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Redalyc.Child and Adolescent Psychosis Salud Mental ISSN: 0185-3325 [email protected] Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz México Ulloa, Rosa Elena; Apiquian, Rogelio; Fresán, Ana; Peña, Francisco de la Child and adolescent psychosis: A review of characteristics and treatment Salud Mental, vol. 23, núm. 4, agosto, 2000, pp. 1-9 Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz Distrito Federal, México Available in: http://www.redalyc.org/articulo.oa?id=58242301 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative Child and adolescent psychosis: A review of characteristics and treatment Rosa Elena Ulloa* Rogelio Apiquian** Ana Fresán** Francisco de la Peña*** Summary diatric patients with symptoms of psychosis were historically classified as schizophrenics, but now it is A revision of the characteristics of psychotic symptoms in becoming apparent that a variety of illnesses may children and adolescents such as hallucinations, delusions and underlie to this syndrome. Common manifestations of thought disorders is presented. Assessment of a psychotic child or adolescent must include a complete physical examination psychosis include hallucinations, delusions, and severe and interviews with family and collaborative sources. disturbances of thinking and behavior, with significant Differential diagnoses of psychosis in this age include impairment in reality testing. The prevalence of schizophrenia, mood, dissociative and pervasive develop- psychosis in community samples of children and ado- mental disorders. Psychotic manifestations in young patients lescents is around 1% (42). are influenced by developmental stage, and their treatment involves interventions in all spheres. Studies with typical and atypical antipsychotics for the treatment of different conditions are revisited. Clinical manifestations of psychosis Key words: Children, adolescents, psychosis, diagnoses, Hallucinations treatment. The hallucinatory experience has been defined as a Resumen “false sensory perception not associated with real external stimuli” (33). Hallucinations may involve any En este artículo se presenta una revisión de las característi- of the senses and must be distinguished from vivid cas de los síntomas psicóticos en niños y adolescentes, tales como: alucinaciones, delirios y los trastornos del pensamien- imagery, fantasy productions and imaginary com- to. La evaluación de un niño o adolescente psicótico debe panions. incluir un examen físico completo y una entrevista con la fa- Hallucinations in children can resemble hallucinations milia u otras fuentes de información. El diagnóstico diferen- in adults: Auditory hallucinations can be insulting or cial de psicosis a esta edad incluye: esquizofrenia, trastornos del estado del ánimo, trastornos disociativos y trastornos del ordering voices, or be many voices talking about the desarrollo. Las manifestaciones psicóticas en los pacientes subject. The context of the visual hallucinations jóvenes están influenciadas por el neurodesarrollo, y en su comprised people, but most children reported seeing tratamiento debe abarcarse todas las esferas. Se exponen, monsters (12). Age affects appearance and content of también, los estudios con antipsicóticos típicos y atípicos para hallucinations: they seem to be rare in children younger el tratamiento de las diferentes condiciones. than 6 or 7 years of age (22,35,37). Palabras clave: Niños, adolescentes, psicosis, diagnóstico, In young children, the sources of the auditory tratamiento. hallucinations are often animals (49). If a voice is identified, children younger than 11 years old usually Definition of psychosis identify it as a relatives voice (35). Adolescents present hallucinations with similar contents to those of adults’. In children and adolescents, as well as in adults, psy- Developmental issues could also be related to the chosis is not defined as a precise disease. Many pe- localization of hallucinations in space, emphasizing the shift form an internal to an external location of voices with age. * Departamento de Farmacología, CINVESTAV. Instituto Politécni- The presence or visual or tactile hallucination without co Nacional. Calz. de los Tenorios 235, Granjas Coapa. Tlalpan, 14330 México, D.F. corresponding auditory hallucinations is a strong ** División de Investigaciones Clínicas, Instituto Nacional de Psi- indicator of organicity (42). Although schizophrenic quiatría. Ramón de la Fuente. children report visual hallucinations in 30% of the ca- *** División de Servicios Clinicos, Clínica de Adolescentes. Institu- ses and tactile hallucinations in 17%, usually they to Nacional de Psiquiatría. Ramón de la Fuente. accompany auditory hallucinations (49). Recibido primera versión: 6 de marzo de 2000. Recibido segunda versión: 30 de junio de 2000. Hallucinations may result from electrical discharges Aceptado: 7 de julio de 2000. in the temporal cortex, amygdala, or hippocampus, or Salud Mental V. 23, No. 4, agosto del 2000 1 may be caused by medications, like pseudoephedrine speech content, echolalia and others (4). The term and methylphenidate (56). “thought disorder” was recently changed to “disorga- In order to be sure that the phenomenon is really an nized speech” in DSM-IV (2). hallucination, while examining a child, it is convenient The explanations for the origin of thought disorder to ask if he is certain that whatever he perceives is include developmental, linguistic/pragmatic, cognitive actually present, if the origin of the hallucinations is and biological perspectives. outside of his internal world and if he cannot make the The findings that children with complex partial seizure voices or the images come and go at will (44). disorder and EEG evidence for frontotemporal Hallucinations are the positive symptoms most involvement have significantly higher illogical thinking commonly seen in schizophrenia. Auditory hallucinations than those without frontal involvement, suggest that are consistently described in about 80% of schizoph- illogical thinking in childhood may reflect frontal lobe renic children (28,37,49). dysfunction (15). As for mood disorders, it has been observed that Formal thought disorder in children occurs in three nearly 45% of prepubertal children with major main nosological categories: psychotic disorders depression report hallucinations (17,51) and 81% of the (schizophrenia, mania, psychotic depression, organic diagnosed auditory hallucinations are mood congruent psychosis and psychotic disorders not otherwise (17) hallucinations often present in prepuberal children specified), personality disorders and developmental with major depressive disorder. disorder. Delusions Affective disturbances A delusion is the belief in something that appears quite Affective disturbances accompany psychotic symptoms false (and sometimes bizarre) to others of the same in many disorders. For example: a flat or blunted affect cultural, social, and religious group, for which there is is a negative symptom of schizophrenia (3,42). Also, a no logical argument or evidence against it. depressed child may present sad affect, poor eye Few studies have objectively studied delusions in contact, psychomotor retardation, and irritability (42). children. They are occasionally mentioned as concomi- Table 1 shows the main psychotic symptoms seen in tant to hallucinations (8), and it has been found that psychotic children. their prevalence is relatively low in childhood and early adolescence (approximately half the recorded rate of Assessment of a psychotic child hallucinations). Few hypotheses have been held to explain the A complete evaluation and assessment of a child or neurobiological origin of delusions. These ideas are adolescent presenting psychotic symptoms is essential almost always based on the positive symptoms of (table 2). The patient’s complete personal and family schizophrenia which have been attributed by some history should be considered as well as the onset and authors to frontal cortex, limbic and diencephalic course of any symptoms documented by family pathology (57). members, friends, caregivers, teachers and others. Also, Delusions are found in about 60% of the children with a complete physical examination including extensive schizophrenia. The content of delusions in children and laboratory tests is needed in order to consider the broad adolescents is similar to that found in adults (28,38,50). range of medical concerns in children and adolescents. Delusions, as well as hallucinations, become more elaborate and complex with age. Children below age Several structured or semistructured interviews have 10 present delusions concerning loss of identity (they been designed for assessing the symptoms and making identify themselves as other persons, animals, or diagnoses of the different psychotic disorders. The three objects) and irrational diffuse fears, often involving best known and most suitable are the Schedule for cosmic threats. In children of 10 to 14 years, delusions Affective Disorders and Schizophrenia for School Age become more systematized and resemble those of Children (K-SADS) (34); the Diagnostic Interview for adults, with the appearance of paranoid, somatic, and religious themes (21,22). Chambers (17) reported TABLE 1 delusions of control, persecution or sin in children Frequent symptoms in psychotic children
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