Prevalence of psychotic symptoms in childhood and adolescence: a systematic review and meta-analysis of population-based studies.

BACKGROUND: Psychotic symptoms occur more frequently in the general population than psychotic disorder and index risk for psychopathology. Multiple studies have reported on the prevalence of these symptoms using self-report questionnaires or clinical interviews but there is a lack of consensus about the prevalence of psychotic symptoms among children and adolescents.MethodWe conducted a systematic review of all published literature on psychotic symptom prevalence in two age groups, children aged 9-12 years and adolescents aged 13-18 years, searching through electronic databases PubMed, Ovid Medline, PsycINFO and EMBASE up to June 2011, and extracted prevalence rates. RESULTS: We identified 19 population studies that reported on psychotic symptom prevalence among children and adolescents. The median prevalence of psychotic symptoms was 17% among children aged 9-12 years and 7.5% among adolescents aged 13-18 years. CONCLUSIONS: Psychotic symptoms are relatively common in young people, especially in childhood. Prevalence is higher in younger (9-12 years) compared to older (13-18 years) children

Psychotic-like experiences in the general population: characterizing a high-risk group for psychosis.

Recent research shows that psychotic symptoms, or psychotic-like experiences (PLEs), are reported not only by psychosis patients but also by healthy members of the general population. Healthy individuals who report these symptoms are considered to represent a non-clinical psychosis phenotype, and have been demonstrated to be at increased risk of schizophrenia-spectrum disorder. Converging research now shows that this non-clinical psychosis phenotype is familial, heritable and covaries with familial schizophrenia-spectrum disorder. A review of the research also shows that the non-clinical phenotype is associated extensively with schizophrenia-related risk factors, including social, environmental, substance use, obstetric, developmental, anatomical, motor, cognitive, linguistic, intellectual and psychopathological risk factors. The criterion and construct validity of the non-clinical psychosis phenotype with schizophrenia demonstrates that it is a valid population in which to study the aetiology of psychosis. Furthermore, it suggests shared genetic variation between the clinical and non-clinical phenotypes. Much remains to be learned about psychosis by broadening the scope of research to include the non-clinical psychosis phenotype.</p

Assessment of the mental health of Irish adolescents in the community

Aim: This study aims to assess a community of Irish adolescents using the Strengths and Difficulties Questionnaire (SDQ) for behavioural difficulties and mental health disorders. Method: All fifth and sixth class pupils attending eight primary schools were eligible to participate. The self-report version of the SDQ was administered to the pupils in the classroom. Results: Thirty participants (8.7%) had an abnormal SDQ score and 53 (15.3%) had a borderline abnormal SDQ score. Abnormal SDQ scores were more common among females (9.7%; mean score = 11.86; sd = 5.4) than among males (7.6%; mean score = 10.96; sd = 5.26). The difference was most pronounced on the emotional symptoms subscale (females received a mean score of 4.03 [sd = 2.1] compared to a mean male score of 2.90 [sd = 2.1]). Conclusions: Mental health problems are widespread among Irish adolescents. The SDQ is a useful preliminary assessment tool of the mental health profile of Irish adolescents and highlights the need for childhood mental health promotion in schools. The SDQ could also be used in a primary care setting to screen adolescents for mental disorders.</p

What mediates the longitudinal relationship between psychotic experiences and psychopathology?

Psychotic experiences (PEs) are common in early adolescence and are associated with nonpsychotic psychopathology. However, not all adolescents with PEs have subsequent psychopathology, and vice versa. To date, factors mediating the relationship between PEs and psychopathology have been understudied. The aims of this study were to investigate the bidirectional relationship between PEs and psychopathology in adolescence and to investigate potentially malleable mediators of these relationships. Data from 2 waves (age 13 and 17 years) of Cohort '98 of the Growing Up in Ireland study were examined (n = 6,206). Using KHB pathway decomposition, we investigated the following as potential mediators of the relationship between psychopathology and PEs: parent-child relationship (conflict and positive), self-concept, and child-peer relationship (alienation and trust). Supplementary counterfactual mediation and sensitivity analyses were conducted. Early adolescents with psychopathology had twofold increased odds of late adolescent PEs (internalizing problems: odds ratio [OR] = 2.03, 95% confidence interval [CI; 1.56, 2.62]; externalizing problems: OR = 1.99, CI [1.51, 2.60]). Parent-child conflict explained between 23% and 34% of the associations between internalizing and externalizing problems and subsequent PEs. Early adolescents with PEs had increased odds of late adolescent psychopathology (internalizing problems: OR = 2.01, CI [1.61, 2.50]; externalizing problems: OR = 1.70, CI [1.25, 2.31]). Self-concept alone accounted for 52% of the relationship between PEs and subsequent internalizing problems. There is a bidirectional heterotypic relationship between psychopathology and PEs. Parent-child conflict and self-concept are important characteristics that mediate a proportion of the relationship between PEs and psychopathology. Interventions targeting parent-child conflict in the context of psychopathology and self-concept in the context of PEs may assist in reducing the incidence of poorer outcomes. Psychotic experiences are common in adolescence and are frequently associated with other mental health problems. However, not all young people with psychotic experiences have mental health problems, and most with mental health problems do not have psychotic experiences. We found that psychotic experiences are bidirectionally associated with mental health problems. The relationship between psychotic experiences and subsequent mental health problems may be explained partly by the young person's self-concept. The relationship between mental health problems and subsequent psychotic experiences may be explained partly by conflict between the young person and their primary caregiver

Phenomenological characteristics and explanations of unusual perceptual experiences, thoughts and beliefs in a population sample of early adolescents

Objectives: Often referred to as psychotic experiences, unusual perceptual experiences, thoughts and beliefs (UPTBs) are not uncommon in youth populations. Phenomenological studies of these experiences are lacking. This study aimed to (1) describe the phenomenological characteristics of UPTBs in a sample of young adolescents and (2) explore how young people made sense of those experiences.Methods: Participants were 53 young people aged 11-13 years from a population-based study of mental health. All met criteria for UPTBs following clinical interviews as part of the study. Documentary data on UPTBs in the form of transcribed notes, recorded during clinical interviews, were analysed using content analysis. Data on UPTBs were coded, organised into categorical themes and quantified using descriptive statistics. Qualitative themes on how participants made sense of their experiences were identified.Results: Participants reported UPTBs across four domains: auditory verbal, auditory non-verbal, non-auditory perceptual experiences and unusual thoughts and beliefs. UPTBs were phenomenologically rich and diverse. Young people sought to make sense of their experiences in multiple ways: normalising them, externalising them by attributing them to paranormal entities and distancing them from psychiatric explanations. Uncertainty about the source of UPTBs was identified as a superordinate theme.Conclusion: Findings from this study offer new insights into the phenomenological qualities and characteristics of UPTBs in young adolescents. They also reveal that early adolescents may not make sense of their experiences within a psychiatric framework. These findings highlight the need to develop a more phenomenologically sensitive and nuanced approach to studying UPTBs in young people.

Changes in self‐concept and risk of psychotic experiences in adolescence: a longitudinal population‐based cohort study

BACKGROUND: Psychotic experiences (PEs) are commonly reported in adolescence and are associated with a range of negative outcomes. Few targets for intervention for PEs have been identified. One potential target is self-concept: an individual's beliefs about his/her personal attributes. Improvements in self-concept have been shown to reduce psychotic symptoms in patients with schizophrenia but no study has investigated the relationship between changes in self-concept and risk of PEs in the general population. We aimed to investigate: (a) the relationship between child and adolescent self-concept and adolescent PEs; and (b) whether changes in self-concept between childhood and adolescence were associated with risk of adolescent PEs. METHOD: Using data from age 9 and age 13 (n = 7,423) of the child cohort (Cohort'98) from the Growing Up in Ireland study we investigated the relationship between self-concept at age 9 and age 13 and PEs at age 13. PEs were measured using the Adolescent Psychotic Symptoms Screener and self-concept was measured using the Piers Harris-II. Using a stratified analysis, we investigated the relationship between change in self-concept between age 9 and age 13 and the risk of PEs at age 13. Additionally we investigated changes across the six self-concept subscales. RESULTS: Psychotic experiences were reported by 13% of participants at age 13. 'Very low' self-concept at age 9 was associated with an increased risk of PEs at age 13 (Adjusted-OR: 2.74, CI: 1.80-4.19), and 'High' self-concept at age 9 was associated with a decreased risk of PEs at age 13 (Adjusted-OR: 0.77, CI: 0.60-0.97). The stratified analysis indicated that improvements in self-concept reduced the odds of adolescent PEs and decline in self-concept increased the odds of adolescent PEs. This effect was noted across the majority of the self-concept subscales. CONCLUSIONS: There is a strong relationship between self-concept and PEs. The antecedents of low self-concept may be a useful target for preventative psychiatry. Broad-spectrum interventions targeting self-concept in childhood may help to reduce the incidence of PEs in adolescence.</p

Examining the association between prenatal and perinatal adversity and the psychotic experiences in childhood

Background: Prenatal and perinatal complications are established risk factors for psychotic disorder, but far less is known about these measures and psychotic experiences (PEs). We investigated the longitudinal effect of prenatal risk factors (maternal behavior, medication complications) and perinatal risk factors (birth weight, medical complications) on frequency of PEs. We also examined the cumulative risk of prenatal/perinatal risk factors, and differences between transient PE, persistent PE, and controls. Methods: The Adolescent Brain Cognitive Development study is a large child cohort (age 9-10 at baseline; n = 11 872 with PE data). PEs were measured longitudinally using the Prodromal Questionnaire-Brief, Child version, and included only if reported as distressing. Mixed-effects models were used for analysis, controlling for random effects, and a substantial number of fixed-effects covariates. Results: Urinary tract infection (β = 0.11, 95% confidence interval [CI] 0.03-0.19) and severe anemia (β = 0.18, 95% CI 0.07-0.29) increased frequency of distressing PEs in childhood. Number of prenatal complications increased frequency of PEs (β = 0.03, 95% CI 0.01-0.06) and risk of persistent PEs (odds ratio [OR] = 1.08, 95% CI 1.01-1.15). Maternal smoking was associated with an increased frequency of PEs (β = 0.11, 95% CI 0.04-0.18) and persistent PEs (OR = 1.31, 95% CI 1.04-1.66). Maternal substance use was a risk factor for a 48% increased risk of persistent PEs (OR = 1.48, 95% CI 1.08-2.01). Perinatal complications showed no effect on PEs. Conclusions: This study provides evidence that certain prenatal medical complications (severe nausea, severe anemia), cumulative number of prenatal medical complications, and maternal behaviors (smoking during pregnancy), increased frequency of distressing PEs in childhood. Maternal smoking and substance use, as well as cumulative number of prenatal complications increased risk of persistent PEs.</p

Do childhood psychotic experiences improve the prediction of adolescent psychopathology? A longitudinal population-based study.

Background: Early identification of individuals at risk of later mental disorders an important goal. A history of one or more psychotic experiences (PE) reported in childhood has been associated with subsequent psychopathology, but it remains unclear if it provides predictive information above beyond what is already captured by established clinical markers. Aims: 1) To investigate the utility of childhood PE as a predictor of adolescent psychopathology while accounting for three known risk factors: childhood mental disorder; traumatic experiences; and poor childhood functioning; and 2) To investigate the additive effects of including childhood PE in predictive clinical model of adolescent psychopathology. Method: The study sample comprised 86 Irish youth who completed two waves of the ‘Adolescent Brain Development’ study’ (baseline x̄Age:11.7 and follow-up x̄Age:15.7). At baseline, participants completed a clinical interview assessing for PE, mental disorders, traumatic experiences and global functioning in childhood. The internalising and externalising problems sub-scales from the Youth Self Report questionnaire were used as follow-up outcomes variables in adolescence. Results:Logistic regression analyses revealed that childhood PE was the only predictor significantly associated with both internalising (OR(Univariate):7.58,CI:2.59-22.15; OR(multivariate):5.43,CI:1.53-19.29) and externalising (OR(Univariate):11.76,CI:3.70-37.41; OR(Multivariate):30.39,CI:5.28-174.80) problems in adolescence. All predictive models with PE significantly predicted adolescent outcomes (AUC range:0.70-0.81; all p Conclusion: Childhood PE is a powerful predictor of adolescent psychopathology, particularly externalising problems. Routine assessment of PE and targeted support for children who report PE may reduce the incidence of mental disorder in adolescence.</p

Examining the association between prenatal and perinatal adversity and the psychotic experiences in childhood

Background: Prenatal and perinatal complications are established risk factors for psychotic disorder, but far less is known about these measures and psychotic experiences (PEs). We investigated the longitudinal effect of prenatal risk factors (maternal behavior, medication complications) and perinatal risk factors (birth weight, medical complications) on frequency of PEs. We also examined the cumulative risk of prenatal/perinatal risk factors, and differences between transient PE, persistent PE, and controls. Methods: The Adolescent Brain Cognitive Development study is a large child cohort (age 9-10 at baseline; n = 11 872 with PE data). PEs were measured longitudinally using the Prodromal Questionnaire-Brief, Child version, and included only if reported as distressing. Mixed-effects models were used for analysis, controlling for random effects, and a substantial number of fixed-effects covariates. Results: Urinary tract infection (β = 0.11, 95% confidence interval [CI] 0.03-0.19) and severe anemia (β = 0.18, 95% CI 0.07-0.29) increased frequency of distressing PEs in childhood. Number of prenatal complications increased frequency of PEs (β = 0.03, 95% CI 0.01-0.06) and risk of persistent PEs (odds ratio [OR] = 1.08, 95% CI 1.01-1.15). Maternal smoking was associated with an increased frequency of PEs (β = 0.11, 95% CI 0.04-0.18) and persistent PEs (OR = 1.31, 95% CI 1.04-1.66). Maternal substance use was a risk factor for a 48% increased risk of persistent PEs (OR = 1.48, 95% CI 1.08-2.01). Perinatal complications showed no effect on PEs. Conclusions: This study provides evidence that certain prenatal medical complications (severe nausea, severe anemia), cumulative number of prenatal medical complications, and maternal behaviors (smoking during pregnancy), increased frequency of distressing PEs in childhood. Maternal smoking and substance use, as well as cumulative number of prenatal complications increased risk of persistent PEs.</p

Psychotic experiences in the general population, a review; definition, risk factors, outcomes and interventions

Psychotic experiences (PE) are common in the general population, in particular in childhood, adolescence and young adulthood. PE have been shown to be associated with an increased risk for later psychotic disorders, mental disorders, and poorer functioning. Recent findings have highlighted the relevance of PE to many fields of healthcare, including treatment response in clinical services for anxiety & depression treatment, healthcare costs and service use. Despite PE relevance to many areas of mental health, and healthcare research, there remains a gap of information between PE researchers and experts in other fields. With this review, we aim to bridge this gap by providing a broad overview of the current state of PE research, and future directions. This narrative review aims to provide an broad overview of the literature on psychotic experiences, under the following headings: (1) Definition and Measurement of PE; (2) Risk Factors for PE; (3) PE and Health; (4) PE and Psychosocial Functioning; (5) Interventions for PE, (6) Future Directions. </p