symptoms are placed within the greater clinical context of the patient’s presentation TABLE 126.27 ACUTE SCHIZOPHRENIA IN ADOLESCENCE: MOST COMMON FEATURES Flat affect (Patient uninvolved and without emotion) Auditory hallucinations (Physician: “Have you been hearing voices even when no one is there?”) Thoughts spoken aloud (Physician: “Can other people read your mind? Can you read their minds?”) Delusions of external control (Physician: “Is anyone trying to kill you?… trying to control your mind or your body?”) Management Psychosis due to a Medical Condition Any child with psychosis in which an underlying medical condition is suspected requires medical admission for diagnostic evaluation and treatment Other important management involves controlling the child’s behavior, preventing injury to self/others, and alleviating the child’s fear and anxiety This should be attempted first with supportive statements acknowledging the child’s condition and distress, and using distractions that allow the child to have some control, such as offering choices of food or drink or safe toys As the child is distractible and anxious, instructions may need to be repeated frequently Brief Psychotic Episode When a brief psychotic episode is suspected, the emergency physician should appreciate that these children may not progress to have a permanent psychiatric disorder The emergency management is similar to that of other psychotic states, including psychiatric consultation