Children and adolescents with psychotic disorder not otherwise specified: A 2-to 8-year follow-up study

Although psychotic phenomena in children with disruptive behavior disorders are more common than expected, their prognostic significance is unknown. T o examine the outcome of pediatric patients with atypical psychoses, a grou p of 26 patients with transient psychotic symptoms were evaluated with clin ical and structured interviews at the time of initial contact (mean age, 11 .6 +/- 2.7 years) and at follow-up 2 to 8 years later. Measures of function ing and psychopathology were also completed at their initial assessment. Ri sk factors associated with adult psychotic disorders (familial psychopathol ogy, eyetracking dysfunction in patients and their relatives, obstetrical c omplications, and premorbid developmental course in the proband) had been o btained at study entry. On follow-up examination (mean age, 15.7 +/- 3.4 ye ars), 13 patients (50%) met diagnostic criteria for a major axis I disorder : three for schizoaffective disorder, four for bipolar disorder, and six fo r major depressive disorder. The remaining 13 patients again received a dia gnosis of psychotic disorder not other-wise specified (NOS), with most bein g in remission from their psychotic symptoms. Among this group who had not developed a mood or psychotic disorder, disruptive behavior disorders were exceedingly common at follow-up and were the focus of their treatment. High er initial levels of psychopathology, lower cognitive abilities, and more d evelopmental motor abnormalities were found in patients with a poor outcome . Obstetrical, educational, and family histories did not differ significant ly between the groups. Through systematic diagnostic evaluation, children a nd adolescents with atypical psychotic disorders can be distinguished from those with schizophrenia, a difference with important treatment and prognos tic implications. Further research is needed to delineate the course and ou tcome of childhood-onset atypical psychoses, but preliminary data indicate improvement in psychotic symptoms in the majority of patients and the devel opment of chronic mood disorders in a substantial subgroup. Copyright (C) 2 001 by W.B. Saunders Company.