Self-reported Psychotic Symptoms Research Articles

Adolescent Psychedelic Use and Psychotic or Manic Symptoms

While psychedelic-assisted therapy has shown promise in the treatment of certain psychiatric disorders, little is known about the potential risk of psychotic or manic symptoms following naturalistic psychedelic use, especially among adolescents. To investigate associations between naturalistic psychedelic use and self-reported psychotic or manic symptoms in adolescents using a genetically informative design. This study included a large sample of adolescent twins (assessed at age 15, 18, and 24 years) born between July 1992 and December 2005 from the Swedish Twin Registry and cross-sectionally evaluated the associations between past psychedelic use and psychotic or manic symptoms at age 15 years. Individuals were included if they answered questions related to past use of psychedelics. Data were analyzed from October 2022 to November 2023. Primary outcome measures were self-reported psychotic and manic symptoms at age 15 years. Lifetime use of psychedelics and other drugs was also assessed at the same time point. Among the 16 255 participants included in the analyses, 8889 were female and 7366 were male. Among them, 541 participants reported past use of psychedelics, most of whom (535 of 541 [99%]) also reported past use of other drugs (ie, cannabis, stimulants, sedatives, opioids, inhalants, or performance enhancers). When adjusting for substance-specific and substance-aggregated drug use, psychedelic use was associated with reduced psychotic symptoms in both linear regression analyses (β, -0.79; 95% CI, -1.18 to -0.41 and β, -0.39; 95% CI, -0.50 to -0.27, respectively) and co-twin control analyses (β, -0.89; 95% CI, -1.61 to -0.16 and β, -0.24; 95% CI, -0.48 to -0.01, respectively). In relation to manic symptoms, likewise adjusting for substance-specific and substance-aggregated drug use, statistically significant interactions were found between psychedelic use and genetic vulnerability to schizophrenia (β, 0.17; 95% CI, 0.01 to 0.32 and β, 0.17; 95% CI, 0.02 to 0.32, respectively) or bipolar I disorder (β, 0.20; 95% CI, 0.04 to 0.36 and β, 0.17; 95% CI, 0.01 to 0.33, respectively). The findings in this study suggest that, after adjusting for other drug use, naturalistic use of psychedelic may be associated with lower rates of psychotic symptoms among adolescents. At the same time, the association between psychedelic use and manic symptoms seems to be associated with genetic vulnerability to schizophrenia or bipolar I disorder. These findings should be considered in light of the study's limitations and should therefore be interpreted with caution.

Differences in self-reported psychotic symptoms between patients with autism spectrum disorder and those with schizophrenia.

Patients with autism spectrum disorder (ASD) are prone to develop overt psychosis and share symptom presentations with those with schizophrenia (SZ). This study aimed to explore differences in the distributions of psychotic symptoms among first-visit patients with ASD, SZ, or a nonpsychiatric diagnosis (N-PD). Data from first-visit patients were retrospectively collected from medical records from the Department of Psychiatry, Dokkyo Medical University Hospital between June 2019 and May 2021. A total of 254 patients with data on the PRIME Screen-Revised (PS-R) assessments were included in our analysis. In the hospital, all psychiatric diagnoses were based on the DSM-5 diagnostic criteria. In the ASD, SZ, and N-PD groups, endorsements of perplexity and delusional mood were 15.6% (7/45), 41.5% (44/106), and 1.1% (1/88), and those of perceptual abnormalities were 11.1% (5/45), 40.6% (43/106), and 2.3% (2/88), respectively. Trend analysis clarified that the endorsement of these psychotic symptoms increased from N-PD to ASD and SZ. In the multivariate-adjusted multinomial logistic regression analysis, the ASD and N-PD groups were compared with the SZ group. Higher age and the presence of perceptual abnormalities were associated with lack of an ASD diagnosis, whereas male sex, lack of perplexity and delusional mood, and lack of perceptual abnormalities were associated with N-PD. Our results are preliminary; however, a detailed assessment of positive symptoms might facilitate differentiation between ASD and SZ.

Prevalence of probable mental, neurological and substance use conditions and case detection at primary healthcare facilities across three districts in Ghana: findings from a cross-sectional health facility survey

BackgroundFew studies have examined the prevalence of mental, neurological and substance use (MNS) conditions, case detection and treatment in primary healthcare in rural settings in Africa. We assessed prevalence and case detection at primary healthcare facilities in low-resource rural settings in Ghana.MethodsA cross-sectional survey was conducted at the health facility level in three demonstration districts situated in Bongo (Upper East Region), Asunafo North (Ahafo Region) and Anloga (Volta Region) in Ghana. The study participants were resident adult (> 17 years) out-patients seeking healthcare at primary care facilities in each of the three demonstration districts. Data were collected on five priority MNS conditions: depression, psychosis, suicidal behaviour, epilepsy and alcohol use disorders.ResultsNine hundred and nine (909) people participated in the survey. The prevalence of probable depression was 15.6% (142/909), probable psychotic symptoms was 12% (109/909), probable suicidal behaviour was 11.8% (107/909), probable epilepsy was 13.1% (119/909) and probable alcohol use disorders was 7.8% (71/909). The proportion of missed detection for cases of depression, self-reported psychotic symptoms, epilepsy and alcohol use disorders (AUD) ranged from 94.4 to 99.2%, and was similar across study districts. Depression was associated with self-reported psychotic symptoms (RR: 1.68; 95% CI: 1.12–1.54). For self-reported psychotic symptoms, a reduced risk was noted for being married (RR: 0.62; 95% CI: 0.39–0.98) and having a tertiary level education (RR: 0.12; 95% CI: 0.02–0.84). Increased risk of suicidal behaviour was observed for those attending a health facility in Asunafo (RR: 2.31; 95% CI: 1.27–4.19) and Anloga districts (RR: 3.32; 95% CI: 1.93–5.71). Age group of 35 to 44 years (RR: 0.43; 95% CI: 0.20–0.90) was associated with reduced risk of epilepsy. Being female (RR: 0.19; 95% CI: 0.12–0.31) and having a tertiary education (RR: 0.27; 95% CI: 0.08–0.92) were associated with reduced risk of AUD.ConclusionsOur study found a relatively high prevalence of probable MNS conditions, and very low detection and treatment rates in rural primary care settings in Ghana. There is a need to improve the capacity of primary care health workers to detect and manage MNS conditions.

216. Self-Reported Psychotic Symptoms Among Patients who Screen Positive for Borderline Personality Disorder in Adult Inpatient Psychiatric Units: A Cross Sectional Study

216. Self-Reported Psychotic Symptoms Among Patients who Screen Positive for Borderline Personality Disorder in Adult Inpatient Psychiatric Units: A Cross Sectional Study

Awareness of illness moderates self-assessment of psychotic symptoms.

Self-reports or patient-reported outcome measures are seldom used in psychosis due to concerns about the ability of patients to accurately report their symptomatology, particularly in cases of low awareness of illness. The aim of this study was to assess the effect of insight on the accuracy of self-reported psychotic symptoms using a computerized adaptive testing tool (CAT-Psychosis). A secondary analysis of data drawn from the CAT-Psychosis development and validation study was performed. The Brief Psychiatric Rating Scale and the Scale of Unawareness of Mental Disorders were administered by clinicians. Patients completed the self-reported version of the CAT-Psychosis. Patients were median-split regarding their insight level to compare the correlation between the two psychosis severity measures. A subgroup sensitivity analysis was performed only on patients with schizophrenia spectrum disorders. A total of 159 patients with a psychotic disorder who completed both CAT-Psychosis and Scale of Unawareness of Mental Disorders were included. For the whole sample, CAT-Psychosis scores showed convergent validity with Brief Psychiatric Rating Scale ratings (r = 0.517, 95% confidence interval = [0.392, 0.622], p < 0.001). Insight was found to moderate this correlation (β = -0.511, p = 0.005), yet agreement between both measures remained statistically significant for both high (r = 0.621, 95% confidence interval = [0.476, 0.733], p < 0.001) and low insight patients (r = 0.408, 95% confidence interval = [0.187, 0.589], p < 0.001), while psychosis severity was comparable between these groups (for Brief Psychiatric Rating Scale: U = 3057, z = -0.129, p = 0.897; disorganization: U = 2986.5, z = -0.274, p = 0.784 and for CAT-Psychosis: U = 2800.5, z = -1.022, p = 0.307). Subgroup of patients with schizophrenia spectrum disorders showed very similar results. Insight moderates the correlation between self-reported and clinician-rated severity of psychosis, yet CAT-Psychosis remains valid in patients with both high and low awareness of illness.

Gender differences in screening self-reported psychotic symptoms in a first help-seeking population.

Gender differences in the frequency and severity of psychotic symptoms have been widely reported. However, in the screening process for the detection of early psychosis, gender differences were largely overlooked in China. This study investigated gender differences in self-reported psychotic symptoms in a clinical population who initially visited a mental health service. In total, 1931 consecutive new patients were included in the current analysis, with a mean age of 25.3years, including 852 (44.1%) men and 1079 (55.9%) women, of whom 388 (20.1%) had psychotic disorders and 1543 (79.9%) had non-psychotic disorders. Psychotic symptoms were assessed using the PRIME Screen-Revised (PS-R) questionnaire. The cohort was grouped according to gender, age (adolescents ≤ 21years, adults > 21years), and clinical diagnosis. Within the full sample, gender differences in psychotic symptoms were not significant, except that females appeared to have more severe symptoms of disorganized communication than males. However, gender differences began to appear at subgroup levels, after stratification by age and diagnosis. Female adolescents reported more severe psychotic symptoms than male adolescents, especially in the symptom of perceptual abnormalities, which refer to hallucinations. Different patterns and predictors were found to significantly discriminate between psychotic and non-psychotic disorders among age and gender groups. Our study highlights gender differences in the severity, frequency, and pattern of self-reported psychotic symptoms when screening in a first help-seeking population. Therefore, gender differences should be considered during psychotic symptoms screening.

Frequency of Self-reported Psychotic Symptoms among 2542 Outpatients at Their First Visit for Mental Health Services

Objective: Psychotic symptoms are prevalent in both clinical settings and the general population. The distribution of psychotic symptoms across patients with different types of psychotic and non-psychotic mental disorders is helpful for understanding symptom specificity. This study aimed to explore the distribution differences of psychotic symptoms in an outpatient population in terms of frequency, age, gender, and psychotic and non-psychotic disorders. Methods: Outpatients were recruited consecutively at their first visit to the Shanghai Mental Health Center. Psychotic symptoms over the preceding year were self-reported through the PRIME Screen-Revised (PS-R) questionnaire. Seven categories of psychotic symptoms were grouped: perplexity and delusional mood (Item-1,5); first rank symptoms (Item-3,6,11); overvalued beliefs (Item-2,4); suspiciousness/persecutory ideas (Item-7), grandiose ideas (Item 8), perceptual abnormalities (Item-9,10), and disorganized communication (Item-12). Comparisons were made with respect to age group, sex, and diagnostic category. Results: Of 2542 outpatients, 1448(57.0%) were screened as positive, which was defined as having two or more symptoms with at least “somewhat agree” scores, ranging from 0 to 6. The threshold of one or more “yes” items was an endorsement to categorize the participant as positive for psychotic symptoms. The frequency of psychotic symptoms declined with age. Younger patients tended to report more psychotic symptoms than older patients(p < .001). Suspiciousness(p = .038) and disorganized communication (p = .004) were more common in females than males. Age, first rank symptoms, suspiciousness/persecutory ideas, grandiose ideas, and perceptual abnormalities were found to significantly differ between psychotic and non-psychotic disorders. Conclusions: Psychotic symptoms appear to be common in the clinical population and represent nonspecific indicators of psychopathology. The difference between psychotic and non-psychotic psychopathologies is more a function of the presence, frequency, and severity of psychotic symptoms.

Previously incarcerated individuals with psychotic symptoms are more likely to report a history of solitary confinement

We examined whether previously incarcerated individuals with self-reported psychotic symptoms were more likely to endorse a history of solitary confinement. A community-based sample of 176 previously incarcerated individuals residing in Baltimore or New York City were surveyed on prison experiences and mental health symptoms. Logistic regression found that previously incarcerated individuals who endorsed a schizophrenia diagnosis or past 12-month psychotic symptoms were significantly more likely to report a history of solitary confinement while incarcerated. This finding is consistent with other research suggesting that individuals with psychotic illness are disproportionately subjected to solitary confinement while incarcerated, which has important socio-legal implications.

Psychotic Symptoms Predict Suicidal Behavior Postdischarge in High Risk Psychiatric Inpatients.

Psychotic disorders, as well as psychotic symptoms, are associated with a greater lifetime risk of suicidal behavior (SB). It is not known, however, whether psychotic symptoms are independent predictors for short-term SB. Data were collected from 201 psychiatric inpatients at Mount Sinai Beth Israel Hospital. Self-reported psychotic symptoms were assessed using the Brief Symptom Inventory (BSI). Postdischarge SB defined as an aborted, interrupted, or actual suicide attempt was assessed using the Columbia-Suicide Severity Rating Scale (C-SSRS), during the 4 to 8 weeks following discharge from an inpatient psychiatric unit (n=127, 63% retention). Logistic regressions were performed to assess the relationships between psychotic symptoms and SB, controlling for primary psychiatric disorders. Self-reported psychotic symptoms were associated with subsequent postdischarge SB. There was no significant difference between the SB versus no SB groups on the basis of primary psychiatric disorder. Self-reported psychotic symptoms remained an independent and significant predictor of postdischarge SB when the analysis controlled for primary psychiatric disorder. These results suggest that psychotic symptoms are a dimensional predictor of near-term postdischarge SB and are a necessary component of suicide risk assessment during inpatient hospitalization, independent of psychiatric diagnosis.

Investigating ethnic variations in reporting of psychotic symptoms: a multiple-group confirmatory factor analysis of the Psychosis Screening Questionnaire.

Epidemiological evidence suggests risk for psychosis varies with ethnicity in Western countries. However, there is little evidence to date on the cross-cultural validity of screening instruments used for such comparisons. Combining two existing UK population-based cohorts, we examined risk for reporting psychotic symptoms across White British (n = 3467), White Irish (n = 851), Caribbean (n = 1899), Indian (n = 2590), Pakistani (n = 1956) and Bangladeshi groups (n = 1248). We assessed the psychometric properties of the Psychosis Screening Questionnaire (PSQ) with a multiple-group confirmatory factor analysis, assessing the equivalence of factor loadings, response thresholds and residual variances in an analysis of measurement non-invariance. Compared with prevalence among British Whites (5.4%), the prevalence of self-reported psychotic symptoms was greater in the Caribbean group (12.7%, adjusted OR = 2.38 [95% CI 1.84-3.07]). Prevalence was also increased among Pakistani individuals (8.3%, adjusted OR = 1.36 [1.01-1.84]) although this difference was driven by a greater likelihood of reporting paranoid symptoms. PSQ items for thought interference, strange experience and hallucination were measured in equivalent ways across ethnic groups. However, our measurement models suggested that paranoid symptoms were measured less reliably among ethnic minorities than among British Whites and appeared to exaggerate latent differences between Pakistani and White British groups when measurement non-invariance was not accounted for. Notwithstanding evidence for measurement non-invariance, the greater risk for reporting psychotic symptoms among Caribbean individuals is unlikely to be an artefact of measurement. Greater residual variance in the recording of paranoid symptoms among ethnic minority respondents warrants caution in using this item to investigate ethnic variation in psychosis risk.

Functional Neuroimaging Predictors of Self-Reported Psychotic Symptoms in Adolescents.

This study investigated the neural correlates of psychotic-like experiences in youths during tasks involving inhibitory control, reward anticipation, and emotion processing. A secondary aim was to test whether these neurofunctional correlates of risk were predictive of psychotic symptoms 2 years later. Functional imaging responses to three paradigms-the stop-signal, monetary incentive delay, and faces tasks-were collected in youths at age 14, as part of the IMAGEN study. At baseline, youths from London and Dublin sites were assessed on psychotic-like experiences, and those reporting significant experiences were compared with matched control subjects. Significant brain activity differences between the groups were used to predict, with cross-validation, the presence of psychotic symptoms in the context of mood fluctuation at age 16, assessed in the full sample. These prediction analyses were conducted with the London-Dublin subsample (N=246) and the full sample (N=1,196). Relative to control subjects, youths reporting psychotic-like experiences showed increased hippocampus/amygdala activity during processing of neutral faces and reduced dorsolateral prefrontal activity during failed inhibition. The most prominent regional difference for classifying 16-year-olds with mood fluctuation and psychotic symptoms relative to the control groups (those with mood fluctuations but no psychotic symptoms and those with no mood symptoms) was hyperactivation of the hippocampus/amygdala, when controlling for baseline psychotic-like experiences and cannabis use. The results stress the importance of the limbic network's increased response to neutral facial stimuli as a marker of the extended psychosis phenotype. These findings might help to guide early intervention strategies for at-risk youths.

The effects of childhood abuse on self-reported psychotic symptoms in severe mental illness: Mediating effects of posttraumatic stress symptoms

The present study examined the role of posttraumatic stress symptoms in the relationship between childhood abuse and self-reported psychotic symptoms in severe mental illness. A total of 126 patients diagnosed with major psychiatric conditions with comorbid symptoms of psychosis participated in the present study. The representative psychiatric diagnoses included schizophrenia, bipolar disorder with psychotic features, major depressive disorder with psychotic features, schizoaffective disorder, schizophreniform disorder, and delusional disorder. The Korean Child Trauma Questionnaire measured the type and degree of childhood abuse including emotional, physical, and sexual abuse. Korean version of the Impact of Event Scale-Revised assessed posttraumatic stress symptoms, and PSYC subscale of the PSY-5 Factor Scale of the MMPI-2 was used as a measure of self-reported psychotic symptoms. There was a significant relationship between childhood physical, emotional, sexual abuse and psychotic symptoms. Posttraumatic stress symptoms partially mediated the relationship between childhood abuse and psychotic symptoms. This implies that childhood abuse is significantly associated with the experience of chronic posttraumatic stress symptoms, and that such symptoms in turn increases the likelihood of experiencing psychotic symptoms. The results highlight the need for appropriate assessment and intervention concerning childhood abuse and posttraumatic stress symptoms in severe mental illness.

Psychopathology in Substance Use Disorder Patients with and without Substance-Induced Psychosis.

Background. Substance-induced psychotic disorder (SIPD) is a diagnosis constructed to distinguish substance-induced psychotic states from primary psychotic disorders. A number of studies have compared SIPD persons with primary psychotic patients, but there is little data on what differentiates substance use disorder (SUD) individuals with and without SIPD. Here, we compared psychopathology, sociodemographic variables, and substance use characteristics between SUD patients with and without SIPD. Methods. A retrospective chart review was conducted on newly admitted patients at a rehabilitation centre between 2007 and 2012. Results. Of the 379 patients included in the study, 5% were diagnosed with SIPD (n = 19) and 95% were diagnosed with SUDs without SIPD (n = 360). More SIPD patients reported using cannabis and psychostimulants, and fewer SIPD patients reported using alcohol than SUDs patients without SIPD. SIPD patients scored higher on the “schizophrenia nuclear symptoms” dimension of the SCL-90R psychoticism scale and exhibited more ClusterB personality traits than SUD patients without SIPD. Discussion. These data are consistent with previous studies suggesting that psychopathology, substance type, and sociodemographic variables play important role in the development of SIPD. More importantly, the results highlight the need for paying greater attention to the types of self-reported psychotic symptoms during the assessment of psychotomimetic effects associated with psychoactive substances.

The relation between childhood maltreatment and psychosis in patients with schizophrenia and non-psychiatric controls

Several lines of evidence suggest that childhood maltreatment is associated with an increased risk for both psychotic disorders and subclinical psychotic-like experiences in the general population. Few studies, however, have sought to examine whether the strength of this relationship is comparable across patient and non-patient groups. The present study sought to compare the strength of the association between childhood maltreatment and self-reported psychotic symptoms in 447 healthy adult volunteers and 184 stable outpatients with schizophrenia or schizoaffective disorder. Strong positive correlations between childhood maltreatment and self-reported symptoms were observed in both groups. Although patients scored significantly higher than controls on both history of childhood maltreatment and self-reported symptoms, the strength of the relationship did not differ between groups. These data provide strong support for etiological continuity between subclinical psychotic symptoms and psychotic disorders.

Time-lagged moment-to-moment interplay between negative affect and paranoia: new insights in the affective pathway to psychosis.

Evidence suggests that affect plays a role in the development of psychosis but the underlying mechanism requires further investigation. This study examines the moment-to-moment dynamics between negative affect (NA) and paranoia prospectively in daily life. A female general population sample (n = 515) participated in an experience sampling study. Time-lagged analyses between increases in momentary NA and subsequent momentary paranoia were examined. The impact of childhood adversity, stress sensitivity (impact of momentary stress on momentary NA), and depressive symptoms on these time-lagged associations, as well as associations with follow-up self-reported psychotic symptoms (Community Assessment of Psychic Experiences and the Symptom Checklist-90-Revised) were investigated. Moments of NA increase resulted in a significant increase in paranoia over 180 subsequent minutes. Both stress sensitivity and depressive symptoms impacted on the transfer of NA to paranoia. Stress sensitivity moderated the level of increase in paranoia during the initial NA increase, while depressive symptoms increased persistence of paranoid feelings from moment to moment. Momentary paranoia responses to NA increases were associated with follow-up psychotic symptoms. Examination of microlevel momentary experience may thus yield new insights into the mechanism underlying co-occurrence of altered mood states and psychosis. Knowledge of the underlying mechanism is required in order to determine source and place where remediation should occur.

Psychosis as a Personal Crisis: An Experience-Based Approach

Back to table of contents Previous article Next article Book ReviewsFull AccessPsychosis as a Personal Crisis: An Experience-Based ApproachJeffrey Stovall, M.D.Jeffrey StovallSearch for more papers by this author, M.D.Published Online:1 May 2012https://doi.org/10.1176/appi.ps.20120p512AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Psychosis as a Personal Crisis: An Experience-Based ApproachRommeMarius and EscherSandra; New York, Routledge, 2012, 240 pages, $34.95The experience of hearing voices has played a significant role in the development of psychiatric nomenclature for two centuries. The interpretation of the experience has varied from the inspirational to the pathological, but the experience is often seen as a marker of severe mental illness. Psychosis as a Personal Crisis is an attempt to challenge the notion of auditory hallucinations as a psychiatric symptom and broaden the understanding of the person who hears voices. This personal experience of hearing voices serves as the core of the arguments discussed here by a group of European authors, primarily British, in a collection aimed at mental health professionals. The authors represent psychiatrists and other clinicians who work with people who hear voices, as well as individuals who themselves have this experience.Many of the authors are connected to the “hearing voices movement” that advocates for the recognition of individual variation between people who hear voices and the nonpathological nature of many of these sensory experiences. The authors stress the importance of self-help and call for individuals to take control of their experience as an essential step in the recovery process. The authors argue that medicalizing the experience of hearing voices stigmatizes the individual, distances the individual from the experience, and sets up an expectation of “curing” the condition that is causing the voices instead of living alongside them. Although the movement does not deny that hearing voices is distressing and debilitating for many individuals, it recognizes the need to understand the personal experiences and vulnerabilities that have led to the development of hearing voices.Overall the text serves as a thorough exposure to an argument not well represented in traditional psychiatric literature. In particular the authors highlight the importance of considering the psychological meaning of hearing voices. The importance of this meaning is often lost in the diagnostic and treatment approaches most commonly used today. The content of the voice (what is being said), rather than its mere existence, takes on a primary importance.The second point the authors make clearly and to which they devote a good portion of the book is the connection between hearing voices and a history of trauma. In clinical work there is a growing distinction between auditory experiences that grow out of trauma, which might fit within the phenomena of posttraumatic stress disorder, and other auditory experiences that are understood as part of a psychotic disorder of either an affective psychosis or schizophrenia.Unfortunately the value of the text suffers from the lack of recognition throughout psychiatric literature of the nonburdensome or nonpathological nature of auditory hallucinations, even from early distinctions between hallucinations of reason and hallucinations of madness through current studies that reveal surprisingly high rates of psychosislike experiences in the general population (1–3). The arguments are weakened by an overreliance on outdated epidemiologic and outcome data and by an alarmist tone that includes statements that refer to “brutal practices … such as electroshock” and to “the damage that psychiatry causes.”Overall, Psychosis as a Personal Crisis invites consideration of an individual's experience of hearing voices in a broader manner than the training of mental health clinicians provides. In particular, the authors effectively make the case for consideration of the individual who is hearing voices and for exploring their meaning.Dr. Stovall is associate professor of psychiatry at Vanderbilt School of Medicine, Nashville, Tennessee.The reviewer reports no competing interests.References1 Daalman K , Zandvoort M , Bootsman F , et al.: Auditory verbal hallucinations and cognitive functioning in healthy individuals. Schizophrenia Research 132:203–207, 2011 Crossref, Medline, Google Scholar2 Johns LC , Cannon M , Singleton N , et al.: Prevalence and correlates of self-reported psychotic symptoms in the British population. British Journal of Psychiatry 185:298–305, 2004 Crossref, Medline, Google Scholar3 Straus JS : Hallucinations and delusions as points on continua function: rating scale evidence. Archives of General Psychiatry 21:581–586, 1969 Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByNone Volume 63Issue 5 May 2012Pages 512-512 Metrics PDF download History Published online 1 May 2012 Published in print 1 May 2012

Boundaries of the Psychosis Phenotype

Since Emil Kraepelin classified psychosis into 3 major categories (organic, affective, and schizophrenic) in the late 19th century, the unitary concept of psychosis was abandoned. This categorical conceptualization of psychosis was more or less accepted by clinicians through the 20th century with some refinements. During my residency training, teachers would highlight qualitative differences in reality distortions across disorders; for instance, unusual visual perceptual distortions associated with substance abuse or the affective tone of delusional thinking in psychosis associated with bipolar illness. Such observations were used to support the categorical view of psychosis and stress phenomenological and biological differences in psychosis across various major psychotic disorders. In the past several years, extensive epidemiological and clinical research has yielded information that challenges the categorical models of psychosis. Epidemiological studies of self-reported psychotic symptoms of hallucinations and delusions show that about a quarter of the general population endorse such symptoms. Multivariate taxometric analyses of these epidemiological survey data suggest a dimensional rather than taxonomic structure for these psychotic experiences.1 Within this dimensional model of psychosis, symptoms vary in severity with most persistent and severe psychosis needing treatment (see Jim van Os and Richard Linscott in the current issue2). There is no discontinuity of psychosis across major psychotic disorders such as schizophrenia and bipolar disorders, although the frequency of symptoms and severity may vary. Less severe symptoms may indicate vulnerability to develop schizophrenia or bipolar disorder or even the prodromal phase particularly in individuals with a family history of these disorders. The dimensional model further posits that the underlying biological underpinnings are uniform. This thesis is supported by neurocognitive and neurophysiological findings in individuals with schizotypal personality disorders, with magical thinking, perceptual distortions, and rare hallucinations indicating the lower end of the psychosis dimension. Furthermore, the dimensional model would suggest that psychotic symptoms occurring in different psychiatric disorders such schizophrenia and bipolar disorder share the same neurobiology and etiological factors. The hypothesis of an extensive overlap in the phenomenology and etiopathophysiology of psychosis occurring across different disorders is a fundamental challenge to the Kraepelinian conceptualization of major psychotic disorders. Several lines of evidence support this hypothesis: phenomenological similarities in psychosis across disorders are frequently observed in clinical practice. Slight qualitative differences in reality distortions can easily be due to the modulating effects of the other features of the disorder. For instance, depressed or elated mood may modulate the expression of psychotic symptoms in affective illness. Studies have extensively compared brain function and structure in order to define the underlying neurobiology of psychosis in different conditions. Findings suggest a large overlap in cognitive impairments in schizophrenia and psychotic affective disorders.3 Similarly, sensory gating, sensory-motor gating, eye tracking, and other information processing impairments known to mark schizophrenia liability are frequently observed in other psychotic disorders.4 Brain imaging studies show some overlap but there are significant differences brain structure between schizophrenia and bipolar disorder.5 Most of these findings come from studies in patient cohorts that support the notion of shared neurobiology, but very few studies compare neurobiology among nonill relatives of psychotic disorders. Similar neurobiological findings in relatives of probands with different psychotic disorders would implicate shared etiological, likely genetic, factors. The Bipolar and Schizophrenia Network on Intermediate Phenotypes (B-SNIP) was organized specifically to address this issue. The consortium has recruited about a thousand families of schizophrenia and bipolar disorder with psychosis probands and administered a comprehensive battery that includes cognitive, neurophysiological, and brain imaging measures. Findings from this project will clarify the extent of overlap in the etiopathophysiology of psychosis in schizophrenia and bipolar disorders. Previous genetic studies have identified several linkage “hot-spots” (such as 18p11, 22q11, 13q32, 10p14, and 1q32) and candidate genes (such as DISC1, NRG1, Dysbindin, NOS1, GRM4, and G30/G72) that are implicated both in schizophrenia and bipolar disorder.6 Together, these data suggest psychotic symptoms that occur in different conditions are in most part similar in phenomenology, neurobiology, and etiology. However, studies have also found significant differences in brain function and structure between schizophrenia and bipolar disorder cohorts. These findings may be driven by unique aspects of each of these disorders. For instance, neurobiology associated with the affective component of the bipolar disorder, or the primary negative symptoms in schizophrenia, may explain the differences found in neurobiology between the 2 disorders. Studies similar to the B-SNIP project that also include families of probands with nonpsychotic bipolar and schizoid disorders are needed to clarify to what extent the neurobiology of psychosis is uniform across disorders.

Children's Psychosis Symptoms Should Set Off Alarms

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessChildren's Psychosis Symptoms Should Set Off AlarmsMark MoranMark MoranSearch for more papers by this authorPublished Online:18 Jun 2010https://doi.org/10.1176/pn.45.12.psychnews_45_12_031AbstractChildren with symptoms of psychosis as early as age 12 are likely to have a constellation of other risk factors common to individuals who later develop schizophrenia.That was the finding of a birth cohort study of 2,232 12-year-olds in Great Britain followed since age 5. The report appeared in the April Archives of General Psychiatry.The study found that children's psychotic symptoms are familial and heritable and occur in the context of a range of other social, familial, and behavioral risk factors associated with later development of schizophrenia. These include living in a city and disadvantaged social conditions, lower birth weight, greater perinatal complications, social isolation, self-harm, negative maternal expressed emotion, and a chaotic household environment.The study appears to confirm that children's self-report of psychotic symptoms—including delusions and hallucinations—is reliable, and that those symptoms may be part of a disease process consistent with the neurodevelopmental theory of schizophrenia.“I think there is a natural inclination to dismiss such symptoms as part of a child's natural flight of fancy,” said study author Avshalom Caspi, Ph.D. “We don't want to be unduly alarmist, but I think one of the things we have learned from this work is that there is a minority of children for whom these kinds of experiences and beliefs signal what is perhaps the early part of a disease process consistent with schizophrenia.”Participants in the study were members of the Environmental Risk Longitudinal Twin Study, which tracks the development of a nationally representative birth cohort of 2,232 British children. The sample was drawn from a larger birth registry of twins born in England and Wales in 1994 and 1995.At age 12, children were assessed for psychosis symptoms. When a child endorsed any symptoms, the interviewer prompted the child to describe his or her experience further to discriminate between experiences that were plausibly real (such as, “I was followed by a man after school”) and those that were probably psychotic (“I was followed by an angel who guards my spirit”). Interviewers then coded the descriptions as “not a symptom,” “probably symptom” and “definite symptom,” and the codes were then reviewed and confirmed by a psychiatrist with expertise in schizophrenia, a child and adolescent psychiatrist, and a psychologist with expertise in interviewing children.Psychosis symptoms were reported by 416 children—291 had “probable” symptoms and 125 had at least one “definite symptom.” Those children were significantly more likely than children not reporting symptoms to have a mother with a psychosis spectrum disorder, to have a family member ever admitted to a psychiatric unit, and to have a family member who had attempted suicide, according to the report.The following social and behavioral risk factors, common to individuals who later develop schizophrenia, were also found to be statistically significantly more common among the children who had psychosis symptoms at age 12: urban living and socioeconomic disadvantage; low birth weight and low IQ; high maternal expressed emotion score; household chaos and physical maltreatment; antisocial behavior, symptoms of ADHD, social isolation, and internalizing problems at age 5; and antisocial behavior, depressive and anxiety symptoms, tobacco use, and self-harm at age 12.Caspi told Psychiatric News that the findings build on a November 2000 study reported in the Archives of General Psychiatry in which he and colleagues found that self-reported psychosis symptoms at age 11 predicted a very high risk of schizophreniform disorder at age 26.For clinicians, that report, combined with the new findings, strongly indicate that psychosis symptoms in childhood are likely to be a marker for an impaired developmental process and should be actively assessed. They generally occur in the context of other psychiatric problems that should be a focus of attention, he said.For researchers, Caspi said that they may want to recruit children reporting psychotic symptoms into neuroimaging and other studies examining the pathophysiology of schizophrenia.Nitin Gogtay, M.D., a staff psychiatrist with the Child Psychiatry Branch at the National Institute of Mental Health, reviewed the study and said that the presence of psychosis symptoms in children even younger than 12 is well known.“However, this study is one of the first to systematically document [the presence of childhood psychotic symptoms] in a large sample and also the first to establish the heritability of such symptoms,” he told Psychiatric News. “The study also strongly validates the need to study psychosis as a ‘dimensional’ phenomenon rather than only as part of a disease or syndrome.”“Etiologic and Clinical Features of Childhood Psychotic Symptoms: Results From a Birth Cohort Study” is posted at <http://archpsyc.ama-assn.org/cgi/content/full/67/4/328>. “Children's Self-Reported Psychotic Symptoms and Adult Schizophreniform Disorder: A 15-Year Longitudinal Study” is posted at <http://archpsyc.ama-assn.org/cgi/content/full/57/11/1053>. ISSUES NewArchived

Etiological and Clinical Features of Childhood Psychotic Symptoms

It has been reported that childhood psychotic symptoms are common in the general population and may signal neurodevelopmental processes that lead to schizophrenia. However, it is not clear whether these symptoms are associated with the same extensive risk factors established for adult schizophrenia. To examine the construct validity of children's self-reported psychotic symptoms by testing whether these symptoms share the risk factors and clinical features of adult schizophrenia. Prospective, longitudinal cohort study of a nationally representative birth cohort in Great Britain. A total of 2232 twelve-year-old children followed up since age 5 years (retention, 96%). Main Outcome Measure Children's self-reported hallucinations and delusions. Children's psychotic symptoms are familial and heritable and are associated with social risk factors (eg, urbanicity); cognitive impairments at age 5; home-rearing risk factors (eg, maternal expressed emotion); behavioral, emotional, and educational problems at age 5; and comorbid conditions, including self-harm. The results provide a comprehensive picture of the construct validity of children's self-reported psychotic symptoms. For researchers, the findings indicate that children who have psychotic symptoms can be recruited for neuroscience research to determine the pathogenesis of schizophrenia. For clinicians, the findings indicate that psychotic symptoms in childhood are often a marker of an impaired developmental process and should be actively assessed.

The impact of psychoticism on perceived hassles, depression, hostility, and hopelessness in non-psychiatric African Americans

Psychotic symptoms are distributed along a continuum that extends from normality to diagnosable psychotic disorders and the presence of psychoticism among individuals in the general population may lead to morbidity and social impairment. This study examined a model in which psychoticism leads to several important psychological consequences. The analysis included 134 African Americans with no psychiatric history who were being seen in medical walk-in clinics for non-emergency medical problems. Psychoticism, perceived hassles, depression, hostility, and hopelessness were measured. The Linear Structural Relations Program (LISREL) was used to test the fit of the data to the proposed model, a trimmed hierarchical version, and two alternative models. The data supported a model in which psychoticism has substantial effects on several important characteristics: perceived daily hassles, depression, and hostility. Depression mediated the association between psychoticism and hopelessness. Goodness-of-fit indices for a final trimmed model that eliminated one path from the initial postulated model revealed good fit to the data, and the two alternative models were found not to fit the data. Like psychosis itself, psychoticism appears to cause meaningful dysfunction even among non-psychiatric individuals from the general population. Additional research is needed to further characterize the detrimental effects of psychoticism or self-reported psychotic symptoms in the general, non-psychiatric population.