A Population-Based Cohort Study Examining the Incidence and Impact of Psychotic Experiences From Childhood to Adulthood, and Prediction of Psychotic Disorder

Abstract

Objective: To investigate the incidence, course and outcome of psychotic experiences from childhood through early adulthood in the general population, and prediction of psychotic disorder.Methods: A population-based cohort study using the semi-structured Psychosis-like Symptoms interview of psychotic experiences at ages 12, 18, and 24 (N=7900 with any data). Incidence rates were estimated using flexible parametric modelling, and positive predictive values (PPV), sensitivity, specificity, and area under the curve estimated for prediction. Results:The incidence rate of psychotic experiences increased between ages 13-24 years, peaking during late adolescence. Of 3866 interviewed at age 24, 313 (8.1%, 95%CI 7.2%, 9.0%) had a definite psychotic experience since age 12. 109 individuals (2.8%) met criteria for a psychotic disorder up to age 24, of whom 70% had sought professional help.Prediction of current psychotic disorder at age 24 (N=47, 1.2%) by both self-report and interviewerrated measures of psychotic experiences at age 18 (PPVs 2.9% and 10.0% respectively) was improved by incorporating information on frequency and distress (PPVs 13.3% and 20.0% respectively), although sensitivities were low. The PPV of an at-risk mental state at age 18 predicting incident disorder ages 18-24 was 21.1% (95%CI 6.1%-45.6%; sensitivity 14.3%, 95%CI 4.0%-32.7%). Conclusions:Our study shows a peak in incidence of psychotic experience during late adolescence, and an unmet need for care in young people with psychotic disorders. Because of the low sensitivity, targeting individuals in non-help-seeking samples based only on more severe symptom cut-off thresholds will likely have little impact on population-levels of first-episode psychosis.We are extremely grateful to all the families who took part in this study, the midwives for their help in recruiting them, and the whole ALSPAC team, which includes interviewers, computer and laboratory technicians, clerical workers, research scientists, volunteers, managers, receptionists and nurses. This publication is the work of all authors and SZ will serve as guarantor for the contents of this paper.

Screening of the College Students at Clinical High Risk for Psychosis in China: A Multicenter Epidemiological Study

“…As prodromal symptoms mentioned in PQ-B were often mixed with psychotic-like experiences (PLEs) that commonly existed in the general population [49][50][51][52], subjects who only had PLEs may also been tested positive with PQ-B, causing false positives. Also, being rated in a clinical setting, rather than a non-clinical setting, may help the participants better understand the prodromal symptoms mentioned in the scale, and thus reducing false positive errors.…”

Childhood adversity and self-reported interpersonal and educational/vocational difficulties in young people with a history of transient psychotic experiences: findings from a population-based study

“…Sub-clinical hallucinatory and delusional experiences, commonly referred to as psychotic-like experiences (PEs), have recently been considered as one potential early indicator of mental health and functioning risk among children and adolescents (13)(14)(15). PEs themselves are not uncommon, particularly in childhood and adolescence (16), with up to 17% of 9-12-year-olds reporting hallucinatory or delusional phenomena (17). However, childhood and adolescent PEs are associated with both concurrent (15) and later psychopathology (16,(18)(19)(20).…”

“…PEs themselves are not uncommon, particularly in childhood and adolescence (16), with up to 17% of 9-12-year-olds reporting hallucinatory or delusional phenomena (17). However, childhood and adolescent PEs are associated with both concurrent (15) and later psychopathology (16,(18)(19)(20). Furthermore, recent evidence has demonstrated that adolescents who report PEs are at increased risk of compromised functioning, even when accounting for psychopathology.…”

“…For about 80% of people, PEs are transient experiences that do not recur or persist over time (23,24). This has been found across the lifespan (25) and during the period from childhood to young adulthood (16). A small number of longitudinal studies have examined the relationship between transient PEs and later functioning in general population youth samples.…”

Self-reported interpersonal and educational/vocational difficulties in young adults with a history of transient psychotic experiences: findings from a population-based study

“…Evidence suggests that, when experienced by youth, PEs may be clinicopathologically signi cant. They have been found to be associated with concurrent (4)(5)(6) and later psychopathology (1,(7)(8)(9), and with multi-morbidity (4).…”