Abstract
Assuming a continuum between psychotic experiences and psychotic symptoms aligned between healthy individuals and patients with non-psychotic and psychotic disorders, recent research has focused on subclinical psychotic experiences. The wide variety of definitions, assessment tools, and concepts of psychotic-like experiences (PLEs) might contribute to the mixed findings concerning prevalence and persistence rates and clinical impact. In this narrative review, we address the panoply of terminology, definitions, and assessment tools of PLEs and associated concerns with this multitude. Moreover, the ambiguous results of previous studies regarding the clinical relevance of PLEs are described. In conclusion, we address clinical implications and highly suggest conceptual clarity and consensus concerning the terminology and definition of PLEs. The development of an agreed upon use of a “gold standard” assessment tool seems essential for more comparable findings in future research.
Highlights
In the last decades, contrary to the categorical approach of the “Kraepelinian dichotomy” [1], research has hypothesized a dimensional approach toward psychosis assuming a continuum of psychotic experiences and symptoms aligned between clinical and non-clinical populations [2]
There is a large heterogeneity concerning the inquired symptoms of psychotic-like experiences (PLEs) assessment tools as well as the measured “outcome” and inferences resulting from the answered items/questions: While the Magical Ideation Scale (MIS) examines magical ideation defined as an indicator of schizotypy and schizophrenia proneness [48], the Community Assessment of Psychic Experiences (CAPE), one of the most frequently used PLE self-rating instruments, was developed to assess the lifetime prevalence of PLEs in the general population by examining subclinical positive, negative, and depressive symptoms [49]
Excellent sensitivity (96%); quick and easy to use tool administered by primary care practitioners to help identify young people who may be in the early stages of psychosis and to make speedy and confident referrals to specialist services Might contribute to higher accuracy of the referral process more detailed assessment; permits early recognition of psychosis risk in three steps of decreasing sensitivity and increasing specificity; translated into several foreign languages; relatively simple and practical to administer with high predictive power for psychosis onset
Summary
Contrary to the categorical approach of the “Kraepelinian dichotomy” [1], research has hypothesized a dimensional approach toward psychosis assuming a continuum of psychotic experiences and symptoms aligned between clinical and non-clinical populations [2]. There is a large heterogeneity concerning the inquired symptoms of PLE assessment tools as well as the measured “outcome” and inferences resulting from the answered items/questions: While the Magical Ideation Scale (MIS) examines magical ideation defined as an indicator of schizotypy and schizophrenia proneness [48], the Community Assessment of Psychic Experiences (CAPE), one of the most frequently used PLE self-rating instruments, was developed to assess the lifetime prevalence of PLEs in the general population by examining subclinical positive, negative, and depressive symptoms [49]. Available as questionnaire and interview; low-threshold screening instrument for people who have approached general practitioners or counseling services because of mental health problems, checklist assesses a contact to one of the early intervention centers should be made for detailed assessment; potential identification of at-risk persons at the earliest possible stage Short self-administered questionnaire based on the positive symptom portion of the SIPS; useful screening tool for alerting clinicians to subjects with psychotic prodromal symptoms, advised for both general practice and clinical settings. Requires minutes to complete; fair to strong measures of validity; clinical construct validity shows that the screening test could sufficiently differentiate a clinical sample from a non-clinical population in the PS-R; excellent sensitivity (100%) and a good specificity (74%) in the PS-R Distinguishing prodromal from non-prodromal subjects with reasonable sensitivity (80%) and specificity (75%) in an epidemiologically mixed sample; useful tool for screening prodromal symptoms of psychosis and selecting subjects for more extensive research interviews
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