Courvoisie H, Labellarte M J, Riddle M A
Division of Child and Adolescent Psychiatry, Johns Hopkins Medical Institutions, Baltimore, Md, USA.
Dialogues Clin Neurosci. 2001 Jun;3(2):79-92. doi: 10.31887/DCNS.2001.3.2/hcourvoisie.
The diagnosis of childhood psychosis raises a host of unresolved problems, despite the Diagnostic and Statistical Manual Of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR) giving identical symptoms and definitions for children, adolescents, and adults. The fantasy lives of children, and issues of developing language and cognition (including retardation), all impair diagnostic accuracy, particularly when differentiating between childhood-onset schizophrenia (COS) (≤12 years), bipolar affective disorder, major depressive disorder, and even obsessive-compulsive disorder and attention-deficit/hyperactivity disorder: the catch-all classification, psychosis not otherwise specified (PNOS), is always available for conundra that prove unsolvable. Typical if nonpathognomonic features include neurocognitive difficulties. Multiple screening instruments and specialized versions of semistructured diagnostic interviews are available. Although smooth-pursuit eye-tracking movements may prove a genetic marker for COS, etiologies are likely to be oligogenetic rather than related to a single gene. No specific biological markers or neuroimages have been identified. As such, psychoses may be indicative of a more general pattern of brain dysfunction. Drug treatments are largely based on the adult literature because of a dearth of controlled data below age 18. There are still no rigorous studies of psychosocial treatments and psychotherapy specific to childhood psychosis.
尽管《精神疾病诊断与统计手册》第4版修订本（DSM-IV-TR）为儿童、青少年和成年人给出了相同的症状和定义，但儿童期精神病的诊断仍引发了一系列未解决的问题。儿童的幻想生活以及语言和认知发展问题（包括发育迟缓），都会影响诊断的准确性，尤其是在区分儿童期起病的精神分裂症（COS，≤12岁）、双相情感障碍、重度抑郁症，甚至强迫症和注意力缺陷多动障碍时：对于无法解决的难题，总有一个统称的分类——未另行规定的精神病（PNOS）可供使用。典型的（虽非特异性的）特征包括神经认知困难。有多种筛查工具和半结构化诊断访谈的专门版本可供使用。尽管平稳跟踪眼球运动可能被证明是COS的一个遗传标记，但病因可能是多基因的，而非与单个基因有关。尚未确定具体的生物学标记或神经影像。因此，精神病可能表明存在更普遍的脑功能障碍模式。由于缺乏18岁以下的对照数据，药物治疗主要基于成人文献。目前仍没有针对儿童期精神病的严格的社会心理治疗和心理治疗研究。
