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NEW RESEARCH

Childhood Onset Schizophrenia: High Rate


of Visual Hallucinations
Christopher N. David, B.A, Deanna Greenstein, Ph.D., Liv Clasen, Ph.D.,
Pete Gochman, M.A., Rachel Miller, Ph.D., Julia W. Tossell, M.D., Anand A. Mattai, M.D.,
Nitin Gogtay, M.D., Judith L. Rapoport, M.D.

Objective: To document high rates and clinical correlates of nonauditory hallucinations in


childhood onset schizophrenia (COS). Method: Within a sample of 117 pediatric patients
(mean age 13.6 years), diagnosed with COS, the presence of auditory, visual, somatic/tactile,
and olfactory hallucinations was examined using the Scale for the Assessment of Positive
Symptoms (SAPS). We also compared hallucination modality membership (presence/absence)
groups on gender, socioeconomic status, ethnicity, age of onset (of psychosis), Full Scale IQ,
Verbal IQ, and clinical severity (Children’s Global Assessment Scale [CGAS) and Scale for the
Assessment of Negative Symptoms [SANS]). Results: A total of 111 COS patients (94.9%)
had auditory and 94 patients (80.3%) had visual hallucinations. Somatic/tactile (60.7%) and
olfactory (29.9%) hallucinations occurred almost exclusively in patients who also had visual
hallucinations. Children who had visual hallucinations had lower IQ, earlier age of onset, and
more severe illness relative to children who did not have visual hallucinations. Conclu-
sions: In this study, we observed that patients with COS have high rates of hallucinations
across all modalities. An increased rate of visual hallucinations is associated with greater
clinical impairment and greater compromise in overall brain functioning. Somatic and
olfactory hallucinations reflect an additive rather than alternative symptom pattern. J. Am.
Acad. Child Adolesc. Psychiatry, 2011;50(7):681– 686. Key Words: childhood onset schizo-
phrenia (COS), visual hallucinations, IQ, severity

C
hildhood onset schizophrenia (COS), de- visual hallucinations with rates ranging from
fined by onset of psychosis before age 13 72%3 to 12%,4 with most ratings less than 35%5-8
years, is a rare and severe form of schizo- (Table S1, available online).
phrenia1 that can be diagnosed reliably in children, A handful of studies of COS suggest higher
is neurobiologically and physiologically continu- rates of visual hallucinations than observed in
ous with adult onset schizophrenia, and usually the adult onset schizophrenia cases,9-12 with
resembles adult patients with chronically poor out- some studies reporting rates as high as 69% from
come.1 There is general consensus about a neuro- chart reviews 13 or 48% using standardized rating
developmental model for schizophrenia with COS scales.14
showing more salient genetic and neuroanatomical During the course of the National Institute of
underpinnings compared to the adult illness.2 Mental Health (NIMH) COS project, there has been
Although auditory hallucinations are reported a strikingly high rate of nonauditory hallucinations.
for the large majority of adult and childhood In this study, we report the rates of hallucinations
onset schizophrenia patients, visual hallucina- for our COS sample to better estimate hallucination
tions are seen less commonly. Studies in adult rates in comparison with those in other published
onset disorders from Western cultures report studies. Our study also included a drug-free obser-
vation period, and thus provided a unique oppor-
tunity to evaluate severity in absence of treatment
This article is discussed in an editorial by Dr. Jon McClellan on effect. We explored where interruption of other
page 642. sensory systems (including olfactory and somatic/
Supplemental material cited in this article is available online. tactile) would reflect even greater impairment
within our patient group.

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DAVID et al.

Based on the severity of illness for this inpa- particular modality. If the score was a 1 (“questionable”)
tient study, we expected that COS patients would or 0 (“none”), the proband was placed in the “no” group.
show higher rates of visual (and other nonaudi- The author of this scale has described the possibility for
tory) hallucinations over the course of their par- differences in base rates depending on the cutoff point
used,19 and our selection of “mild” was based on previ-
ticipation in the study. Similarly, based on clini-
ous work in COS hallucinations describing rates with this
cal impressions, we hypothesized that within our SAPS criteria.20 Other COS studies of hallucination rates
sample, patients with both visual and auditory have relied on retrospective chart reviews of patient
hallucinations would be more severely ill than admissions or single clinical interviews. Scoring method
those with auditory hallucinations alone. and other details for these studies are given in Table S1
(available online).
The number of patients in analyses varies somewhat
METHOD due to missing data. IQs (post-onset) were obtained
either preadmission or during admission to the NIH. The
Subjects
Institutional Review Board of the National Institutes of
The NIMH COS study has been ongoing since 1990. To
Health approved the protocol for this study. Adult
date, our branch has received approximately 3,000 case
subjects received informed consents and minor children
submissions for the COS screening protocol, of which
received assents alongside parental permission.
more than 300 were invited to the NIH campus for
outpatient screening. Following screening, over 200 were
admitted for in-patient observation which included for Statistical Analysis
most a 2- to 3-week drug-free observation period. (those We used t tests to explore group differences in continu-
without a drug free period were either drug free on ous demographic and clinical measures. We assessed
admission or on very low doses of drug, and the drug- violations of homogeneity of variance with a modified
free period was not considered necessary). Inclusion Levene test, and assessed the normality assumption
criteria for the study were: onset of psychosis before the using the D’Agostino omnibus test. If a violation of either
13th birthday, premorbid IQ of 70 or above, and absence the homogeneity of variance assumption or the normal-
of significant neurological illness. To date, 117 patients ity assumption was noted, we examined the Aspin-
aged 6.5 to 17 years (mean age 13.6 years, SD 2.6 years; 67 Welch t and p values and the Mann–Whitney U and
male and 50 female) received a COS diagnosis. p values, respectively. These results were consistently
comparable (relative to rejecting or failing to reject the
null) to the t test for independent groups, and as a result,
Clinical Ratings for the sake of simplicity, we only report the t and
Details of the study’s clinical ratings are provided corresponding p values. For group associations with
elsewhere.15 The Scale for the Assessment of Positive categorical measures, we used ␹2 tests of independence.
Symptoms (SAPS)16 and the Scale for the Assessment Statistical analyses were performed using R21, SPSS ver-
of Negative Symptoms (SANS)17 provide itemized sion 16.0, and NCSS Statistical Software 2007. We also
scales for individual positive and negative symptoms, examined the frequency of combinations of visual, audi-
including hallucination intensity for each modality. tory, olfactory, and/or somatic/tactile symptoms and
Children’s Global Assessment Scale (CGAS)18 is a present the results with a Venn diagram: checks for the
rating scale from 0 to 100 with descriptive anchor number assignment for placement within the four-set
points for overall level of functioning at home, school, Venn were performed using Venny.22
and with peers. Hallucinations are not mentioned, and
the stress is on overall behavior. These clinical ratings
were obtained at screening, and during admission, and
at follow-up. CGAS interrater reliability agreement on RESULTS
final ratings was satisfactory (␬ ⫽ 0.8). As expected, most COS patients (95%) reported
auditory hallucinations, which are often part of
the basis for referral. Supporting our clinical
Hallucination Groups impressions, 94 patients (80.3%) also reported
To explore the relationship of severity measures to visual hallucinations, 71 (60.7%) reported somat-
hallucination ratings, we classified probands within
ic/tactile hallucinations, and 35 (30%) had olfac-
two time-based groups: at screening/admission and at
drug-free time point. The overall presence/absence of
tory hallucinations. These are generally higher
hallucinations (during NIH screening, admission, or rates of hallucinations compared to their adult
follow-up) was also considered. Hallucinations were schizophrenia counterparts across all hallucina-
scored using the SAPS item 1 (auditory) item 6 (vi- tion subtypes and higher than most previous
sual), item 4 (somatic/tactile), and item 5 (olfactory). A reports for childhood onset patients (Table S1).
score of 2 or higher was considered “present” for that We searched the literature for large samples (n ⫽

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682 www.jaacap.org VOLUME 50 NUMBER 7 JULY 2011
VISUAL HALLUCINATIONS IN COS

FIGURE 1 Hallucination modalities in the National ities (i.e., no subjects only had olfactory or somatic/
Institute of Mental Health (NIMH) Childhood Onset tactile hallucinations). As seen in Figure 1, within
Schizophrenia (COS) cohort. the COS subjects, there was significant overlap
between visual and auditory hallucinations; only
one subject had visual without also having audi-
tory hallucinations. Somatic/tactile and olfactory
hallucinations were absent in cases without both
visual and auditory hallucinations being present.
Thus there appears to be an additive progression of
hallucination categories in order of descending
frequency. Qualitative nature of the psychotic phe-
nomena did not indicate a predominance of over-
lapping experiences on a unitary theme. For exam-
ple, a typical patient reported demonic voices, saw
magical fairies, and felt spiders crawling on her
skin. Another patient explained: “You’re not get-
ting it, it’s not just about hearing the demons, it’s
about seeing other stuff too. Like the aliens in their
50 or more for adults) describing schizophrenia spaceships.”
hallucination rates; methods varied and only Ethnicity, gender, and SES were not signifi-
Andreasen’s 1987 adult study,8 met this criteria, cantly different in patients with visual hallucina-
and no other large COS studies employed these tions compared to those without. Duration of
instruments. We located 20 English language illness, as measured from the time of psychosis
reports, 18 of which drew from populations of onset to the time of rating at the NIMH (mini-
Western societies, and all reports of COS that mum ⫽ 0.75, maximum ⫽ 11.9, mean ⫽ 3.75
measured hallucinations were included. years) was not found to be significant, whereas
The ␹2 comparisons with Andreasen’s adult duration of illness, as measured from time of first
schizophrenia study8 (which used the same SAPS symptom onset (minimum ⫽ 0.24 years, maxi-
items) showed our sample to have higher audi- mum ⫽ 14.92, mean ⫽ 6.97) was found to be
tory (p ⬍ .01), visual (p ⬍ .01), somatic/tactile significant (p ⬍ .01), for patients with visual
(p ⬍ .01), and olfactory (p ⬍ .01) hallucination hallucinations compared with those without.
rates in our COS cohort. Table 1 shows clinical measures in relation to
The overall overlap between groups was con- presence/absence of visual hallucinations. As
siderable, with auditory, visual, and other modal- shown in Table 1, the presence of visual hallucina-

TABLE 1 Reported Visual Hallucinations and Clinical Ratings for Childhood Onset Schizophrenia Patients (N ⫽ 117)
No Visual Visual
Hallucinations Hallucinations
(mean ⴞ SD) (mean ⴞ SD) p
Measure (n ⴝ 24) (n ⴝ 94) T (df) Value

Age at assessment 15.1 (2.62) 13.23 (2.79) 2.9 (115) .003


IQ 83.3 (21.0) 71.2 (17.4) 2.7 (93) .007
VIQ 87.8 (20.17) 74.1 (15.1) 3.2 (76) .002
Age at psychosis onset 10.7 (1.59) 9.7 (2.1) 2.1 (115) .036a
CGAS score (admission) 38.7 (8.19) 31.8 (11.3) 2.4 (104) .016
CGAS score (drug-free) 33.1 (14.79) 22.7 (12.2) 2.9 (93) .003
SANS sum (drug-free) 31.2 (16.94) 53.1 (21.2) ⫺3.4 (88) .001
Duration of illness from psychosis onset 4.4 (2.30) 3.5 (2.16) 1.5 (115) .130a
Duration of illness from age of first symptoms 9.2 (3.61) 6.4 (3.67) 3.2 (115) .002

Note: CGAS ⫽ Children’s Global Assessment Scale; IQ ⫽ Intelligence Quotient; SANS ⫽ Scale for the Assessment of Negative Symptoms; VIQ ⫽ Verbal
Intelligence Quotient.
a
Did not survive false discovery rate (FDR) procedure.

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DAVID et al.

FIGURE 2 Verbal IQ in relation to visual and additional modalities for the National Institute of Mental Health
(NIMH) Childhood Onset Schizophrenia (COS) cohort.

tions indicated greater severity as evidenced by hallucinations (by modality) between the two indi-
earlier age of psychosis onset (p ⬍ .05), younger age vidual admission/screening and drug-free time
at assessment (p ⬍ .01), lower Full Scale IQ scores points appeared similar, with a mean time between
(p ⬍ .01), lower CGAS scores at admission (p ⬍ .01), admission/screening and drug-free assessments of
and at drug-free time point (p ⬍ .01), and a shorter 38.1 days (SD ⫽ 17.1). Not surprisingly, the screen-
duration of illness from age of first symptoms onset ing/admission clinical measures did not relate as
(p ⬍ .01). Also, girls were more likely to experience consistently to hallucination status, presumably be-
olfactory hallucinations (␹2 ⫽ 6.1, df ⫽ 1, p ⫽ .016). cause of variability in treatment availability and
Most survived the false discovery rate procedure23: response.
visual hallucinations (ever) and IQ, verbal IQ
(VIQ), CGAS (from drug-free time point and ad-
mission), age at assessment, duration of illness DISCUSSION
from age of first symptoms, and SANS sum (from The NIMH childhood onset patients show high
drug-free time point), as well as visual hallucina- rates across all hallucination modalities. This may
tions (at drug free time point) and VIQ. When reflect severity of our inpatient population. As
accounting for the additive nature of hallucination expected, almost all had auditory hallucinations,
modalities in the COS cohort, a stepwise decline in since auditory hallucinations are important diag-
VIQ was observed (Figure 2). VIQ distribution of nostic criteria for these pediatric patients, and were

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684 www.jaacap.org VOLUME 50 NUMBER 7 JULY 2011
VISUAL HALLUCINATIONS IN COS

often the symptom that led to referral to our study. subjects and inconsistent methodology, difficulty of
The relationship between non-auditory hallucina- interstudy comparison is noted. Despite method-
tions to severity, however, is strongly supported by ological differences between our study’s data col-
analyses within our sample. Visual hallucinations lection and previous smaller reports, the similar
showed a significant relationship to lower IQ and distributions of hallucination modality member-
earlier age of onset. Drug-free observation permit- ship in probands at both the admission/screening
ted further within-sample observation of the signif- and drug-free time points indicates that treatment
icant relationship between visual hallucinations status does not affect lifetime reporting of these
and overall clinical severity. Both the duration of events. We also found that those studies that as-
psychotic illness as well as duration of “psychiatric sessed hallucination rates from a more comprehen-
or other problems requiring attention” were sive timeframe,13 instead of a one-time clinical
shorter in children who had visual hallucinations interview, also reported higher hallucination rates
although only the latter reached significance. more in line with our findings.
There were surprisingly high rates for tactile A limitation of this study was that although
and olfactory hallucinations in this group, and this is the largest reported study of COS, the
they occurred exclusively in patients who had subgroup of patients without visual hallucina-
visual hallucinations. Visual, olfactory and tactile tions is small. In addition, national recruiting of a
hallucinations thus appear to be a general marker rare patient population has referral biases that
of increased severity of psychosis. In addition, are not easily identified. An impaired connectiv-
verbal IQ, in particular, demonstrated a consis- ity model of schizophrenia is consistent with the
tent relationship with the presence of visual, broader impairment of sensory domains seen in
somatic/tactile and olfactory hallucinations (Fig- our severely ill chronic schizophrenia subjects.
ure 2), even when each modality was considered Future research may link these four hallucination
independently, although the numbers of subjects modalities to other indicators of brain disconnec-
remain too small to compare statistically. It is tivity. Functional neuroimaging of these COS
important to note, however, that COS is ex- patients with consideration to visual hallucina-
tremely rare, and the majority of children expe- tions is currently underway. &
riencing hallucinations do not progress to COS.24
Nonetheless, our data are unique and demon- Accepted March 29, 2011.
strate an additive nature of hallucinations by the Drs. Greenstein, Clasen, Miller, Tossell, Mattai, Gogtay, and Rapo-
pattern of overlap and the additive pattern’s port, and Mr. David and Mr. Gochman are with the National Institute
of Mental Health.
relationship to IQ. We do not believe that the
This research was funded through the Intramural Program at the
finding of greater severity rated by CGAS score National Institute of Mental Health, Bethesda, MD.
with two or more modalities of hallucination to The work described in the above manuscript was conducted as part of
be tautological. The CGAS is an overall global employment with the federal government at the National Institute of
rating without reference to hallucinations. In Mental Health.

addition, the finding of greater severity was held Disclosure: Drs. Greenstein, Clasen, Miller, Tossell, Mattai, Gogtay,
and Rapoport, and Mr. David, and Mr. Gochman report no biomed-
with respect to IQ, VIQ, and earlier ages of onset ical financial interests or potential conflicts of interest.
of nonpsychotic symptoms. The use of the SAPS Correspondence to Christopher N. David, Child Psychiatry Branch,
rating scale provided more reliable information National Institute of Mental Health, Building 10, Room 3N202,
Bethesda, MD 20892-1600; email: davidcn@mail.nih.gov
in contrast to several previous reports, some of
0890-8567/$36.00/©2011 American Academy of Child and
which relied upon chart review or clinical inter- Adolescent Psychiatry
views (Table S1, available online). Because of the DOI: 10.1016/j.jaac.2011.03.020
lack of other studies with equal numbers of

REFERENCES
1. Nicolson R, Rapoport JL. Childhood-onset schizophrenia: rare but 5. Lewandowski KE, DePaola J, Camsari GB, Cohen BM, Ongur D.
worth studying. Biol Psychiatry. 1999;46:1418-1428. Tactile, olfactory, and gustatory hallucinations in psychotic disor-
2. Addington AM, Rapoport JL. The genetics of childhood-onset ders: a descriptive study. Ann Acad Med Singapore. 2009;38:383-385.
schizophrenia: when madness strikes the prepubescent. Curr 6. Bracha HS, Wolkowitz OM, Lohr JB, Karson CN, Bigelow LB.
Psychiatry Rep. 2009;11:156-161. High prevalence of visual hallucinations in research subjects with
3. Goodwin DW, Alderson P, Rosenthal R. Clinical significance of chronic schizophrenia. Am J Psychiatry. 1989;146:526-528.
hallucinations in psychiatric disorders. A study of 116 hallucina- 7. Small IF, Small JG, Andersen JM. Clinical characteristics of
tory patients. Arch Gen Psychiatry. 1971;24:76-80. hallucinations of schizophrenia. Dis Nerv Syst. 1966;27:349-353.
4. Mueser KT, Bellack AS, Brady EU. Hallucinations in schizophre- 8. Andreasen NC. The diagnosis of schizophrenia. Schizophr Bull.
nia. Acta Psychiatr Scand. 1990;82:26-29. 1987;13:9-22.

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DAVID et al.

9. Green WH, Campbell M, Hardesty AS, et al. A comparison of 16. Andreasen NC. The Scale for the Assessment of Postivie Symp-
schizophrenic and autistic children. J Am Acad Child Psychiatry. toms (SAPS). Iowa City, IA: University of Iowa; 1984.
1984;23:399-409. 17. Andreasen NC. The Scale for the Assessment of Negative Symp-
10. Russell AT, Bott L, Sammons C. The phenomenology of schizo- toms (SANS). Iowa City, IA: The University of Iowa; 1984.
phrenia occurring in childhood. J Am Acad Child Adolesc Psy- 18. Shaffer D, Gould MS, Brasic J, et al. A Children’s Global Assess-
chiatry. 1989;28:399-407. ment Scale (CGAS). Arch Gen Psychiatry. 1983;40:1228-1231.
11. Green WH, Padron-Gayol M, Hardesty AS, Bassiri M. Schizo- 19. Andreasen NC, Flaum M. Schizophrenia: the characteristic symp-
phrenia with childhood onset: a phenomenological study of 38 toms. Schizophr Bull. 1991;17:27-49.
20. Russell AT. The clinical presentation of childhood-onset schizo-
cases. J Am Acad Child Adolesc Psychiatry. 1992;31:968-976.
phrenia. Schizophr Bull. 1994;20:631-646.
12. Egdell HG, Kolvin I. Childhood hallucinations. J Child Psychol
21. R: a language and environment for statistcal computing. Vienna,
Psychiatry. 1972;13:279-287.
Austria: R Foundation for Statistical Computing; 2009.
13. Spencer EK, Campbell M. Children with schizophrenia: diagno- 22. Oliveros JC. An interactive tool for comparing lists with Venn
sis, phenomenology, and pharmacotherapy. Schizophr Bull. 1994; diagrams. 2007. Available at: http://bioinfogp.cnb.csic.es/tools/
20:713-725. venny/index.html. Accessed January 15, 2011.
14. Asarnow JR, Tompson MC, Goldstein MJ. Childhood-onset 23. Benjamini Y. Discovering the false discovery rate. J R Stat Soc B.
schizophrenia: a followup study. Schizophr Bull. 1994;20:599-617. 2010;72:405-416.
15. Shaw P, Sporn A, Gogtay N, et al. Childhood-onset schizophrenia: 24. Polanczyk G, Moffitt TE, Arseneault L, et al. Etiological and
a double-blind, randomized clozapine-olanzapine comparison. clinical features of childhood psychotic symptoms: results from a
Arch Gen Psychiatry. 2006;63:721-730. birth cohort. Arch Gen Psychiatry. 2010;67:328-338.

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VISUAL HALLUCINATIONS IN COS

TABLE S1 Hallucinations in Adult Onset and Childhood Onset Schizophrenia Populations


Sample Pool Survey Methods Sample Age

A: Adult Onset
(Small, Small et al. 1966)1 50 AOSZ patients at NIMH study, Clinical interview, use of medical 19–48 Years
psychiatrist interviews of 100 records
questions hallucinatory
phenomena
(Andreasen 1987)2 111 Adult SZ SAPS and SANS ratings;- Unspecified age
presented rates are obtained
using the same 2 or greater
cut-off criteria as in our own
study
(Mueser, Bellack et al. 117 SZ or AOSZ SCZ-AFF Structured Clinical Interview for 18–56 Years
1990)3 DSM-III (SCID)
(Bracha, Wolkowitz et al. 100 AOSZ at NIMH Clinical interviews using DSM-III Unspecified age, adult
1989)4 criteria for visual hallucinations SZ admitted to
(glossary of technical terms) NIMH study,
reviewed
retrospectively
(Lewandowski, DePaola et 133 AOSZ Positive and Negative Syndrome 19–65 Years
al. 2009)5 Scale (PANSS), Young Mania
Rating Scale (YMRS)
(Goodwin, Alderson et al. 45 AOSZ patients (32 chronic, Structured interview consisting of 18–86 Years
1971)6 13 acute) a hallucinations inventory,
including open and close-
ended questions
1B: Childhood Onset
(Edgell and Kolvin 1972)7 33 cases of childhood psychosis Observational criteria as set by 5–15 Years
of late onset- b/w 5-15, as the authors (mean ⫽ 11.1 years)
opposed to before age
3 (“early” onset)
(Green, Campbell et al. 24 COS Children’s Behavior Inventory 6.7–11.11 Years
1984)8 (CBI) (mean ⫽ 9.96 years)
(Russell, Bott et al. 1989)9 35 COS Interview for Childhood 4–13 Years
Disorders and Schizophrenia (mean ⫽ 9.5 years)
(ICDS) ⫹ clinical interviews ⫹
collateral data ⫹ additional
questions in schizotypy
(Green, Padron, Gayol et 38 children with SZ disorder Children’s Behavior Inventory 5.7–11.11 Years
al. 1992)10 (CBI) is the only instrument (mean ⫽ 9.58 years)
mentioned. During
hospitalization over 3 months
(average) beginning with a
med-free period of 1 week
(Spencer and Campbell 16 COS Review of medical history reports 5.5–11.75 Years
1994)11 ⫹ semi-structured diagnostic
interviews ⫹ hospital
observation
(Asarnow, Tompson et al. 21 COS Schedule for Affective Disorders 7–14 Years
1994)12 and Schizophrenia for School-
Age Children– Epidemiological
Version (K-SADS-E)

Note: AOSZ ⫽ adult onset schizophrenia; AOSZ SCZ-AFF⫽ adult onset schizophrenia or schizo-affective; COS ⫽ childhood onset schizophrenia;
NIMH ⫽ National Institute of Mental Health; SANS ⫽ Scale for the Assessment of Negative Symptoms; NIMH ⫽ National Institute of Mental
Health; SAPS ⫽ Scale for the Assessment of Positive Symptoms; SZ ⫽ schizophrenia.

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DAVID et al.

TABLE S1 Continued
Auditory, n (%) Visual, n (%) Somatic–Tactile, n (%) Olfactory, n (%)

33 (66%) 15 (30%) 21 (42%) 19 (38%)

77 (70%) 34 (31%) 18 (16%) 7 (6%)

71 (63%) 14 (12%) 15 (13%) 11 (10%)

84 (84%) 32 (32%) 4 (4 %) 0 (0 %)

101 (75.9%) 32 (24.1%) 27 (20.3%) 23 (17.3%)

94% (Voices) chronic 72% chronic 53% Chronic 19% Chronic


69% (Voices) acute 46 % acute 54% Acute 23% Acute

27 (81.8%) 10 (30.3 %) 12 (36%) N/A

19 (79.2%) 11 (45.8%) 2 (8.3%) N/A

28 (80%) 13 (37%) Tactile 2 (6%)


6 (17%)
Somatic
2 (6%)

32 (84.2%) 18 (47.4%) 3 (7.9%) N/A

16 (100%) 11 (69%) 4 (25%) N/A

76% Definite 10 (48 %) 3 [(14%) Other- 3 (14% other—tactile or olfactory)


(95% definite ⫹ possible) Tactile or Olfactory]

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VISUAL HALLUCINATIONS IN COS

REFERENCES 7. Egdell HG, Kolvin I. Childhood hallucinations. J Child Psychol


1. Small IF, Small JG, Andersen JM, Clinical characteristics of Psychiatry. 1972;13:279-287.
hallucinations of schizophrenia. Dis Nerv Syst. 1996;27:349-353. 8. Green WH, Campbell M, Hardesty AS, et al. A comparison of
2. Andreasen NC. The diagnosis of schizophrenia. Schizophr Bull. schizophrenic and autistic children. J Am Acad Child Psychiatry.
1987;13:9-22. 1984;23:399-409.
3. Mueser KT, Bellack AS, Brady EU, Hallucinations in schizophre- 9. Russell AT, Bott L, Sammons C. The phenomenology of schizo-
nia. Acta Psychiatr Scand. 1990;82:26-29. phrenia occurring in childhood. J Am Acad Child Adolesc Psy-
4. Bracha HS, Wolkowitz OM, Lohr JB, Karson CN, Bigelow LB. chiatry. 1989;28:399-407.
High prevalence of visual hallucinations in research subjects with 10. Green WH, Padron-Gayol M, Hardesty AS, Bassiri M. Schizo-
chronic schizophrenia. Am J Psychiatry. 1989;146:526-528. phrenia with childhood onset: a phenomenological study of 38
5. Lewandowski KE, DePaola J, Camsari GB, Cohen BM, Ongur D. cases. J Am Acad Child Adolesc Psychiatry. 1992;31:968-976.
Tactile, olfactory, and gustatory hallucinations in psychotic dis- 11. Spencer EK, Campbell M. Children with schizophrenia: diagno-
orders: a descriptive study. Ann Acad Med Singapore. 2009;38: sis, phenomenology, and pharmacotherapy. Schizophr Bull. 1994;
383-385. 20:713-725.
6. Goodwin DW, Alderson P, Rosenthal R. Clinical significance of 12. Asarnow JR, Tompson MC, Goldstein MJ, Childhood-onset
hallucinations in psychiatric disorders. A study of 116 hallucina- schizophrenia: a followup study. Schizophr Bull. 1994;20:599-
tory patients. Arch Gen Psychiatry. 1971;24:76-80. 617.

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