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Psychotic Experiences and Psychotic Disorders at Age 18 in Relation to Psychotic Experiences at Age 12 in a Longitudinal Population-Based Cohort Study
Stanley Zammit, Ph.D.; Daphne Kounali, Ph.D.; Mary Cannon, Ph.D.; Anthony S. David, M.D.; David Gunnell, Ph.D.; Jon Heron, Ph.D.; Peter B. Jones, Ph.D.; Shôn Lewis, Ph.D.; Sarah Sullivan, M.Sc.; Dieter Wolke, Ph.D.; Glyn Lewis, Ph.D.
Am J Psychiatry 2013;170:742-750. doi:10.1176/appi.ajp.2013.12060768
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The authors report no financial relationships with commercial interests.

Funded by MRC grant G0701503. Dr. Zammit received support from a Clinician Scientist Award funded by the National Assembly for Wales. Professor David receives salary support from the National Institute for Health Research Biomedical Research Center for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College, London. Dr. G. Lewis and Dr. Gunnell are senior investigators for the National Institute for Health Research.

From the MRC Center for Neuropsychiatric Genetics and Genomics, Cardiff University, U.K.; the School of Social and Community Medicine, University of Bristol, U.K.; the Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin; the Institute of Psychiatry, King’s College, London; the Department of Psychiatry, University of Cambridge, U.K.; the Department of Psychiatry, University of Manchester, U.K.; and the Department of Psychology, University of Warwick, U.K.

Address correspondence to Dr. Zammit (zammits@cardiff.ac.uk).

Copyright © 2013 by the American Psychiatric Association

Received June 12, 2012; Revised August 31, 2012; Revised November 11, 2012; Revised December 29, 2012; Accepted January 07, 2013.

Abstract

Objective  The authors examined the development of psychotic experiences and psychotic disorders in a large population-based sample of young adults and explored their relationship to psychotic phenomena earlier in childhood.

Method  The authors conducted a longitudinal birth cohort study of individuals assessed with the semistructured Psychosis-Like Symptom Interviews at ages 12 and 18 years.

Results  Of the 4,724 individuals interviewed at age 18, 433 (9.2%) had either suspected (N=203 [4.3%]) or definite (N=230 [4.9%]) psychotic experiences. Of these, 79 (1.7%) met criteria for a psychotic disorder, and of those, only 50% sought professional help. All psychotic outcomes were more likely in young women and in those from socioeconomically disadvantaged backgrounds. Of the participants who had psychotic experiences at age 12, 78.7% had remitted by age 18. The risk of psychotic disorders at age 18 was greater in those with suspected (odds ratio=5.6, 95% CI=2.6–12.1) and especially in those with definite (odds ratio=12.7, 95% CI=6.2–26.1) psychotic experiences at age 12, and also among those with psychotic experiences at age 12 attributed to sleep or fever or with nonpsychotic experiences such as depersonalization. The positive predictive values for increasing frequency of experiences at age 12 predicting psychotic disorders at age 18 ranged from 5.5% to 22.8%.

Conclusions  Despite evidence for a continuum of psychotic experiences from as early as age 12, positive predictive values for predicting psychotic disorders were too low to offer real potential for targeted interventions. Psychotic disorders in young adults are relatively uncommon, but they constitute an important unmet need for care given that half of the individuals in this study who met criteria for a psychiatric disorder had not sought help for these problems despite high levels of associated distress and impairment.

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FIGURE 1. Psychotic Outcomes at Age 18 in Relation to Psychotic Experiences as Age 12

FIGURE 2. Psychotic Experiences at Age 12 Predicting Psychotic Outcomes at Age 18

a Individuals interviewed at age 12 who were also interviewed at age 18.

b Definite psychotic experiences excluding those meeting criteria for a psychotic disorder or at-risk mental state.

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TABLE 1.Individuals Rated as Having Psychotic Experiences and Odds Ratios for Suspected or Definite Psychotic Experiences in Relation to Sociodemographic Characteristics at Birth
Table Footer Note

a Suspected or definite psychotic experiences.

Table Footer Note

b Highest of either parent, with class I=highest and class V=lowest.

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TABLE 2.Psychotic Experiences, Psychotic-Like Experiences, or Unusual Experiences at Age 12 With Subsequent Psychotic Experiences and Psychotic Disorders at Age 18
Table Footer Note

a Hierarchical coding, with “more psychotic” category taking priority.

Table Footer Note

b Includes suspected (N=49) or definite (N=26) psychotic experiences.

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TABLE 3.Sensitivity, Specificity, and Positive Predictive Value of Experiences at Age 12 in Relation to Psychotic Disorders at Age 18
Table Footer Note

a “Yes” response to any stem question.

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Approximately what proportion of 18-year-olds in the general population report a definite psychotic experience occurring since age 12 on semi-structured interview?
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In this study, the prevalence of psychotic experiences is at the lower end of the inter-quartile range of estimates reported in a recent meta-analysis. The most likely reason for this is:
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