Diagnosis and Evaluation of Hallucinations and Other Psychotic Symptoms in Children and Adolescents - 06/09/13

Doi : 10.1016/j.chc.2013.06.005

Linmarie Sikich, MD
ASPIRE Program, University of North Carolina at Chapel Hill, CB 7167 UNC-CH, 2218 Nelson Highway, Suite 1, Chapel Hill, NC 27599-7167, USA

Résumé

Recognizing positive psychotic symptoms and their diagnostic context in youth is challenging. A large minority say they “hear things others do not hear,” though they seldom present with complaints of hallucinations or delusions. Few have schizophrenia spectrum disorder, but many have other psychiatric disorders. Frequently, they have psychotic symptoms for an extended period before diagnosis. Clinicians should understand psychotic symptoms and their differential diagnoses. This article reviews the epidemiology, associated diagnoses, and prognosis of hallucinations and delusions in youth. Strategies for optimizing the clinical diagnostic interview, appropriate laboratory tests, indications for psychological testing, and rating scales are reviewed.

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Keywords : Hallucinations, Psychosis, Differential diagnosis, Positive and Negative Syndrome Scale, Brief Psychiatric Rating Scale for Children, Affective psychoses, Benign hallucinations, Early-onset schizophrenia

Plan

Key points

Overview

Characteristics of hallucinations and delusions in youth

Epidemiology of positive psychotic symptoms in the general pediatric population

Psychotic symptoms among youth in psychiatric care

Pediatric prevalence of psychiatric disorders that may include psychotic symptoms

Other medical conditions that may include positive psychotic symptoms

Assessment of positive symptoms in youth

Use of rating scales

Differential diagnosis

Summary

Disclosures: All disclosures for 2009 to 2013. Dr Sikich receives or has received research funding from NIMH, NICHD, Foundation of Hope, Autism Speaks, Case Western Reserve University (subcontract from NICHD), Research Foundation for Mental Hygiene Research (subcontract from NIMH), Pfizer, and Bristol Myers-Squibb. She is participating or has participated in clinical trials with Bristol Myers-Squibb, Otsuka Research Institute, Forest Pharmaceuticals, SynapDX, Merck, Curemark, and Seaside Pharmaceuticals. She also received medication for clinical trials from Eli Lilly, Janssen, Pfizer, and Bristol Myers-Squibb, and software for a computer intervention in schizophrenia from Posit Science. She has no stock or equity in any companies that provide services to individuals with mental health problems.