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Sullivan SA, Kounali D, Cannon M, David AS, Fletcher PC, Holmans P, Jones H, Jones PB, Linden DEJ, Lewis G, Owen MJ, O'Donovan M, Rammos A, Thompson A, Wolke D, Heron J, Zammit S. A Population-Based Cohort Study Examining the Incidence and Impact of Psychotic Experiences From Childhood to Adulthood, and Prediction of Psychotic Disorder. Am J Psychiatry 2020; 177:308-317. [PMID: 31906710 DOI: 10.1176/appi.ajp.2019.19060654] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors investigated the incidence, course, and outcome of psychotic experiences from childhood through early adulthood in the general population and examined prediction of psychotic disorder. METHODS This was a population-based cohort study using the semistructured Psychosis-Like Symptoms Interview at ages 12, 18, and 24 (N=7,900 with any data). Incidence rates were estimated using flexible parametric modeling, and positive predictive values (PPVs), sensitivity, specificity, and area under the curve were estimated for prediction. RESULTS The incidence rate of psychotic experiences increased between ages 13 and 24, peaking during late adolescence. Of 3,866 participants interviewed at age 24, 313 (8.1%, 95% CI=7.2, 9.0) had a definite psychotic experience since age 12. A total of 109 individuals (2.8%) met criteria for a psychotic disorder up to age 24, of whom 70% had sought professional help. Prediction of current psychotic disorder at age 24 (N=47, 1.2%), by both self-report and interviewer-rated measures of psychotic experiences at age 18 (PPVs, 2.9% and 10.0%, respectively), was improved by incorporating information on frequency and distress (PPVs, 13.3% and 20.0%, respectively), although sensitivities were low. The PPV of an at-risk mental state at age 18 predicting incident disorder at ages 18-24 was 21.1% (95% CI=6.1, 45.6) (sensitivity, 14.3%, 95% CI=4.0, 32.7). CONCLUSIONS The study results show a peak in incidence of psychotic experiences during late adolescence as well as an unmet need for care in young people with psychotic disorders. Because of the low sensitivity, targeting individuals in non-help-seeking samples based only on more severe symptom cutoff thresholds will likely have little impact on population levels of first-episode psychosis.
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Affiliation(s)
- Sarah A Sullivan
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Daphne Kounali
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Mary Cannon
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Anthony S David
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Paul C Fletcher
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Peter Holmans
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Hannah Jones
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Peter B Jones
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - David E J Linden
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Glyn Lewis
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Michael J Owen
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Michael O'Donovan
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Alexandros Rammos
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Andrew Thompson
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Dieter Wolke
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Jon Heron
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
| | - Stanley Zammit
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, U.K. (Sullivan, Kounali, H. Jones, Heron, Zammit); Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin (Cannon); Institute of Mental Health, University College London (David, Lewis); Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge (Fletcher, P.B. Jones); MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Cardiff, U.K. (Holmans, Linden, Owen, O'Donovan, Rammos, Zammit); Division of Psychiatry, Warwick Medical School, Warwick, Coventry, U.K. (Thompson); Orygen, Centre of Excellence in Youth Mental Health, Melbourne, Australia (Thompson); and Department of Psychology, Division of Mental Health and Wellbeing, University of Warwick, Coventry, U.K. (Wolke)
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