Treatment of psychosis in children and adolescents: a review.

Recognition and treatment of psychosis in children remain challenging. This may be partly because of the subtle nature of prodromal features and partly because psychosis-like experiences are rather common in that a rich fantasy life is normative for developing children. Recent research suggests that only about 5% of patients with schizophrenia have an onset before age 15 years. To help with early recognition, an understanding of frequently used concepts and terms such as ultra high risk, attenuated symptoms, and clinical high risk for schizophrenia were reviewed as part of this article. During prodrome of schizophrenia, marked difficulties with emotions, cognition, motor skills, and socialization are seen. A careful workup of children in whom a psychotic process is suspected is warranted and may help with diagnostic clarification and likely treatment strategies. In treating a patient at ultra high risk, second-generation antipsychotics may reduce the severity of prodromal symptoms; however, high dropout rates and limited treatment adherence are significant concerns. Other helpful strategies may include treatment with selective serotonin reuptake inhibitors and omega-3 fatty acids and therapies such as cognitive-behavioral therapy. The most important aspect of the early treatment, however, may be working with a specialized multidisciplinary early psychosis treatment team that will address and support the individual and his or her family with academic needs, socialization, and other needs or components in a comprehensive manner.