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Cited by 893Schizophrenia research and treatmentMental Health and PsychiatryMental Health Treatment and Access

Strauss (1969) revisited: a psychosis continuum in the general population?

van Os, Jim, Hanssen, Manon, Bijl, Rob V., Ravelli, Anneloes·2000·Schizophrenia Research
DOI 10.1016/s0920-9964(99)00224-8
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Abstract

Although dichotomously defined for clinical purposes, psychosis may exist as a continuous phenotype in nature. A random sample of 7076 men and women aged 18-64years were interviewed by trained lay interviewers with the Composite International Diagnostic Interview (CIDI). Those with evidence of psychosis according to the CIDI were additionally interviewed by psychiatrists. For the 17 CIDI core psychosis items, we compared a psychiatrist's rating of hallucinations and/or delusions (Clinical Psychosis; sample prevalence 4.2%) with three other possible positive CIDI ratings of the same items: (i) symptom present, but not clinically relevant (NCR Symptom; sample prevalence 12.9%); (ii) symptom present, but the result of drugs or somatic disorder (Secondary Symptom; sample prevalence 0.6%); (iii) symptom appears present, but there is a plausible explanation (Plausible Symptom; sample prevalence 4.0%). Of the 1237 individuals with any type of positive psychosis rating (sample prevalence 17.5%), only 26 (2.1%) had a DSM-III-R diagnosis of non-affective psychosis. All the different types of psychosis ratings were strongly associated with the presence of psychiatrist-rated Clinical Psychosis (NCR Symptom: OR=3.4; 95% CI: 2.9-3.9; Secondary Symptom: OR=4.5; 95% CI: 2.7-7.7; Plausible Symptom: OR=5.8; 95% CI: 4.7-7.1). Associations with lower age, single marital status, urban dwelling, lower level of education, lower quality of life, depressive symptoms and blunting of affect did not differ qualitatively as a function of type of rating of the psychotic symptom, were similar in individuals with and without any CIDI lifetime diagnosis, and closely resembled those previously reported for schizophrenia. Presence of any rating of hallucinations was strongly associated with any rating of delusions (OR=6.7; 95% CI: 5.6-8.1), regardless of presence of any CIDI lifetime diagnosis. The observation by Strauss (1969. Hallucinations and delusions as points on continua function. Arch. Gen. Psychiatry 21, 581-586) that dichotomously diagnosed psychotic symptoms in clinical samples are, in fact, part of a continuum of experiences, may also apply to the general population. The boundaries of the psychosis phenotype may extend beyond the clinical concept of schizophrenia.

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Authors
van Os, J., Hanssen, M., Bijl, R. V., & Ravelli, A.
Affiliations
  • Maastricht University (NL)
  • Trimbos Institute (NL)
Venue
Schizophrenia Research
Publisher
Elsevier BV
Published
2000-09
Volume
45
Issue
1-2
Pages
11-20
ISSN
0920-9964 (ISSN-L)
DOI
10.1016/s0920-9964(99)00224-8
OpenAlex
W1981674452
Cited by
893
References
50
Citations by year
2026: 22 · 2025: 8 · 2024: 21 · 2023: 27 · 2022: 24 · 2021: 28 · 2020: 23 · 2019: 30 · 2018: 38 · 2017: 51 · 2016: 32 · 2015: 33 · 2014: 41 · 2013: 56 · 2012: 55
FWCI
14.19
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Schizophrenia Research (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
continuum
MeSH terms
Adolescent, Adult, Delusions, Female, Humans, Male, Mass Screening, Middle Aged, Netherlands, Population Surveillance, Psychiatric Status Rating Scales, Psychotic Disorders, Risk Factors, Schizophrenia

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