Acute medical workup for new-onset psychosis in children and adolescents: A retrospective cohort

Abstract

No consensus exists about which medical testing is indicated for youth with new-onset psychotic symptoms. We conducted a chart review of youths aged 7-21 years who were medically hospitalized for workup of new-onset psychotic symptoms from January 2017 through September 2020 in a free-standing children's hospital. The sample included 131 patients. At discharge, 129 (98.5%; 95% confidence interval [CI]: 94.5-99.8) were diagnosed with a primary psychiatric condition, 1 was diagnosed with levetiracetam-induced psychosis, and 1 with seronegative autoimmune encephalitis. Notably, 33 (25.2%; 95% CI: 18.0-33.5) had incidental findings unrelated to psychosis, 14 (10.7%; 95% CI: 6.0-17.3) had findings that required medical intervention but did not explain the psychosis, 12 (9.2%; 95% CI: 4.8-15.5) had a positive urine drug screen, and 4 (3.1%; 95% CI: 0.8-7.6) had a neurological exam consistent with conversion disorder. In conclusion, extensive medical testing in the acute setting for psychosis had a low yield for identifying medical etiologies of new-onset psychotic symptoms.

Figure 1:. Abnormalities Found in Medical Workup, by Type Among Pediatric Patients Admitted for Psychosis Symptoms (N=131)

Any clinically significant finding: a composite of the previous 5 categories. Red herring: required downstream workup to determine whether related to psychosis and was ultimately unrelated. Incidental: clinically significant finding was incidental and unrelated to psychosis. Psychiatric etiology: confirmed psychiatric etiology for psychosis. Needed medical treatment: required medical intervention for a finding that did not explain psychosis. Medical etiology: confirmed medical etiology for psychosis. Clinically insignificant out-of-normal range values, such as mildly elevated transaminases, were not included.