Auditory hallucinations in the population: what do they mean and what should we do about them?

There has been a dramatic surge in research on auditory hallucinations over the past 15 years. Of the more than 100 papers identified in a recent meta-analysis of studies on definition, description and causes of auditory hallucinations (1), greater than 90% were published since the year 2000. This glut of publications points to an upheaval that has taken place in psychiatry. Simply put, there has been a paradigm shift: a movement away from the Schneiderian view of auditory hallucinations as (predominantly) symptoms of psychotic disorder, towards an increasingly accepted view that these are experiences that occur in the full range of mental disorders and, indeed, none

SOCRATES Assessment of Perceptual Abnormalities and Unusual Thought Content

The aim of the SOCRATES assessment is to provide a systematic and comprehensive approach to the assessment of perceptual abnormalities and unusual thought content in research and clinic settings. The method provides a template for the information that should be gathered in relation to reported phenomena. It provides a standardised approach to assessment that assists the identification of changes over time and facilitates comparisons between centres

Putting psychosis in its place.

The classic nosologic divide in psychiatry has been between neurosis and psychosis. Originally conceptualised as two distinct categories of mental illness, it was only the odd (irreverent) case that ‘tipped over’ from the former to the latter. Extensive research over the past decade and a half has upended this notion, blurring previously sharp diagnostic boundaries, reframing psychosis as a continuum, and casting the relationship between neurosis and psychosis in a very different light

Psychotic experiences as a predictor of the natural course of suicidal ideation: a Swedish cohort study

Psychotic experiences are far more prevalent in the population than psychotic disorders and are associated with a wide range of depressive, anxiety and behavioral disorders, as well as increased risk for psychotic disorder. Recently, psychotic experiences have been highlighted as a potentially valuable clinical marker of risk for suicidal behavior. There have been few studies to date, however, to assess psychotic experiences as a predictor of suicidality over time. We wished to assess whether young persons with suicidal ideation at baseline assessment who reported psychotic experiences were at higher risk for persistence of suicidal ideation at follow-up than young persons who also reported suicidal ideation at baseline but who did not report co-occurring psychotic experiences. A total of 2,263 adolescents were assessed at age 13 to 14 years for psychotic experiences, suicidal ideation and internalizing and externalizing psychopathology. Participants were re-assessed at ages 16 to 17 years and 19 to 20 years. Among 13- to 14-year olds with suicidal ideation, co-occurring psychotic experiences did not predict an increased odds of persistence of suicidal ideation to age 16 to 17 years (OR=0.94, 95% CI: 0.19-4.78). Among 16- to 17-year olds with suicidal ideation, however, co-occurring psychotic experiences predicted a 6-fold increased odds of persistence of suicidal ideation to age 19 to 20 years (OR=5.53, 95% CI: 1.33-23.00). Psychotic experiences are an important but under-recognized marker of risk for persistence of suicidal ideation, in particular from mid-adolescence. An increased emphasis on the clinical assessment of psychotic experiences in mental health services should be a priority.VetenskapsrådetForteManuscrip

An Epidemiological Investigation of Adolescents and Symptomatic High Risk for Psychosis

Background: Epidemiological research has shown that hallucinations and delusions, the classic symptoms of psychosis, are far more prevalent in the population than actual psychotic disorder. These symptoms are especially prevalent in childhood and adolescence. Longitudinal research has demonstrated that psychotic symptoms in adolescence increase risk for psychotic disorder in adulthood. There has been little research, however, on the immediate clinicopathological significance of psychotic symptoms in adolescence and on the prevalence of prodromal risk syndromes in the community. Aims: Aim 1 : To assess the prevalence of psychotic symptoms and the association of psychotic symptoms with age and with DSM-IV Axis-1 psychopathology Aim 2: To assess the relationship between psychotic symptoms and suicidal behaviour Aim 3: To assess the neurocognitive profile of adolescents who report psychotic symptoms Aim 4: To assess the prevalence of prodromal risk syndromes in the population and assess associations with non-psychotic psychopathology and global functioning Method: Data from three population studies were used: Study 1 involved a school-based survey of 1,131 1 1 -to 13-year olds for psychotic symptoms, assessed using the Adolescent Psychotic Symptom Screener, and for emotional and behavioural symptoms of psychopathology, assessed using the Strengths and Difficulties Questionnaire. Studies 2 and 3 involved in-depth diagnostic interview assessments of psychotic symptoms and lifetime Axis-1 disorders in two community samples of 11-to 15-year olds, involving 423 adolescents in total. Psychotic symptoms, Axis-1 psychiatric disorders and suicidal behaviour were assessed using the Schedule for Affective Disorders and Schizophrenia (K-SADS). Global functioning was assessed using the Children’s Global Assessment Scale. Neurocognition was assessed using the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) consensus battery. Prodromal risk syndromes were assessed using the criteria of prodromal syndromes from the Structured Interview for Prodromal Syndromes. Results: A majority of community-based adolescents who reported psychotic symptoms had at least one lifetime diagnosable Axis-1 disorder on clinical interview: Study 2, Odds ratio (OR)=3.57, 95% confidence interval (CI95)=1.87-6.84, p Conclusions: The majority of adolescents who report psychotic symptoms have at least one lifetime diagnosable Axis-1 disorder and demonstrate poorer neurocognitive performance than controls. Prodromal risk syndromes are relatively common in the community, which has implications for the proposed DSM-V diagnosis of Attenuated Psychosis Syndrome. Psychotic symptoms are important risk markers for severe multiple Axis-1 disorders and suicidal behaviour and should be routinely assessed in child and adolescent psychiatric clinics

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 disorder

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

Microstructural Correlates of Resilience against Major Depressive Disorder: Epigenetic Mechanisms?

Mental disorders are a major cause of long-term disability and are a direct cause of mortality, with approximately 800.000 individuals dying from suicide every year worldwide - a high proportion of them related to major depressive disorder (MDD)^1^. Healthy relatives of patients with major depressive disorder (MDD) are at risk to develop the disease. This higher vulnerability is associated with structural^2-4^ and functional brain changes^5^. However, we found using high angular resolution diffusion imaging (HARDI) with 61 diffusion directions that neuron tracts between frontal cortices and limbic as well as temporal and parietal brain regions are characterized by better diffusion coefficients in unaffected relatives (UHR), who managed to stay healthy, compared to healthy volunteers without any family history for a psychiatric disease (HC). Moreover, those UHR with stronger fibre connections better managed incidences of adversity in early life without later developing depression, while in HC axonal connections were found to be decreased when they had early-life adversity. Altogether these findings indicate the presence of stronger neural fibre connections in UHR, which seem to be associated with resilience against environmental stressors, which we suggest occur through epigenetic mechanisms

The Mental Health of Young People in Ireland: A report of the Psychiatric Epidemology Research across the Lifespan (PERL) Group

There is increasing concern about the mental health of young people in Ireland. Reports of psychological distress, substance abuse and suicide among Irish youths have become common. While we know that many young people in Ireland are experiencing mental distress, little research has been done to determine the actual number of young people who are experiencing a diagnosable mental disorder. This report goes some way towards addressing this issue by presenting findings from two research studies that have used clinical interview assessments to establish the rate of diagnosable mental disorders among Irish adolescents and young adults. These studies, funded by the Health Research Board, are part of a broader programme of research by the Psychiatric Epidemiology Research across the Lifespan (PERL) Group in the Department of Psychiatry, Royal College of Surgeons in Ireland (RCSI). The findings in this report have relevance for young people, parents, teachers, health professionals, allied health professionals and any other individuals or groups who are concerned about the mental health of young people. They provide essential information to inform healthcare policy and to guide the development of high quality, accessible and responsive mental health services for any young person who needs them. They also highlight the need to ensure that we, as a society, are committed to the protection and promotion of young people’s mental health