A Population-Based Cohort Study Examining the Incidence and Impact of Psychotic Experiences From Childhood to Adulthood, and Prediction of Psychotic Disorder.
Sullivan, Sarah A
Linden, David EJ
Owen, Michael J
The American journal of psychiatry
American Psychiatric Publishing, Inc.
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Sullivan, S. A., Kounali, D., Cannon, M., David, A. S., Fletcher, P., Holmans, P., Jones, H., et al. (2020). A Population-Based Cohort Study Examining the Incidence and Impact of Psychotic Experiences From Childhood to Adulthood, and Prediction of Psychotic Disorder.. The American journal of psychiatry, 177 (4), 308-317. https://doi.org/10.1176/appi.ajp.2019.19060654
Abstract Objective: To investigate the incidence, course and outcome of psychotic experiences from childhood through early adulthood in the general population, and prediction of psychotic disorder. Methods: A population-based cohort study using the semi-structured Psychosis-like Symptoms interview of psychotic experiences at ages 12, 18, and 24 (N=7900 with any data). Incidence rates were estimated using flexible parametric modelling, and positive predictive values (PPV), sensitivity, specificity, and area under the curve estimated for prediction. Results: The incidence rate of psychotic experiences increased between ages 13-24 years, peaking during late adolescence. Of 3866 interviewed at age 24, 313 (8.1%, 95%CI 7.2%, 9.0%) had a definite psychotic experience since age 12. 109 individuals (2.8%) met criteria for a psychotic disorder up to age 24, of whom 70% had sought professional help. Prediction of current psychotic disorder at age 24 (N=47, 1.2%) by both self-report and interviewer-rated measures of psychotic experiences at age 18 (PPVs 2.9% and 10.0% respectively) was improved by incorporating information on frequency and distress (PPVs 13.3% and 20.0% respectively), although sensitivities were low. The PPV of an at-risk mental state at age 18 predicting incident disorder ages 18-24 was 21.1% (95%CI 6.1%-45.6%; sensitivity 14.3%, 95%CI 4.0%-32.7%). Conclusions: Our study shows a peak in incidence of psychotic experience during late adolescence, and an unmet need for care in young people with psychotic disorders. Because of the low sensitivity, targeting individuals in non-help-seeking samples based only on more severe symptom cut-off thresholds will likely have little impact on population-levels of first-episode psychosis.
Humans, Hallucinations, Incidence, Cohort Studies, Prospective Studies, Predictive Value of Tests, Delusions, Psychotic Disorders, Adolescent, Child, Female, Male, Young Adult, United Kingdom
The UK Medical Research Council and Wellcome (Grant ref: 102215/2/13/2) and the University of Bristol provide core support for ALSPAC. This study was funded by the Medical Research Council (MRC) Grant MR/M006727/1. The following authors acknowledge support: S.Z by the NIHR Biomedical Research Centre (BRC) at University Hospitals Bristol NHS Foundation Trust and the University of Bristol; A.S.D and G.H by the NIHR BRC at University College London Hospital; P.B.J. by the NIHR CLAHRC East of England, NIHR PGfAR RP-PG-0616-20003 (TYPPEX) and the Wellcome Trust Neuroscience in Psychiatry Network (095844/Z/11/Z); PCF by the Wellcome Trust (206368/Z/17/Z) and the Bernard Wolfe health Neuroscience Fund; M.C. by a European Research Council Consolidator Award (iHEAR 724809). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care
Wellcome Trust (095844/Z/11/Z)
Wellcome Trust (206368/Z/17/Z)
External DOI: https://doi.org/10.1176/appi.ajp.2019.19060654
This record's URL: https://www.repository.cam.ac.uk/handle/1810/300960
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