Top

Published in:

01-04-2012 | CHILD AND ADOLESCENT DISORDERS (TD BENTON, SECTION EDITOR)

Evaluation and Treatment of Children and Adolescents With Psychotic Symptoms

Authors: Sibel Algon, James Yi, Monica E. Calkins, Christian Kohler, Karin E. Borgmann-Winter

Published in: Current Psychiatry Reports | Issue 2/2012

Abstract

In recent years, there have been increasing efforts to develop early detection and prevention strategies for patients at risk of the development of psychotic disorders. These efforts have led to improved recognition and characterization of psychotic symptoms in youth. This review focuses on the evaluation of children and adolescents with psychotic symptoms who are experiencing functional impairment but who do not meet current criteria for schizophrenia. For this article, emphasis is placed on the evaluation of symptoms, differential diagnosis, and consideration of potential interventions.

Gearing, R. E. Evidence-based family psychoeducational interventions for children and adolescents with psychotic disorders. J Can Acad Child Adolesc Psychiatry. 2008;17(1).

• Masi G, Liboni F. Management of schizophrenia in children and adolescents: focus on pharmacotherapy. Drugs. 2011;71(2):179–208. In this systematic review, the authors offer a comprehensive overview of available literature on pharmacologic interventions for childhood-onset schizophrenia. The authors summarize limitations in several aspects of current pharmacotherapy, including low effect size, high rates of adverse effects, and low rates of remission. They highlight the need for further research with both randomized, placebo-controlled studies and long-term, naturalistic follow-up of large samples of patients with different age ranges. PubMedCrossRef

Simon AE, et al. Defining subjects at risk for psychosis: a comparison of two approaches. Schizophr Res. 2006;81(1):83–90.PubMedCrossRef

Miller TJ, et al. Prospective diagnosis of the initial prodrome for schizophrenia based on the Structured Interview for Prodromal Syndromes: preliminary evidence of interrater reliability and predictive validity. Am J Psychiatry. 2002;159(5):863–5.PubMedCrossRef

Klosterkotter J, et al. Diagnosing schizophrenia in the initial prodromal phase. Arch Gen Psychiatry. 2001;58(2):158–64.PubMedCrossRef

Miller TJ, et al. Prodromal assessment with the structured interview for prodromal syndromes and the scale of prodromal symptoms: predictive validity, interrater reliability, and training to reliability. Schizophr Bull. 2003;29(4):703–15.PubMedCrossRef

Borgmann-Winter K, et al. Assessment of adolescents at risk for psychosis. Curr Psychiatry Rep. 2006;8(4):313–21.PubMedCrossRef

Sachdev P. Schizophrenia-like psychosis and epilepsy: the status of the association. Am J Psychiatry. 1998;155(3):325–36.PubMed

Lax Pericall MT, Taylor E. Psychosis and epilepsy in young people. Epilepsy Behav. 2010;18(4):450–4.PubMedCrossRef

10.

Yu HH, et al. Neuropsychiatric manifestations in pediatric systemic lupus erythematosus: a 20-year study. Lupus. 2006;15(10):651–7.PubMedCrossRef

11.

Bismilla Z, Sell E, Donner E. Hashimoto encephalopathy responding to risperidone. J Child Neurol. 2007;22(7):855–7.PubMedCrossRef

12.

Arrojo M, et al. Psychiatric presentation of Hashimoto’s encephalopathy. Psychosom Med. 2007;69(2):200–1.PubMedCrossRef

13.

Benvenga S, Lapa D, Trimarchi F. Don’t forget the thyroid in the etiology of psychoses. Am J Med. 2003;115(2):159–60.PubMedCrossRef

14.

Dalmau J, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol. 2008;7(12):1091.PubMedCrossRef

15.

Florance NR, et al. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children and adolescents. Ann Neurol. 2009;66:11.PubMedCrossRef

16.

Fenton KA. Changing epidemiology of HIV/AIDS in the United States: implications for enhancing and promoting HIV testing strategies. Clin Infect Dis. 2007;45:S213.PubMedCrossRef

17.

Maling S, et al. HIV-1 seroprevalence and risk factors for HIV infection among first-time psychiatric admissions in Uganda. AIDS Care. 2011;23(2):171–8.PubMedCrossRef

18.

Scharko AM. DSM psychiatric disorders in the context of pediatric HIV/AIDS. AIDS Care. 2006;18(5):441–5.PubMedCrossRef

19.

Misdrahi D, et al. DSM-IV mental disorders and neurological complications in children and adolescents with human immunodeficiency virus type 1 infection (HIV-1). Eur Psychiatry. 2004;19(3):182–4.PubMedCrossRef

20.

Carman JS, Wyatt RJ. Calcium: pacesetting the periodic psychoses. Am J Psychiatry. 1979;136(8):1035–9.PubMed

21.

Ang AW, Ko SM, Tan CH. Calcium, magnesium, and psychotic symptoms in a girl with idiopathic hypoparathyroidism. Psychosom Med. 1995;57(3):299–302.PubMed

22.

Hershko C, et al. Lead poisoning in a West Bank Arab Village. Arch Intern Med. 1984;144(10):1969–73.PubMedCrossRef

23.

McCracken JT. Lead intoxication psychosis in an adolescent. J Am Acad Child Adolesc Psychiatry. 1987;26(2):274–6.PubMedCrossRef

24.

Hancu A, Mihai MC, Axelerad AD. Wilson’s disease: a challenging diagnosis. Clinical manifestations and diagnostic procedures in 12 patients. Rev Med Chir Soc Med Nat Iasi. 2011;115(1):58–63.PubMed

25.

Dening TR, Berrios GE. Wilson’s disease. Psychiatric symptoms in 195 cases. Arch Gen Psychiatry. 1989;46(12):1126–34.PubMedCrossRef

26.

Rahman A, et al. Zinc, manganese, calcium, copper, and cadmium level in scalp hair samples of schizophrenic patients. Biol Trace Elem Res. 2009;127(2):102–8.PubMedCrossRef

27.

Lauterbach MD, Stanislawski-Zygaj AL, Benjamin S. The differential diagnosis of childhood- and young adult-onset disorders that include psychosis. J Neuropsychiatry Clin Neurosci. 2008;20(4):409.PubMedCrossRef

28.

Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings, in NSDUH Series H-41, HHS Publication No. (SMA) 11-4658, S.A.a.M.H.S. Administration, Editor. 2011: Rockville, MD.

29.

Veen ND, et al. Cannabis use and age at onset of schizophrenia. Am J Psychiatry. 2004;161(3):501–6.PubMedCrossRef

30.

Dragt S, et al. Cannabis use and age at onset of symptoms in subjects at clinical high risk for psychosis. Acta Psychiatr Scand. 2012;125(1):45–53.PubMedCrossRef

31.

Curran C, Byrappa N, McBride A. Stimulant psychosis: systematic review. Br J Psychiatry. 2004;185:196–204.PubMedCrossRef

32.

Tome AM, Filipe A. Quinolones: review of psychiatric and neurological adverse reactions. Drug Saf. 2011;34(6):465–88.PubMedCrossRef

33.

Young CM, Findling RL. Pharmacologic treatment of adolescent and child schizophrenia. Expert Rev Neurother. 2004;4(1):53–60.PubMedCrossRef

34.

AACAP official action. Summary of the practice parameters for the assessment and treatment of children and adolescents with schizophrenia. American Academy of Child and Adolescent Psychiatry. J Am Acad Child Adolesc Psychiatry. 2000;39(12):1580–2.CrossRef

35.

Lubman DI, et al. Incidental radiological findings on brain magnetic resonance imaging in first-episode psychosis and chronic schizophrenia. Acta Psychiatr Scand. 2002;106:331.PubMedCrossRef

36.

Katzman GL, Dagher AP, Patronas NJ. Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers. JAMA. 1999;282(1):36–9.PubMedCrossRef

37.

Freudenreich O, et al. The evaluation and management of patients with first-episode schizophrenia: a selective, clinical review of diagnosis, treatment, and prognosis. Harv Rev Psychiatry. 2007;15(5):189–211.PubMedCrossRef

38.

Arseneault L, et al. Childhood trauma and children’s emerging psychotic symptoms: a genetically sensitive longitudinal cohort study. Am J Psychiatry. 2011;168(1):65–72.PubMedCrossRef

39.

Mazzoni P, et al. Childhood onset diagnoses in a case series of teens at clinical high risk for psychosis. J Child Adolesc Psychopharmacol. 2009;19(6):771–6.PubMedCrossRef

40.

Meyer SE, et al. The psychosis prodrome in adolescent patients viewed through the lens of DSM-IV. J Child Adolesc Psychopharmacol. 2005;15(3):434–51.PubMedCrossRef

41.

Velthorst E, et al. Baseline differences in clinical symptomatology between ultra high risk subjects with and without a transition to psychosis. Schizophr Res. 2009;109(1–3):60–5.PubMedCrossRef

42.

Woods SW, et al. Validity of the prodromal risk syndrome for first psychosis: findings from the North American Prodrome Longitudinal Study.[see comment]. Schizophr Bull. 2009;35(5):894–908.PubMedCrossRef

43.

Pavuluri M, Herbener E, Sweeney J. Psychotic symptoms in pediatric bipolar disorder. J Affect Disord. 2004;80:19–28.PubMedCrossRef

44.

Ulloa RE, et al. Psychosis in a pediatric mood and anxiety disorders clinic: phenomenology and correlates. J Am Acad Child Adolesc Psychiatry. 2000;39(3):337–45.PubMedCrossRef

45.

Calderoni D, et al. Differentiating childhood-onset schizophrenia from psychotic mood disorders. J Am Acad Child Adolesc Psychiatry. 2001;40(10):1190–6.PubMedCrossRef

46.

Biederman J, et al. Phenomenology of childhood psychosis: findings from a large sample of psychiatrically referred youth. J Nerv Ment Dis. 2004;192(9):607–14.PubMedCrossRef

47.

Norman RM, et al. The role of treatment delay in predicting 5-year outcomes in an early intervention program. Psychol Med. 2011;(Journal Article):1–11.

48.

Lappin JM, et al. Duration of untreated psychosis and neuropsychological function in first episode psychosis. Schizophr Res. 2007;95(1–3):103–10.PubMedCrossRef

49.

Perkins DO, et al. Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry. 2005;162(10):1785–804.PubMedCrossRef

50.

Malla AK, et al. Duration of untreated psychosis is associated with orbital-frontal grey matter volume reductions in first episode psychosis. Schizophr Res. 2011;125(1):13–20.PubMedCrossRef

51.

McGorry PD, et al. Intervention in individuals at ultra-high risk for psychosis: a review and future directions. J Clin Psychiatry. 2009;70(9):1206–12.PubMedCrossRef

52.

• Simon AE, et al. Ultra high-risk state for psychosis and non-transition: a systematic review. Schizophr Res. 2011;132(1):8–17. This systematic review summarizes available literature on outcomes of those identified as UHR. A total of 31 studies met the inclusion criteria, and on average, 76% (range, 46%–92.6%) of UHR patients made no transition to psychosis during a follow-up period (range, 6–40 months). Characteristics of those who did not transition were poorly investigated. The authors highlight the limited specificity of current UHR criteria and the need for more studies investigating the characteristics associated with nontransition versus transition. PubMedCrossRef

53.

Filakovic P, et al. Ethics of the early intervention in the treatment of schizophrenia. Psychiatr Danub. 2007;19(3):209–15.PubMed

54.

McGlashan TH. Psychosis treatment prior to psychosis onset: ethical issues. Schizophr Res. 2001;51(1):47–54.PubMedCrossRef

55.

Rabinovitch MB-EL, et al. Early predictors of nonadherence to antipsychotic therapy in first-episode psychosis. Can J Psychiatry. 2009;54(1):28.PubMed

56.

•• de Koning MB, et al. Early intervention in patients at ultra high risk of psychosis: benefits and risks. Acta Psychiatr Scand. 2009;119(6):426–42. In this paper, early interventions in patients at UHR for psychosis are reviewed. The authors compiled preliminary publications and unpublished data from the German Research Network on Schizophrenia. Patients from the Bechdolf et al. [58] (2007) cohort who received CBT were found less likely to convert to psychosis or develop a late prodromal state at 1-year follow-up than those who received supportive counseling. PubMedCrossRef

57.

Addington J, et al. A randomized controlled trial of cognitive behavioral therapy for individuals at clinical high risk of psychosis. Schizophr Res. 2011;125(1):54–61.PubMedCrossRef

58.

Bechdolf A, et al. Randomized controlled multicentre trial of cognitive behaviour therapy in the early initial prodromal state: effects on social adjustment post treatment. Early Interv Psychiatry. 2007;1(1):71–8.PubMedCrossRef

59.

French P, et al. Effects of cognitive therapy on the longitudinal development of psychotic experiences in people at high risk of developing psychosis. Br J Psychiatry Suppl. 2007;51:s82–7.PubMedCrossRef

60.

Poon MY, Siu AM, Ming SY. Outcome analysis of occupational therapy programme for persons with early psychosis. Work. 2010;37(1):65–70.PubMed

61.

Rietdijk J, et al. A single blind randomized controlled trial of cognitive behavioural therapy in a help-seeking population with an at risk mental state for psychosis: the Dutch Early Detection and Intervention Evaluation (EDIE-NL) trial. Trials. 2010;11:30.PubMedCrossRef

62.

• Yung AR, et al. Randomized controlled trial of interventions for young people at ultra high risk for psychosis: 6-month analysis. J Clin Psychiatry. 2011;72(4):430–40. The authors conducted a randomized controlled trial in youth at UHR for psychosis comparing CT plus low-dose risperidone with CT, supportive counseling, and a monitoring control condition. All treatment groups had improvements in measures of psychosis and depression, and no differences were found among groups. Declining transition rates, inadequate power, transition post-study, and a placebo effect in the monitoring control condition may explain these findings. PubMedCrossRef

63.

Morrison AP, et al. Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial. Br J Psychiatry. 2004;185:291–7.PubMedCrossRef

64.

Tucker P. Substance misuse and early psychosis. Australas Psychiatry. 2009;17(4):291–4.PubMedCrossRef

65.

Compton MT, et al. Pre-illness cannabis use and the early course of nonaffective psychotic disorders: associations with premorbid functioning, the prodrome, and mode of onset of psychosis. Schizophr Res. 2011;126(1–3):71–6.PubMedCrossRef

66.

Larson MK, Walker EF, Compton MT. Early signs, diagnosis and therapeutics of the prodromal phase of schizophrenia and related psychotic disorders. Expert Rev Neurother. 2010;10(8):1347–59.PubMedCrossRef

67.

•• Liu P, et al. An evidence map of interventions across premorbid, ultra-high risk and first episode phases of psychosis. Schizophr Res. 2010;123(1):37–44. The authors generated an evidence map of controlled trials, meta-analysis, and systematic reviews of biologic and psychosocial interventions in premorbid, UHR, and first-episode patients with psychosis. Most studies in this population involved first-episode patients, antipsychotic medication trials, and CBT trials. The authors concluded that trials of biologic interventions, other than antipsychotics and psychosocial treatments other than CBT, are lacking and are needed in these patients. PubMedCrossRef

68.

McGlashan TH, et al. Randomized, double-blind trial of olanzapine versus placebo in patients prodromally symptomatic for psychosis. Am J Psychiatry. 2006;163(5):790–9.PubMedCrossRef

69.

McGorry PD, et al. Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms. Arch Gen Psychiatry. 2002;59(10):921–8.PubMedCrossRef

70.

Cornblatt BA, et al. Can antidepressants be used to treat the schizophrenia prodrome? Results of a prospective, naturalistic treatment study of adolescents. J Clin Psychiatry. 2007;68(4):546–57.PubMedCrossRef

71.

• Amminger GP, et al. Long-chain omega-3 fatty acids for indicated prevention of psychotic disorders: a randomized, placebo-controlled trial. Arch Gen Psychiatry. 2010;67(2):146–54. The utility of omega-3 PUFAs to diminish the progression of high-risk youth with subthreshold psychotic symptoms to first-episode psychosis was explored in the randomized, placebo-controlled trial. The authors concluded that long-chain omega-3 PUFAs reduce the risk of transition to psychotic disorders and are a safe and well-tolerated prevention strategy in youth with subthreshold psychotic symptoms. PubMedCrossRef

72.

Woods SW, et al. Glycine treatment of prodromal symptoms, Abstracts of the 5th International Conference on Early Psychosis. Schizophr Res. 2006;86(WC2E):S7.CrossRef

73.

Liu CC, et al. Rapid response to antipsychotic treatment on psychotic prodrome: implications from a case series. Psychiatry Clin Neurosci. 2010;64(2):202–6.PubMedCrossRef

74.

Woods SW, et al. Aripiprazole in the treatment of the psychosis prodrome: an open-label pilot study. Br J Psychiatry Suppl. 2007;51:s96–s101.PubMedCrossRef

Title: Evaluation and Treatment of Children and Adolescents With Psychotic Symptoms
Authors: Sibel Algon
James Yi
Monica E. Calkins
Christian Kohler
Karin E. Borgmann-Winter
Publication date: 01-04-2012
Publisher: Current Science Inc.
Published in: Current Psychiatry Reports / Issue 2/2012
Print ISSN: 1523-3812
Electronic ISSN: 1535-1645
DOI: https://doi.org/10.1007/s11920-012-0258-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Evaluation and Treatment of Children and Adolescents With Psychotic Symptoms

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2012

Assessing Gender Identity Concerns in Children and Adolescents: Evaluation, Treatments, and Outcomes

Animal Models of Stress Vulnerability and Resilience in Translational Research

Treatment of Anorexia Nervosa in Children and Adolescents

Treatment and Outcomes for Anxiety Disorders Among Children and Adolescents: A Review of Coping Strategies and Parental Behaviors

The Influence of Gene–Environment Interactions on the Development of Alcoholism and Drug Dependence

Gene–Environment Interaction in Major Depression and Antidepressant Treatment Response