The template of symptoms and presentation can apply easily to older adolescents as well as adults, but the situation is less clear in younger children. Because of variability of selleck inhibitor symptom presentation, psychotic symptoms that can occur within the spectrum comprising childhood-onset schizophrenia (COS, age of onset (≤12 years), eg, schizophreniform disorder, schizotypal disorder, and schizoaffective disorder, are difficult to distinguish from psychotic and nonpsychotic symptoms related to BPAD and major depressive disorder (MDD). Psychotic symptoms in children and adolescents need to be differentiated Inhibitors,research,lifescience,medical from other, intense, repetitive, but nonpsychotic phenomena, such as obsessions related
to obsessive-compulsive disorder (OCD), anticipatory anxiety related to non-OCD anxiety disorders, rumination related to depression, perseverative thoughts related to developmental disorders, simple disorganization related to attention-deficit/hyperactivity disorder (ADHD), and overvalued ideas. In addition, language
deficits and cognitive deficits related to mental retardation may suggest psychosis Inhibitors,research,lifescience,medical in nonpsychotic children. Furthermore, nonspecific symptoms, such as anxiety, distractibility, and irritability, may precede a psychotic break and confuse diagnosis based on course of illness. Psychosis not otherwise specified (PNOS) is intended to classify psychotic symptoms not associated with COS, BPAD, or MDD. Accurate Inhibitors,research,lifescience,medical and reliable diagnosis of psychosis during childhood remains elusive, and is indicative of the necessity for more thoughtful study. Prevalence Sparse epidemiological data suggest that psychosis is rare in children. Schizophrenia with onset during middle to late adolescence is fairly common, with 1% prevalence, compared with the extremely rare COS with Inhibitors,research,lifescience,medical a prevalence of 0.2 to 0.4/10 000.2 The largest study of COS to date, involving 1400 national Inhibitors,research,lifescience,medical referrals to the National Institute of Mental Health (NIMH) over 10 years, identified 260 children with psychosis3. Only 71 patients met criteria for COS at study entry,3 whereas only 54 children retained the diagnosis of COS (Rapoport JL, personal communication, 2000).
In contrast, MDD may occur in 1% of children and 5% of adolescents,4,5 whereas BPAD occurs in 1% to 2% of adolescents.6,7 Mood disorders with psychosis arc considerably rarer in children and adolescents. The prevalence of psychosis NOS and BPAD in children is hard to ascertain because of controversy about validity. Phenomenology Childhood-onset schizophrenia almost As with schizophrenia diagnosed at any age, COS presents with two types of symptom clusters, positive psychotic symptoms and negative psychotic symptoms. Positive symptoms (phenomena that are present and should not be) in children include gross disturbance of thought process or thought content, whereas delusions likely appear with increasing developmental age. Negative symptoms (phenomena that are not present and should be) include flat affect, ancrgy, and paucity of speech and thought.
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