The term ‘psychosis’ describes symptoms usually associated with severe mental illness. These symptoms are characterized by a loss of contact with reality. Children, as well as adults, can experience psychosis for a number of reasons. Common psychotic symptoms are:
- Hallucinations- distorted sensory experiences in which one sees or hears things that are not there.
- Delusions- fixed, false beliefs about what is taking place that is contrary to reality
It is not clear why some people develop psychosis. Research indicates that psychosis develops primarily due to genetic risk. There are additional theories that certain toxins or experiences can trigger this risk, but these speculations have been difficult to prove.
People experiencing psychosis can react to the experiences in many different ways. People find these symptoms very real, and often confusing and scary. Their behavior and thought processing may be affected and they may have trouble organizing their thoughts and making decisions. They can often be distracted by the hallucinatory experiences or delusional beliefs, which can also be significantly anxiety-provoking.
Some early warning signs of psychosis in children are a drop in grades, new trouble with thinking clearly and concentrating, decline in self-care or hygiene, withdrawal from peer groups or spending more time alone, mistaking noises for voices, suspiciousness or unease with others, increased sensitivity to sights and sounds, unusually intense beliefs or new ideas, and having strange new feelings or no feelings at all.
Schizophrenia is the main psychiatric disorder that involves psychosis. It can include hallucinations, delusions, paranoia, or difficulties interacting with other people.
Bipolar disorder, although primarily a mood disorder, can include psychosis.
In children, psychosis is rare, commonly associated with depression and anxiety. Schizophrenia can be diagnosed in children, and it is usually associated with other severe neuropsychiatric symptoms, such as cognitive deficits and other developmental delays. The onset of schizophrenia usually happens slowly over time. The most common age of onset of schizophrenia is between 16 and 30.
Detection of schizophrenia in the early phase of the first onset or in children can be difficult.
Psychosis can sometimes be caused by other medical problems, so potential medical causes need to be ruled out. This will include a thorough evaluation by a physician including relevant laboratory studies and a complete medical history and examination. If medical causes are ruled out, a psychiatric evaluation is necessary for diagnostic purposes and treatment planning.
There are some free online tools for screening of psychosis symptoms, however, because patients with psychosis often have little insight into their problems, these should be intepreted with caution. One example is the Schizophrenia Test and Early Psychosis Indicator (STEPI):
Before full schizophrenia has developed, there is usually a prodromal phase. Symptoms during the prodromal phase can be more subtle. The Prodromal Questionnaire – Brief Version (PQ-B) is a 21-item self-report questionnaire. The number of items endorsed Yes gives a Total Score, and the sum of Likert ratings for each item gives a Distress Score. A Total Score of 3 or more, or a Distress Score of 6 or more, had the best combinations of sensitivity and specificity for detecting prodromal diagnoses (Loewy et al., 2011). The PQ-B should be used to indicate the need for further assessment, not to make diagnoses. The PQ-B is available below (permission was obtained from the author)..
Schizotypal personality traits, or schizotypy, reflect a theory that some individuals have quasi-psychotic traits, but not full psychosis, and do not necessarily have a mental illness. Features include unusual perceptual experiences, cognitive disorganization, introverted anhedonia, and impulsive nonconformity. A questionnaire that measures these traits is available below, called the O-LIFE Short Form.
When to Refer/Seek Help
Symptoms of psychosis usually indicate a serious problem and patients should seek help immediately. If your child is experiencing subtle changes in academics, peer relations, social functioning, as well as exhibiting odd behaviors, then parents should seek help.
If the psychosis is due to an underlying medical illness (i.e., hyperthyroid, hypokalemia, side effect to a medication), treatment of the medical cause ought to make the psychosis rapidly disappear.
If the psychosis is purely psychiatric in origin, the first-line treatment is almost always anti-psychotic medication. Some patients with milder symptoms and high-functioning coping skills may be able to function without medication, but those situations are uncommon.
For all patients, regular contact with a clinician is also helpful to monitor changes in symptoms, provide reality feedback, supportive therapy through life decisions, and arranging other supportive services. Patients experiencing severe psychosis may need inpatient psychiatric hospitalization to treat symptoms. If a patient is experiencing thoughts of harming self or others, or hallucinations are commanding harm to self or others, then emergency treatment is required.
There are programs nationally that focus on treatment of the first episode of psychosis, associated with mental illness. These programs specialize in early intervention in order to improve prognosis. There are also programs studying the ‘prodrome’ of psychosis which aims to identify those at-risk for psychosis.
The Early Psychosis Intervention Clinic (EPIC-NOLA), founded in 2016, is the only known clinic in the region that specializes in treatment of adolescents and young adults with early phase psychosis. Directed by Ashley Weiss, D.O., the team includes Serena Chaudhry, DSW, Michael Dyer, LPC, Ashleigh Castro, LPC-S, Doug Headrick, LPC, Jane Lefkowitz, MSW, and Grinasha Dillon.
They are located at:
Tulane Doctors Specialty Psychiatry Clinic
4000 Bienville Street, Suite G
New Orleans, LA 70119
National Alliance on Mental Illness has a vast array of resources on their website, including local support groups for individuals as well as families. There are articles focused on psychosis including educational information about various illnesses and treatments. They also have educational meetings to help families understand what is happening to their loved one. The NAMI Connection program gives information on local support groups. www.NAMI.org
The American Academy of Child and Adolescent Psychiatry has online general information: http://www.aacap.org/AACAP/Families_and_Youth/Glossary_of_Symptoms_and_Illnesses/Psychosis.aspx
- Updated February 13, 2019