The authors of this paper do not have any commercial associations that might pose a conflict of interest in connection with this manuscript.
Psychotic phenomena in 257 young children and adolescents with bipolar I disorder: delusions and hallucinations (benign and pathological)
Article first published online: 10 JAN 2008
Volume 10, Issue 1, pages 45–55, February 2008
How to Cite
Tillman, R., Geller, B., Klages, T., Corrigan, M., Bolhofner, K. and Zimerman, B. (2008), Psychotic phenomena in 257 young children and adolescents with bipolar I disorder: delusions and hallucinations (benign and pathological). Bipolar Disorders, 10: 45–55. doi: 10.1111/j.1399-5618.2008.00480.x
- Issue published online: 10 JAN 2008
- Article first published online: 10 JAN 2008
- Received 9 August 2006, revised and accepted for publication 18 December 2006
- bipolar disorder;
Objectives: 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.
Methods: 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 ≤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.
Results: 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.
Conclusions: 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.