Assessing Youth with Psychotic Experiences: A Phenomenological Approach

Positive psychotic symptoms in childhood and adolescence

“…Contrary to these numbers, PPS and their subthreshold expressions, in particular those related to perception, significantly decrease from childhood (median prevalence of 17%) throughout adolescence (median prevalence of 7%) and adulthood (median prevalence of 5%) in the community [16][17][18][19][20][21][22]. This opposing trend in the occurrence of psychotic disorders compared to PPS and their subthreshold expressions already implicates what is widely acknowledged; that is, that diagnosing a psychotic disorder is more difficult in minors [1][2][3][4]13]. This results in misjudgement of PPS and, consequently, frequent misdiagnoses [3][4][5] and contributes to the significantly longer duration of untreated psychosis in EOP compared to adult-onset psychosis (AOP) that may be a main J o u r n a l P r e -p r o o f cause of the commonly assumed poorer prognosis of EOP compared to AOP [8].…”

“…Of these, full-blown positive psychotic symptoms (PPS; hallucinations, delusions and disorganized speech) are the most critical, with at least one of them required for diagnosis of any psychotic disorder [1]. However, PPS are not dichotomic phenomena but the extreme expression on a continuum that, influenced by many factors including neurocognitive (see 3), neurobiogenetic (see 4) and culturerelated ones (see 5), ranges from normal to psychopathological experiences [2,3]. This complex nature of PPS and their subthreshold expressions complicates their accurate diagnostic appraisal, leading not only to significant overdiagnosing [3,4] but also underdiagnosing in minors with neurodevelopmental disorders and intellectual deficits [5].…”

“…Differences described in the clinical picture of childhood and/or adolescent, and adult-onset psychosis[1][2][3]9,[12][13][14].…”

“…Developmentally informed differential considerations in the assessment of potential attenuated (APS) or full-blown positive psychotic symptoms (PPS)[2,3,13,18].…”