First-psychotic episode in childhood and adolescence

Psychosis in childhood and adolescence are defines as having delusions or hallucinations, with the hallucinations occurring in the absence of insight into their pathological nature. A broader definition includes symptoms such as disorganised speech and grossly disorganised or catatonic behavior. Negative symptoms such as alogia, amotivation and anhedonia can be present. Cognitive and mood symptoms may also be present. There are relatively few epidemiological studies on child and adolescent onset psychosis. It is generally held that the incidence of psychosis, and especially of schizophrenia, increases markedly during the teenage years, with a preponderance of male over female patients.

This is a descriptive review of child and adolescents with psychotic symptoms. It aims to describe their clinical profile, associated risk factors and management strategies utilised.

While psychotic disorders are considered rare in children and adolescents, they may severely affect development and long-term functioning. Early identification and intervention are critical to improving outcome. This review suggests that a considerable number of adolescents presenting with psychosis required lengthy periods of inpatient care.

There is often diagnostic uncertainty in the first episode of child and adolescent-onset psychosis. Key diagnostic issues relate to distinguishing schizophrenia from bipolar disorder in psychotic adolescents. The differential diagnosis may include psychotic disorder due to a general medical condition, or a substance-induced psychotic disorder.