Clinical Significance of Psychotic Experiences in the General Population

Epidemiological studies have demonstrated that the prevalence of psychotic disorders is exceeded by that of sub-threshold psychotic experiences, which are phenomenologically similar to threshold psychosis but of less intensity or associated impairment. Recent research has highlighted the potential clinical significance of psychotic experiences with regards to psychological distress, service utilization, psychiatric comorbidities, and suicide risk. The aims of this three paper dissertation are to: 1) determine risk for suicidal behavior among respondents with psychotic experiences; 2) examine the prevalence of psychotic experiences among respondents with common mental disorders, and describe the clinical significance of these symptoms when occurring in the context of common mental disorders; and 3) evaluate factors associated with the persistence or remission of psychotic experiences in the general population. For all three papers, data were drawn from the Collaborative Psychiatric Epidemiology Surveys (n=20,013), composed of the National Comorbidity Survey-Replication, National Latino and Asian American Study, and National Survey of American Life. Psychotic experiences and other clinical variables were assessed using the World Health Organization Composite International Diagnostic Interview, version 3.0. Analyses consisted primarily of logistic regression models, with effect sizes calculated as adjusted odds ratios. Psychotic experiences were found to be associated with elevated risk for suicidal ideation and suicide attempts, and with multiple co-morbidities with common mental health conditions. The persistence of psychotic experiences over time was primarily associated with the type of symptom experienced (i.e. hearing voices) and with marital status. Co-morbid mental health conditions, although extensive, did not predict the persistence of psychotic experiences, although persistent psychotic experiences were associated with ongoing suicide risk. Together, these data support the clinical significance of sub-threshold psychotic experiences among a large general population sample of adults in the United States. The most clinically notable features of psychotic experiences are that they indicate drastically elevated risk for suicide attempts (particularly severe attempts with intent to die) and the presence of multiple co-morbid mental health conditions. These findings will have clinical utility in highlighting unique needs of individuals with sub-threshold psychotic symptoms, and will have public health value in identifying a significant risk factor for severe suicidal behavior that may be easily screened in the general population as well as in clinical settings

Analyzing polysemiosis: Language, gesture, and depiction in two cultural practices with sand drawing

Human communication is by default polysemiotic: it involves the spontaneous combination of two or more semiotic systems, the most important ones being language, gesture, and depiction. We formulate an original cognitive-semiotic framework for the analysis of polysemiosis, contrasting this with more familiar systems based on the ambiguous term “multimodality.” To be fully explicit, we developed a coding system for the analysis of polysemiotic utterances containing speech, gesture, and drawing, and implemented this in the ELAN video annotation software. We used this to analyze 23 video-recordings of sand drawing performances on Paama, Vanuatu and 20 sand stories of the Pitjantjatjara culture in Central Australia. Methodologically we used the conceptual-empirical loop of cognitive semiotics: our theoretical framework guided general considerations, such as distinguishing between the “tiers” of gesture and depiction, and the three kinds of semiotic grounds (iconic, indexical, symbolic), but the precise decisions on how to operationalize these were made only after extensive work with the material. We describe the coding system in detail and provide illustrative examples from the Paamese and Pitjantjatjara data, remarking on both similarities and differences in the polysemiosis of the two cultural practices. We conclude by summarizing the contributions of the study and point to some directions for future research

Epidemiology of depression with psychotic experiences and its association with chronic physical conditions in 47 low- and middle-income countries

BACKGROUND: The co-existence of depression and psychotic experiences (PEs) is associated with more pronounced adverse health outcomes compared to depression alone. However, data on its prevalence and correlates are lacking in the general adult population, and there is no published data on its association with chronic physical conditions. METHOD: Cross-sectional, community-based data from 201 337 adults aged ⩾18 years from 47 low- and middle-income countries from the World Health Survey were analyzed. The presence of past 12-month PE and DSM-IV depression was assessed with the Composite International Diagnostic Interview (CIDI). Information on six chronic medical conditions (chronic back pain, edentulism, arthritis, angina, asthma, diabetes) were obtained by self-report. Multivariable logistic regression analysis was performed. RESULTS: The crude overall prevalence of co-morbid depression/PEs was 2.5% [95% confidence interval (CI) 2.3-2.7%], with the age- and sex-adjusted prevalence ranging from 0.1% (Sri Lanka, Vietnam) to 9.03% (Brazil). Younger age, urban setting, current smoking, alcohol consumption, and anxiety were significant correlates of co-existing depression/PEs. Co-occurring depression/PEs was associated with significantly higher odds for arthritis, angina, and diabetes beyond that of depression alone after adjusting for sociodemographics, anxiety, and country, with odds ratios (depression/PEs v. depression only) being: arthritis 1.30 (95% CI 1.07-1.59, p = 0.0086); angina 1.40 (95% CI 1.18-1.67, p = 0.0002); diabetes 1.65 (95% CI 1.21-2.26, p = 0.0017). CONCLUSIONS: The prevalence of co-existing depression/PEs was non-negligible in most countries. Our study suggests that when depression/PE or a chronic condition (e.g. arthritis, angina, diabetes) is detected, screening for the other may be important to improve clinical outcomes

Pantolang: A synthetic cognitive-semiotic approach to language origins

We present an ongoing international project, From Pantomime to Language (PANTOLANG), aiming to develop a comprehensive, empirically grounded theory of the evolution of human language and the human mind, relying on the new paradigm of cognitive semiotics, which combines methods and concepts from the humanities and the sciences (Zlatev, 2015; Zlatev, et al. 2016)

Sexual assault and psychosis in two large general population samples:Is childhood and adolescence a developmental window of sensitivity?

Background: Research has shown a strong relationship between psychosis and sexual assault. Theories on developmental trauma as a causal factor for psychosis suggest that exposure to sexual trauma in childhood would have a stronger association with psychosis than sexual trauma in adulthood. We hypothesized that exposure to sexual trauma earlier in childhood and adolescence would be more strongly associated with hallucinations, delusional beliefs and psychotic disorder than sexual trauma that occurred later in life. Methods: Using the 2007 and 2014 Adult Psychiatric Morbidity Surveys (N = 14,949) we calculated the prevalence of sexual assault, hallucinations, delusional beliefs, and psychotic disorder. We used logistic regression to examine the relationship between age of exposure to sexual assault (first exposure 16. Our findings do not support the idea that childhood and adolescence are uniquely sensitive periods for the emergence of psychotic experiences or psychotic disorder in relation to sexual trauma

Hallucinations in the general population across the adult lifespan:Prevalence and psychopathologic significance

Background: Community studies have found a relatively high prevalence of hallucinations, which are associated with a range of (psychotic and non-psychotic) mental disorders, as well as with suicidal ideation and behaviour. The literature on hallucinations in the general population has largely focused on adolescents and young adults. Aims: We aimed to explore the prevalence and psychopathologic significance of hallucinations across the adult lifespan. Method: Using the 1993, 2000, 2007 and 2014 cross-sectional Adult Psychiatric Morbidity Survey series (N = 33 637), we calculated the prevalence of past-year hallucinations in the general population ages 16 to ≥90 years. We used logistic regression to examine the relationship between hallucinations and a range of mental disorders, suicidal ideation and suicide attempts. Results: The prevalence of past-year hallucinations varied across the adult lifespan, from a high of 7% in individuals aged 16-19 years, to a low of 3% in individuals aged ≥70 years. In all age groups, hallucinations were associated with increased risk for mental disorders, suicidal ideation and suicide attempts, but there was also evidence of significant age-related variation. In particular, hallucinations in older adults were less likely to be associated with a cooccurring mental disorder, suicidal ideation or suicide attempt compared with early adulthood and middle age. Conclusions Our findings highlight important life-course developmental features of hallucinations from early adulthood to old age

Policy Recommendations for Meeting the Grand Challenge to Ensure Healthy Development for All Youth

This brief was created forSocial Innovation for America’s Renewal, a policy conference organized by the Center for Social Development in collaboration with the American Academy of Social Work & Social Welfare, which is leading theGrand Challenges for Social Work initiative to champion social progress. The conference site includes links to speeches, presentations, and a full list of the policy briefs

Association of Exposure to Police Violence With Prevalence of Mental HealthSymptoms Among Urban Residents in the United States

Importance Police violence is reportedly widespread in the United States and may pose a significant risk to public mental health. Objective To examine the association between 12-month exposure to police violence and concurrent mental health symptoms independent of trauma history, crime involvement, and other forms of interpersonal violence exposure. Design, Setting, and Participants This cross-sectional, general population survey study of 1221 eligible adults was conducted in Baltimore, Maryland, and New York City, New York, from October through December 2017. Participants were identified through Qualtrics panels, an internet-based survey administration service using quota sampling. Exposures Past 12-month exposure to police violence, assessed using the Police Practices Inventory. Subtypes of violence exposure were coded according to the World Health Organization domains of violence (ie, physical, sexual, psychological, and neglectful). Main Outcomes and Measures Current Kessler Screening Scale for Psychological Distress (K6) score, past 12-month psychotic experiences (World Health Organization Composite International Diagnostic Interview), and past 12-month suicidal ideation and attempts. Results Of 1221 eligible participants, there were 1000 respondents (81.9% participation rate). The sample matched the adult population of included cities on race/ethnicity (non-Hispanic white, 339 [33.9%]; non-Hispanic black/African American, 390 [39.0%]; Hispanic/Latino, 178 [17.8%]; other, 93 [9.3%]), age (mean [SD], 39.8 [15.2] years), and gender (women, 600 [60.0%]; men, 394 [39.4%]; transgender, 6 [0.6%]) within 10% above or beyond 2010 census distributions. Twelve-month prevalence of police violence was 3.2% for sexual violence, 7.5% for physical violence without a weapon, 4.6% for physical violence with a weapon, 13.2% for psychological violence, and 14.9% for neglect. Police violence exposures were higher among men, people of color, and those identified as homosexual or transgender. Respondents reported suicidal ideation (9.1%), suicide attempts (3.1%), and psychotic experiences (20.6%). The mean (SD) K6 score was 5.8 (6.1). All mental health outcomes were associated with police violence exposure in adjusted logistic regression analyses. Physical violence with a weapon and sexual violence were associated with greater odds of psychotic experiences (odds ratio [95% CI]: 4.34 [2.05-9.18] for physical violence with a weapon; 6.61 [2.52-17.36] for sexual violence), suicide attempts (odds ratio [95% CI]: 7.30 [2.94-18.14] for physical violence with a weapon; 6.63 [2.64-16.64] for sexual violence), and suicidal ideation (odds ratio [95% CI]: 2.72 [1.30-5.68] for physical violence with a weapon; 3.76 [1.72-8.20] for sexual violence). Conclusions and Relevance Police violence was commonly reported, especially among racial/ethnic and sexual minorities. Associations between violence and mental health outcomes did not appear to be explained by confounding factors and appeared to be especially pronounced for assaultive forms of violence

Review of factors resulting in systemic biases in the screening, assessment, and treatment of individuals at clinical high-risk for psychosis in the United States

BACKGROUND: Since its inception, research in the clinical high-risk (CHR) phase of psychosis has included identifying and exploring the impact of relevant socio-demographic factors. Employing a narrative review approach and highlighting work from the United States, sociocultural and contextual factors potentially affecting the screening, assessment, and service utilization of youth at CHR were reviewed from the current literature. RESULTS: Existing literature suggests that contextual factors impact the predictive performance of widely used psychosis-risk screening tools and may introduce systemic bias and challenges to differential diagnosis in clinical assessment. Factors reviewed include racialized identity, discrimination, neighborhood context, trauma, immigration status, gender identity, sexual orientation, and age. Furthermore, racialized identity and traumatic experiences appear related to symptom severity and service utilization among this population. CONCLUSIONS: Collectively, a growing body of research from the United States and beyond suggests that considering context in psychosis-risk assessment can provide a more accurate appraisal of the nature of risk for psychosis, render more accurate results improving the field\u27s prediction of conversion to psychosis, and enhance our understanding of psychosis-risk trajectories. More work is needed in the U.S. and across the globe to uncover how structural racism and systemic biases impact screening, assessment, treatment, and clinical and functional outcomes for those at CHR

Sensory gain control at fixation

One mechanism by which spatial attention affects visual perception is through the alteration of the signal-to-noise ratio for a particular stimulus. This is known as sensory gain control. Sensory gain effects can be measured electrophysiologically through changes in the amplitude of the P1 event related potential (ERP) component. Manipulating perceptual load by increasing or decreasing task difficulty can influence spatial attention and can therefore modulate the P1 component. Sensory gain effects are well characterized with peripheral attention, but have rarely been studied at fixation. The few studies that have been conducted that look at sensory gain for foveal stimuli have yielded conflicting results, and sensory gain with centrally presented extrafoveal stimuli has only been found in emotion studies. The present study manipulated attention allocation towards foveal and extrafoveal stimuli at fixation, using two levels of perceptual load for each stimulus size. ERPs were recorded in response to stimulus onset, and tested for differences in P1 and N1 amplitude across perceptual load conditions. Sensory gain effects, as indexed by an increase in P1 amplitude with an increase in perceptual load, were predicted for extrafoveal but not foveal stimuli. Changes in P1 amplitude were not found for either type of stimuli, suggesting that sensory gain effects either may not be present at fixation or are not susceptible to manipulation by perceptual load. The N1 component was expected to increase in amplitude for high-load stimuli, due to the N1 attention effect. However, the opposite result was found, suggesting that there is an additional effect of perceptual load on early visual processing, distinct from sensory gain control.M.S.Committee Chair: Corballis, Paul; Committee Member: Schumacher, Eric; Committee Member: Spieler, Danie