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A Population-Based Cohort Study Examining the Incidence and Impact of Psychotic Experiences From Childhood to Adulthood, and Prediction of Psychotic Disorder

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Sullivan, Sarah A., Kounali, Daphne, Cannon, Mary, David, Anthony S., Fletcher, Paul C., Holmans, Peter, Jones, Hannah, Jones, Peter B. +9 more·2020·American Journal of Psychiatry
DOI 10.1176/appi.ajp.2019.19060654
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Abstract

OBJECTIVE: The authors investigated the incidence, course, and outcome of psychotic experiences from childhood through early adulthood in the general population and examined prediction of psychotic disorder. METHODS: This was a population-based cohort study using the semistructured Psychosis-Like Symptoms Interview at ages 12, 18, and 24 (N=7,900 with any data). Incidence rates were estimated using flexible parametric modeling, and positive predictive values (PPVs), sensitivity, specificity, and area under the curve were estimated for prediction. RESULTS: The incidence rate of psychotic experiences increased between ages 13 and 24, peaking during late adolescence. Of 3,866 participants interviewed at age 24, 313 (8.1%, 95% CI=7.2, 9.0) had a definite psychotic experience since age 12. A total of 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 at ages 18-24 was 21.1% (95% CI=6.1, 45.6) (sensitivity, 14.3%, 95% CI=4.0, 32.7). CONCLUSIONS: The study results show a peak in incidence of psychotic experiences during late adolescence as well as 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 cutoff thresholds will likely have little impact on population levels of first-episode psychosis.

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Authors
Sullivan, S. A., Kounali, D., Cannon, M., David, A. S., Fletcher, P. C., Holmans, P., Jones, H., Jones, P. B., Linden, D. E. J., Lewis, G., Owen, M. J., O’Donovan, M., Rammos, A., Thompson, A., Wolke, D., Heron, J., & Zammit, S.
Affiliations
  • Royal College of Surgeons in Ireland (IE)
  • Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke’s Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K...
Corresponding author
Sullivan, Sarah A.
ORCID
Venue
American Journal of Psychiatry
Publisher
American Psychiatric Association Publishing
Published
2020-04-01
Volume
177
Issue
4
Pages
308-317
ISSN
  • 0002-953X (ISSN-L)
  • 1535-7228
DOI
10.1176/appi.ajp.2019.19060654
OpenAlex
W2986902715
Cited by
176
References
47
Citations by year
2026: 21 · 2025: 26 · 2024: 41 · 2023: 24 · 2022: 23 · 2021: 29 · 2020: 12
FWCI
15.96
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • American Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
  • Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
  • Explore Bristol Research (acceptedVersion, other-oa)
  • UCL Discovery (University College London) (submittedVersion)
  • ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion)
  • Apollo (University of Cambridge) (submittedVersion)
  • Apollo
Funders
  • Wellcome Trust (095844/Z/11/Z, 206368/Z/17/Z)
  • Medical Research Council (MR/P005748/1, MR/L010305/1, MR/M006727/1)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
psychotic experiences, psychosis, incidence, clinical high risk for psychosis, first-episode psychosis, psychosis prediction, late adolescence, symptom distress, help-seeking, unmet mental health needs, childhood to adulthood
MeSH terms
Adolescent, Child, Delusions, Female, United Kingdom, Hallucinations, Humans, Male, Predictive Value of Tests, Prospective Studies, Psychotic Disorders, Cohort Studies, Incidence, Young Adult

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