Etiological and Clinical Features of Childhood Psychotic Symptoms

Department of Psychology and Neuroscience, Duke University, 2020 W Main St, Ste 201, Campus Box 104410, Durham, NC 27708, USA.
Archives of general psychiatry (Impact Factor: 14.48). 04/2010; 67(4):328-38. DOI: 10.1001/archgenpsychiatry.2010.14
Source: PubMed


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.

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Available from: Guilherme V. Polanczyk, Sep 30, 2015
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    • "The incidence of PEs is reportedly higher among children and adolescents than in adults (Cougnard et al. 2007; Kelleher et al. 2012), and persistence of PEs is a strong indicator of increased risk for later disorder, including psychosis (Kaymaz et al. 2012). Also, the mere presence of PEs has been linked with poor psychosocial outcomes, general psychopathology, self-harm, and cognitive impairment, even in the absence of a transition to psychosis (Nishida et al. 2010; Polanczyk et al. 2010; Barnett et al. 2012; Downs et al. 2013). "
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    ABSTRACT: Psychotic experiences (PEs) occur in the general population, especially in children and adolescents, and are associated with poor psychosocial outcomes, impaired cognition, and increased risk of transition to psychosis. It is unknown how the presence and persistence of PEs during early adulthood affects cognition and brain function. The current study assessed working memory as well as brain function and structure in 149 individuals, with and without PEs, drawn from a population cohort. Observer-rated PEs were classified as persistent or transient on the basis of longitudinal assessments. Working memory was assessed using the n-back task during fMRI. Dynamic causal modeling (DCM) was used to characterize frontoparietal network configuration and voxel-based morphometry was utilized to examine gray matter. Those with persistent, but not transient, PEs performed worse on the n-back task, compared with controls, yet showed no significant differences in regional brain activation or brain structure. DCM analyses revealed greater emphasis on frontal connectivity within a frontoparietal network in those with PEs compared with controls. We propose that these findings portray an altered configuration of working memory function in the brain, potentially indicative of an adaptive response to atypical development associated with the manifestation of PEs. © The Author 2015. Published by Oxford University Press.
    Cerebral Cortex 08/2015; DOI:10.1093/cercor/bhv181 · 8.67 Impact Factor
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    • "Future work should explore the etiological underpinnings of the relationship between cannabis and PEs longitudinally. Cannabis use and PEs were in part heritable, as suggested by previous studies (Polanczyk et al., 2010; Ericson et al., 2011; Verweij et al., 2011; Hur et al., 2012) with the remaining variance for PEs largely attributable to unique environmental factors, and also common environmental factors for parent-rated negative symptoms and cannabis use. Our findings demonstrate that the relationship between cannabis use in adolescence and paranoia, cognitive disorganization and parent-rated negative symptoms is explained by common and unique environmental influences. "
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    ABSTRACT: Cannabis users are more likely to have psychotic experiences (PEs). The degree to which these associations are driven by genetic or environmental influences in adolescence is unknown. This study estimated the genetic and environmental contributions to the relationship between cannabis use and PEs. Specific PEs were measured in a community-based twin sample (4830 16-year-old pairs) using self-reports and parent-reports. Adolescents reported on ever using cannabis. Multivariate liability threshold structural equation model-fitting was conducted. Cannabis use was significantly correlated with PEs. Modest heritability (37%), common environmental influences (55%) and unique environment (8%) were found for cannabis use. For PEs, modest heritability (27-54%), unique environmental influences (E=12-50%) and little common environmental influences (11-20%), with the exception of parent-rated Negative Symptoms (42%), were reported. Environmental influences explained all of the covariation between cannabis use and paranoia, cognitive disorganization and parent-rated negative symptoms (bivariate common environment=69-100%, bivariate unique environment=28-31%), whilst the relationship between cannabis use and hallucinations indicated familial influences. Cannabis use explains 2-5% of variance in positive, cognitive, and negative PEs. Cannabis use and psychotic experience co-occur due to environmental factors. Focus on specific environments may reveal why adolescent cannabis use and psychotic experiences tend to 'travel together'. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
    Psychiatry Research 04/2015; 227(2-3). DOI:10.1016/j.psychres.2015.03.041 · 2.47 Impact Factor
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    • "Of course, additional prospective and retrospective research studies are needed to confirm these findings and their relevance to these efforts. The findings reported here, in conjunction with research suggesting that childhood psychotic symptoms may be both heritable and associated with non-specific problems typical of psychotic illnesses (Polanczyk et al., 2010), support the need to expand psychosis risk assessment to children under the age of 13 (e.g., Kelleher et al., 2011a; Fux et al., 2013). Based on the age distributions of initial positive symptom onset (see Supplemental Fig. 1), screening children ages 10–12 might be particularly fruitful. "
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    ABSTRACT: Background Psychosis prevention and early intervention efforts in schizophrenia have focused increasingly on sub-threshold psychotic symptoms in adolescents and young adults. Although many youth report symptom onset prior to adolescence, the childhood incidence of prodromal-level symptoms in those with schizophrenia or related psychoses is largely unknown. Methods This study reports on the retrospective recall of prodromal-level symptoms from 40 participants in a first-episode of schizophrenia (FES) and 40 participants at “clinical high risk” (CHR) for psychosis. Onset of positive and non-specific symptoms was captured using the Structured Interview for Prodromal Syndromes. Frequencies are reported according to onset during childhood (prior to age 13), adolescence (13–17), or adulthood (18 +). Results Childhood-onset of attenuated psychotic symptoms was not rare. At least 11% of FES and 23% of CHR reported specific recall of childhood-onset of unusual or delusional ideas, suspiciousness, or perceptual abnormalities. Most recalled experiencing non-specific symptoms prior to positive symptoms. CHR and FES did not differ significantly in the timing of positive and non-specific symptom onset. Other than being younger at assessment, those with childhood onset did not differ demographically from those with later onset. Conclusion Childhood-onset of initial psychotic-like symptoms may be more common than previous research has suggested. Improved characterization of these symptoms and a focus on their predictive value for subsequent schizophrenia and other major psychoses are needed to facilitate screening of children presenting with attenuated psychotic symptoms. Accurate detection of prodromal symptoms in children might facilitate even earlier intervention and the potential to alter pre-illness trajectories.
    Schizophrenia Research 09/2014; 158(1-3). DOI:10.1016/j.schres.2014.05.017 · 3.92 Impact Factor
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