Psychotic features in adolescent mood disorders: clinical severity, neurodevelopmental vulnerabilities, and short-term naturalistic outcomes

In adolescents with mood disorders, psychotic features are linked to greater clinical severity, functional impairment, and a higher risk of misdiagnosis. This study aimed to better characterize factors associated with psychotic features in pediatric mood disorders based on a secondary analysis of data pooled from three cross-sectional studies. Among 305 youths with mood disorders referred for specialized care (mean age 14.38 years; 57% female; 9% bipolar disorders, 91% depressive disorders), 41 presented psychotic features. A 72-item grid was used to collect main socio-demographic and clinical characteristics, in addition to the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children PL (KSADS-PL), the Clinical Global Impression Scale Severity and Improvement scales (CGI-S, CGI-I), and the Children’s Global Assessment Scale (CGAS). Patients with mood disorders and psychotic features had higher illness severity (+ 0.94 points on the CGI-S) and lower functioning (-11 points on the CGAS). Among psychosocial adversity factors, only parent-child conflicts were associated with psychotic features in the sample (Odds Ratio, OR = 2.36, 95% CI [1.21, 4.62]). Youths with mood disorders and psychotic features also had higher rates of communication disorders OR = 4.25, 95% CI [1.74, 10.42] and intellectual developmental disorder OR = 5.83, 95% CI [1.69, 20.10]. The findings should be interpreted with caution in light of several limitations of the study, in particular, heterogeneity in clinical practice across sites and time periods, underrepresentation of bipolar disorders, the small sample size, and the cross-sectional design. These findings suggest that among youths with mood disorders, a substantial burden of developmental difficulties is likely to be reported in those with psychotic features. Not applicable.