Doda Vandana, Kumar Archana, Schwartz Shaina
Psychiatry, Moses Cone Hospital, Greensboro, USA.
Clinical Sciences, Fred Wilson School of Pharmacy, High Point University, High Point, USA.
Cureus. 2024 Jul 29;16(7):e65675. doi: 10.7759/cureus.65675. eCollection 2024 Jul.
Background Psychotic disorders are commonly diagnosed in the mid-20s but symptoms often emerge earlier during late teenage years to mid-20s. Notably, studies have shown that psychotic symptoms can also affect younger individuals, with a higher prevalence among preteens than teens. Head imaging via computed tomography (CT) or magnetic resonance imaging (MRI) can be performed to rule out non-psychiatric causes of psychotic symptoms in this population but may pose additional risks and financial burdens. Practice patterns vary regarding when to utilize head imaging in pediatric patients with first-episode psychosis (FEP). The purpose of this study is to better understand the use of head imaging in pediatric FEP and associated patient characteristics. Methods A retrospective cohort study was performed. Eligible patients were <18 years of age with an encounter documented between 2013 and 2023 where a diagnosis code for psychosis was first applied. Medical records were manually reviewed if head imaging was performed during the index encounter or within one month. Descriptive statistics were used to report the study population demographics. Independent t-testing was used to compare characteristics between patients who did and did not receive head imaging. Results A total of 113 patients met the inclusion criteria for the study, of which 12 (10.6%) received head imaging within the specified timeframe. All received CT criteria head scans, and a significantly higher proportion were African American or Black when compared to those who did not receive head imaging (10/12 (83.3%) vs. 53/101 (52.5%) p=0.023). None of the imaging tests performed yielded significant neurological findings that suggested an underlying pathology for psychosis. Conclusions Head imaging was rarely utilized for the initial assessment of pediatric FEP in this study. When it was used, CT head scans were the modality of choice but did not yield any remarkable findings to suggest a non-psychiatric cause of psychotic symptoms. This adds to the body of evidence supporting a conservative approach when considering head imaging in pediatric FEP.
精神病性障碍通常在25岁左右被诊断出来，但症状往往在青少年晚期到25岁中期更早出现。值得注意的是，研究表明精神病性症状也会影响更年轻的个体，在青春期前儿童中的患病率高于青少年。可以通过计算机断层扫描（CT）或磁共振成像（MRI）进行头部成像，以排除该人群中精神病性症状的非精神科病因，但这可能带来额外风险和经济负担。对于首次发作精神病（FEP）的儿科患者何时使用头部成像，临床实践模式各不相同。本研究的目的是更好地了解儿科FEP中头部成像的使用情况及相关患者特征。方法：进行了一项回顾性队列研究。符合条件的患者年龄小于18岁，在2013年至2023年期间有一次记录，首次应用了精神病诊断代码。如果在索引就诊期间或一个月内进行了头部成像，则对病历进行人工审查。使用描述性统计报告研究人群的人口统计学特征。采用独立t检验比较接受和未接受头部成像的患者之间的特征。结果：共有113名患者符合该研究的纳入标准，其中12名（10.6%）在指定时间范围内接受了头部成像。所有患者均接受了CT标准头部扫描，与未接受头部成像的患者相比，非裔美国人或黑人的比例显著更高（12例中的10例（83.3%）对101例中的53例（52.5%），p = 0.023）。所进行的影像学检查均未产生显著的神经学发现，提示精神病存在潜在病理。结论：在本研究中，头部成像很少用于儿科FEP的初始评估。当使用时，CT头部扫描是首选方式，但未产生任何显著发现以提示精神病性症状的非精神科病因。这增加了支持在考虑儿科FEP头部成像时采用保守方法的证据。
