood/affect.
Schizophrenia usually diagnosed → 18 -35 years
Early-onset or adolescent onset schizophrenia → 13-18 years
Early-onset Schizophrenia → poor prognosis
Psychiatric Conditions associated with psychotic episode in Children and adolescents
Alcohol intox/withdrawal
ADHD
Autism Spectrum disorders
Bipolar
Brief reactive psychosis
Cataonia
Delerium
Delusional Disorders
Factitious Disorders
MDD
OCD
Parasomnias
PTSD
Schizoaffective Disorders
Schizophrenia
Schizophreniform Disorders
Severe Stress
Also rule out: Medical Disorders, CNS lesions, traumatic Injury
Psychotic symptoms in children more likely to be:
* MD, Bipolar, dissociative states
Clinical Features
Hallucinations
Impaired Functioning
Flattened Affect
Social Withdrawal
Prodrome:
Nonspecific,Irregular/unusal, social and cognitive development
Diagnosis
Disitinguish between first episode and secondary Episode
First Episode
Demarcation between prodromal and frank psychosis
As for Adult Schizophrenia
1. 2/more active for at least a month:
Hallucinations
Delusions
Disorganised Speech
Disorganised/catatonic behaviour
Negative Symptoms
2. With for period of 6 months
Functional Imparments
Continued Dysfunction
Not explained by any other disorder/disturbance
Factor in Biospychosocial Model
Investigations
FBC, LFT, UEC, Electrolytes, TFT
Tox- screen
EEG,MRI/CT
Etiology
Genetic
Behavioral
Environmental
Mechanisims
Neurodevelopment Theory
Combo of
genetic
risk and
acquired damage
Become evident during
pruning
( late teens and early 20's)
Management
Medical Cause: Find and Treat
Psychological: CBT
Social: Psycho education, environment alteration
Biological: Pharmacotherapy:
Atypical and typical ( refer to Pediatric Psychiatrist)
Arpiprazole (Ambilify)
Lurasidone ( Latuda)
Clozapine ( Clorazil)
Olanzipine (Zyprexa)
Quetiapine (Seroquel)
Rispiridone (Risperdal)
