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Psychotic Symptoms in Children and Adolescents: Assessment, Differential Diagnosis, and Treatment

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Diagnostic Considerations

Aripiprazole monotherapy in an adolescent worsens psychosis. Indian J Pharmacol. With normalization and other coping strategies, children with visual hallucinations can learn to transform in their mind the frightful image to a funnier one, which is less anxiety-provoking and gives them a sense of control. Suggestions for evaluating hallucinating children in the ED. The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

Skip to main content. Evidence-Based Reviews. Discussing the diagnosis including differentials and management with family and carers is essential. GPs should ensure the family are given a clear formulation and explanation. In most cases of emerging psychosis, there is a contribution from substance use or stress-diathesis.

The management of both is an ongoing challenge. Some diagnostic labels have worrying implications. Where the diagnosis remains uncertain, terms such as schizophrenia and schizoaffective disorder should be avoided. Compliance is an issue in the treatment of psychosis and is especially challenging in adolescents. The best way to keep the young person engaged with their treatment team is through education and the encouragement of insight in the patient and their social supports. Establishing a good rapport is critical; it is important that your patient can discuss difficulties with compliance openly with you and to be able to speak frankly about their thoughts about treatment.

Even with the best of care, it may be that an adolescent will want to experiment with non-compliance. Clinicians must be prepared to make the shift from optimal care to harm minimisation, until the young person hopefully comes to a more mature approach to their illness. Forced compliance may prevent that important developmental process, with negative effects on long-term outcome if the condition turns out to be chronic.

Psychosis in Youth: Risk Factors and Treatments - Health Matters

Prognostically, most cases of emerging psychosis do not lead on to schizophrenia or schizoaffective disorder. There are guidelines to suggest maintaining antipsychotic medication treatment for at least 12 months after a first episode of acute psychosis. In most cases, pharmacotherapy should play a secondary or adjunctive role to sociological and psychological interventions.

Key points in the GP management of post-acute psychosis are listed in Table 3. General practitioners will not often initiate antipsychotics in this setting, but there is a very important role for the GP in monitoring antipsychotic use, particularly their effects on physical health.

Atypical antipsychotics carry a significant risk of metabolic derangements. There needs to be some consideration of risk factors such as family history of heart disease or diabetes, diet and ethnicity. Intensive and systematic monitoring is essential and may be best carried out by a GP, as outlined in Table 4. Competing interests: None. Provenance and peer review: Commissioned; externally peer reviewed.

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