5.2.5 Psychosis
Psychosis
Psychosis is a severe mental disorder characterized by a loss of contact with reality, including symptoms such as delusions, hallucinations, and disordered thinking. Psychosis in children and adolescents is a relatively rare occurrence, with an estimated prevalence of less than 1% in the general population (Rajji & Miranda, 2014). However, early-onset psychosis can have a significant impact on an individual’s development, social functioning, and overall quality of life. Regarding schizophrenia, one in 10,000 children have the condition, this increases with age, with peak onset 15yrs onwards.
The aetiology of psychosis in children and adolescents is complex and multifactorial. It is believed to arise from a combination of genetic, environmental, and neurodevelopmental factors. Genetic factors may include a family history of psychosis or other mental illnesses, while environmental factors can include exposure to trauma, substance use, infections, and autoimmune disorders (Sikich et al., 2021). Neurodevelopmental factors may also play a role in the onset of psychosis, with studies showing that individuals with early-onset psychosis often exhibit developmental delays and cognitive impairments (Rajji & Miranda, 2014).
The presentation of psychosis in children and adolescents can vary widely but may include hallucinations, delusions, disordered thinking, and behavioural changes such as social withdrawal or aggression (Rajji & Miranda, 2014). These symptoms can be highly distressing for the individual and can lead to significant impairment in functioning across multiple domains, including school, work, and social relationships.
The treatment of psychosis in children and adolescents typically involves a combination of antipsychotic medication and psychosocial interventions, such as cognitive behavioural therapy or family therapy (Sikich et al., 2021). Antipsychotic medication can be effective in reducing the positive symptoms of psychosis, such as hallucinations and delusions. Risperidone is usually the first line, and aripiprazole second line (if risperidone has not been tolerated, contraindicated, or ineffective). Psychosocial interventions can help individuals learn coping strategies and develop the skills needed to manage their symptoms and improve their overall functioning.
The outcome of psychosis in children and adolescents can also vary widely, with some individuals experiencing complete remission of symptoms, while others may experience ongoing difficulties with psychosis and require long-term treatment and support (Rajji & Miranda, 2014). Early intervention and effective treatment are key in improving outcomes for individuals with psychosis, particularly in terms of reducing the severity and impact of symptoms on their daily lives.
| Psychosis | |
| Prevalence/Incidence | The estimated prevalence of less than 1% (Rajji & Miranda, 2014) |
| Aetiology | Multifactorial including genetic, environmental, and neurodevelopmental factors (Sikich et al., 2021) |
| Presentation | Hallucinations, delusions, disordered thinking, and behavioural changes such as social withdrawal or aggression (Rajji & Miranda, 2014) |
| Treatments | Combination of antipsychotic medication and psychosocial interventions (Sikich et al., 2021) |
| Outcome | The outcome varies, with some individuals experiencing complete remission of symptoms and others requiring long-term treatment and support (Rajji & Miranda, 2014). |
An Understanding of How Psychosis Relates to Behaviours (e.g. Self-harm, Refusal to Attend School etc.) and Contexts (e.g. Pre-school Behaviours)
In children, psychosis can manifest in different ways, and some common symptoms include:
- Hearing or seeing things that aren’t there (hallucinations)
- Believing things that aren’t true (delusions)
- Disorganized thinking and speech
- Changes in mood or behaviour
- Social withdrawal
- Difficulty with concentration and memory
These symptoms can lead to a range of behaviours that can be challenging for children and their caregivers. For example, children with psychosis may engage in self-harm, such as cutting or burning themselves, as a way of coping with the distressing symptoms they experience. They may also refuse to attend school, avoid social situations, and have difficulty with daily tasks such as bathing and eating.
The behaviours associated with psychosis in children can also be influenced by the context in which they occur. For example, preschool-aged children with psychosis may exhibit behaviours that are different from those seen in older children or adults. Young children may have difficulty expressing their thoughts and feelings, which can make it challenging for caregivers to understand their experiences and provide appropriate support.
In addition to age-related differences, the behaviours associated with psychosis in children can also be influenced by environmental factors such as family stress, trauma, and substance abuse. For example, a child who experiences neglect or abuse at home may develop psychosis as a coping mechanism, and their behaviours may be shaped by the ongoing stress and trauma they experience.
Overall, psychosis in children can have a significant impact on their behaviours and functioning in various contexts. Understanding the symptoms and behaviours associated with psychosis in children can help caregivers provide appropriate support and treatment to help them manage their condition and improve their quality of life.
In summary, psychosis in children and adolescents is a complex and multifaceted disorder that can have a significant impact on an individual’s development, social functioning, and overall quality of life. Early recognition and intervention are crucial in improving outcomes, with a combination of antipsychotic medication and psychosocial interventions being the primary treatment approach.
References:
- Rajji, T. K., & Miranda, D. (2014). Psychosis in children and adolescents: A review of the etiology, current treatment, and clinical outcomes. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 23(1), 4–13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3908316/
- Sikich, L., et al. (2021). Treatment of Early-Onset Schizophrenia Spectrum Disorders and Psychotic Mood Disorders. In S. H. Keshavan & R. E. Gur (Eds.), Pediatric and Adolescent Psychopharmacology: A Practical Manual for Pediatricians (pp. 157–183). Springer International Publishing. https://doi.org/10.1007/978-3-030-71769-1_8