Self-Reported Psychotic Symptoms in the General Population: Correlates in an Iranian Urban Area

Abstract

Background: Psychosis exists in the community as a continuum of severity. Here, we examine the correlates of self-reported psychotic symptoms in an urban catchment area of Iran. Sampling and Methods: Two thousand one hundred and fifty-eight participants (age 18–65 years) residing in southern Tehran (the capital city of Iran) were interviewed using the psychoticism and paranoia dimensions of the Symptom Checklist-90-Revised (SCL-90-R) to assess the severity of psychotic symptoms. Other dimensions of the SCL-90-R assessing nonpsychotic symptoms and a sociodemographic questionnaire were also used. Paykel’s Interview for Recent Life Events was used to assess stressful life events. Results: Independent associations were observed between younger age, female gender, stressful life events and dimensions of depression, anxiety, hostility, obsessive-compulsive symptoms and interpersonal sensitivity and psychoticism. Independent associations were also observed for marital problems, unemployment, stressful life events and dimensions of depression, anxiety, hostility, interpersonal sensitivity and phobic anxiety with paranoid ideation. There was also a trend toward an association between higher educational levels and the severity of psychotic symptoms, particularly paranoid ideation. Conclusions: Most of the previously accepted correlations for psychotic symptoms in the community were replicated. An unexpected association between paranoia and female gender, and a trend toward higher rates of psychotic symptoms in more educated participants, were in contrast with the studies in developed settings. The insufficient coverage of psychosis-relevant questions from the SCL-90-R for the entire psychotic diagnostic spectrum should be considered a limitation.

Psychotic experiences and risk of death in the general population: 24–27 year follow-up of the Epidemiologic Catchment Area study

“…Much of the discussion on the public health burden of psychotic disorders is limited to schizophrenia and other psychotic conditions that meet the criteria for distinct DSM diagnoses. The findings from this study and other studies on the health and social consequences of the psychosis spectrum 5–9,32,33 suggest that psychotic experiences, which are more prevalent than specific psychotic disorders, are also associated with adverse social and health consequences. The link between psychosis, on the one hand, and social well-being and physical health, on the other hand, might be more widespread than suggested by prior research limited to psychotic disorders.…”

Interpersonal processes in paranoia: a systematic review

“…Sample sizes ranged from N = 11 (Bell & Freeman, 2014) to N = 8576 (Bebbington et al 2013), with the median sample size of n = 90. Except for the population samples in two studies (Sharifi et al 2012; Bebbington et al 2013), all samples were initially self-selected. In two studies, researchers conducted the selection of participants for a second experiment based on participants’ initial paranoia scores (Freeman et al 2005 c ; Green et al 2011) to ensure a range of paranoia scores across the sample.…”

Psychotic and schizotypal symptoms in non-psychotic patients with obsessive-compulsive disorder

“…Thus, it seems likely that patients might have difficulties with responding to self-report questionnaires assessing such symptoms. Future research should explore in greater depth the reliability of self-reported psychotic symptoms; although some studies have provided preliminary evidence of reliability and validity [ 28 ]. Future research should also explore the relationship between poor insight and psychotic symptoms in OCD.…”

“…Its factor structure and generalizability has been debated [ 27 ], and it has been suggested that the SCL-90-R is a measure of negative affect rather than nine different symptom clusters. Nevertheless, a study has shown that the two subscales psychoticism and paranoid ideation can discriminate patients with psychotic disorder or psychotic symptoms from patients with non-psychotic disorder or psychosis in remission [ 28 ]. Furthermore, these subscales, and new subscales consisting of questions from both subscales, have been utilized as measures of both subclinical psychotic and schizotypal symptoms in several studies [ 15 , 29 – 34 ].…”