Copyright © The REACH Institute. All rights reserved. Psychosis

Copyright © The REACH Institute. All rights reserved.

Psychosis

http://www.thereachinstitute.org/


Learning Objectives

• Differentiate among psychosis and other pediatric behavioral health problems with psychotic features

• List cognitive symptoms of psychosis

• Describe treatment options and clinical recommendations when selecting and using medications for psychosis


What is Psychosis?

• Severely disrupted thought & behavior resulting in loss of developmentally appropriate reality testing

• Overt changes in function, w/evidence of disrupted thinking on mental status exam

• Psychotic symptoms - characteristic of schizophrenia, but do occur in other illnesses, e.g.:– mood disorders– neurologic conditions– acute intoxication


Epidemiology of Psychosis in Children and Adolescents

Epidemiology of Psychosis in Children and Adolescents

• Children < 12 years old– Schizophrenia is very, very rare – Consider non psychiatric causes, MDD with

psychotic features, bipolar disorder, severe PTSD, or other potential ideologies

• Adolescents 13-17 years old– Schizophrenia = 0.3-0.5 percent– Same considerations as above

• Adults > 18 years old– Schizophrenia = about 1%


Medical Causes of PsychosisMedical Causes of Psychosis

• CNS infections• Delirium• Neoplasms• Endocrine disorders• Genetic syndromes

– (e.g., velocardiofacial [22q11] syndrome)• Autoimmune disorders• Toxins


Substances That May Cause Psychosis

Substances That May Cause Psychosis

• Dextromethorphan, LSD, hallucinogenic mushrooms (e.g., psilocybin, peyote), MJ, stimulants, inhalants

• Steroids, anesthetics, anticholinergics, antihistamines, amphetamines

• Acute psychosis due to intoxication usually remits within days to weeks after substance is D/C’ed

• Sometimes schizophrenia (and/or unresolved psychosis) first presents after substance ingestion


Symptoms That May Seem Psychotic in Children

Symptoms That May Seem Psychotic in Children

• Illusions: Sounds and visualizations at night often associated with anxiety

• “Voices”: Often a single voice telling the child to do something “bad”

• Imaginary Friends

• Fantasy: In young, cognitively-delayed or language-delayed child


Core Cognitive Symptoms of Psychosis in Children & YouthCore Cognitive Symptoms of

Psychosis in Children & YouthDelusions

Ideas of reference Belief of be persecuted or controlled

Hallucinations Usually auditory, threatening voices giving

comments, laughing , humming Visual hallucinations appear more common in

children under age 13

Thought Distortions Breaks in the train of thought – so-called

“private logic” Incoherent vague thoughts


Asking kids about psychosis• Things to say & ask: “Lots of times kids hear or see

weird, funny, or even scary things they aren’t sure are real…” – “Does your mind ever play tricks like that on you?” – “Do you hear voices talking to you when no one is there?” – “Does your mind ever feel confused”

• Youth can often describe relevant aspects of their psychotic symptoms, but some are too disorganized, confused, and/or paranoid to give accurate details or hx

• Parents, family members, teachers, and treatment providers are important sources of information for identifying changes in behavior, thinking, or function


Evaluation of Psychosis

• Core Symptoms• Impairment and Function• Drug Toxicology Screen• R/O CNS Lesion (MRI)• R/O Other Medical Conditions


Psychosis Treatment: Acute Psychosis Treatment: Acute

• Referral for emergency/crisis care, if needed• Referral for psychiatric consultation, if

possible• Use of antipsychotic medication, as needed• FDA approved for schizophrenia (ages 13-17

y.o.)– Aripiprazole (Abilify)– Risperidone (Risperdal)– Olanzapine (Zyprexa)– Quetiapine (Seroquel)


Psychosis Treatment: Chronic

• Patients in your practice– Schizophrenia– Other disorders with psychotic symptoms

• Identification and management of adverse effects– Coming up next!


Q&A

Ask The Experts

Q&A

Ask The Experts


REMINDER: Please fill out Unit M

evaluation


RESOURCE SLIDE:Psychiatric Disorders other than Schizophrenia

that may present with psychotic symptoms

• Schizoaffective disorder

– psychotic symptoms plus prominent mood episodes (meeting full criteria for mania or depression) that are present for a substantial duration of the illness

• Psychotic mood disorders (especially bipolar disorder)

– Full-blown mania in teenagers often presents with florid psychosis, including hallucinations, delusions, and thought disorder

– Psychotic depression may present with hallucinations or delusions

• PTSD and or abused youth are esp. vulnerable to report psychotic-like symptoms - dissociation and/or anxiety, intrusive thoughts/worries, derealization, depersonalization, etc.


RESOURCE SLIDE:Emergency Medication for

Psychosis

• Olanzapine orally disintegrating Tabs (Zydis)– 5-10 mg PO once prn

• Risperdal M-Tabs– 1-2 mg PO once pm

• Ziprasidone IM– 10-20 mg IM once prn

Documents

Copyright © The REACH Institute. All rights reserved. Psychosis