Abstracts

Rationale: Childhood psychosis is frequently misdiagnosed leading to a delay in adequate treatment. The goal of our study was to look for markers in routine laboratory screening in a group of children with a first psychotic episode and coexisting epilepsyMethods: We retrospectively reviewed the records of all psychotic patients admitted to a child and adolescent psychiatric inpatient unit at the Cleveland Clinic over the past 3 years. Out of 1500 cases reviewed, 102 patients below the age of 18 years were identified with first onset psychosis, among them 11 had reported epilepsy. All the patients were evaluated by the same psychiatrist, using a structured interviewed to diagnosed psychosis and schizophrenia according to the DSM IV, the epilepsy diagnosis was done by EEG and previous past medical history, 4 of the patients were also admitted to the PEMU for further monitoring. Laboratory exams obtained were CBC, CMP, U tox, cooper, lead, ceruloplasmin, Imaging studies (brain MRI or Head CT scan), and also a Brief Psychiatric Rating Scale to quantify the severity of the psychosisResults: 10% of our psychotic group had been diagnosed with epilepsy. Most of our patients were male, half of them Caucasian. The most frequent psychotic symptom was hallucinations seen in all patients. 8/11 reported delusions, 5 demonstrated disorganized behavior. 9 /11 had history of violence more frequently against people, half of them against themselves, none of this patients had history of substance abuse (urine toxicology was negative). 4 / 11 reported a history of physical abuse . 2/11 reported history of sexual abuse. The most frequent comorbidity seen in 6/11 was ADHD. 9 / 11 were at school, 2 / in vocational school. All 11 patietns with psychosis and epilepsy had a monocytosis in their CBC. 3 / 11 had abnormal EEGs consisting of nonspecific slowing and epileptiform abnormalities in 1 patient. Conclusions: The incidence of epilepsy in an inpatient cohort of children with new onset psychosis was approximately 10%. Peripheral monocytosis was frequently seen in these patients. We postulate that inflammatory mechanisms may play a role in the CNS manifestations of psychosis and epilepsy. during the past several years, there has been increasing interest in the role of the blood brain barrier (BBB) in epilepsy, a growing body of evidence has shown that inflammatory mechanisms may participate in the pathological changes observed in epileptic brain as well as in the patients with psychosis. Clinical data also correlate inflammation, immunological responses and psychosis.Further research is needed