Psychosis in Childhood and Its Management

The appearance of psychotic symptoms in childhood, albeit rare, is an important clinical entity. This importance extends beyond their clinical prevalence and has begun to influence our understanding of the principal psychotic conditions. The term psychosis is generally categoric and includes subgroups within it. It is clear that the peak onset of the most common psychotic disorders, schizophrenia and bipolar disorder, is in adolescence (1,2). This points directly toward developmental events in biological, social, and psychological domains of late childhood and adolescence that set the stage for activating psychotic disorders. However, in addition, it appears increasingly likely that certain early childhood characteristics and developmental deficits may presage psychosis and are related to the outcome of psychotic disorders. For the purposes of this chapter, psychosis is defined as the presence of disruptions in thinking, accompanied by delusions or hallucinations, along with an alteration in the thought processes, termed a thought disorder.Delusions and hallucinations are considered to be positive psychotic symptoms. Delusions are fixed, false, idiosyncratic beliefs that the child cannot be deterred from, with logical reasoning, whereas hallucinations are percepts that arise in the absence of external sensory stimulus. Psychotic symptoms always encompass a broad range of conditions, but it is particularly so when they appear in children and adolescents. Psychotic symptoms in children present distinctive diagnostic and clinical challenges because of the powerful influences of immaturity and the moving target produced by development. Although there may at one time have been confusion about whether children are capable of having psychotic