title: Association of psychosis with suicidality in pediatric bipolar I, II and bipolar NOS patients.
abstract: BACKGROUND
  Psychosis in pediatric mood disorder patients may be related to suicidal ideation. Bipolar (BP) adolescents are at high risk of completed suicide. We examined whether pediatric BP patients with psychosis have a higher prevalence of suicidality than non-psychotic BP patients. Based on previous findings in adult BP patients, we predicted that pediatric BP patients with psychotic symptoms would have higher prevalence of suicidality, higher occurrence of lifetime psychiatric hospitalizations and worse current Global Assessment of Functioning Scale (GAF) scores compared to non-psychotic BP patients.
  
  
  METHODS
  We studied 43 BP children and adolescents (mean age +/- S.D = 11.2 +/- 2.8 y, range = 8-17) who did (n = 17) or did not have (n = 26) a lifetime history of psychotic symptoms. Indicators of suicidality (thoughts of death and suicidal ideation, plans, and attempts), psychiatric diagnoses, psychotic symptoms, psychiatric hospitalizations and GAF scores were assessed with the K-SADS-PL interview.
  
  
  CONCLUSIONS
  Small sample size, cross-sectional study and exclusion of substance abuse comorbidity.
  
  
  RESULTS
  Pediatric BP patients with a lifetime history of psychotic symptoms compared to BP patients without psychosis were more likely to have thoughts of death (100% versus 69.2%, p = 0.01), suicidal ideation (94.1% versus 42.3%, p = 0.001) and suicidal plans (64.7% versus 15.4%, p = 0.002). Occurrence of psychiatric hospitalization was higher in psychotic BP patients compared to non-psychotic BP patients (82.4% versus 46.2%, p = 0.018).
  
  
  CONCLUSIONS
  Psychotic symptoms in pediatric BP patients are associated with suicidal ideation and plans, and psychiatric hospitalizations. Psychotic symptoms are a risk factor for suicidality amongst pediatric BP patients.
authors.affiliation: Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
authors.forename: Sheila C
authors.initials: SC
authors.lastname: Caetano
authors.forename: Rene L
authors.initials: RL
authors.lastname: Olvera
authors.forename: Kristina
authors.initials: K
authors.lastname: Hunter
authors.forename: John P
authors.initials: JP
authors.lastname: Hatch
authors.forename: Pablo
authors.initials: P
authors.lastname: Najt
authors.forename: Charles
authors.initials: C
authors.lastname: Bowden
authors.forename: Steven
authors.initials: S
authors.lastname: Pliszka
authors.forename: Jair C
authors.initials: JC
authors.lastname: Soares
mesh_terms: D000293:Adolescent; D001714:Bipolar Disorder / Q000453:epidemiology* / Q000523:psychology; D002648:Child; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000523:psychology; D012307:Risk Factors; D013223:Statistics as Topic; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*