In children with first psychotic symptoms, 23.5% had substance- or medically-associated psychosis after extensive workup.

This retrospective cohort study examined 68 children and adolescents admitted to a tertiary pediatric center for a first presentation of psychotic symptoms. The primary exposure was a comprehensive medical workup, which included physical examinations, laboratory tests, toxicology screens, neuroimaging, and lumbar puncture when indicated. The primary outcome was the diagnosis of substance- or medically-associated psychosis.

Results indicated that 16 of the 68 patients (23.5%) were diagnosed with substance- or medically-associated psychosis. No specific data regarding serious adverse events, discontinuations, or tolerability were reported in the study. The analysis did not report p-values or confidence intervals for the primary outcome.

Key limitations include the younger age of the participants and the very early onset of psychosis, which may influence diagnostic criteria application. As an observational study, the design precludes definitive causal conclusions regarding the workup procedures themselves. Funding sources and potential conflicts of interest were not reported.

Clinicians should recognize that a substantial proportion of pediatric psychosis cases may be linked to medical or substance factors. However, the lack of reported safety data and the specific limitations of early-onset populations necessitate cautious interpretation of these results in broader practice settings.