Psychotic-like experiences in a community sample of 8000 children aged 9 to 11 years: An item response theory analysis

Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, Australia.
Psychological Medicine (Impact Factor: 5.43). 10/2011; 42(7):1495-506. DOI: 10.1017/S0033291711002108
Source: PubMed

ABSTRACT Psychotic-like experiences (PLEs) in the general population are common, particularly in childhood, and may constitute part of a spectrum of normative development. Nevertheless, these experiences confer increased risk for later psychotic disorder, and are associated with poorer health and quality of life.
This study used factor analytic methods to determine the latent structure underlying PLEs, problem behaviours and personal competencies in the general child population, and used item response theory (IRT) to assess the psychometric properties of nine PLE items to determine which items best represented a latent psychotic-like construct (PSY). A total of 7966 children aged 9-11 years, constituting 95% of eligible children, completed self-report questionnaires.
Almost two-thirds of the children endorsed at least one PLE item. Structural analyses identified a unidimensional construct representing psychotic-like severity in the population, the full range of which was well sampled by the nine items. This construct was discriminable from (though correlated with) latent dimensions representing internalizing and externalizing problems. Items assessing visual and auditory hallucination-like experiences provided the most information about PSY; delusion-like experiences identified children at more severe levels of the construct.
Assessing PLEs during middle childhood is feasible and supplements information concerning internalizing and externalizing problems presented by children. The hallucination-like experiences constitute appropriate items to screen the population to identify children who may require further clinical assessment or monitoring. Longitudinal follow-up of the children is required to determine sensitivity and specificity of the PLE items for later psychotic illness.

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Available from: Matthew Sunderland, Jul 29, 2015
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    • "According to the multidimensional perspective, PLEs are heterogeneous and differentially associated with mental health problems (Armando et al., 2010; Barragan et al., 2011). However, it has also been posited that these experiences could be represented by a unidimensional construct, as Laurens et al. (2012) observed in a large sample of children aged 9– 11 years, which parallels recent findings showing the existence of a general psychosis dimension in both early psychosis and enduring psychosis (Reininghaus et al., 2013). Various self-report screening questionnaires have been developed to measure PLEs in the general population (Kline et al., 2012). "
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    ABSTRACT: Psychotic-like experiences (PLEs) are prevalent in the general population and are associated with poor mental health and a higher risk of psychiatric disorders. The Community Assessment of Psychic Experiences—Positive (CAPE-P15) scale is a self-screening questionnaire to address subclinical positive psychotic symptoms (PPEs) in community contexts. Although its psychometric properties seem to be adequate to screen PLEs, further research is needed to evaluate certain validity aspects, particularly its internal structure and its functioning in different populations.
    Schizophrenia Research 04/2015; 165(2-3). DOI:10.1016/j.schres.2015.04.018 · 4.43 Impact Factor
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    • "Psychotic experiences are far more common in the population than psychotic disorder (Lin et al., 2011; Saha et al., 2011a; Laurens et al., 2012; Devylder et al., 2013; Cullen et al., 2014). Amongst young people, these experiences most commonly occur in the form of auditory hallucinations , which may be frankly psychotic in nature or, more commonly, attenuated (that is, hallucinatory experiences with intact reality testing) (Kelleher et al., 2011). "
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    ABSTRACT: Psychotic experiences are far more common in the population than psychotic disorder. They are associated with a number of adverse outcomes but there has been little research on associations with functioning and distress. We wished to investigate functioning and distress in a community sample of adolescents with psychotic experiences. Two hundred and twelve school-going adolescents were assessed for psychotic experiences, mental distress associated with these experiences, global (social/occupational) functioning on the Children's Global Assessment Scale, and a number of candidate mediator variables, including psychopathology, suicidality, trauma (physical and sexual abuse and exposure to domestic violence) and neurocognitive functioning. Seventy five percent of participants who reported psychotic experiences reported that they found these experiences distressing (mean score for severity of distress was 6.9 out of maximum 10). Participants who reported psychotic experiences had poorer functioning than participants who did not report psychotic experiences (respective means: 68.6, 81.9; OR=0.25, 95% CI=0.14-0.44). Similarly, participants with an Axis-1 psychiatric disorder who reported psychotic experiences had poorer functioning than participants with a disorder who did not report psychotic experiences (respective means: 61.8, 74.5; OR=0.28, 95% CI=0.12-0.63). Candidate mediator variables explained some but not all of the relationship between psychotic experiences and functioning (OR=0.48, 95% CI=0.22-1.05, P<0.07). Young people with psychotic experiences have poorer global functioning than those who do not, even when compared with other young people with psychopathology (but who do not report psychotic experiences). A disclosure of psychotic experiences should alert treating clinicians that the individual may have significantly more functional disability than suggested by the psychopathological diagnosis alone. Copyright © 2015 Elsevier B.V. All rights reserved.
    Schizophrenia Research 04/2015; 165(1). DOI:10.1016/j.schres.2015.03.020 · 4.43 Impact Factor
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    • "For instance, recent studies of children in Ireland and Greater London found that children's questionnaire endorsement of hallucinations (e.g., " yes, definitely " to the question " Have you ever heard voices or sounds that no one else can hear? " ) was associated most closely with a latent psychosis construct, and had the highest predictive power for psychotic-like symptoms on interview (Kelleher et al., 2011a; Laurens et al., 2012). Yet, the retrospective report of symptoms by FES participants in the current study suggests that their childhood experience of attenuated psychotic symptoms was not dominated by hallucinatory experiences; delusional and persecutory ideas were just as common. "
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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 · 4.43 Impact Factor
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