Psychosis in a pediatric mood and anxiety disorders clinic: Phenomenology and correlates

Objective: To examine the demographics and phenomenology of psychosis in a sample of children and adolescents referred to a mood and anxiety disorders clinic. Method: Patients (N = 2,031) were assessed with the Schedule for A ffective Disorders and Schizophrenia for School-Age Children-Present Episod e version and classified as definite, probable, or nonpsychotic. Clinical a nd demographic characteristics of the groups were compared, and symptoms of psychosis were analyzed using factor analysis. Results: Definite psychotic symptoms were seen in approximately 90 (4.5%) patients: 80% of these repor ted hallucinations (mainly auditory), 22% delusions, and 3.3% thought disor der. Of the patients with definite psychotic symptoms, 24% had bipolar diso rder, 41% had major depression, 21% had subsyndromal depression, and 14% ha d schizophrenia spectrum disorders (schizophrenia and schizoaffective disor ders). Factor analysis of the definite psychotic symptoms yielded 4 factors : hallucinations, thought disorder, delusions, and manic thought disorder. Psychotic patients had a higher frequency of comorbid disorders and suicida l ideation than nonpsychotic patients. Conclusions: Outpatient youngsters w ith mood disorders frequently present with psychotic symptoms, in particula r auditory hallucinations. These patients commonly have comorbid psychiatri c disorders and suicidal ideation.