Childhood Psychosis

ICD-10 code: F09

DESCRIPTION

It is important to note that children who present with symptoms such as hallucinations, confusion and intensely aggressive or disturbed behaviour may not be psychotic or suffer from schizophrenia. Delirium should be the first diagnosis to consider, before a psychotic disorder is suspected. Failure to recognise a delirium may delay the diagnosis of the underlying medical condition or drug-related delirium and place the child at risk.

Delirium is a non-specific neuropsychiatric disorder, which indicates global encephalopathic dysfunction in medically ill patients. The core features consist of attentional disturbances, an altered level of consciousness and diffuse cognitive deficits. It is fluctuating in nature and may present with perceptual disturbances, commonly visual hallucinations.

Any child presenting with an apparent psychosis is considered a medical emergency and should have a medical work-up before being referred to a psychiatrist. This should include FBC, U&E, LFT, TSH, drug screen, EEG and brain CT scan.

Sedate before transfer if behaviourally disturbed. Refer to: Sedation of an acutely disturbed child or adolescent.

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition

Chapter 14: Child & Adolescent Psychiatry,  14.9 Childhood Psychosis

Click here for  14.9.1 Schizophrenia