Presenting Characteristics and Manifestations of Psychosis among Adolescents and Children
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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).