2002: Exclude Organic Source Of Psychotic Symptoms

Clinical Psychiatry News; March 2002 . Volume 30 . Number 3


Clinical Rounds



In children and adolescents
Exclude Organic Source Of Psychotic Symptoms




Carl Sherman
Contributing Writer

NEW YORK - The diagnosis of psychosis in children must include a
thorough
laboratory work-up to exclude organic causes of symptoms, Dr. Jean
Frazier
said at a psychopharmacology update sponsored by the American Academy
of
Child and Adolescent Psychiatry.

In particular, such possibilities as central nervous system infection
and
metabolic disorders should not be overlooked in treatment-refractory
cases,
said Dr. Frazier, director of child psychiatry outpatient services and
the
pediatric psychotic disorders program at McLean Hospital, Belmont,
Mass.

The early identification of psychotic disorders in young patients is
crucial: Timely treatment can enhance the developmental trajectory of
affected children and slow or halt progression of the illness. But
misdiagnosis has substantial costs in unnecessary exposure to
medication and
in labeling that can have lasting consequences.

Several factors complicate the diagnosis of psychosis in childhood.
Standard
criteria rely on the patient's description of a rather complicated
state of
mental affairs, which may be beyond a child's capability. The
significance
of apparent difficulty in distinguishing between fantasy and reality
must be
understood in light of the child's developmental level. Familiarity
with
normal cognitive and language limitations also is important.

A thorough organic work-up should be a central part of the evaluation.
"When
a child is acutely psychotic, you have to think of possible medical
underpinnings. ... I have all children see a pediatric neurologist, and
I
push for an MRI and electroencephalogram," she said.

At one referral center, three cases were seen in which children with
treatment-resistant psychosis were found to have CNS Lyme disease, with
punctate lesions in the frontal lobe, Dr. Frazier said. One child
treated
unsuccessfully with neuroleptics for 2 years, improved when the
infectious
disease was adequately addressed.

Cerebrospinal fluid studies might be ordered for a child with
treatment-refractory psychosis that follows a deteriorating course, to
rule
out occult CNS infections.

Dr. Frazier said she has seen four children with chronic, deteriorating
early-onset psychosis who had mitochondrial disorders identified by
laboratory studies assessing lactate, pyruvate, and ketone levels. In
such
cases, "nutritional interventions might slow down deterioration" she
said.

The differential diagnosis should not ignore the possibility of anxiety
disorders and traumatically induced dissociation; of mood disorders;
and of
developmental disorders. Schizotypal disorders may be hard to
distinguish
from Asperger's syndrome, Dr. Frazier said.

.

Relevant Pages

  • Exclude Organic Source Of Psychotic Symptoms - In children and adolescents
    ... Child and Adolescent Psychiatry. ... said Dr. Frazier, director of child psychiatry outpatient services and ... pediatric psychotic disorders program at McLean Hospital, Belmont, ... Several factors complicate the diagnosis of psychosis in childhood. ...
    (sci.med.diseases.lyme)
  • Re: 2002: Exclude Organic Source Of Psychotic Symptoms
    ... > Child and Adolescent Psychiatry. ... > said Dr. Frazier, director of child psychiatry outpatient services ... > pediatric psychotic disorders program at McLean Hospital, Belmont, ... > Several factors complicate the diagnosis of psychosis in childhood. ...
    (sci.med.diseases.lyme)
  • Re: Disabled back to work, but what about.....
    ... disorders and anxiety disorders. ... psychosis was also observed. ... don't need to waste NHS resources. ...
    (uk.people.disability)
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