Pediatric emergency medicine trisk 4209 4209

TABLE 126.29
GUIDELINES FOR MANAGEMENT OF ACUTE ADOLESCENT
PSYCHOSIS
Diagnose underlying cause.
Request immediate psychiatric consultation.
Utilize medical hospitalization, if psychosis due to an underlying medical
condition is suspected.
Request psychiatric consultation with psychotic drug intoxications, either
immediately or when mental status stabilizes.
Use quiet room, family and friends, and constant medical supervision.
Use emergency agitation medications and restraints as necessary.
Recognize clinical variations of extrapyramidal reactions to antipsychotic
medications.

POSTTRAUMATIC STRESS DISORDERS
PTSD can occur in childhood and adolescence and is usually due to severe
trauma during earlier years. Children may be more sensitive to the effects of
trauma than are adults and thus may have higher rates of PTSD. Either the
reemergence of the old trauma, the emergence of a new similar one, or the
recollection of the original trauma can activate a PTSD.
Traumatic events involve situations where there was threatened or actual
death, serious injury, or disease to someone. Highly stressful experiences
leading to PTSD in children may include but are not limited to any of the
following: physical violence, verbal threats, sexual abuse, long-standing
hunger and poverty, as well as medical interventions such as bone marrow
transplant, and injury such as burns and motor vehicle accidents. Children
may respond to traumatic events with intense fear, helplessness or horror, or
even disorganized or agitated behavior. In addition, the traumatic event is
persistently reexperienced in one or more ways, for example, persistent
avoidance of stimuli associated with the trauma, numbing of general
responsiveness, and persistent hyperarousal.

With children, PTSD probably emerges through a combination of
traumatic events, along with a silent or nonaccepting environment that fails