Childhood psychotic experiences predict adolescent mental health service, psychotropic medication use

Childhood psychotic experiences predict use of mental health services and psychotropic medications during adolescence, according to results of a longitudinal register-based follow-up study conducted in Denmark and published in American Journal of Psychiatry.

“Although childhood psychotic experiences are relatively common and may occur as transient phenomena within the range of normal development, they share genetic and environmental vulnerabilities with psychotic disorders and mark an increased risk for psychotic disorders later in life,” Martin Køster Rimvall, MD, of the Child and Adolescent Mental Health Center, Capital Region of Denmark, and colleagues wrote.

According to the researchers, studies conducted in a mainly adult population showed that psychotic experiences predict later mental disorders transdiagnostically, especially in the context of comorbid psychopathology and a family history of mental disorders. Further, a recent meta-analysis revealed that although childhood psychotic experiences are significantly associated with nonpsychotic mental disorders in cross-sectional studies, longitudinal studies are lacking.

To investigate whether psychotic experiences at ages 11 to 12 years predicted treatment with psychotropic medications or a psychiatric diagnosis by ages 16 to 17, Rimvall and colleagues assessed psychotic experiences via face-to-face interviews with 1,632 children aged 11 to 12 years who were included in the Copenhagen Child Cohort 2000. They also assessed these children for IQ and mental disorders, and evaluated national registry data for information on perinatal and sociodemographic characteristics, psychiatric disorders diagnosed at child and adolescent mental health services, and prescribed psychotropic medications through ages 16 to 17 years.

Results showed that after adjustment for perinatal and sociodemographic adversities and IQ, children who had not been previously diagnosed but who had a psychotic experience between ages 11 and 12 years were more likely to receive a psychiatric diagnosis in child and adolescent mental health services before ages 16 to 17 years (adjusted HR [aHR] = 3.13; 95% CI, 1.93-5.07). The risk was increased among children who met criteria for a co-occurring mental disorder, which was not diagnosed in mental health settings, at baseline compared with no diagnosis or psychotic experiences at baseline (aHR = 7.85; 95% CI, 3.94-15.63). However, having psychotic experiences alone was associated with a significantly increased risk for later psychiatric diagnoses (aHR = 2.76; 95% CI, 1.48-5.13). The researchers found similar patterns for treatment with psychotropic medications.

“This study adds to the existing evidence that psychotic experiences should be part of any mental health screening of children and adolescents,” they wrote. “Even though psychotic experiences usually should not prompt imminent concern about development of a psychotic disorder, they should induce concern for the well-being of the child and lead to examination and identification of potential areas of intervention to reduce overall distress and burden. This in turn may ultimately lead to prevention and alleviation of mental health problems, and disorders for some individuals, across the diagnostic spectrum.” – by Joe Gramigna

Disclosures: Rimvall reports research grant funding from the Research Foundation of the Mental Health Services, Capital Region of Denmark. Please see the study for all other authors’ relevant financial disclosures.