Abstract
Purpose: Psychotic experiences in childhood (such as hearing voices or being suspicious) represent an important phenotype for early intervention. However, these experiences can be defined in several ways: self-reported psychotic experiences (SRPE) rely exclusively on the child’s report, clinically validated psychotic experiences (CRPE) are based on clinical assessment, and attenuated psychotic symptoms (APS) represents a categorization to do with clinical relevance in relation to severity. Very few studies have investigated how these distinctions impact clinical and other domains. The present study aims to compare SRPE, CRPE, and APS among children and adolescents.Methods: This study is part of the Brazilian High-Risk Cohort Study for Psychiatric Disorders, in which 2,241 individuals aged 6–14 years provided self-ratings of 20 psychotic experiences using the Community Assessment of Psychic Experiences (CAPE). A trained psychologist conducted an interview to validate or reject reported experiences and to rate the presence of APS and affective flattening. In parallel, parents provided information about child mental health to an independent interviewer. We tested the association of mutually exclusive categories of non-validated SRPE (nSRPE), clinically validated PE below the threshold for APS (nCRPE), and APS (nSRPE = 33%, nCRPE = 11%, APS = 6%), with parents’ information about the child’s positive attributes and levels of psychopathology and psychologist assessment of blunted affect.Results: Most associations were qualitatively similar, and there was a dose–response in the strength of associations across categories, such that APS > nCRPE > nSRPE. Experiences in all three categories were associated with female sex. nSRPE were associated with overall levels of psychopathology, but to a lesser degree than nCRPE and APS. APS and nCRPE were associated with less positive attributes, with APS more so than nCRPE. Only APS was associated with affective flattening.Conclusions: In children and adolescents, SRPE, CRPE, and APS all index liability for psychopathology, but as clinician rated relevance increases, associations get stronger and become evident across more domains.
Highlights
Children and adolescents who present with unusual experiences, such as perceptual a bnormalities and cognitive distortions that resemble delusions and hallucinations but are below the threshold for clinical psychosis [1, 2], are at risk of mental health problems in later life [1, 3, 4]
Of the 2,511 children included in the study, 267 children did not attend psychological evaluation and four children who attended psychological evaluation had more than four items of the Community Assessment of Psychic Experiences (CAPE) missing and were excluded
We found that clinical validation of psychotic experiences (PE) (CRPE) and higher levels of severity of PE (PE meeting attenuated psychotic symptoms” (APS) criterion) impacted the pattern of associations with psychopathology, protective factors, and psychotic disorderspecific psychopathology
Summary
Children and adolescents who present with unusual experiences, such as perceptual a bnormalities and cognitive distortions that resemble delusions and hallucinations but are below the threshold for clinical psychosis [1, 2], are at risk of mental health problems in later life [1, 3, 4]. APS, on the other hand, are assessed in a clinical context, with a particular focus on help-seeking late adolescents or young adults approaching the age for the peak incidence of psychosis [21]. While PE are assumed to be present to varying degrees in non-clinical populations [22], APS are typically assessed in the context of help-seeking for disorders of anxiety, depression, and drug misuse and may even index imminent conversion to psychosis [19]. Clinical validation of SRPE was examined in a number of studies, usually to examine the predictive validity of self-report against clinical judgment [14, 16, 17, 25]
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