EPA-0556 - Abuse or psychosis?

A 15-year-old female patient with sensoperceptives alterations and delusional ideation in conjunction with significant emotional and behavioral impact (agressiveness). The girl was physically abused by her father who was a drug addict. As consequence, the patient presented a progressive isolation, abandonment of self and agressiveness to her mother blaming her for the situation. She gained 30 kg in 2 years. Six months later the mother and the girl left home and they began tracking psychologist specializing in family abuse. Whereas she was in hospital, the girl was stabilized by treatment of aripiprazole (20 mg/dia) with good response: by decreasing the intensity and frequency of psychotic symptoms. Negative symptoms initiated two years ago, but at the time of her admission to the hospital, the behavior was attributed to the sequel of abuse received by her father. Whilst the patient did not reveal the alucinations that she had, she was not derived to the derivative emergency hospital. At the end, she was diagnosed with paranoid schizophrenia. One of the characteristics for child psychiatry is that the emergence of psychopathology is extremely modulated by environmental factors, especially by family issues. The clinician can directly attribute new symptoms to the single cause related to the abuse. Then, he could forget the strict application of the science of semiology and the presence of multiple factors to achieve a correct diagnosis. Establishing proper treatment is difficult without a good diagnosis and prognosis without proper treatment of the disease in a patient such young can be tragic.