Adolescent Psychotic Experiences Research Articles

S32. ANXIETY IN THE DEVELOPMENT OF PSYCHOTIC EXPERIENCES IN CHILDREN AND ADOLESCENTS: A SYSTEMATIC REVIEW

BackgroundAlthough traditionally separated in psychiatry, the overlap between psychosis and neurosis is becoming clear. It has been argued that emotional processes are not only a core component of psychotic experiences (PEs), but also have a causal role in symptom development. In particular, increasing evidence has highlighted anxiety may be especially important in the emergence of psychotic experiences. As the time when psychotic symptoms first emerge, understanding how anxiety influences their development in childhood and adolescence will inform early intervention. In this systematic review, we investigate the role of anxiety across the spectra of psychotic experiences in children and young people. We examine the available evidence whilst aiming to answer the questions of whether anxiety and psychotic experiences co-occur in young people and if anxiety plays a contributory causal role.MethodsA systematic literature search was conducted on PsychINFO, Medline, EMBASE, and Scopus (updated October 2017). Papers published in peer-reviewed journals were identified that investigated the relationship between anxiety and PEs in children and adolescents within both non-clinical and clinical populations. Twenty-three papers met inclusion criteria. The RTI item bank assessment framework for observational studies was used to evaluate the precision and risk of bias of each individual study.ResultsThe findings of this review demonstrated clear evidence for a consistent relationship between anxiety and psychotic experiences in non-clinical populations of young people, which generally displayed the highest quality of evidence. Although of overall lower quality, this relationship was also evident in clinical populations of young people with mental health problems other than psychosis. Evidence for the role of anxiety in those at clinical risk high for psychosis or diagnosed with psychosis was less conclusive, with very few studies, of variable quality, identified. These studies provided mixed findings, with some evidence for a co-occurrence between anxiety and psychosis risk/disorder, but no clear evidence of a causal role for anxiety in the transition to psychotic disorder. The size of the associations with anxiety appeared to vary by psychotic experience, with moderate evidence for hallucinations and little evidence grandiosity or anhedonia. Paranoia has the strongest evidence for a relationship with anxiety. Most studies were cross-sectional with few longitudinal studies preventing clear conclusions on a causal role of anxiety.DiscussionEvidence suggests that anxiety and psychotic experiences may co-occur in young people. This relationship appears to be transdiagnostic and potentially specific to individual psychotic experiences. As a result, more studies focusing on specific psychotic symptoms and psychological mechanisms are needed. However, research must move beyond cross-sectional associations and test the potential contributory causal role of anxiety using prospective, experimental, and interventionist designs. Despite the unknown direction of causality, the notable associations of psychotic experiences and anxiety in child mental health services indicate that this relationship may be of clinical importance. Establishing higher quality research in clinical settings is essential. Testing the effect of treating anxiety on the severity of psychotic symptoms will inform early intervention.

Adverse life outcomes associated with adolescent psychotic experiences and depressive symptoms

PurposeTo investigate whether psychotic experiences and depressive symptoms at ages 12 and 18 years are associated with adverse life outcomes across a range of functional domains between 16 and 20 years of age.MethodsData were gathered from ALSPAC, a UK birth cohort. Individuals were assessed with the semi-structured Psychosis-Like Symptoms Interview and the Short Mood and Feeling Questionnaire at ages 12 and 18 years. Logistic regression was used to explore associations with outcomes in education, occupation, social functioning, substance use (alcohol, cannabis, smoking, and other drugs), and illegal behaviour between the ages of 16 and 20 years. All associations were adjusted for socio-demographic and childhood confounders and for comorbid psychotic experiences or depressive symptoms.ResultsPsychotic experiences and depression at age 12 were associated with poorer educational, occupational, and social outcomes between the ages of 16 and 20; these withstood adjustment for confounding. Depressive symptoms at age 12 were also associated with harmful drinking. Psychotic experiences and depression at age 18 were additionally associated with other forms of substance use and illegal behaviour. Comorbidity had little impact at age 12, but was associated with significantly worse educational, social, and substance use outcomes at age 18.ConclusionsAdolescent psychotic experiences and depression represent a risk marker for a number of later adverse outcomes, most consistently with education and employment, but also social impairment, harmful drinking, and substance use. This highlights the importance of recognizing adolescent psychopathology, so that support can be provided to try and minimize adverse outcomes.

Trajectories of Early Childhood Developmental Skills and Early Adolescent Psychotic Experiences: Findings from the ALSPAC UK Birth Cohort.

Objective: The aim of this study was to use prospective data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to examine association between trajectories of early childhood developmental skills and psychotic experiences (PEs) in early adolescence.Method: This study examined data from n = 6790 children from the ALSPAC cohort who participated in a semi-structured interview to assess PEs at age 12. Child development was measured using parental report at 6, 18, 30, and 42 months of age using a questionnaire of items adapted from the Denver Developmental Screening Test – II. Latent class growth analysis was used to generate trajectories over time for measures of fine and gross motor development, social, and communication skills. Logistic regression was used to investigate associations between developmental trajectories in each of these early developmental domains and PEs at age 12.Results: The results provided evidence that decline rather than enduringly poor social (adjusted OR = 1.28, 95% CI = 1.10–1.92, p = 0.044) and communication skills (adjusted OR 1.12, 95% CI = 1.03–1.22, p = 0.010) is predictive of suspected or definite PEs in early adolescence, than those with stable and/or improving skills. Motor skills did not display the same pattern of association; although gender specific effects provided evidence that only declining pattern of fine motor skills was associated with suspected and definite PEs in males compared to females (interaction OR = 1.47, 95% CI = 1.09–1.97, p = 0.012).Conclusion: Findings suggest that decline rather than persistent impairment in social and communication skills were most predictive of PEs in early adolescence. Findings are discussed in terms of study’s strengths, limitations, and clinical implications.

In the eye of the beholder: Perceptions of neighborhood adversity and psychotic experiences in adolescence.

Adolescent psychotic experiences increase risk for schizophrenia and other severe psychopathology in adulthood. Converging evidence implicates urban and adverse neighborhood conditions in the etiology of adolescent psychotic experiences, but the role of young people's personal perceptions of disorder (i.e., physical and social signs of threat) in their neighborhood is unknown. This was examined using data from the Environmental Risk Longitudinal Twin Study, a nationally representative birth cohort of 2,232 British twins. Participants were interviewed at age 18 about psychotic phenomena and perceptions of disorder in the neighborhood. Multilevel, longitudinal, and genetically sensitive analyses investigated the association between perceptions of neighborhood disorder and adolescent psychotic experiences. Adolescents who perceived higher levels of neighborhood disorder were significantly more likely to have psychotic experiences, even after accounting for objectively/independently measured levels of crime and disorder, neighborhood- and family-level socioeconomic status, family psychiatric history, adolescent substance and mood problems, and childhood psychotic symptoms: odds ratio = 1.62, 95% confidence interval [1.27, 2.05], p < .001. The phenotypic overlap between adolescent psychotic experiences and perceptions of neighborhood disorder was explained by overlapping common environmental influences, rC = .88, 95% confidence interval [0.26, 1.00]. Findings suggest that early psychological interventions to prevent adolescent psychotic experiences should explore the role of young people's (potentially modifiable) perceptions of threatening neighborhood conditions.

A twin study exploring the association between childhood emotional and behaviour problems and specific psychotic experiences in a community sample of adolescents.

BackgroundChildhood emotional and behaviour problems are antecedents for later psychopathology. This study investigated genetic and environmental influences shaping the longitudinal association between childhood emotional and behaviour problems and specific PEs.MethodIn a community‐based twin sample, parents reported on emotional and behaviour problems when twins were ages 7 and 12 years. At age 16 years, specific PEs were measured using self‐reports and parent reports. Structural equation model‐fitting was conducted.ResultsChildhood emotional and behaviour problems were significantly associated with paranoia, cognitive disorganisation and parent‐rated negative symptoms in adolescence (mean r = .15–.38), and to a lesser extent with hallucinations, grandiosity and anhedonia (mean r = .04‐.12). Genetic influences on childhood emotional and behaviour problems explained significant proportions of variance in adolescent paranoia (4%), cognitive disorganisation (8%) and parent‐rated negative symptoms (3%). Unique environmental influences on childhood emotional and behaviour problems explained ≤1% of variance in PEs. Common environmental influences were only relevant for the relationship between childhood emotional and behaviour problems and parent‐rated negative symptoms (explaining 28% of variance) and are partly due to correlated rater effects.ConclusionsChildhood emotional and behaviour problems are significantly, if weakly, associated with adolescent PEs. These associations are driven in part by common genetic influences underlying both emotional and behaviour problems and PEs. However, psychotic experiences in adolescence are largely influenced by genetic and environmental factors that are independent of general childhood emotional and behaviour problems, suggesting they are not merely an extension of childhood emotional and behaviour problems.

Cumulative Effects of Neighborhood Social Adversity and Personal Crime Victimization on Adolescent Psychotic Experiences.

Background: Little is known about the impact of urbanicity, adverse neighborhood conditions and violent crime victimization on the emergence of adolescent psychotic experiences. Methods: Participants were from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally-representative cohort of 2232 British twins who were interviewed about adolescent psychotic experiences at age 18. Urbanicity, neighborhood characteristics, and personal victimization by violent crime were measured during childhood and adolescence via geocoded census data, surveys of over 5000 immediate neighbors of the E-Risk participants, and interviews with participants themselves. Results: Adolescents raised in urban vs rural neighborhoods were significantly more likely to have psychotic experiences (OR = 1.67, 95% CI = 1.21–2.30, P = .002). This association remained significant after considering potential confounders including family socioeconomic status, family psychiatric history, and adolescent substance problems (OR = 1.43, 95% CI = 1.01–2.03, P = .042), but became nonsignificant after considering adverse social conditions in urban neighborhoods such as low social cohesion and high neighborhood disorder (OR = 1.35, 95% CI = 0.94–1.92, P = .102). The combined association of adverse neighborhood social conditions and personal crime victimization with adolescent psychotic experiences (adjusted OR = 4.86, 95% CI = 3.28–7.20, P < .001) was substantially greater than for either exposure alone, highlighting a potential interaction between neighborhood conditions and crime victimization (interaction contrast ratio = 1.81, 95% CI = −0.03 to 3.65) that was significant at the P = .054 level. Conclusions: Cumulative effects of adverse neighborhood social conditions and personal victimization by violent crime during upbringing partly explain why adolescents in urban settings are more likely to report psychotic experiences. Early intervention efforts for psychosis could be targeted towards victimized youth living in urban and socially adverse neighborhoods.

Cat Owners—and Kids—at No Extra Risk for Psychosis

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessCat Owners—and Kids—at No Extra Risk for PsychosisAaron LevinAaron LevinSearch for more papers by this authorPublished Online:5 May 2017https://doi.org/10.1176/appi.pn.2017.4a22AbstractA new study from England explores the connection between having a cat and psychotic symptoms in teens.The cat and mouse game between toxoplasmosis and schizophrenia entered another round recently when a British study concluded that owning a cat was no grounds for increased risk of psychosis.iStock/skynesherHouse cats, especially those who explore the outdoors, may carry the parasite Toxoplasmosis gondii, and epidemiological and animal studies at least hint at an increased risk for schizophrenia among offspring following in utero or early childhood exposure to the parasite.There may be such a connection, but mere ownership of a cat during pregnancy or in early childhood does not increase the risk of psychotic events when children reach age 13 or 18, wrote Francesca Solmi, Ph.D., a postdoctoral research associate in psychiatric epidemiology at University College London, in a study published online February 22 in Psychological Medicine.“The interpretation of our findings is that if there is a real association between T. gondii and schizophrenia, it would appear that owning a cat does not put the owners at an increased risk of infection compared to other potential sources, like handling infected soil, eating raw meat, and so on,” Solmi told Psychiatric News.However, mere ownership of a feline isn’t enough to trigger the hypothesized cascade of risk, said Alan Brown, M.D., M.P.H, a professor of psychiatry and epidemiology at Columbia University Medical Center.“Exposure to the parasite requires direct contact with cat feces followed by placing the hand to the mouth,” said Brown, who has studied the connection between toxoplasmosis and psychiatric illness for years.T. gondii may also be present in soil or water, or can be ingested by eating raw, unwashed foods grown in infested gardens.Solmi and her colleagues used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), based on an initial cohort of 16,734 pregnant women in southwestern England who gave birth in the 13 months after April 1991. The study assessed 6,705 children at age 13 and 4,676 at age 18. After adjustment for several potential confounders, they found no evidence that cat ownership when the mothers were pregnant or when children reached age 4 or 10 was associated with psychotic symptoms at ages 13 and 18.“While most people who experience psychotic symptoms in adolescence will not develop psychotic disorders later in life, these symptoms often indicate an increased risk for schizophrenia and other mental illnesses, including depression,” said Solmi. Symptoms were chosen as the outcome measure because the original number of children in ALSPAC (about 14,000) was too small to provide enough adolescents with clinical diagnoses of schizophrenia at age 18.Symptoms of psychosis are found in several psychiatric conditions, and inferring a diagnosis of schizophrenia or psychosis from those symptoms may be premature, said Brown.Nonetheless, cat owners should take basic sanitary precautions, said both Solmi and Brown.“While pregnant women should continue to avoid handling soiled cat litter, given possible T. gondii exposure, our study strongly indicates that cat ownership in pregnancy or early childhood does not confer an increased risk of later adolescent psychotic experiences,” Solmi and colleagues concluded.“It’s great to own a cat; I own a cat,” said Brown. “But cat owners should always wash their hands after cleaning the litter box. Cats are getting a bad rap.” ■An abstract of “Curiosity Killed the Cat: No Evidence of an Association Between Cat Ownership and Psychotic Symptoms at Ages 13 and 18 Years in a UK General Population Cohort” can be accessed here. ISSUES NewArchived

6.3 Psychotic Experiences in Adolescence and Later Risk of Suicidal Behavior and Substance Use in a Swedish Longitudinal Cohort

6.3 Psychotic Experiences in Adolescence and Later Risk of Suicidal Behavior and Substance Use in a Swedish Longitudinal Cohort

34. Relationship Between Adolescent Metabolites and Psychosis Risk and Academic Performance in Adolescence: Results From a Finnish Birth Cohort

Abstract Background: Psychotic experiences in adolescence index risk for later psychotic disorders and adolescents with psychotic experiences in the population show evidence of some of the cognitive deficits observed in those with clinical psychotic disorders. Metabolomics approaches have been fruitful in predicting psychotic disorders in young adults and the development of cognitive deficits in older adults. Erthyrocyte lipid abnormalities (in omega-3 and omega-9) have been associated with cognitive deficits in young people at risk for psychosis. However, metabolomics approaches have not been applied to examine predictors of psychotic experiences or cognitive deficits in population samples of young adults. In this study, we aimed to use metabolomics approaches to clarify whether serum metabolites were associated with adolescent psychotic experiences in the population and with adolescent academic difficulties, and whether observed associations with academic difficulties differed by psychotic experience status. Methods: Using data from the Northern Finland Birth Cohort 1986 (NFBC 1986; n = 6985 at 16 years, 74% follow-up), we used logistic regression to measure the association between 77 metabolic measures and positive and negative psychotic experiences (measured using the PROD-screen) and academic performance, controlling for sex, maternal education and body mass index at 16 years. Analyses were adjusted for multiple testing. Observed associations with academic performance were tested for interaction with positive psychotic experiences using chi-squared test for interaction. Results: No metabolites were associated with positive psychotic experiences or negative psychotic experiences at the corrected P value of <.0026. However, nineteen metabolites were associated with academic performance. A number of these associations interacted with positive psychotic experiences. Specifically, higher ratios of omega-3 to total fatty acids was significantly more protective in terms of academic performance among those with psychotic experiences (OR = 0.72, 95% CI: 0.62–0.83) than those without (OR = 0.84, 95% CI: 0.77–0.91; P = .036 for difference). There was also a trend towards a more protective effect among those with psychotic experiences in association with higher ratios of polyunsaturated fatty acids to total fatty acids (P = .063), and towards higher risk associated with higher levels of total fatty acids (P = .058) and higher monounsaturated fatty acid levels (P = .055). Conclusion: Observed associations with academic performance were strong across the population, though the protective association with higher omega-3 ratios were particularly strong among those with positive psychotic experiences. This may suggest that higher ratios of omega-3 in this group are particularly important in preventing adverse cognitive outcomes.

Curiosity killed the cat: no evidence of an association between cat ownership and psychotic symptoms at ages 13 and 18 years in a UK general population cohort.

Congenital or early life infection with Toxoplasma gondii has been implicated in schizophrenia aetiology. Childhood cat ownership has been hypothesized as an intermediary marker of T. gondii infection and, by proxy, as a risk factor for later psychosis. Evidence supporting this hypothesis is, however, limited. We used birth cohort data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to investigate whether cat ownership in pregnancy and childhood (ages 4 and 10 years) was associated with psychotic experiences (PEs) in early (age 13, N = 6705) and late (age 18, N = 4676) adolescence, rated from semi-structured interviews. We used logistic regression to examine associations between cat ownership and PEs, adjusting for several sociodemographic and socioeconomic factors, household characteristics and dog ownership. Missing data were handled via multiple imputation. Cat ownership during pregnancy was not associated with PEs at age 13 years [adjusted odds ratio (OR) 1.15, 95% confidence interval (CI) 0.97-1.35] or 18 years (OR 1.08, 95% CI 0.86-1.35). Initial univariable evidence that cat ownership at ages 4 and 10 years was associated with PEs at age 13 years did not persist after multivariable adjustment (4 years: OR 1.18, 95% CI 0.94-1.48; 10 years: OR 1.12, 95% CI 0.92-1.36). There was no evidence that childhood cat ownership was associated with PEs at age 18 years. While pregnant women should continue to avoid handling soiled cat litter, given possible T. gondii exposure, our study strongly indicates that cat ownership in pregnancy or early childhood does not confer an increased risk of later adolescent PEs.

Psychosis risk screening: Validation of the youth psychosis at‐risk questionnaire – brief in a community‐derived sample of adolescents

There have been several attempts to identify individuals potentially at high risk for psychotic-spectrum disorders using brief screening measures. However, relatively few studies have tested the psychometric properties of the psychosis screening measures in representative samples of adolescents. The main purpose of the present study was to analyse the prevalence, factorial structure, measurement invariance across gender, and reliability of the Youth Psychosis At-Risk Questionnaire - Brief (YPARQ-B) in a community-derived sample of adolescents. Additionally, the relationship between YPARQ-B, depressive symptoms, psychopathology, stress manifestations, and prosocial skills was analysed. One thousand and twenty students from high schools participated in a cross-sectional survey. The YPARQ-B, the Reynolds Adolescent Depression Scale, the Strengths and Difficulties Questionnaire, and the Student Stress Inventory - Stress Manifestations were used. A total of 85.1% of the total sample self-reported at least one subclinical psychotic experience. We observed a total of 10.9% of adolescents with a cutoff score of ≥11 or 6.8% with a cutoff score of ≥13. The analysis of internal structure of the YPARQ-B yielded an essentially unidimensional structure. The YPARQ-B scores showed measurement invariance across gender. The internal consistency of the YPARQ-B total score was 0.94. Furthermore, self-reported subclinical psychotic experiences were associated with depressive symptoms, emotional and behavioural problems, poor prosocial skills, and stress manifestations. These results would appear to indicate that YPARQ-B is a brief and easy tool to assess self-reported subclinical psychotic experiences in adolescents from the general population. The assessment of these experiences in community settings, and its associations with psychopathology, may help us to enhance the possibility of an early identification of adolescents potentially at risk for psychosis and mental health problems.

A longitudinal study of adolescent psychotic experiences and later development of substance use disorder and suicidal behavior

IntroductionPsychotic experiences are associated with later substance use disorder and suicidal behavior, but individual psychotic experiences have not been examined in a longitudinal data set. Also, the potential dose–response relationship between these phenomena remains unknown. MethodCohort study including 9242 adolescents who participated in The Child and Adolescent Twin Study in Sweden (CATSS). At ages 15 and/or 18, seven psychotic experiences (auditory and visual hallucinations, and five delusions) were assessed via questionnaires. Outcomes at follow-up were physician-assigned diagnoses of substance use disorder and suicide attempts ascertained from the Swedish Patient Register. Associations were estimated with Cox regressions and expressed as hazard ratios. ResultsAll psychotic experiences were associated with later substance use disorder and/or suicide attempts, with hazard ratios ranging from 1.6 to 3.0. A dose–response relationship was observed between psychotic experiences and later substance use disorder, and suicide attempt. DiscussionAuditory and visual hallucinations as well as delusions in adolescence are associated with later development of substance use disorder and suicide attempt, and there is a dose–response relationship between the load of psychotic experiences and these adverse outcomes. Clinicians should assess subclinical hallucinations as well as delusions in psychiatric evaluations of adolescents.

Association between stressful life events and psychotic experiences in adolescence: evidence for gene-environment correlations.

BackgroundStressful life events (SLEs) are associated with psychotic experiences. SLEs might act as an environmental risk factor, but may also share a genetic propensity with psychotic experiences.AimsTo estimate the extent to which genetic and environmental factors influence the relationship between SLEs and psychotic experiences.MethodSelf- and parent reports from a community-based twin sample (4830 16-year-old pairs) were analysed using structural equation model fitting.ResultsSLEs correlated with positive psychotic experiences (r = 0.12–0.14, all P<0.001). Modest heritability was shown for psychotic experiences (25–57%) and dependent SLEs (32%). Genetic influences explained the majority of the modest covariation between dependent SLEs and paranoia and cognitive disorganisation (bivariate heritabilities 74–86%). The relationship between SLEs and hallucinations and grandiosity was explained by both genetic and common environmental effects.ConclusionsFurther to dependent SLEs being an environmental risk factor, individuals may have an underlying genetic propensity increasing their risk of dependent SLEs and positive psychotic experiences.

Association between childhood psychiatric disorders and psychotic experiences in adolescence: A population-based longitudinal study

BackgroundAdolescent psychotic experiences (PEs) are common, and are associated with both psychotic and non-psychotic illnesses. In order to examine psychopathological and cognitive antecedents of adolescent PEs, we have conducted a longitudinal study of common childhood psychiatric disorders and subsequent adolescent PEs in the population-based prospective ALSPAC birth cohort. MethodDepression, anxiety, attention deficit hyperactivity disorder, oppositional defiant or conduct disorder, and pervasive developmental disorder were diagnosed according to DSM-IV criteria in 8253 participants at age 8years. IQ was assessed by WISC-III also at 8years. PEs, depressive and anxiety symptoms were assessed at 13years. Logistic regression calculated odds ratio (OR) for PEs at 13years associated with psychiatric disorders at 8years. Linear regression calculated mean difference in IQ between groups with and without psychiatric disorder. Mediating effects of IQ, mood and anxiety symptoms on the psychiatric disorder-PEs relationship were examined. ResultsIn total, 599 children were assessed to have a DSM-IV psychiatric disorder at 8years (7.2%). These children compared with those without any psychiatric disorder performed worse on all measures of IQ; adjusted mean difference in total IQ −6.17 (95% CI, −7.86, −4.48). Childhood psychiatric disorders were associated with PEs subsequently in adolescence; adjusted OR 1.96 (95% CI, 1.47–2.68). The association between psychiatric disorder and subsequent PEs was partly mediated by, independently, IQ deficit at 8years and depressive and anxiety symptoms at 13years. ConclusionsThe findings indicate that adolescent PEs are associated with general cognitive ability and past and present psychopathological factors.

Dimensional psychotic experiences in adolescence: Evidence from a taxometric study of a community-based sample

Psychotic experiences of varying severity levels are common in adolescence. It is not known whether beyond a certain severity in the general population, psychotic experiences represent a categorically distinct phenomena to milder psychotic experiences. We employed taxometric analytic procedures to determine whether psychotic experiences in adolescence are taxonic (i.e. categorical) or dimensional. Six different psychotic experiences were assessed in a community sample of approximately 5000 adolescents. Three taxometric procedures were conducted. Across all procedures, there was no evidence of a taxon (i.e. a separate latent population) underlying psychotic experiences in adolescence. Rather, a dimensional structure was supported. The results support the notion that psychotic experiences are continuously distributed throughout the general population, and there is no clear discontinuity between milder and more severe psychotic experiences. Thus, these findings support the use of dimensional approaches to understanding psychotic experiences in etiological studies. In clinical practice, categorical cut-offs are needed: the present findings show that a ‘natural’ break point is not present for identifying severe psychotic experiences, and it is likely therefore that other criteria (such as general functioning) might better aid decision-making with regards to identifying individuals with severe psychotic experiences in need of care during adolescence.

Shared Etiology of Psychotic Experiences and Depressive Symptoms in Adolescence: A Longitudinal Twin Study.

Psychotic disorders and major depression, both typically adult-onset conditions, often co-occur. At younger ages psychotic experiences and depressive symptoms are often reported in the community. We used a genetically sensitive longitudinal design to investigate the relationship between psychotic experiences and depressive symptoms in adolescence. A representative community sample of twins from England and Wales was employed. Self-rated depressive symptoms, paranoia, hallucinations, cognitive disorganization, grandiosity, anhedonia, and parent-rated negative symptoms were collected when the twins were age 16 (N = 9618) and again on a representative subsample 9 months later (N = 2873). Direction and aetiology of associations were assessed using genetically informative cross-lagged models. Depressive symptoms were moderately correlated with paranoia, hallucinations, and cognitive disorganization. Lower correlations were observed between depression and anhedonia, and depression and parent-rated negative symptoms. Nonsignificant correlations were observed between depression and grandiosity. Largely the same genetic effects influenced depression and paranoia, depression and hallucinations, and depression and cognitive disorganization. Modest overlap in environmental influences also played a role in the associations. Significant bi-directional longitudinal associations were observed between depression and paranoia. Hallucinations and cognitive disorganization during adolescence were found to impact later depression, even after controlling for earlier levels of depression. Our study shows that psychotic experiences and depression, as traits in the community, have a high genetic overlap in mid-adolescence. Future research should test the prediction stemming from our longitudinal results, namely that reducing or ameliorating positive and cognitive psychotic experiences in adolescence would decrease later depressive symptoms.

A longitudinal investigation of childhood communication ability and adolescent psychotic experiences in a community sample

BackgroundSome childhood speech and language impairments precede psychosis but it is not clear whether they also precede adolescent psychotic experiences and whether this association is specific to psychotic experiences. MethodsPragmatic language and expressive speech and language (parent-assessed using the Children's Communication Checklist) at age 9 and psychotic experiences and depression at ages 12 and 18 were investigated in 7659 participants from the Avon Longitudinal Study of Parents and Children. Associations were investigated using multivariate modelling. ResultsPoorer pragmatic language at 9years was associated with psychotic experiences at both ages (12years OR 1.22, 95% CI 1.11, 1.34; 18years OR 1.25, 95% CI 1.10, 1.41) but only with depression at 18years (OR 1.10, 95% CI 1.00, 1.22). Poorer expressive speech and language ability was not associated with psychotic experiences or depression at either age. There was evidence that pragmatic language was specifically associated with psychotic experiences at age 12 but no evidence that the strength of any of the associations changed over time. ConclusionsDeficits in pragmatic language precede early and late adolescent psychotic experiences and early adolescent depression. Interventions aimed at helping children improve pragmatic language skills may reduce the incidence of adolescent psychopathology and associated psychological disorder and dysfunction later in life.

The association between childhood autistic traits and adolescent psychotic experiences is explained by general neuropsychiatric problems.

Studies suggest associations between childhood autistic traits and adolescent psychotic experiences. However, recent research suggests that a general neuropsychiatric problems factor predicts adverse outcomes better than specific diagnostic entities. To examine if the alleged association between autistic traits and psychotic experiences could rather be explained by a general neuropsychiatric problems factor comprising symptoms of ADHD, tic disorder, developmental coordination disorder, and learning disorder, we conducted a prospective cohort study based on the Child and Adolescent Twin Study in Sweden. In addition, we examined the genetic and environmental influences on the associations. A total of 9,282 twins with data on childhood autistic traits and other neuropsychiatric problems, and follow-up data on psychotic experiences at ages 15 and/or 18 years were included. First, psychotic experiences were regressed on autistic traits and second, the general neuropsychiatric problems factor was added to the model. Auditory hallucinations were analyzed separately from the other psychotic experiences. Finally, twin analyses were employed to disentangle genetic from environmental influences in the observed associations. Replicating prior research, significant associations were found between autistic traits in childhood and auditory hallucinations at ages 15 and 18. However, after controlling for the general neuropsychiatric problems factor, the associations between autistic traits and auditory hallucinations disappeared, whereas the association between the general neuropsychiatric problems factor and auditory hallucinations persisted after controlling for autistic traits. Twin analyses revealed that the association between the general neuropsychiatric problems factor and auditory hallucinations was driven by shared genetic influences. © 2015 Wiley Periodicals, Inc.

Prevalence and correlates of psychotic like experiences in a nationally representative community sample of adolescents in Ireland

Adolescent psychotic like experiences (PLEs) are an important area of research, yet only a small number of community surveys have investigated their psychosocial correlates. This study presents the prevalence and correlates of three types of PLEs in a nationally representative community sample of 12–19year olds in Ireland (N=5910). Correlates are considered across five domains: demographic, stressful life experiences, emotional/behavioral problems, substance use, and personal resources. Auditory hallucinations were reported by 13.7% of participants, 10.4% reported visual hallucinations and 13.1% reported paranoid thoughts. Participants who had experienced two of the three PLEs were assigned “risk” status (10.4%; n=616). Using binary logistic regression, PLEs were associated with a range of correlates across the five domains. Key correlates of risk status include depression (OR 4.07; 95% CI 3.39–4.88), low self-esteem (OR 4.03 95% CI 3.34–4.86), low optimism (OR 3.56; 95% CI 2.96–4.28), school misconduct (OR 3.10 95%; CI 2.56–3.75), and high avoidance coping (OR 2.86 95% CI 2.34–3.49). These associations remained significant in a multivariate analysis. While correlates for each of the three PLEs were similar, there were some nuances in these patterns. Notably, demographic and substance use variables were the weakest groups of correlates. Personal resources (e.g. self-esteem, optimism and coping) have been poorly studied in the adolescent PLE literature and these findings provide important insights for future research and intervention design.

A longitudinal twin study of the association between childhood autistic traits and psychotic experiences in adolescence.

BackgroundThis twin study investigated whether autistic traits during childhood were associated with adolescent psychotic experiences.MethodsData were collected from a community sample of approximately 5000 twin pairs, which included 32 individuals with diagnosed autism spectrum conditions (ASC). Parents rated autistic traits in the twins at four points between ages 8–16 years. Positive, negative, and cognitive psychotic experiences were assessed at age 16 years using self- and parent-report scales. Longitudinal twin analyses tested the associations between these measures.ResultsAutistic traits correlated weakly or nonsignificantly with positive psychotic experiences (paranoia, hallucinations, and grandiosity), and modestly with cognitive psychotic experiences (cognitive disorganisation). Higher correlations were observed for parent-rated negative symptoms and self-reported anhedonia, although the proportion of variance in both accounted for by autistic traits was low (10 and 31 %, respectively). The majority of the genetic influences on negative symptoms and anhedonia were independent of autistic traits. Additionally, individuals with ASC displayed significantly more negative symptoms, anhedonia, and cognitive disorganisation than controls.ConclusionsAutistic traits do not appear to be strongly associated with psychotic experiences in adolescence; associations were also largely restricted to negative symptoms. Of note, the degree to which the genetic and environmental causes of autistic traits influenced psychotic experiences was limited. These findings thus support a phenotypic and etiological distinction between autistic traits and psychotic experiences.Electronic supplementary materialThe online version of this article (doi:10.1186/s13229-015-0037-9) contains supplementary material, which is available to authorized users.