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posted on 22.11.2019by Ian Kelleher, Helen Keeley, Paul Corcoran, Fionnuala Lynch, Carol Fitzpatrick, Nina Devlin, Charlene Molloy, Sarah Roddy, Mary C. Clarke, Michelle Harley, Louise Arseneault, Camilla Wasserman, Vladimir Carli, Marco Sarchiapone, Christina Hoven, Danuta Wasserman, Mary Cannon
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 the risk of psychotic disorder in adulthood. There has been a lack of research, however, on the immediate clinicopathological significance of psychotic symptoms in adolescence.
AIMS: To investigate the relationship between psychotic symptoms and non-psychotic psychopathology in community samples of adolescents in terms of prevalence, co-occurring disorders, comorbid (multiple) psychopathology and variation across early v. middle adolescence.
METHOD: Data from four population studies were used: two early adolescence studies (ages 11-13 years) and two mid-adolescence studies (ages 13-16 years). Studies 1 and 2 involved school-based surveys of 2243 children aged 11-16 years for psychotic symptoms and for emotional and behavioural symptoms of psychopathology. Studies 3 and 4 involved in-depth diagnostic interview assessments of psychotic symptoms and lifetime psychiatric disorders in community samples of 423 children aged 11-15 years.
RESULTS: Younger adolescents had a higher prevalence (21-23%) of psychotic symptoms than older adolescents (7%). In both age groups the majority of adolescents who reported psychotic symptoms had at least one diagnosable non-psychotic psychiatric disorder, although associations with psychopathology increased with age: nearly 80% of the mid-adolescence sample who reported psychotic symptoms had at least one diagnosis, compared with 57% of the early adolescence sample. Adolescents who reported psychotic symptoms were at particularly high risk of having multiple co-occurring diagnoses.
CONCLUSIONS: Psychotic symptoms are important risk markers for a wide range of non-psychotic psychopathological disorders, in particular for severe psychopathology characterised by multiple co-occurring diagnoses. These symptoms should be carefully assessed in all patients.
The Adolescent Brain Development Study was supported by an Essel NARSAD/Brain and Behavior Research Foundation Independent Investigator award and a Clinician Scientist Award (CSA/2004/1) from the Health Research Board (Ireland) to M.C. The research leading to these results has received funding from the European Community’s Seventh Framework Programme under grant agreement HEALTH-F2-2010-241909 (Project EU-GEI); EU-GEI is the acronym of the project European Network of National Schizophrenia Networks Studying Gene–Environment Interactions. The Challenging Times study was supported by Friends of the Children’s University Hospital (Dublin), the American Foundation for Suicide Prevention, the Health Service Executive (HSE) Northern Area and the Mater Misericordiae University Hospital, Dublin. The Saving and Empowering Young Lives in Europe (SEYLE) project is supported through Coordination Theme 1 (Health) of the European Union Seventh Framework Program (FP7), grant agreement HEALTH-F2-2009-223091. The SEYLE project in Ireland was also supported by funding from the HSE National Office for Suicide Prevention. The project leader and coordinator of SEYLE is Professor Danuta Wasserman, head of the National Swedish Prevention of Mental Ill-Health and Suicide (NASP), Karolinska Institute, Stockholm, Sweden. Other members of the Executive Committee are Professor Marco Sarchiapone, Department of Health Sciences, University of Molise, Campobasso, Italy; Vladimir Carli, NASP, Karolinska Institute, Stockholm, Sweden; Professor Christina Hoven and Camilla Wasserman, Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA.
This is an author-produced electronic version of an article accepted for publication in the British Journal of Psychiatry. The definitive publisher-authenticated version is available online at http://bjp.rcpsych.org
Kelleher I, Keeley H, Corcoran P, Devlin N, Molloy C, Roddy S, Clarke MC, Lynch F, Fitzpatrick C, Harley M, Arseneault L, Wasserman C, Carli V, Sarchiapone M, Hoven C, Wasserman D, Cannon M. Clinicopathological significance of psychotic experiences in non-psychotic young people: Evidence from 4 population-based studies. British Journal of Psychiatry. 2012; 201:26-32.