Evidence That Onset of Psychosis in the Population Reflects Early Hallucinatory Experiences That Through Environmental Risks and Affective Dysregulation Become Complicated by Delusions

Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands.
Schizophrenia Bulletin (Impact Factor: 8.45). 10/2010; 38(3):531-42. DOI: 10.1093/schbul/sbq117
Source: PubMed


To examine the hypothesis that the "natural" combination of delusions and hallucinations in psychotic disorders in fact represents a selection of early subclinical hallucinatory experiences associated with delusional ideation, resulting in need for care and mental health service use.
In the Early Developmental Stages of Psychopathology study, a prospective, 10-year follow-up of a representative cohort of adolescents and young adults in Munich, Germany (n = 2524), clinical psychologists assessed hallucinations and delusions at 2 time points (T2 and T3). Analyses compared differences in psychopathology, familial liability for nonpsychotic disorder, nongenetic risk factors, persistence, and clinical outcome between groups characterized by: (1) absence of positive psychotic symptoms, (2) presence of isolated hallucinations, (3) isolated delusions, and (4) both hallucinations and delusions.
Delusions and hallucinations occurred together much more often (T2: 3.1%; T3: 2.0%) than predicted by chance (T2: 1.0%; T3: 0.4%; OR = 11.0; 95% CI: 8.1, 15.1). Content of delusions was contingent on presence of hallucinations but modality of hallucinations was not contingent on presence of delusions. The group with both hallucinations and delusions, compared to groups with either delusions or hallucinations in isolation, displayed the strongest associations with familial affective liability and nongenetic risk factors, as well as with persistence of psychotic symptoms, comorbidity with negative symptoms, affective psychopathology, and clinical need.
The early stages of psychosis may involve hallucinatory experiences that, if complicated by delusional ideation under the influence of environmental risks and (liability for) affective dysregulation, give rise to a poor prognosis hallucinatory-delusional syndrome.

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    • "Factors that have been identified as important for the course of AVH during childhood, are (amongst others) the co-occurrence of AVH with delusions (Smeets et al., 2012) and the persistence of voices over time (Bartels-Velthuis et al., 2011). AVH severity is positively associated with delusions (Bartels-Velthuis et al., 2012b), and compared to experiencing hallucinations or delusions in isolation, a combination of these experiences is more persistent and associated with more help seeking (Smeets et al., 2012). Moreover, persistent and incident AVH during childhood in itself are also associated with more problem behaviour and worse school performance (Bartels-Velthuis et al., 2011). "
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    • "This may also be useful in knowing which symptom subtypes are more likely to lead to or indicate prolonged impairment in terms of co-morbidities, psychological distress, or suicide risk. Further, persistent hallucinations may be particularly clinically relevant as they potentially lead to threshold psychotic disorder (Smeets et al., 2012). "
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