Predicting persistence of hallucinations from childhood to adolescence.

Lisa R Steenkamp,Henning Tiemeier,Manon H J Hillegers,Koen Bolhuis,Steven A Kushner,Laura M E Blanken

doi:10.1192/bjp.2021.115

Abstract

Psychotic experiences predict adverse health outcomes, particularly if they are persistent. However, it is unclear what distinguishes persistent from transient psychotic experiences. In a large population-based cohort, we aimed to (a) describe the course of hallucinatory experiences from childhood to adolescence, (b) compare characteristics of youth with persistent and remittent hallucinatory experiences, and (c) examine prediction models for persistence. Youth were assessed longitudinally for hallucinatory experiences at mean ages of 10 and 14 years (n = 3473). Multi-informant-rated mental health problems, stressful life events, self-esteem, non-verbal IQ and parental psychopathology were examined in relation to absent, persistent, remittent and incident hallucinatory experiences. We evaluated two prediction models for persistence with logistic regression and assessed discrimination using the area under the curve (AUC). The persistence rate of hallucinatory experiences was 20.5%. Adolescents with persistent hallucinatory experiences had higher baseline levels of hallucinatory experiences, emotional and behavioural problems, as well as lower self-esteem and non-verbal IQ scores than youth with remittent hallucinatory experiences. Although the prediction model for persistence versus absence of hallucinatory experiences demonstrated excellent discriminatory power (AUC-corrected = 0.80), the prediction model for persistence versus remittance demonstrated poor accuracy (AUC-corrected = 0.61). This study provides support for the dynamic expression of childhood hallucinatory experiences and suggests increased neurodevelopmental vulnerability in youth with persistent hallucinatory experiences. Despite the inclusion of a wide array of psychosocial parameters, a prediction model discriminated poorly between youth with persistent versus remittent hallucinatory experiences, confirming that persistent hallucinatory experiences are a complex multifactorial trait.

Highlights

Psychotic experiences, such as hallucinations, commonly occur in the general population.[1,2] Their expression peaks in childhood with a prevalence of 17% and declines in adolescence to a prevalence of 7.5%,3 which suggests that childhood psychotic experiences are often transient phenomena
Persistent psychotic experiences are in particular associated with adverse outcomes, including psychotic and non-psychotic mental disorders, substance use and suicidality,[4,5,6] and likely to be more clinically relevant than transient psychotic experiences
A recent review stated that, many studies have compared youth with persistent psychotic experiences to those without psychotic experiences, there is a paucity of information regarding differences between youth with persistent versus remittent patterns.[7]

Summary

Introduction

Psychotic experiences, such as hallucinations, commonly occur in the general population.[1,2] Their expression peaks in childhood with a prevalence of 17% and declines in adolescence to a prevalence of 7.5%,3 which suggests that childhood psychotic experiences are often transient phenomena. Persistent psychotic experiences are in particular associated with adverse outcomes, including psychotic and non-psychotic mental disorders, substance use and suicidality,[4,5,6] and likely to be more clinically relevant than transient psychotic experiences. And accurate identification of youth who will develop persistent psychotic experiences is of great clinical importance. To this end, it is necessary to identify clinical determinants of symptom persistence versus discontinuation. With the growing pressure on child and adolescent mental health services, predictive models to assess individual risk for persistence of psychotic experiences may improve outcomes from a public mental health perspective

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