Psychosis

Psychosis is a psychiatric disorder characterized by a severe disturbance in perception of reality, thoughts, and emotions. There is a disconnect between the patient’s external reality and their internal reality, fears, and fantasies.

Psychosis typically first appears in adolescence or early adulthood, but it can sometimes occur in early childhood. Depending on how it manifests, several types of childhood psychosis can be identified:

• Substance-induced psychotic episode: This is brief in duration and has a specific cause (intoxication from a toxic substance or drug). It is characterized by disturbances in speech, thought, and/or the presence of hallucinations or delusions.
• Psychotic disorder: There are several types that vary depending on symptom presentation and duration (schizophrenia, brief psychotic disorder, schizophreniform disorder, etc.), but all share the presence of positive symptoms (hallucinations, delusions, or disorganization) and/or negative symptoms (emotional flattening, abulia, apathy, anhedonia…).

Symptoms

Symptoms of childhood psychosis are rare, as it primarily develops in adolescence or early adulthood. However, some signs that may raise concern include:

• Speech disturbances: Language and communication development is slower than normal. The child has limited speech, with phenomena such as echolalia (repeating what they hear), pronoun reversal, or a complete absence of speech.
• Motor disturbances: Poor development of motor functions, characterized by delayed crawling, late walking, clumsy movements, or lack of coordination. Abnormal body behaviors may also appear, such as constant rocking, arm flapping, or unusual and uncoordinated postures, such as catatonia.
• Hallucinations: Perceptions through the senses that do not correspond to real external stimuli. The child believes they see, hear, or even touch things that do not exist. These are less elaborated than hallucinations experienced by adults with psychosis.
• Delusions: Beliefs not based on real facts. Common types include persecutory, hypochondriacal, or grandiose ideas. These are also less developed than in adults but become more systematized as the child grows.
• Disorganized speech and thinking: Agitated, incoherent, illogical, or incomprehensible speech, with no apparent continuity or meaning.
• Difficulty relating to others: Poor social integration with other children, isolation.
• Adaptation difficulties: Resistance to change, lack of spontaneity, and inability to adjust to new situations.
• Apathy, abulia (lack of energy), general lack of interest.
• Lack of emotional expression or inappropriate emotional responses to the context.

Causes

Depending on the most common causes, psychotic disorders can be divided into two groups:

• Primary or idiopathic psychosis: No apparent cause.
• Secondary psychosis: An identifiable cause is present.
• Organic psychosis: Caused by an underlying condition.
  • Mental illnesses, such as schizophrenia, bipolar disorder, or major depression.
  • Neurological injuries and disorders, such as structural or functional brain abnormalities, strokes, or brain infections.
• Toxic psychosis: Triggered by drug use or certain medications.

Risk Factors

Risk factors that predispose a child to developing a psychotic disorder include:

• Family history of psychosis, schizophrenia, or bipolar disorder.
• Obstetric and perinatal complications.
• Traumatic experiences during development: physical or sexual abuse, accidents, death of loved ones, or emotional neglect in the family, among others.

Complications

The main issue with childhood psychosis is that it often receives a late diagnosis due to symptom overlap with other conditions, such as autism spectrum disorders or attention-deficit/hyperactivity disorder (ADHD). This delay in treatment can lead to worsening symptoms, preventing the child from reaching a normal level of functioning and leading a fulfilling life.

Prevention

There is no way to prevent psychosis. However, it is essential to observe the child and remain vigilant for any developmental or behavioral abnormalities to enable early diagnosis, and to provide protection, support, and emotional stability.

What specialist treats psychosis?

Childhood psychosis is assessed and treated by the child psychiatry unit.