Psychotic Disorders
Introduction to Psychotic Disorders
Psychosis means a loss of contact with reality. Kids or teens may hear or see things that others don’t (hallucinations), hold strong false beliefs (delusions), or have very disorganized speech or behavior. These symptoms are uncommon in children, and they can appear in several conditions—such as schizophrenia, bipolar disorder with psychotic features, severe depression, or after substance use or certain medical illnesses. A careful, step-by-step evaluation helps find the cause and the best treatment. With the right care, many young people improve. PMC+1
Safety note:
If your child talks about suicide or has a plan to harm themselves or others, call 911 or go to the nearest ER. In the U.S., you can also call or text 988.
Causes and Risk Factors
There isn’t one single cause. Possible contributors include:
- Biology and genetics: family history may raise risk.
- Other mental health conditions: mood disorders (depression, bipolar), autism-related needs, or anxiety/OCD can overlap or be mistaken for psychosis.
- Medical issues and substances: seizures, infections, autoimmune encephalitis (e.g., anti-NMDA receptor), thyroid or metabolic problems, medications or substances. These must be ruled out.
- Developmental factors and stress: sleep loss, grief, bullying, or major life changes can worsen symptoms; some brief hallucinations in children are not schizophrenia.
Because many conditions can look similar, professional assessment is essential before naming a diagnosis.
Treatment and Management
Care at Texas Pediatric Mental Health Services starts with a thorough evaluation. We review symptoms, medical history, labs or imaging if needed, and functioning at home and school. With your consent, we coordinate with your pediatrician and teachers. Treatment may include:
- Antipsychotic medication (when indicated): modern second-generation agents are commonly used; dosing and side effects are monitored closely.
- Therapy and skills: psychoeducation for families, CBT-based approaches for psychosis, coping skills, and support for returning to school.
- Safety planning and follow-up: we set clear goals, monitor progress, and adjust the plan together.
Early, coordinated care helps most youth do better over time.