Differential Diagnosis Childhoodonset Psychosis

The clinical picture of childhood-onset psychosis may include a tendency towards isolation and becoming reserved and withdrawn, but also soft neurological signs, delayed language development and attention deficit. These features, which might be characteristic of children who suffer from ADHD, do sometimes cause diagnostic confusion. They raise the question of whether a child who was diagnosed with ADHD and later with schizophrenia suffered from the outset from early signs of the latter disorder.

This question is important, since the traditional treatment for ADHD, i.e. psychostimulants, conflicts with the common treatment for schizophrenia, and there are those who assert that it might even increase the risk of developing the symptoms of the latter disorder. In a recent study, ADHD was diagnosed in 31% of first-degree relatives of schizophrenic patients, much more than should be expected in the general population [53]. In addition, it was found that among these children there were more prominent characteristics of cognitive and perceptive disturbances, as well as neurological signs. Obviously, these findings strengthen the suspicion that these early symptoms can be preliminary signs for the development of schizophrenia.

Children suffering from ODD are also likely to camouflage signs of childhood psychosis. Impaired judgement of reality and cognitive disabilities are liable to appear as promiscuous behaviour, violence and delinquency such as theft or lying, which the child does not perceive as such due to the distorted reality in which he/she lives [54]. Treatment of ODD is indeed closer to treatment of psychotic conditions than treatment of ADHD. However, if the child is actually suffering from psychosis, it constitutes insufficient and incorrect treatment, so that the differential diagnosis is an important one.

Children suffering from PTSD are also likely to be misleading by creating a pseudo-psychotic picture, primarily due to the dissociative characteristics that accompany this disorder. For example, children who have undergone sexual abuse frequently exhibit dissociative, sexual/seductive or anxious behaviours [55,56]. These children are also likely to exhibit visual and auditory hallucinations caused by ''flashbacks'', irritability and mistrust, detachment and avoidance. These characteristics are liable to suggest the presence of a psychotic condition, especially if the clinician has not considered the possibility of physical or sexual trauma.

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