Psychotic phenomena in 257 young children and adolescents with bipolar I disorder: delusions and hallucinations (benign and pathological)

Abstract

In contrast to studies of adult bipolar I disorder (BP-I), there is a paucity of data on psychotic phenomena in child BP-I. Therefore, the aim of this work was to describe delusions and hallucinations in pediatric BP-I. Subjects were 257 participants, aged 6-16, in either of two large, ongoing, NIMH-funded studies, 'Phenomenology and Course of Pediatric Bipolar Disorders' or 'Treatment of Early Age Mania (TEAM)'. All subjects had current DSM-IV BP-I (manic or mixed phase) with a Children's Global Assessment Scale score <or=60 (definite clinical impairment), and all had cardinal mania symptoms (i.e., elation and/or grandiosity). Comprehensive assessments included the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia (WASH-U-KSADS), which was administered to parents about their children and separately to children about themselves by experienced research clinicians. The WASH-U-KSADS contains modules for developmentally child-age-specific manifestations of numerous categories of psychotic phenomena. Psychosis was present in 76.3% (n = 196) of subjects, which included 38.9% (n = 100) with delusions, 5.1% (n = 13) with pathological hallucinations, and 32.3% (n = 83) with both. The most common delusion was grandiose (67.7%, n = 174), and the most common pathological hallucination was visual (16.0%, n = 41). Benign hallucinations occurred in 43.6% (n = 112). A median split by age yielded 6-9 year-olds (n = 139) and 10-16 year-olds (n = 118). Analyses of these two groups, and of 6, 7, 8, and 9 year-olds separately, found no significant differences in psychotic phenomena. Counterintuitively, psychosis was equally prevalent in 6-9 compared to 10-16 year-olds. High prevalence of psychosis in child BP-I warrants focus in intervention strategies and is consistent with increasing evidence of the severity of child-versus adult-onset BP-I.