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- An appropriate screening history and medical review is necessary before you involve psychiatric services.
- If you are unsure whether psychiatric assessment is necessary or appropriate, talk to the Consultation Liaison team. (After hours, talk to the on call Child Psychiatrist or Registrar).
- All patients presenting with deliberate self harm or suicidal ideation must be seen by the psychiatric service, after initial medical assessment. Be aware of the possibility of concurrent paracetamol or ethanol ingestion. These should be screened for routinely when someone presents with an overdose.
- The on call Child and Adolescent Consultant psychiatrist is available through the operator. On call Psychiatric registrar is available through Te Whetu Tawera (ext 25800) or through the call centre (0800 800 717)
Psychiatric Assessment of Young People with Possible Psychosis
The majority of children / adolescents with "psychotic" behaviour are likely to be delirious because of drug induced states, and sometimes physical illness. (The Child and Family Unit has picked up young people with cerebral tumours, lobar pneumonia, encephalitis and electrolyte abnormalities initially referred as psychotic). Drug-induced states may also mimic psychosis, especially belladonna derivatives and amphetamine-like drugs and chronic marijuana use.
However, if there are no signs / symptoms suggestive of physical illness, the young person's behaviour is highly disturbed and they are post-pubertal, psychosis is possible.
The main symptoms are hallucinations (usually auditory), delusions, disorganised speech and behaviour, and decline in general function. Young people often have a "florid" presentation with highly disturbed behaviour - including agitation and extremely bizarre ideas (sometimes bodily symptoms) which may bring them to medical services.
Screening questions for schizophrenia include:
- Do you ever hear sounds/people talking when there is no one there?
- Has anything strange or unusual been happening to you?
- Is there any problem with your thinking?
If the young person is very disturbed family will probably give a clearer history of unusual behaviour.
Bipolar Disorder (Manic - Depression)
Teenagers who are manic are overactive, have poor sleep, racing thoughts, grandiose ideas. They may have disinhibited behaviour, and often auditory hallucinations and delusions as well. Many teenagers who are manic will also be very irritable, becoming angry at various questions and occasionally aggressive.
Teenagers with a depressive illness will have depressive symptoms, but may also have delusions with depressive themes. Both manic and depressive states may be dismissed as "adolescent turmoil."
Other Psychotic Illnesses
These can occur in adolescence, but are pretty rare.
- A thorough medical history and assessment (including drug screens) are required
- Schizophrenia and Bipolar disorder need skilled psychiatric care (often inpatient), and medication. Therefore, discuss and refer anyone who you suspect has schizophrenia or a manic episode. Urgent assessment is necessary.
- In a psychiatric emergency (such as refusal of a seriously suicidal person to stay or dangerous aggressive behaviour) it is possible that committal under the Mental Health Act will be required. Consult the Child Psychiatrist on call about this.
- It is legally possible to restrain someone or prevent them leaving hospital if you have immediate concerns for their safety. However, psychiatric services must be contacted asap if this proves necessary.
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- Date last published: 01 March 2010
- Document type: Clinical Guideline
- Services responsible: Consult Liaison Psychiatry
- Author(s): Leah Andrews
- Editor: Greg Williams
- Review frequency: 2 years
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