Psychotic Symptoms Are Selectively Associated with Mood Symptom Severity and Worse Outcome in Pediatric Bipolar Disorder

Poster A17, Monday, October 8, 11:30 am - 1:00 pm, Essex Ballroom

Peter Bachman1, John Merranko1, Itziar Baltasar Tello2, David Axelson3, Benjamin Golstein4, Michael Strober5, Mary Kay Gill1, Jeffrey Hunt6, Satish Iyengar1, Neal Ryan1, Martin Keller6, Boris Birmaher1; 1University of Pittsburgh, 2Universidad Autónoma de Madrid, 3The Ohio State University, 4University of Toronto, 5University of California, Los Angeles, 6Brown University

Presence of psychosis is associated with worse outcome among adults with Bipolar Disorder (BD). Among youth with BD, however, the clinical significance of psychosis is unknown. Understanding its prognostic value may help us make critical decisions regarding the allocation of limited treatment resources. Using data from the longitudinal Course and Outcome in Bipolar Youth (COBY) study (mean follow-up=10 years, +/-12.45 mos), we compared bipolar youth with one or more psychotic symptoms during at least one study time point (PSY+, N=137) to bipolar youth with no history of psychosis (PSY-, N=239) on measures of clinical outcome. Compared to PSY- youth, PSY+ youth display: more severe mania and depression (p's<0.02), higher anxiety (p=0.006), more hospitalizations (p<0.001), more past abuse (p=0.012), more suicide attempts and ideation (p’s<0.001), and more self-injury (p=0.038). Age, IQ, sex, and pubertal status does not differ between the groups, nor does family history of psychosis, nor do measures of aggression, irritability, or impulsivity. When PSY+ youth are sub-divided into those endorsing psychosis at one time-point (N=91) versus two or more time points (N=46), the latter display higher anxiety (p=0.003), and more suicide attempts (p<0.001) and ideation (p=0.006), suggesting dose-dependent associations. Among youth with BD, psychotic symptoms – even those reported only once over years of follow up – are associated with worse mood symptoms and worse outcome on other selected measures. We conclude that psychosis does indeed index more severe pediatric BD, and that a particularly high level of care may be necessary to prevent hospitalization and suicide.

Topic Area: Diagnosis and Phenomenology

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