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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.

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. We 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. 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. 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.

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. 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. 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. 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. 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.

Recent community-based research has suggested that psychotic experiences act as markers of severity of psychopathology. There has, however, been a lack of clinic-based research. We wished to investigate, in a clinical sample of adolescents referred to a state-funded mental health service, the prevalence of (attenuated or frank) psychotic experiences and the relationship with (i) affective, anxiety and behavioural disorders, (ii) multimorbid psychopathology, (iii) global functioning, and (iv) suicidal behaviour. The investigation was a clinical case-clinical control study using semi-structured research diagnostic psychiatric assessments in 108 patients newly referred to state adolescent mental health services. Psychotic experiences were prevalent in a wide range of (non-psychotic) disorders but were strong markers of risk in particular for multimorbid psychopathology (Z = 3.44, p = 0.001). Young people with psychopathology who reported psychotic experiences demonstrated significantly poorer socio-occupational functioning than young people with psychopathology who did not report psychotic experiences, which was not explained by multimorbidity. Psychotic experiences were strong markers of risk for suicidal behaviour. Stratified analyses showed that there was a greatly increased odds of suicide attempts in patients with a major depressive disorder [odds ratio (OR) 8.89, 95% confidence interval (CI) 1.59-49.83], anxiety disorder (OR 15.4, 95% CI 1.85-127.94) or behavioural disorder (OR 3.13, 95% CI 1.11-8.79) who also had psychotic experiences compared with patients who did not report psychotic experiences. Psychotic experiences (attenuated or frank) are an important but under-recognized marker of risk for severe psychopathology, including multimorbidity, poor functioning and suicidal behaviour in young people who present to mental health services.

Psychotic experiences (PE) are commonly reported in the general population, where they are associated with elevated clinical need and functional impairment. Research studies typically exclude PE that occur in the context of sleep or substance use (PE-SS), based on the assumption that they are normative within these contexts. This is the first study to formally test clinical and functional outcomes associated with PE that occur in the context of sleep or substance use. Data from the Collaborative Psychiatric Epidemiology Surveys (n = 11 776) were used to assess the associations between both PE and PE-SS and a broad range of outcomes, including psychiatric co-morbidity, suicidal behavior, mental health treatment utilization and World Health Organization (WHO) domains of function, using logistic regression analyses. Lifetime PE and PE-SS were mutually exclusive categories, assessed using the WHO Composite International Diagnostic Interview psychosis screen. PE were associated with all 10 clinical and functional outcomes. Similarly, respondents reporting PE-SS had greater clinical need and impaired function relative to controls, which was significant for seven of the 10 outcome variables. When directly compared, the PE and PE-SS groups differed only in their associations with role function (greater impairment for PE) and self-care (greater impairment for PE-SS). PE-SS were associated with a broad range of clinical and functional outcomes in this large general population sample. These associations were similar to those found for PE. Future studies should investigate relative differences between sleep- and substance-induced PE.

IntroductionPsychotic experiences (PE) occur most often in childhood, at the same age many mental disorders (MD) develop. There is growing evidence that those who report PE and MD show poorer health outcomes. If this occurs in psychosocial outcomes e.g. self-esteem, stress, mental distress, or social support, is under examined. Attachment anxiety and avoidance are the dimensions of attachment, which is hypothesized to develop in infancy as a mechanism for interpersonal relationships in times of need.ObjectivesTo examine the role of transient childhood PE in adult psychosocial outcomes, in those with and without MD. Additionally, to examine if the dimensions of attachment attenuate this model.MethodsOne hundred and three participants attended baseline (age 11 – 13) and 10-year follow-up. PE and MD were collected using the Schedule for Affective Disorders and Schizophrenia for School-aged Children, Present & Lifetime Version. Attachment and outcomes were collected using self-report measures. Analysis compared those with PE, MD and PE and MD, to healthy controls.ResultsPE in childhood was associated with lower self-esteem and lower perceived social support from friends. Lower self-esteem in adulthood was more pronounced in those reporting PE and MD, and was additionally associated with stress in relationships, daily life, and mental distress. Childhood MD without PE was not significantly associated with any psychosocial outcomes. Attachment dimensions significantly attenuated the relationship between PE and self-esteem.ConclusionsThis paper illustrates the significant association of childhood PE on adult outcomes, independent of the effect of co-occurring MD, and demonstrate attachment dimensions role in this model.DisclosureNo significant relationships.

Psychotic disorders develop gradually along a continuum of severity. Understanding factors associated with psychosis development, such as sleep, could aid in identification of individuals at elevated risk. This study aimed to assess (1) the dynamic relationship between psychotic experiences (PEs) and sleep quality and quantity, and (2) whether this relationship differed between different clinical stages along the psychosis continuum. We used daily diary data (90 days) of individuals ( = 96) at early stages (i.e. before a first diagnosis of psychosis) along the psychosis continuum. Multilevel models were constructed with sleep quality and sleep quantity as predictors of PEs and vice versa. Post-hoc, we constructed a multilevel model with both sleep quality and quantity as predictors of PEs. In addition, we tested whether associations differed between clinical stages. Within persons, poorer sleep predicted next day PEs ( = -0.02, = 0.01), but not vice versa. Between persons, shorter sleep over the 90-day period predicted more PEs ( = -0.04, = 0.002). Experiencing more PEs over 90-days predicted poorer ( = -0.02, = 0.02) and shorter ( = -1.06, = 0.008) sleep. We did not find any significant moderation effects for clinical stage. We found a bidirectional relationship between sleep and PEs with daily fluctuations in sleep predicting next day PEs and general patterns of more PEs predicting poorer and shorter sleep. Our results highlight the importance of assessing sleep as a risk marker in the early clinical stages for psychosis.

Introduction Psychotic experiences (PEs) are associated with increased risk of later mental disorders and so could be valuable in prevention studies. However, to date few intervention studies have examined PEs. Given this lack of evidence, in the current study a secondary data analysis was conducted on a clustered-randomized control trial (RCT) of 3 school based interventions to reduce suicidal behaviour, to investigate if these may reduce rates of PEs, and prevent PE, at 3-month and 1-year follow-up. Methods The Irish site of the Saving and Empowering Young Lives in Europe study, trial registration (DRKS00000214), a cluster-RCT designed to examine the effect of school-based interventions on suicidal thoughts and behaviour. Seventeen schools (n = 1096) were randomly assigned to one of three intervention arms or a control arm. The interventions included a teacher training (gate-keeper) intervention, an interactive educational (universal-education) intervention, and a screening and integrated referral (selective-indicative) intervention. The primary outcome of this secondary data-analysis was reduction in point-prevalence of PEs at 12 months. A second analysis excluding those with PEs at baseline was conducted to examine prevention of PEs. Additional analysis was conducted of change in depression and anxiety scores (comparing those with/without PEs) in each arm of the intervention. Statistical analyses were conducted using mixed-effects modelling. Results At 12-months, the screening and referral intervention was associated with a significant reduction in PEs (OR:0.12,95%CI[0.02–0.62]) compared to the control arm. The teacher training and education intervention did not show this effect. Prevention was also observed only in the screening and referral arm (OR:0.30,95%CI[0.09–0.97]). Participants with PEs showed higher levels of depression and anxiety symptoms, compared to those without, and different responses to the screening and referral intervention & universal-education intervention. Conclusions This study provides the first evidence for a school based intervention that reduce & prevent PEs in adolescence. This intervention is a combination of a school-based screening for psychopathology and subsequent referral intervention significantly reduced PEs in adolescents. Although further research is needed, our findings point to the effectiveness of school-based programmes for prevention of future mental health problems.

Adolescent cannabis use has been shown in many studies to increase the risk of later psychosis. Childhood trauma is associated with both substance misuse and risk for psychosis. In this study our aim was to investigate whether there is a significant interaction between cannabis use and childhood trauma in increasing the risk for experiencing psychotic symptoms during adolescence. Psychiatric interviews using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) semi-structured instrument were carried out with 211 adolescents aged between 12 and 15 years and their parents as part of a population-based study. The interview enquired about early traumatic events, cannabis use and psychiatric symptoms in adolescence. In separate analyses both cannabis use and childhood trauma were significantly associated with risk of experiencing psychotic symptoms. However, the presence of both childhood trauma and early cannabis use significantly increased the risk for psychotic symptoms beyond the risk posed by either risk factor alone, indicating that there was a greater than additive interaction between childhood trauma and cannabis use. Our finding of a greater than additive interaction between childhood trauma and cannabis use may have implications for the identification of individuals at high risk of experiencing psychotic symptoms. For example, measures to actively discourage or intensively treat cannabis use in children and adolescents who have experienced abuse may help to prevent the development of psychosis in this vulnerable group. Our findings require replication in larger samples to confirm this interaction effect.

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. 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. 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. 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.