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experience
the same range and types of psychotic
symptoms as do adults. They can lose the
connections between their thoughts (formal
thought disorder) and have perceptions without
external stimuli (hallucinations).
Psychosis
Mental life has been disrupted in its capacities
or forms, as a result of a process that generates
new forms of psychological experience.
Organic Psychoses
Neurologic Conditions
Seizure Disorder
Deteriorative Neurologic Disorders
Central Nervous System Lesions
Metabolic and Hormonal
Disturbances
Toxic Psychoses
Functional Psychoses
Childhood Onset
Schizophrenia
Mood Disorders
Brief Reactive Psychosis
Anxiety Disorders
Clinician-Rated Dimensions of
Psychosis Symptom Severity
Clinician-Rated Dimensions of
Psychosis Symptom Severity
Factors to Consider
Misdiagnosis remain due to symptom overlap
Anxiety and stress are probably the most common
Diagnostic Challenges
Distinguishing true psychotic phenomena in
developmental delays,
exposure to disturbing and traumatic events, and
overactive and vivid imaginations
Childhood Psychosis
Adult Schizophrenia (?)
Childhood Onset Schizophrenia
Adult Schizophrenia
Childhood Onset Schizophrenia
= Adult Schizophrenia
History
Maudsley first wrote a description of the
1874
1919
1920-1970
1971
1980s
History
De Sanctis may be credited first with setting out
1874
1919
1920-1970
1971
1980s
History
Kraeplin introduced the concept of
1874
1919
1920-1970
1971
1980s
History
The term psychosis was used so broadly in
1874
1919
1920-1970
1971
1980s
History
The landmark studies of Kolvin first
1874
1919
1920-1970
1971
1980s
History
Schizophrenia with childhood onset was
1874
1919
1920-1970
1971
1980s
Early-Onset Schizophrenia
onset of disease before the age of 18 years,
Childhood-Onset Schizophrenia
a very rare and virulent form of schizophrenia now
Childhood-Onset Schizophrenia
more significant deficits in measures of intelligence quotient
Diagnosis of Schizophrenia
Active Phase
At least one of the following: delusions, hallucinations,
disorganized speech
At least one additional symptom present most of the time
for a month: delusions, hallucinations, disorganized
speech, grossly disorganized or catatonic behavior, or
negative symptoms (i.e. diminished emotional expression
or avolition)
Symptoms are present for a significant amount of time
during a single month AND cause impairment (social,
academic, occupational)
To meet full criteria for schizophrenia, continuous
Epidemiology
Frequency of COS is less than one case in about
Epidemiology
In adolescents, the prevalence of schizophrenia is
Etiology
a neurodevelopmental disorder
to abnormal connectivity
Genetic Factors
Heritability estimates at 80%
8x more prevalent among first degree relatives
with schizophrenia
Higher concordance rates among monozygotic
twins than in dizygotic twins
Higher rates among relatives of childhood-onset
schizophrenia than in adult-onset schizophrenia
No reliable method can identify persons at the
highest risk for schizophrenia in a given family.
MRI Studies
progressive loss of gray matter
delayed and disrupted white matter growth
decline in cerebellar volume
Gray matter abnormalities were normalized over
Eye Tracking
genetic factors underlying eyetracking dysfunction (Smooth
pursuit eye movement) may be more salient for COS than AOS
Familial Schizophrenia Spectrum Disorders
rate of familial schizophrenia spectrum disorders was higher for
COS than AOS, and both were higher than community controls
Neurocognitive Functioning in
COS Probands
perform poorly on tasks involving fine motor
Comorbid Disorders
depression (54%)
obsessive-compulsive disorder (OCD;21%)
generalized anxiety disorder (GAD; 15%)
attention deficit hyperactivity disorder
(ADHD; 15%)
Vulnerability Factors
shyness, and disturbances in adaptive social
behavior
early language deficits and motor impairments
Intellectual delays
Differentials
Affective
disorders
Medical
conditions
Mood
congruent
psychotic
symptoms
Medical
illnesses
Stable clinical
outcome
Substance
use
Pervasive
development
al disorders
Severe
impairment in
reciprocal
communication,
social
interactions,
and odd
stereotyped
behaviors
Differentials
Conduct disorder and
various other
behavioral
disturbances
Atypical psychosis
associated
with
hallucinations
Multi
Dimensionally
Impaired
(MDI) by the
NIMH group
Lewiss Child & Adolescent Psychiatry: A Comprehensive Textbook 4th Edition
disorder
Pharmacotherapy
some efficacy:
Risperidone up to 3 mg per day
Olanzapine
randomized 6-week controlled trial of olanzapine in adolescents
Aripiprazole
At two fixed doses, superior to placebo in the treatment of
Clozapine
more effective than haloperidol in improving both positive and
Pharmacotherapy
Clozapine vs high dose Olanzapine
response rates were about twice as great for clozapine as
Psychosicial Interventions
Psychotherapists who work with children with