Psychosis in Children and Youth: Focus on Early-Onset Schizophrenia

Practice Gap

Psychosis is the third most disabling condition worldwide in youth. Evaluation of children who present with a psychotic episode requires the clinician to understand the broad range of causes and the criteria used to differentiate primary psychotic disorders, other psychiatric and nonpsychiatric illnesses, and drug effects.

Objectives

After completing this article, readers should be able to:

1. Define psychosis and be aware of the conditions that can present with psychotic symptoms in children and youth.

2. Identify the qualifiers of psychotic symptoms and behaviors that are suggestive of early-onset schizophrenia (EOS).

3. Know the epidemiology, pathogenesis, and clinical correlates of EOS.

4. Understand the pharmacologic and nonpharmacologic treatment modalities recommended for management of EOS.

5. Be aware of ongoing efforts to identify those in the earliest stage of onset of schizophrenia in children and youth (at risk or prodromal youth).

Matt is a 16-year-old in grade 10. Matt has always been a good student. He had 3 close male friends who have known him for years. Matt plays basketball and recently took up acoustic guitar. He has a good relationship with his parents, who describe him as always having been a quiet kid, “a thinker.” Recently, however, Matt seems different. His grades are going down at school from Bs to Cs; he failed English. He sits quietly in class wearing his headphones and rarely talks to anyone, which is new for him. Teachers find him to be distracted and distant, as if he is not paying attention or is “zoned out.” He started hanging out with a new crowd of friends, who all seem to use cannabis regularly; he seems to be avoiding his old friends and stopped playing his …