Psychotic Disorders

Childhood-onset schizophrenia is a quite rare clinical picture. In the adolescent period, its frequency approaches that of the adult period somewhat and is observed at approximately 0.5-1%. Among the clinical signs and findings, there are especially auditory hallucinations and, at times more frequently in children, visual hallucinations, delusions that are simpler and less organized at early ages, thought disorders, disorganized and strange speech content, disorganized behaviors, social withdrawal, reduction in emotional expression, flat facial expression, anhedonia, inability to derive pleasure, loss of motivation, reduction in the quantity, variety and content of speech, loss of attention and concentration, memory impairments, reduction in organizational and planning capacity, and reduction in problem-solving ability. When evaluating signs and symptoms, the developmental characteristics in children should be taken into consideration. Normal developmental fantasies, imaginary friends, and transient hallucinatory experiences should be distinguished from psychosis.

Psychosis in a first-degree relative, advanced maternal and paternal age, birth complications, prenatal infections, developmental delay during pregnancy, low intelligence, language and speech delay, childhood traumas, urban living, migration and being a member of a minority group, low socioeconomic level, high stress within the family, and substance use during adolescence are among the risk factors.

Differential diagnosis should be made from other conditions that may accompany psychotic findings in children and adolescents, such as mood disorders (depression and bipolar disorder), trauma-related disorders (post-traumatic stress disorder), medical causes, and substance use.

The first choice in treatment is medications known as antipsychotics. In children and adolescents, atypical antipsychotics known as risperidone, aripiprazole, olanzapine, quetiapine, and paliperidone are frequently used and approved drugs. Psychosocial interventions are also very important in treatment. Psychoeducation aimed at informing family members about the illness, symptom recognition, and treatment compliance, family therapy, the skill of recognizing high levels of expressed emotion, and developing communication skills are beneficial. Cognitive Behavioral Therapy, which will be useful in areas such as developing insight into the illness, social skills training, and coping with delusions and hallucinations, is an effective type of therapy. Individualized education programs for school, reorganization of academic goals, and social integration support can be provided. Early diagnosis and good treatment compliance, strong family support, good premorbid functioning, acute rapid onset, and the presence of fewer negative symptoms are indicators of a good course and positive response to treatment regarding the illness.

Early evaluation and intervention, a multidisciplinary approach—that is, the inclusion of psychologists, social workers, and educators in the process—the involvement of the family in the treatment process, and the creation of a comprehensive treatment plan rather than medication treatment alone are important.