In the Journals

Study offers insights into trajectory of psychotic experiences from childhood to adulthood

Sarah A. Sullivan

An unmet need exists for care among young people with psychotic disorders, according to results of a population-based cohort study published in American Journal of Psychiatry. Researchers reported that incidence of psychotic experiences peaked during late adolescence.

Approximately 10% of young adults have had a psychotic experience since early adolescence,” Sarah A. Sullivan, PhD, of the Centre for Academic Mental Health at the University of Bristol in the U.K., told Healio Psychiatry. “Most experiences are transient, but nevertheless about a third describe them as severe enough to lead to impaired functioning or help seeking. Our results show an important unmet care need in young people, with about 30% of those meeting criteria for a psychotic disorder never having sought professional help for this.

The researchers examined the outcome, course and incidence of psychotic experiences from childhood through early adulthood in the general population, as well as prediction of psychotic disorder. To do so, they analyzed data from 7,900 individuals who were assessed at ages 12, 18 and 24 years using the Psychosis-Like Symptoms Interview. They estimated incidence rates using flexible parametric modeling, as well as positive predictive values, sensitivity, specificity and area under the curve for prediction.

Sullivan and colleagues reported an increase in the incidence rate of psychotic experiences between ages 13 and 24, with a peak during late adolescence. Among a subgroup 3,866 participants interviewed at age 24, 8.1% (95% CI, 7.2-9) had a definite psychotic experience since age 12. Further, 2.8% met criteria for a psychotic disorder up to age 24 years, with 70% having sought professional help. The researchers noted that incorporating information on frequency and distress into prediction of current psychotic disorder at age 24 years, by both interviewer-rated measures and self-report of psychotic experiences at age 18 years, improved the prediction. However, sensitivities were low. The positive predictive value of an at-risk mental state at age 18 years predicting incident disorder at ages 18 to 24 years was 21.1% (95% CI, 6.1-45.6), with a sensitivity of 14.3% (95% CI, 4-32.7).

It was interesting, but concerning, that so many people who appeared to need clinical help had not sought it," Sullivan said. "It was disappointing that it was difficult to predict accurately who would develop a clinical disorder using measures of psychotic experiences earlier on during their development. However, it has motivated us to explore the use of other types of information that might improve the prediction of psychotic disorder.” – by Joe Gramigna

Disclosures: Sullivan reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Sarah A. Sullivan

An unmet need exists for care among young people with psychotic disorders, according to results of a population-based cohort study published in American Journal of Psychiatry. Researchers reported that incidence of psychotic experiences peaked during late adolescence.

Approximately 10% of young adults have had a psychotic experience since early adolescence,” Sarah A. Sullivan, PhD, of the Centre for Academic Mental Health at the University of Bristol in the U.K., told Healio Psychiatry. “Most experiences are transient, but nevertheless about a third describe them as severe enough to lead to impaired functioning or help seeking. Our results show an important unmet care need in young people, with about 30% of those meeting criteria for a psychotic disorder never having sought professional help for this.

The researchers examined the outcome, course and incidence of psychotic experiences from childhood through early adulthood in the general population, as well as prediction of psychotic disorder. To do so, they analyzed data from 7,900 individuals who were assessed at ages 12, 18 and 24 years using the Psychosis-Like Symptoms Interview. They estimated incidence rates using flexible parametric modeling, as well as positive predictive values, sensitivity, specificity and area under the curve for prediction.

Sullivan and colleagues reported an increase in the incidence rate of psychotic experiences between ages 13 and 24, with a peak during late adolescence. Among a subgroup 3,866 participants interviewed at age 24, 8.1% (95% CI, 7.2-9) had a definite psychotic experience since age 12. Further, 2.8% met criteria for a psychotic disorder up to age 24 years, with 70% having sought professional help. The researchers noted that incorporating information on frequency and distress into prediction of current psychotic disorder at age 24 years, by both interviewer-rated measures and self-report of psychotic experiences at age 18 years, improved the prediction. However, sensitivities were low. The positive predictive value of an at-risk mental state at age 18 years predicting incident disorder at ages 18 to 24 years was 21.1% (95% CI, 6.1-45.6), with a sensitivity of 14.3% (95% CI, 4-32.7).

It was interesting, but concerning, that so many people who appeared to need clinical help had not sought it," Sullivan said. "It was disappointing that it was difficult to predict accurately who would develop a clinical disorder using measures of psychotic experiences earlier on during their development. However, it has motivated us to explore the use of other types of information that might improve the prediction of psychotic disorder.” – by Joe Gramigna

Disclosures: Sullivan reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.