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

Does childhood trauma play a role in the aetiology of psychosis? A review of recent evidence.

There has been a resurgence of interest in the role of childhood trauma in the aetiology of psychosis. In this review, recent findings on the association between childhood trauma and a continuum of psychotic symptoms are presented. Evidence of the association between specific childhood trauma subtypes and psychotic symptoms is examined, with a brief discussion of some current hypotheses about the potential mechanisms underlying the associations that have been found. Some practice implications of these findings are also highlighted. Learning Objectives • Identify findings from recent meta-analyses on the association between childhood trauma and a range of psychotic outcomes, from non-clinical psychotic experiences to psychotic disorders • Consider which childhood traumas are the most potent in the context of psychotic outcomes • Recognise that the relationships between childhood trauma, psychotic symptoms and other psychopathology are complex, dynamic and multidimensional</p

We Need to Talk About Prevention

Since the turn of the century, the study of psychotic experiences in the general population has emerged as a major paradigm in mental health research. We now know that psychotic experiences are a relatively prevalent phenomenon, particularly in children and adolescents (1). They do not occur randomly and are clustered with other psychopathology (2–4), poor functioning (5, 6), and suicidal thoughts and behaviors (4, 7). A systematic review (3) has shown that psychotic experiences in childhood and adolescence are associated with a fourfold increased risk of a later psychotic disorder but that evidence for longitudinal associations with nonpsychotic disorders is sparse. Recent work has shown that psychotic experiences by themselves appear to have low predictive value and low sensitivity for predicting a later psychotic disorder (8) and that a more nuanced approach is needed to harness the predictive power of psychotic experience

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

COVID-19, hypercoagulation and what it could mean for patients with psychotic disorders

It has been recently shown that COVID-19 is associated with a clinically significant coagulopathy. Several studies have indicated that elevated markers of fibrin degradation (D-dimers) in hospitalised patients are associated with poorer prognosis (death or ICU admission) (Fogarty et al., 2020, Connors and Levy, 2020). Coagulation test screening is suggested and routine thromboprophylaxis measures (including use of low molecular weight heparin) are recommended, although full anticoagulation is not yet advised in the management of such patients unless otherwise clinically indicated (Connors and Levy, 2020). We wish to draw attention to a potentially enhanced risk of thromboembolic complications in patients with psychotic disorders. </p

Prenatal and perinatal complications in the development of psychosis: canaries in the coalmine

Although first suggested as early as the 1930s, the study of obstetric complications as risk factors for later psychotic disorders came to the fore in the late 1980s, when proponents of the neurodevelopmental aetiological model of schizophrenia cited the association between obstetric adversity and later schizophrenia as an essential building block for this theoretical approach. A meta-analytic review of this literature in 2002 concluded that no specific obstetric complications were associated with schizophrenia– rather a host of prenatal and perinatal risk factors of small effect size (typically with odds ratios [ORs] of less than 2).<br

Inconsistent trauma reporting is associated with emotional and behavioural problems and psychotic experiences in young people

Background: Little is known about the prevalence of inconsistent trauma reporting in community samples and about its associations with psychopathology. This study aimed to assess for the first time the prevalence of inconsistent trauma reporting in a community sample of children/adolescents and to explore associations with both psychotic experiences and with psychopathology more generally.Method: A community-based sample of 86 children/adolescents (baseline mean age 11.5) were interviewed at two time points with data collected in relation to potentially traumatic events through the K-SADS. Emotional and behavioural problems were assessed at follow-up (mean age 15.7) through the Youth Self Report questionnaire while the presence of psychotic experiences was based on expert consensus post interview. Logistic regression models were used to test associations between inconsistent reporting and psychotic experiences at baseline and follow-up, with associations with emotional and behavioral problems at follow-up also assessed.Results: Overall, 16.3% of adolescents failed to report previously reported potentially traumatic events at follow-up and were therefore defined as inconsistent trauma reporters. Inconsistent reporting was associated with emotional and behavioural problems as assessed by the Youth Self Report with the exception of rule breaking behaviour and with psychotic experiences as assessed on interview.Conclusions: Inconsistent trauma reporting is associated with psychotic experiences and emotional and behavioural problems in young people and may represent an important marker for psychopathology in youth.</p

Birth weight and childhood psychopathology in the ABCD cohort: association is strongest for attention problems and is moderated by sex

Many studies have shown low birth weight is associated with psychopathology later in life, particularly attention-deficit/hyperactivity disorder (ADHD). The association is well-replicated, independent from a variety of potential familial confounds, and follows a dose–response curve (decreasing birth weight linked with increasing odds of disorder). However, the specificity of the association to attention problems is called into question by the extent of comorbidity in ADHD, and recent findings that the association is stronger for autism than ADHD. We test the relative dose–response strength of birth weight on multiple aspects of behavior to explore specificity of the effect to attention problems. We also test recent suggestions that the association between birth weight and attention problems is driven by males. Our sample consisted of 9,076 children aged 9–10 from the United States (Adolescent Brain Cognitive Development study). Outcomes included 9 problem-scales and the total problems scale from the Child Behavior Checklist (CBCL). Attention problems were the most strongly associated with birth weight after controlling for gestational age, potential familial confounds, and multiple testing, supporting the outcome-specificity of this association. Contrary to recent registry-based findings, an association between birth weight and an autism scale was not observed. Sex moderated the effect of birth weight on total problems, attention problems and aggressive behavior such that these inverse associations were strongly driven by males. Our findings have strong implications for sex-specific prediction and etiological models of childhood psychopathology.</p

Childhood adversity and adolescent psychopathology: evidence for mediation in a national longitudinal cohort study

BACKGROUND: Childhood adversity is a well-established risk factor for psychopathology; however, many who experience adversity do not go on to develop psychopathology. Poor self-concept and poor parental support are known risk factors for adolescent psychopathology, which may account for some of this mechanism.AIMS: To investigate candidate mediators in the relationship between childhood adversity and psychopathology.METHOD: We used data from the age 9 and 13 waves of the child-cohort of the Growing Up in Ireland study. We undertook mediation analysis by path decomposition of the relationship between childhood adversity and psychopathology (internalising and externalising problems) at age 13 and persistent psychopathology. Candidate mediators were self-concept, parent-child relationship and hobby participation at age 9.RESULTS: Childhood adversity was reported by 28.2% of participants, and was significantly associated with internalising and externalising problems. Parent-child conflict mediated the relationship between childhood adversity and both age 13 and persistent psychopathology, accounting for 52.4% of the relationship between childhood adversity and persistent externalising problems (indirect odds ratio, 1.30; 95% CI 1.19-1.43) and 19.2% for persistent internalising problems (indirect odds ratio, 1.24; 95% CI 1.15-1.34). There was a small mediating effect of self-concept. Hobby participation and positive parent-child relationship did not mediate these relationships.CONCLUSIONS: Parent-child conflict explains almost half the relationship between childhood adversity and persisting externalising problems in adolescence, and a fifth of the relationship with persisting internalising problems. This suggests parent-child conflict is a good target for interventions in childhood to prevent adolescent psychopathology.DECLARATION OF INTEREST: None.</div

Youth mental health in the time of COVID-19

Youth mental health is a rapidly developing field with a focus on prevention, early identification, treatment innovation and service development. In this perspective piece, we discuss the effects of COVID-19 on young people's mental health. The psychosocial effects of COVID-19 disproportionately affect young people. Both immediate and longer-term factors through which young people are affected include social isolation, changes to the delivery of therapeutic services and almost complete loss of all structured occupations (school, work and training) within this population group. Longer-term mechanisms include the effects of the predicted recession on young people's mental health. Opportunities within this crisis exist for service providers to scale up telehealth and digital services that may benefit service provision for young people's mental health in the future