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POST # 1 NGOZY
Presenting Characteristics and Manifestations of Psychosis among Adolescents and Children
Psychosis is the third most disabling condition worldwide in youth. Evaluation of children who present with a psychotic episode requires the clinician to understand the broad range of causes and the criteria used to differentiate primary psychotic disorders, other psychiatric and non-psychiatric illnesses, and drug effects (Yearwood et al., 2012). The most common manifestations in young people with psychosis are hallucinations, impaired functioning, flattened affect, and social withdrawal. Caregivers are more likely than the child patients themselves to report these problems to the clinician, as children often minimize, misinterpret, or avoid mentioning their symptoms. Hence, a comprehensive psychiatric assessment should include interviews with the child and his or her family members, review of records, information gathered from other involved adults, including a detailed description of the presentation and course of the psychotic symptoms, attention to developmental delays, a family psychiatric history, a history of abuse and/or neglect, and a mental status examination. Unlike adults, children with psychosis rarely demonstrate waxy flexibility or become catatonic. On the other hand, they can be emotionally reactive or agitated (Yearwood et al., 2012).
The majority of children with childhood-onset schizophrenia often exhibit “soft” neurologic signs, including primitive reflexes, abnormal stereognosis, 2-point discrimination, and dysdiadochokinesia (impaired rapid alternating movements). Affected youth may manifest either a decreased or increased rate of eye blinking, as well as paroxysmal saccadic eye movements (inability to follow an object with smooth eye movements) (Stevens et al., 2017). In children and adolescents, psychosis is characterized by overt disruptions in thought, perceptions, and behavior. Complex syndromes presenting with psychosis, including schizophrenia spectrum disorders, mood disorders, and medical illnesses, are differentiated by characteristic patterns of symptom presentation and course of illness. Accurate diagnosis is important to guide treatment and to avoid inaccurate labeling, because most youth reporting psychotic-like experiences do not have a true psychotic disorder (McClellan, 2018).
References
McClellan, J. (2018). Psychosis in Children and Adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 57(2), 308–312.
Stevens, J. R., Prince, J. B., Prager, L. M., & Sterns, T. A. (20176). Psychotic Disorders in Children and Adolescents: A Primer on Contemporary Evaluation and Management. The primary care companion for CNS disorders, 6(2), 1–10.
Yearwood, E., P, G. S., Pearson, & Newland, J. A. (2012). Child and Adolescent Behavioral Health (2nd ed.). Sussex, UK: Wiley Blackwell.
RESOURCES
For additional background information on psychotic disorders in adolescents and children, review the following resources:
· Online resources such as NAMI (National Alliance in Mental Illness) and SAMHSA (Substance Abuse and Mental Health Services Administration). For instance, NAMI is one of the appropriate and essential resources that provide valuable information on mental health conditions including psychotic disorders. Review this resource by accessing https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions .
· SAMHSA is another useful resource that provides crucial and valuable information related to mental health disorders. Review this resource by accessing https://www.samhsa.gov/ .
You may also review the following articles .
· 1) Young children with psychotic symptoms and risk for suicidal thoughts and behaviors: a research note Keneisha Sinclair-McBride, Nicholas Morelli, Sahil Tembulkar, Kelsey Graber, Joseph Gonzalez-Heydrich, & Eugene J. D’Angelo. (2018). Young children with psychotic symptoms and risk for suicidal thoughts and behaviors: a research note. BMC Research Notes, 11(1), 1–5. https://doi.org/10.1186/s13104-018-3680-3
· 2) Psychotic Disorders in Children and Adolescents: A Primer on Contemporary Evaluation and Management Stevens, J. R., Prince, J. B., Prager, L. M., & Stern, T. A. (2014). Psychotic disorders in children and adolescents: a primer on contemporary evaluation and management. The primary care companion for CNS disorders, 16(2), PCC.13f01514. https://doi.org/10.4088/PCC.13f01514
· 3) Evaluation and Treatment of Children and Adolescents with Psychotic Symptoms
· Algon, S., Yi, J., Calkins, M. E., Kohler, C., & Borgmann-Winter, K. E. (2012). Evaluation and treatment of children and adolescents with psychotic symptoms. Current psychiatry reports, 14(2), 101–110. https://doi.org/10.1007/s11920-012-0258-y
· 4) Medical evaluation of psychotic symptoms in children and adolescents: Key approaches.