Episode 400: #93-2 Psychosis: Schizophrenia

In Episode 2 of our series on psychosis, we take a closer look at schizophrenia in children and adolescents, including the typical onset of symptoms, the role of genetics, and the relationship between cannabis use and psychosis. Our host Paul Paul Wirkus, MD, FAAP and guest Kristi Kleinschmit, MD review the disorders and conditions that commonly overlap with schizophrenia or occur at higher rates, including autism, major depressive disorder, bipolar disorder, schizoaffective disorder, anxiety, and substance use disorders.The conversation also explores how schizophrenia can progress over time and what clinicians can expect as the illness unfolds. We discuss the role of psychotherapy alongside other treatments and the important role pediatricians can play in supporting patients and families throughout the course of illness.Finally, we highlight the Utah Psychiatric Call-Up Line, a publicly funded resource available to Utah primary care and pediatricians for consultation and support when navigating psychiatric concerns. The episode also addresses the pediatrician's role in helping adolescents and young adults transition from pediatric to adult mental health care.Utah Call-Up Line: 801.587.3636 or https://healthcare.utah.edu/hmhi/programs/call-up.Have a question for our hosts or guests? Email [email protected]. For more information, additional episodes, and available CME/MOC credit, visit vcurb.com.The Virtual Curbside is a podcast of the American Academy of Pediatrics, Utah Chapter (UTAAP), connecting pediatricians and subspecialists through practical, accessible pediatric education. Learn more about UTAAP at aaputah.org.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This month we turn to psychiatric topics, beginning with an important clinical question: when a child or adolescent presents with unusual thoughts, perceptions, or behaviors, how do we distinguish psychosis from other psychiatric or medical conditions?In this episode, our host Paul Wirkus, MD and guest Kristi Kleinschmit, MD discuss psychotic experiences and how they can occur in conditions including major depression, bipolar disorder, and OCD, as well as with substance use and trauma or PTSD. We explore how to think about experiences such as imaginary friends and vivid imagination, and when symptoms such as catatonia should prompt a closer evaluation.The conversation also emphasizes the importance of looking beyond a psychiatric diagnosis. Infection, other medical illnesses, and genetic syndromes can all play a role in changes in behavior or perception, making a thoughtful history and appropriate medical evaluation essential. The episode offers pediatricians a framework for recognizing concerning symptoms, considering the broader differential diagnosis, and determining when additional evaluation or referral is needed.Have a question for our hosts or guests? Email [email protected]. For more information, additional episodes, and available CME/MOC credit, visit vcurb.com.The Virtual Curbside is a podcast of the American Academy of Pediatrics, Utah Chapter (UTAAP), connecting pediatricians and subspecialists through practical, accessible pediatric education. Learn more about UTAAP at aaputah.org.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This week we wrap up our series on supporting children’s social, emotional, and relational health with a conversation focused on what pediatricians and other clinicians can take from the series and put into practice. Our host Paul Wirkus, MD and guests Neal Davis, MD and Quang-Tuyen "Q" Nguyen join us to reflect on the key messages from the previous episodes and explore how clinicians can incorporate relational health into everyday pediatric care, particularly when working with families facing additional challenges.The discussion emphasizes that supporting children’s mental and relational health doesn’t always require a lengthy intervention. Sometimes, it happens in the small encounters - a pediatrician showing genuine care, listening to a family, noticing what they need, and helping parents feel supported. We also consider how clinical care can be strengthened when the policies and systems surrounding families are designed to work for them rather than create additional barriers.Q shares practical insights into advancing relational health in pediatric practice and supporting vulnerable populations, while Neal offers a broader vision for the future of early childhood health care. The episode closes by looking at the role pediatricians, health systems, and communities can play in creating a healthier future for Utah’s children and families.Book Club: Amazing GenerationHave a question? Email [email protected] more information about available credit, visit vCurb.com, or for information about the UTAAP, visit aaputah.org.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This week, we turn to one of the most common parenting questions in pediatric practice: screen time and digital wellness. Our host Paul Wirkus, MD, FAAP and guest Mark Witt, MD, discuss the unique role pediatricians have in helping families navigate technology use, while recognizing the challenge of addressing an increasingly complex topic within the limited time of a well-child visit.Rather than focusing only on a specific number of screen-time hours, the conversation emphasizes an age-specific approach and encourages pediatricians to consider what screen use may be displacing. We explore how increased screen time can affect physical activity, family time, sleep, and even where children use screens within the home. The discussion also highlights the value of establishing screen-free spaces and creating healthy boundaries around technology.Throughout the episode, our guest offers practical ways pediatricians can begin conversations about digital wellness and help families develop healthy, sustainable habits around screens.AAP Statement on Screen Time Book Club: Amazing GenerationHave a question? Email [email protected]. For more information about available credit, visit vCurb.com, or for information about the UTAAP, visit aaputah.org.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In Episode 2 of our quality improvement series on parenting advice in pediatric practice, we focus on the role pediatricians can play in supporting emotional resilience for both children and their parents. Host Paul Wirkus, MD, FAAP and guest Ryan Gottfredson, DO begin by discussing why quality improvement matters in clinical practice and how small, intentional changes can help pediatricians incorporate meaningful parenting guidance into routine care.The conversation explores modern parenting challenges, including stress, toxic levels of stress, and strategies for building resilience. We discuss how parents can teach resilience by modeling healthy behaviors, while maintaining balanced boundaries that provide children with both structure and support. Additional topics include helping children navigate failure, fostering independence, and finding the balance between parental authority and recognizing the humanity of both parents and children.Finally, we address a practical challenge familiar to every pediatrician: how to make space for these important conversations during a well-child visit when time is limited. The episode offers ideas for integrating parenting guidance into everyday clinical encounters without adding an unrealistic burden to already busy practices.Have a question? Email [email protected] more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This month, we begin a new series on quality improvement initiatives that pediatric practices can implement to support families. Our first episode focuses on promoting social and emotional health by equipping pediatricians with practical strategies to help parents foster resilience, healthy relationships, and emotional well-being in their children.Our host Paul Wirkus, MD, FAAP and Cindy Brough, MD discuss the importance of building awareness, empathy, effective communication, problem-solving skills, self-confidence, and a strong sense of self from an early age. The conversation introduces a simple framework for coaching families through emotions: "notice, name, normalize, and navigate." We also explore how pediatricians can help parents provide consistent guidance, model healthy emotional regulation, and tailor expectations to a child's developmental stage.Additional topics include teaching conflict resolution, supporting positive peer relationships, recognizing when social withdrawal or changes in friendships may signal a concern, and understanding how a parent's own social and emotional health influences their child. Throughout the episode, Dr. Brough shares practical conversation starters that pediatricians can incorporate into routine visits, along with a wealth of evidence-based resources to support families in raising emotionally healthy children.Have a question? Email [email protected] more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In this Q&A episode of our Postural Orthostatic Tachycardia Syndrome (POTS) series, host Paul Wirkus, MD, FAAP and guest Kirti Sivakoti, MD, answer listener questions about diagnosing and managing POTS in pediatric patients. The discussion explores how to distinguish POTS from conditions with overlapping symptoms, including Mast Cell Activation Syndrome (MCAS) and other common POTS mimics, and when referral to an immunologist may be appropriate.We also review commonly used medications for symptom management, including practical considerations for initiating and tapering therapy as patients improve. Additional topics include the effects of caffeine, stimulant medications, ADHD treatments, and vasoconstrictors on orthostatic symptoms, helping clinicians navigate treatment decisions in children and adolescents with complex presentations.Throughout the episode, Dr. Sivakoti emphasizes the importance of individualized care, careful assessment, and ongoing follow-up to optimize outcomes for patients living with POTS.Have a question? Email [email protected]. For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In this episode of our Postural Orthostatic Tachycardia Syndrome (POTS) series, we look beyond diagnosis and treatment to discuss what the future holds for children and adolescents living with POTS. Host Paul Wirkus, MD, FAAP and guest Kirti Sivakoti, MD, review the long-term prognosis, highlighting what is currently known about recovery, symptom progression, and functional outcomes over time.The conversation also explores the complex relationship between POTS and other conditions, including the impact of COVID-19, eating disorders, chronic pain syndromes, and functional neurologic disorders. We discuss how these overlapping conditions can influence diagnosis, management, and quality of life, and examine where current research is headed as our understanding of POTS continues to evolve.Finally, our Dr. Sivakoti shares what they believe is the most misunderstood aspect of POTS and identifies one of the most undervalued interventions that can make a meaningful difference for patients. This episode offers practical insights into the evolving science of POTS while reinforcing the importance of a comprehensive, individualized approach to care.Have a question? Email [email protected]. Listener questions will be answered next week.For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

In Episode 2 of our series on Postural Orthostatic Tachycardia Syndrome (POTS), we focus on evidence-based treatment strategies to help children and adolescents manage symptoms and improve daily functioning. Host Paul Wirkus, MD, FAAP and guest Kirti Sivakoti, MD, review the foundation of POTS management, emphasizing lifestyle interventions such as maintaining adequate hydration, increasing salt intake when appropriate, establishing healthy sleep habits, and implementing a gradual, structured exercise program.The discussion also explores the role of nutrition, compression garments, and heat avoidance in reducing symptom burden, along with practical accommodations that can support patients at school and in everyday activities. Finally, we review pharmacologic treatment options, discussing when medications may be appropriate and how they fit into an individualized care plan. Throughout the episode, the emphasis is on developing a comprehensive, patient-centered approach that helps children and adolescents regain function and improve their quality of life.Have a question? Email [email protected]. Listener questions will be answered in episode four. For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This month we begin a new series on Postural Orthostatic Tachycardia Syndrome (POTS), exploring the diagnosis and management of this increasingly recognized condition in pediatric patients. In this episode, host Paul Wirkus, MD, FAAP and guest Kirti Sivakoti, MD, provide an overview of POTS before discussing current approaches to diagnosis and recent updates in the field. We review the diagnostic criteria, including orthostatic symptoms and the degree of functional impairment, and consider how these factors help guide clinical evaluation and management.The conversation also examines the growing understanding of POTS as a spectrum disorder, with many patients experiencing overlapping symptoms and contributing conditions. Finally, we discuss how to distinguish POTS from vasovagal syncope and review current thinking on the underlying causes and pathophysiology of POTS. This episode provides pediatricians with a practical framework for recognizing and evaluating children and adolescents with orthostatic intolerance.Have a question? Email [email protected]. Listener questions will be answered in episode four. For more information about available credit, visit vCurb.com.ACCME Accreditation StatementThis activity has been planned and implemented in accordance with the accreditation requirements and policies of the Colorado Medical Society through the joint providership of Kansas Chapter, American Academy of Pediatrics and Utah Chapter, AAP.  Kansas Chapter, American Academy of Pediatrics is accredited by the Colorado Medical Society to provide continuing medical education for physicians. AMA Credit Designation StatementKansas Chapter, American Academy of Pediatrics designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.