Sarah A Sullivan

Psychotic Experiences and Psychotic Disorders at Age 18 in Relation to Psychotic Experiences at Age 12 in a Longitudinal Population-Based Cohort Study

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.

The DEBIT trial: an intervention to reduce antipsychotic polypharmacy prescribing in adult psychiatry wards - a cluster randomized controlled trial

BACKGROUND Clinical guidelines advise against prescribing more than one antipsychotic with limited exceptions. Despite this, surveys continue to report high antipsychotic polypharmacy rates. The aim of the study was to investigate the effectiveness of a multi-faceted intervention in reducing prescribing of antipsychotic polypharmacy on general adult psychiatry wards, compared with guidelines alone. METHOD A pragmatic cluster randomized controlled trial recruited 19 adult psychiatric units (clusters) from the South West of England. Participants were all ward doctors and nurses. The multi-faceted intervention comprised: an educational/CBT workbook; an educational visit to consultants; and a reminder system on medication charts. RESULTS The odds of being prescribed antipsychotic polypharmacy in those patients prescribed antipsychotic medication was significantly lower in the intervention than control group when adjusted for confounders (OR 0.43, 95% CI 0.21-0.90, p=0.028). There was considerable between-unit variation in polypharmacy rates and in the change in rates between baseline and follow-up (5 months after baseline). CONCLUSION The intervention reduced levels of polypharmacy prescribing compared to guidelines alone although the effect size was relatively modest. Further work is needed to elicit the factors that were active in changing prescribing behaviour.

Association between locus of control in childhood and psychotic symptoms in early adolescence : results from a large birth cohort

Introduction. Specific attributional styles have been demonstrated in individuals with psychotic disorders and are implicated in the development of psychotic symptoms. We aimed to examine the association between locus of control (LOC) assessed in childhood and psychotic symptoms reported in early adolescence. Methods. We used a prospective longitudinal design using data from a large birth cohort (the Avon Longitudinal Study of Parents and Children, ALPSAC). 6455 subjects completed a semistructured clinical interview assessing 12 individual psychotic symptoms at a mean age of 12.9 years. A measure of LOC was previously collected in the cohort at the age of 8. Results. Children who reported an externalised LOC at age 8 were at increased risk of reporting both broadly defined (OR 1.77, 95% CI 1.49 to 2.08) and narrowly defined (OR 2.06, 95% CI 1.58 to 2.67) psychotic symptoms at age 13 years. These associations were only slightly attenuated after adjustment for potential confounders. The associations were similar for broadly defined specific paranoid symptoms but weaker for narrowly defined specific paranoid symptoms. Conclusions. An externalised LOC appears to be associated with later reporting of psychotic symptoms in early adolescence. Further investigation of the role of attributional styles, such as LOC, in increasing the risk for psychotic disorders, is warranted.

Common versus psychopathology-specific risk factors for psychotic experiences and depression during adolescence

Background An argument often used to support the view that psychotic experiences (PEs) in general population samples are a valid phenotype for studying the aetiology of schizophrenia is that risk factors for schizophrenia show similar patterns of association with PEs. However, PEs often co-occur with depression, and no study has explicitly tested whether risk factors for schizophrenia are shared between PEs and depression, or are psychopathology specific, while jointly modelling both outcomes. Method We used data from 7030 subjects from a birth cohort study. Depression and PEs at age 18 years were assessed using self-report questionnaires and semi-structured interviews. We compared the extent to which risk factors for schizophrenia across sociodemographic, familial, neurodevelopmental, stress–adversity, emotional–behavioural and substance use domains showed different associations with PEs and depression within bivariate models that allowed for their correlation. Results Most of the exposures examined were associated, to a similar degree, with an increased risk of both outcomes. However, whereas female sex and family history of depression showed some discrimination as potential risk factors for depression and PEs, with stronger associations in the former, markers of abnormal neurodevelopment showed stronger associations with PEs. Conclusions The argument that PEs are valid markers for studying the aetiology of schizophrenia, made simply on the basis that they share risk factors in common, is not well supported. PEs seem to be a weak index of genetic and environmental risk for schizophrenia; however, studies disentangling aetiological pathways to PEs from those impacting upon co-morbid psychopathology might provide important insights into the aetiology of psychotic disorders.

Longitudinal associations between adolescent psychotic experiences and depressive symptoms

Background Psychotic experiences are prevalent in community samples and are highly correlated with depressive symptoms. This study aimed to investigate the longitudinal associations between psychotic experiences and depressive symptoms between adolescence and young adulthood. Method Prospective cohort study with a 6 year follow-up in a community sample of 7632 adolescents and young adults. Depressive symptoms were assessed with the Short Moods and Feelings Questionnaire and psychotic experiences with a semi-structured clinical interview at 12 and 18 years. Longitudinal and cross-sectional associations were investigated with regression and structural equation models. Results Depressive symptoms and psychotic experiences were associated at each time-point (12 years r = 0.486 [95% CI 0.457, 0.515]; 18 years r = 0.286 [95% CI 0.233, 0.339]) and there were longitudinal within-phenotype associations (depressive symptoms r = 0.252 [95% CI 0.205, 0.299]; psychotic experiences r = 0.662 [95% CI 0.595, 0.729]). There was an across-phenotype association between psychotic experiences at 12 and depressive symptoms at 18 r = 0.139 [95% CI 0.086, 0.192; p<0.001], but no association between depressive symptoms at 12 and psychotic experiences at 18 r = −0.022 [95% CI −0.032, 0.077; p = 0.891]. Conclusions Longitudinal across-phenotype associations were substantially weaker than cross-sectional associations or within-phenotype longitudinal associations. Whilst psychotic experiences at 12 years were associated with a small increase in depression at 18 years, depression at 12 years was not associated with psychotic experiences at 18 years once across-phenotype cross-sectional and within-phenotype longitudinal associations were accounted for. This suggests that the biological mechanisms underlying depression at this age do not increase subsequent risk of psychotic experiences once they resolve.

Theory of mind and social functioning in first episode psychosis

Introduction. There is evidence of associations between social functioning and theory of mind performance and between social functioning and negative symptoms in chronic psychosis. This study investigates these associations in those with first episode psychosis who are unaffected by factors related to long-term mental illness. Our first hypothesis states that there is an association between theory of mind and social functioning. The second hypothesis states that there is no association between symptoms of psychosis and social functioning. Methods. Fifty-two individuals with first episode psychosis were assessed for social functioning, theory of mind ability (using the Hinting test with verbal stimuli and the Visual Cartoon test with pictorial stimuli), and symptoms of psychosis. Multivariable logistic regression was used to examine associations. Results. Social functioning and theory of mind were associated when measured by the Hinting test (OR 1.70, 95% CI 1.08, 2.66), but not with the Visual Cartoon test (ToM jokes OR 0.61, 95% CI 0.15, 2.53). There was no association between social functioning and symptoms (psychotic symptoms; OR 0.95, 95% CI 0.81, 1.12; selected negative symptoms; OR 1.33, 95% CI 0.78, 2.25). Conclusions. Theory of mind assessed by verbal stimuli is associated with social functioning in a population with first episode psychosis. These findings may be related to language disorders in psychosis.

Child literacy and psychotic experiences in early adolescence: Findings from the ALSPAC study

The aim of this study was to use prospective data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to examine the differences in literacy skills in children who later completed the psychotic like symptoms (PLIKS) interview at 12 years of age. We further examined the association between literacy skills over time in relation to the likelihood of reporting psychotic experiences (PEs). This study examined data from n=6790 children from the ALSPAC cohort who participated in the PLIKS semi-structured interview. Literacy skills such as spelling, basic real and non-real word reading, and reading skills and comprehension were assessed by an ALSPAC spelling task, Wechsler Objective Reading Dimension, and the revised Neale Analysis of Reading Ability (NARA II) respectively. Relative to the group unaffected by PEs, we found a lower performance in all measurements of child literacy skills in those with suspected or definite PEs. The majority of these differences persisted after adjusting for a range of covariates. In addition, both a consistently low pattern of performance and a decline were associated with suspected or definite PEs. Implications for preventative intervention models focussed on children at risk of developing psychotic disorders are discussed within the context of speech and language development.

Childhood facial emotion recognition and psychosis-like symptoms in a nonclinical population at 12 years of age: Results from the ALSPAC birth cohort

Introduction. Nonclinical psychotic symptoms (for example, low intensity or low frequency psychotic symptoms such as ideas of reference or single word auditory hallucinations) are common in adolescents and may be associated with an increased risk of developing a psychotic disorder in adulthood. Those at high risk of developing a psychotic disorder appear to perform poorly on facial emotion recognition tasks but the relationship between facial emotion recognition and nonclinical “psychosis like symptoms” (PLIKS) in children is unclear. We aimed to examine the association between childhood facial emotion recognition and PLIKS in adolescents. Methods. Longitudinal study using a large birth cohort. 6455 subjects completed a semistructured clinical assessment for psychotic symptoms (the PLIKSi) at the mean age of 12.9 (SD=0.23). Facial emotion recognition (using the DANVA) was previously assessed at the age of 8 in the cohort. Results. There was no increase in odds of reporting any PLIKS either in relation to the total score on the measure of facial emotion recognition or for the individual emotion scores of fear, sadness, anger, and happiness. Similar results were also found when examining more intense and/or more frequently experienced psychotic symptoms. Conclusions. Deficits in facial emotion recognition in 8-year-olds do not appear to predict later reporting of nonclinical psychotic symptoms in early adolescence. The results do not support the proposal that recognition of emotion is a trait phenomenon in those individuals at increased risk for psychosis. However, further research is warranted in older children/adolescents when more subtle emotion recognition deficits can be investigated.

Hemispheric Language Asymmetry in First Episode Psychosis and Schizotypy: The Role of Cannabis Consumption and Cognitive Disorganization

Cannabis use has been related to an elevated psychosis risk and attenuated cognitive functioning. Cannabis-related cognitive impairments are also observed in populations along the psychosis dimension. We here investigated whether a potential behavioral marker of the psychosis dimension (attenuated functional hemispheric asymmetry) is even further attenuated in individuals using cannabis (CU) vs those not using cannabis (nCU). We tested 29 patients with first-episode psychosis (FEP; 11 CU) and 90 healthy controls (38 CU) on lateralized lexical decisions assessing left-hemisphere language dominance. In patients, psychotic symptoms were assessed by Positive & Negative Symptom Scale (PANSS). In controls, self-reported schizotypy was assessed (The Oxford-Liverpool Inventory of Feelings and Experiences: O-LIFE). Results indicated that nCU FEP patients had a relative reduced hemispheric asymmetry, as did controls with increasing cognitive disorganization (CogDis) scores, in particular when belonging to the group of nCU controls. Positive, disorganized and negative PANSS scores in patients and negative and positive schizotypy in controls were unrelated to hemispheric asymmetry. These findings suggest that cannabis use potentially balances rather than exacerbates uncommon hemispheric laterality patterns. Moreover, in healthy populations, the potential stabilization of typical hemispheric asymmetry in CU might be most relevant to individuals with elevated CogDis. We discuss the potential beneficial and harmful effects of cannabis use along the psychosis dimension together with propositions for future studies that should account for the mediating role of additional substances (eg nicotine), cannabis composition (eg cannabidiol content), and individual differences (eg physical health, or absence of significant polysubstance use).

Factors Predicting Atypical Development of Nighttime Bladder Control

Objective: To derive latent classes (longitudinal “phenotypes”) of frequency of bedwetting from 4 to 9 years and to examine their association with developmental delay, parental history of bedwetting, length of gestation and birth weight. Method: The authors used data from 8,769 children from the UK Avon Longitudinal Study of Parents and Children cohort. Mothers provided repeated reports on their childs frequency of bedwetting from 4 to 9 years. The authors used longitudinal latent class analysis to derive latent classes of bedwetting and examined their association with sex, developmental level at 18 months, parental history of wetting, birth weight, and gestational length. Results: The authors identified 5 latent classes: (1) “normative”—low probability of bedwetting; (2) “infrequent delayed”—delayed attainment of nighttime bladder control with bedwetting <twice a week; (3) “frequent delayed”—delayed attainment of nighttime bladder control with bedwetting ≥ twice a week; (4) “infrequent persistent”—persistent bedwetting < twice a week; and (5) “frequent persistent”—persistent bedwetting ≥ twice a week. Male gender (odds ratio = 3.20 [95% confidence interval = 2.36–4.34]), developmental delay, for example, delayed social skills (1.33 [1.11–1.58]), and maternal history of wetting (3.91 [2.60–5.88]) were associated with an increase in the odds of bedwetting at 4 to 9 years. There was little evidence that low birth weight and shorter gestation period were associated with bedwetting. Conclusion: The authors described patterns of development of nighttime bladder control and found evidence for factors that predict continuation of bedwetting at school age. Increased knowledge of risk factors for bedwetting is needed to identify children at risk of future problems attaining and maintaining continence.