{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:48:09Z","timestamp":1792788489268,"version":"4.5.0"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T00:00:00Z","timestamp":1776124800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Psychotic symptoms in children and adolescents may represent either normative developmental phenomena or severe psychiatric and medical conditions, requiring careful differential diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study aimed to evaluate the medical workup of children and adolescents admitted for a first presentation of psychotic symptoms at a tertiary pediatric center over a 10-year period. The sample included 68 patients (mean age 13.7 \u00b1 3.7 years) who underwent clinician-directed evaluations including physical exams, laboratory tests, toxicology screens, neuroimaging, and lumbar puncture when indicated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixteen patients (23.5%) were diagnosed with substance-\/medication-induced or medically-associated psychosis. In this cohort, younger age, very early onset psychosis (&amp;lt;13 years), and catatonia at first presentation were more frequently observed among patients with secondary etiologies, whereas documented prior subthreshold symptoms were more frequently documented among those diagnosed with primary psychiatric disorders. Most investigations did not identify a secondary cause, reflecting clinician-directed evaluation in routine practice; however, selected cases (e.g., autoimmune encephalitis, multiple sclerosis) illustrate the clinical importance of careful assessment when specific suspicion is present.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>These findings suggest that targeted medical evaluation may be useful in pediatric psychosis, particularly when clinical features raise suspicion for secondary etiologies, and may help inform clinical decision-making in tertiary pediatric settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1678974","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T05:37:02Z","timestamp":1776145022000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Medical evaluation of first presentation of psychotic symptoms in children and adolescents"],"prefix":"10.3389","volume":"17","author":[{"given":"Orly","family":"Lavan","sequence":"first","affiliation":[{"name":"Gray School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University","place":["Ramat-Aviv, Israel"]},{"name":"Department of Psychiatry, Schneider Children\u2019s Medical Center of Israel","place":["Petah Tikva, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Ganelin-Cohen","sequence":"additional","affiliation":[{"name":"Gray School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University","place":["Ramat-Aviv, Israel"]},{"name":"Department of Neurology, Schneider Children\u2019s Medical Center of Israel","place":["Petah Tikva, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Schneider Children\u2019s Medical Center of Israel","place":["Petah Tikva, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomer","family":"Mevorach","sequence":"additional","affiliation":[{"name":"Gray School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University","place":["Ramat-Aviv, Israel"]},{"name":"Children and Adolescent Psychiatric Clinic, Tel Aviv Sourasky Medical Center \u2013 Ichilov","place":["Tel Aviv, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shani","family":"Frank","sequence":"additional","affiliation":[{"name":"Gray School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University","place":["Ramat-Aviv, Israel"]},{"name":"Department of Neurology, Schneider Children\u2019s Medical Center of Israel","place":["Petah Tikva, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Apter","sequence":"additional","affiliation":[{"name":"Gray School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University","place":["Ramat-Aviv, Israel"]},{"name":"Department of Psychiatry, Schneider Children\u2019s Medical Center of Israel","place":["Petah Tikva, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvana","family":"Fennig","sequence":"additional","affiliation":[{"name":"Gray School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University","place":["Ramat-Aviv, Israel"]},{"name":"Department of Psychiatry, Schneider Children\u2019s Medical Center of Israel","place":["Petah Tikva, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noa","family":"Benaroya-Milshtein","sequence":"additional","affiliation":[{"name":"Gray School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University","place":["Ramat-Aviv, Israel"]},{"name":"Department of Psychiatry, Schneider Children\u2019s Medical Center of Israel","place":["Petah Tikva, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Krivoy","sequence":"additional","affiliation":[{"name":"Gray School of Medicine, Faculty of Medical and Health Sciences, Tel Aviv University","place":["Ramat-Aviv, Israel"]},{"name":"Geha Mental Health Center","place":["Petah Tikva, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291711002960","article-title":"Prevalence of psychotic symptoms in childhood and adolescence: A systematic review and meta-analysis of population-based studies","volume":"42","author":"Kelleher","year":"2012","journal-title":"Psychol Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1751-7893.2008.00105.x","article-title":"Initial medical work-up of first-episode psychosis: A conceptual review","volume":"3","author":"Freudenreich","year":"2009","journal-title":"Early Interv Psychiatry"},{"key":"B3","doi-asserted-by":"publisher","first-page":"xv","DOI":"10.1016\/j.chc.2019.09.001","article-title":"Psychosis in children and adolescents: A guide for clinicians","volume":"29","author":"House","year":"2020","journal-title":"Child Adolesc Psychiatr Clin N Am"},{"key":"B4","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.chc.2019.08.005","article-title":"Medical etiologies of secondary psychosis in children and adolescents","volume":"29","author":"Merritt","year":"2020","journal-title":"Child Adolesc Psychiatr Clin N Am"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1111\/jcpp.13777","article-title":"Practitioner review: Psychosis in children and adolescents","volume":"64","author":"Sunshine","year":"2023","journal-title":"J Child Psychol Psychiatry"},{"key":"B6","doi-asserted-by":"publisher","first-page":"9","DOI":"10.31887\/DCNS.2015.17.1\/WGAEBEL","article-title":"Focus on psychosis","volume":"17","author":"Gaebel","year":"2015","journal-title":"Dialogues Clin Neurosci"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3371\/CSRP.6.3.6","article-title":"Phenomenology of first-episode psychosis in schizophrenia, bipolar disorder, and unipolar depression: A comparative analysis","volume":"6","author":"Rosen","year":"2012","journal-title":"Clin Schizophr Relat Psychoses"},{"key":"B8","volume-title":"Diagnostic and statistical manual of mental disorders","year":"2013"},{"key":"B9","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.chc.2019.08.010","article-title":"First episode psychosis medical workup: Evidence-informed recommendations and introduction to a clinically guided approach","volume":"29","author":"Skikic","year":"2020","journal-title":"Child Adolesc Psychiatr Clin N Am"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2018.08.057","article-title":"First-presentation with psychotic behavior to the emergency department: Meningitis or not, that is the question","volume":"36","author":"Laher","year":"2018","journal-title":"Am J Emerg Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.schres.2017.05.011","article-title":"An overview of medical risk factors for childhood psychosis: Implications for research and treatment","volume":"192","author":"Giannitelli","year":"2018","journal-title":"Schizophr Res"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.187.3.248","article-title":"Schizophrenia practice guidelines: International survey and comparison","volume":"187","author":"Gaebel","year":"2005","journal-title":"Br J Psychiatry"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1111\/eip.12980","article-title":"Recommendations for the medical work-up of first episode psychosis, including specific relevance to Indigenous Australians: A narrative review","volume":"15","author":"Dorney","year":"2021","journal-title":"Early Interv Psychiatry"},{"key":"B14","article-title":"Psychosis and schizophrenia in adults: Prevention and management (NICE Guideline CG178)","year":"2014"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1177\/0706743717719895","article-title":"Canadian treatment guidelines for individuals at clinical high risk of psychosis","volume":"62","author":"Addington","year":"2017","journal-title":"Can J Psychiatry"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaac.2013.02.008","article-title":"Practice parameter for the assessment and treatment of children and adolescents with schizophrenia","volume":"52","author":"McClellan","year":"2013","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"B17","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.jemermed.2018.04.014","article-title":"First presentation with psychotic symptoms to the emergency department","volume":"55","author":"Etlouba","year":"2018","journal-title":"J Emerg Med"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2015.11.020","article-title":"Is it still correct to differentiate between early and very early onset psychosis","volume":"170","author":"Lin","year":"2016","journal-title":"Schizophr Res"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.psc.2007.04.007","article-title":"Epidemiology of schizophrenia: Review of findings and myths","volume":"30","author":"Messias","year":"2007","journal-title":"Psychiatr Clin North Am"},{"key":"B20","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1016\/j.chc.2019.08.017","article-title":"Childhood-onset schizophrenia and early-onset schizophrenia spectrum disorders: An update","volume":"29","author":"Driver","year":"2020","journal-title":"Child Adolesc Psychiatr Clin N Am"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S82380","article-title":"Autoimmune encephalitis in psychiatric institutions: Current perspectives","volume":"12","author":"Bost","year":"2016","journal-title":"Neuropsychiatr Dis Treat"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2013.01.014","article-title":"First-onset psychosis, anti-NMDAR encephalitis, schizophrenia and consultation-liaison psychiatry","volume":"35","author":"van de Riet","year":"2013","journal-title":"Gen Hosp Psychiatry"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1024\/1422-4917\/a001003","article-title":"Autoimmune psychosis as a differential diagnosis of primary schizophreniform psychosis in children and adolescents","volume":"53","author":"Briegel","year":"2024","journal-title":"Z Fr Kinder- und Jugendpsychiatrie und Psychotherapie"},{"key":"B24","doi-asserted-by":"publisher","first-page":"302","DOI":"10.4103\/psychiatry.IndianJPsychiatry_232_20","article-title":"Psychosis as acute presentation in Hashimoto\u2019s thyroiditis","volume":"63","author":"Gondwal","year":"2021","journal-title":"Indian J Psychiatry"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S82380","article-title":"Postpartum psychosis induced by bromocriptine and pseudoephedrine","volume":"45","author":"Reeves","year":"1997","journal-title":"J Fam Pract"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2013.01.014","article-title":"Paranoid hallucinatory psychosis following medication with anorectics containing D-nor-pseudoephedrine [case report","volume":"52","author":"Rieger","year":"1981","journal-title":"Nervenarzt"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1986.00360170099016","article-title":"Erythromycin ototoxicity and acute psychotic reaction in cancer patients with hepatic dysfunction","volume":"146","author":"Umstead","year":"1986","journal-title":"Arch Intern Med"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/S0074-7742(05)72008-0","article-title":"Towards a valid nosography and psychopathology of catatonia in children and adolescents","volume":"72","author":"Cohen","year":"2006","journal-title":"Int Rev Neurobiol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.schres.2017.07.028","article-title":"Catatonia in children and adolescents: New perspectives","volume":"200","author":"Benarous","year":"2018","journal-title":"Schizophr Res"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnpbp.2020.110028","article-title":"Psychiatric autoimmune conditions in children and adolescents: Is catatonia a severity marker","volume":"104","author":"Ferrafiat","year":"2021","journal-title":"Prog Neuro-Psychopharmacol Biol Psychiatry"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1614.2003.01125.x","article-title":"Incidence of catatonia in children and adolescents in a paediatric psychiatric clinic","volume":"37","author":"Thakur","year":"2003","journal-title":"Aust N Z J Psychiatry"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2019-322702","article-title":"Visual hallucinations in neurological and ophthalmological disease: Pathophysiology and management","volume":"91","author":"O\u2019Brien","year":"2020","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbu036","article-title":"Visual hallucinations in the psychosis spectrum and comparative information from neurodegenerative disorders and eye disease","volume":"40","author":"Waters","year":"2014","journal-title":"Schizophr Bull"},{"key":"B34","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.chc.2019.08.001","article-title":"The prodrome of psychotic disorders: Identification, prediction, and preventive treatment","volume":"29","author":"Nelson","year":"2020","journal-title":"Child Adolesc Psychiatr Clin N Am"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/sbn072","article-title":"Basic symptoms and ultrahigh risk criteria: Symptom development in the initial prodromal state","volume":"36","author":"Schultze-Lutter","year":"2010","journal-title":"Schizophr Bull"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1093\/schbul\/22.2.353","article-title":"The prodromal phase of first-episode psychosis: Past and current conceptualizations","volume":"22","author":"Yung","year":"1996","journal-title":"Schizophr Bull"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1016\/j.cld.2017.06.011","article-title":"Wilson disease: Diagnosis, treatment, and follow-up","volume":"21","author":"Schilsky","year":"2017","journal-title":"Clin Liver Dis"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.2069","article-title":"Retrospective study on structural neuroimaging in first-episode psychosis","volume":"2016","author":"Coentre","year":"2016","journal-title":"PeerJ"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2023.2225","article-title":"Prevalence of neuroradiological abnormalities in first-episode psychosis: A systematic review and meta-analysis","volume":"80","author":"Blackman","year":"2023","journal-title":"JAMA Psychiatry"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1176\/appi.neuropsych.11120363","article-title":"EEG screening for temporal lobe epilepsy in patients with acute psychosis","volume":"24","author":"Raybould","year":"2012","journal-title":"J Neuropsychiatry Clin Neurosci"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.12905","article-title":"Acute medical workup for new-onset psychosis in children and adolescents: A retrospective cohort","volume":"17","author":"Muhrer","year":"2022","journal-title":"J Hosp Med"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1177\/08830738231156804","article-title":"Approach to new-onset psychosis in pediatrics: A review of current practice and an interdisciplinary consensus-driven clinical pathway at a single-center institution","volume":"38","author":"Jonokuchi","year":"2023","journal-title":"J Child Neurol"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1678974\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T05:37:03Z","timestamp":1776145023000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1678974\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,14]]},"references-count":42,"alternative-id":["10.3389\/fpsyt.2026.1678974"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1678974","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,14]]},"article-number":"1678974"}}