Skip to main content Accessibility help
×
Home

Psychotic experiences in a mental health clinic sample: implications for suicidality, multimorbidity and functioning

  • I. Kelleher (a1) (a2), N. Devlin (a1), J. T. W. Wigman (a3), A. Kehoe (a4), A. Murtagh (a1), C. Fitzpatrick (a4) (a5) and M. Cannon (a1) (a6)...

Abstract

Background

Recent community-based research has suggested that psychotic experiences act as markers of severity of psychopathology. There has, however, been a lack of clinic-based research. We wished to investigate, in a clinical sample of adolescents referred to a state-funded mental health service, the prevalence of (attenuated or frank) psychotic experiences and the relationship with (i) affective, anxiety and behavioural disorders, (ii) multimorbid psychopathology, (iii) global functioning, and (iv) suicidal behaviour.

Method

The investigation was a clinical case–clinical control study using semi-structured research diagnostic psychiatric assessments in 108 patients newly referred to state adolescent mental health services.

Results

Psychotic experiences were prevalent in a wide range of (non-psychotic) disorders but were strong markers of risk in particular for multimorbid psychopathology (Z = 3.44, p = 0.001). Young people with psychopathology who reported psychotic experiences demonstrated significantly poorer socio-occupational functioning than young people with psychopathology who did not report psychotic experiences, which was not explained by multimorbidity. Psychotic experiences were strong markers of risk for suicidal behaviour. Stratified analyses showed that there was a greatly increased odds of suicide attempts in patients with a major depressive disorder [odds ratio (OR) 8.89, 95% confidence interval (CI) 1.59–49.83], anxiety disorder (OR 15.4, 95% CI 1.85–127.94) or behavioural disorder (OR 3.13, 95% CI 1.11–8.79) who also had psychotic experiences compared with patients who did not report psychotic experiences.

Conclusions

Psychotic experiences (attenuated or frank) are an important but under-recognized marker of risk for severe psychopathology, including multimorbidity, poor functioning and suicidal behaviour in young people who present to mental health services.

Copyright

Corresponding author

* Address for correspondence: Ian Kelleher, Ph.D., Karolinska Institute, National Centre for Suicide Research and Prevention of Mental Ill-Health, World Health Organization Collaborating Centre, Granits vag 4, 17177 Stockholm, Sweden. (Email: iankelleher@rcsi.ie)

References

Hide All
Addington, J, Cornblatt, BA, Cadenhead, KS, Cannon, TD, McGlashan, TH, Perkins, DO, Seidman, LJ, Tsuang, MT, Walker, EF, Woods, SW, Heinssen, R (2011). At clinical high risk for psychosis: outcome for nonconverters. American Journal of Psychiatry 168, 800805.
Afifi, TO, Enns, MW, Cox, BJ, Asmundson, GJ, Stein, MB, Sareen, J (2008). Population attributable fractions of psychiatric disorders and suicide ideation and attempts associated with adverse childhood experiences. American Journal of Public Health 98, 946952.
Altman, H, Collins, M, Mundy, P (1997). Subclinical hallucinations and delusions in nonpsychotic adolescents. Journal of Child Psychology and Psychiatry 38, 413420.
Angst, J, Sellaro, R, Ries Merikangas, K (2002). Multimorbidity of psychiatric disorders as an indicator of clinical severity. European Archives of Psychiatry and Clinical Neuroscience 252, 147154.
Arseneault, L, Cannon, M, Fisher, HL, Polanczyk, G, Moffitt, TE, Caspi, A (2011). Childhood trauma and children's emerging psychotic symptoms: a genetically sensitive longitudinal cohort study. American Journal of Psychiatry 168, 6572.
Bartels-Velthuis, AA, van de Willige, G, Jenner, JA, van Os, J, Wiersma, D (2011). Course of auditory vocal hallucinations in childhood: 5-year follow-up study. British Journal of Psychiatry 199, 296302.
Bebbington, P, Jonas, S, Kuipers, E, King, M, Cooper, C, Brugha, T, Meltzer, H, McManus, S, Jenkins, R (2011). Childhood sexual abuse and psychosis: data from a cross-sectional national psychiatric survey in England. British Journal of Psychiatry 199, 2937.
Chambers, WJ, Puig-Antich, J, Tabrizi, MA, Davies, M (1982). Psychotic symptoms in prepubertal major depressive disorder. Archives of General Psychiatry 39, 921927.
Dube, SR, Anda, RF, Felitti, VJ, Chapman, DP, Williamson, DF, Giles, WH (2001). Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: findings from the Adverse Childhood Experiences Study. Journal of the American Medical Association 286, 30893096.
Evans, E, Hawton, K, Rodham, K (2005). Suicidal phenomena and abuse in adolescents: a review of epidemiological studies. Child Abuse and Neglect 29, 4558.
Fisher, HL, Caspi, A, Poulton, R, Meier, MH, Houts, R, Harrington, H, Arseneault, L, Moffitt, TE (2013). Specificity of childhood psychotic symptoms for predicting schizophrenia by 38 years of age: a birth cohort study. Psychological Medicine. Published online 10 01 2013 . doi:10.1017/S0033291712003091.
Fisher, HL, Schreier, A, Zammit, S, Maughan, B, Munafò, MR, Lewis, G, Wolke, D (2012). Pathways between childhood victimization and psychosis-like symptoms in the ALSPAC birth cohort. Schizophrenia Bulletin. Published online 1 09 2012 . doi:10.1093/schbul/sbs088.
Freeman, D, Fowler, D (2009). Routes to psychotic symptoms: trauma, anxiety and psychosis-like experiences. Psychiatry Research 169, 107112.
Freeman, D, Garety, PA, Kuipers, E, Fowler, D, Bebbington, PE (2002). A cognitive model of persecutory delusions. British Journal of Clinical Psychology 41, 331347.
Kaufman, J, Birmaher, B, Brent, D, Rao, U, Ryan, N (1996). The Schedule for Affective Disorders and Schizophrenia for School Aged Children: Present and Lifetime Version. University of Pittsburgh, Western Psychiatric Institute and Clinic: Pittsburgh.
Kaymaz, N, Drukker, M, Lieb, R, Wittchen, HU, Werbeloff, N, Weiser, M, Lataster, T, van Os, J (2012). Do subthreshold psychotic experiences predict clinical outcomes in unselected non-help-seeking population-based samples? A systematic review and meta-analysis, enriched with new results. Psychological Medicine. Published online 20 01 2012 . doi:10.1017/S0033291711002911.
Kelleher, I, Connor, D, Clarke, MC, Devlin, N, Harley, M, Cannon, M (2012 a). Prevalence of psychotic symptoms in childhood and adolescence: a systematic review and meta-analysis of population-based studies. Psychological Medicine 42, 18571864.
Kelleher, I, Corcoran, P, Keeley, H, Wigman, JTW, Devlin, N, Ramsay, H, Wasserman, C, Carli, V, Sarchiapone, M, Hoven, C, Wasserman, D, Cannon, M (2013 a). Psychotic symptoms and population risk for suicide attempt: a prospective cohort study. JAMA Psychiatry. Published online 17 07 2013 . doi:10.1001/jamapsychiatry.2013.140.
Kelleher, I, Harley, M, Lynch, F, Arseneault, L, Fitzpatrick, C, Cannon, M (2008). Associations between childhood trauma, bullying and psychotic symptoms among a school-based adolescent sample. British Journal of Psychiatry 193, 378382.
Kelleher, I, Keeley, H, Corcoran, P, Lynch, F, Fitzpatrick, C, Devlin, N, Molloy, C, Roddy, S, Clarke, MC, Harley, M, Arseneault, L, Wasserman, C, Carli, V, Sarchiapone, M, Hoven, C, Wasserman, D, Cannon, M (2012 b). Clinicopathological significance of psychotic experiences in non-psychotic young people: evidence from four population-based studies. British Journal of Psychiatry 201, 2632.
Kelleher, I, Keeley, H, Corcoran, P, Ramsay, H, Wasserman, C, Carli, V, Sarchiapone, M, Hoven, C, Wasserman, D, Cannon, M (2013 b). Childhood trauma and psychosis in a prospective cohort study: cause, effect and directionality. American Journal of Psychiatry 170, 734741.
Kelleher, I, Lynch, F, Harley, M, Molloy, C, Roddy, S, Fitzpatrick, C, Cannon, M (2012 c). Psychotic symptoms in adolescence index risk for suicidal behavior: findings from two population-based case–control clinical interview studies. Archives of General Psychiatry 69, 12771283.
Kelleher, I, Murtagh, A, Molloy, C, Roddy, S, Clarke, MC, Harley, M, Cannon, M (2012 d). Identification and characterization of prodromal risk syndromes in young adolescents in the community: a population-based clinical interview study. Schizophrenia Bulletin 38, 239246.
Lataster, T, Wichers, M, Jacobs, N, Mengelers, R, Derom, C, Thiery, E, Van Os, J, Myin-Germeys, I (2009). Does reactivity to stress cosegregate with subclinical psychosis? A general population twin study. Acta Psychiatrica Scandinavica 119, 4553.
Laurens, KR, Hobbs, MJ, Sunderland, M, Green, MJ, Mould, GL (2012). Psychotic-like experiences in a community sample of 8000 children aged 9 to 11 years: an item response theory analysis. Psychological Medicine 42, 14951506.
Lin, A, Wigman, JT, Nelson, B, Vollebergh, WA, van Os, J, Baksheev, G, Ryan, J, Raaijmakers, QA, Thompson, A, Yung, AR (2011). The relationship between coping and subclinical psychotic experiences in adolescents from the general population – a longitudinal study. Psychological Medicine. Published online 28 04 2011 . doi:10.1017/S0033291711000560.
Mackie, CJ, Castellanos-Ryan, N, Conrod, PJ (2011). Developmental trajectories of psychotic-like experiences across adolescence: impact of victimization and substance use. Psychological Medicine 41, 4758.
McGlashan, TH, Miller, TJ, Woods, SW (2001). Pre-onset detection and intervention research in schizophrenia psychoses: current estimates of benefit and risk. Schizophrenia Bulletin 27, 563570.
Poulton, R, Caspi, A, Moffitt, TE, Cannon, M, Murray, R, Harrington, H (2000). Children's self-reported psychotic symptoms and adult schizophreniform disorder: a 15-year longitudinal study. Archives of General Psychiatry 57, 10531058.
Saha, S, Scott, JG, Johnston, AK, Slade, TN, Varghese, D, Carter, GL, McGrath, JJ (2011). The association between delusional-like experiences and suicidal thoughts and behaviour. Schizophrenia Research 132, 197202.
Schimmelmann, BG, Michel, C, Schaffner, N, Schultze-Lutter, F (2011). What percentage of people in the general population satisfies the current clinical at-risk criteria of psychosis? Schizophrenia Research 125, 99100.
Scott, J, Chant, D, Andrews, G, Martin, G, McGrath, J (2007 a). Association between trauma exposure and delusional experiences in a large community-based sample. British Journal of Psychiatry 190, 339343.
Scott, J, Martin, G, Bor, W, Sawyer, M, Clark, J, McGrath, J (2009). The prevalence and correlates of hallucinations in Australian adolescents: results from a national survey. Schizophrenia Research 107, 179185.
Scott, JG, Nurcombe, B, Sheridan, J, McFarland, M (2007 b). Hallucinations in adolescents with post-traumatic stress disorder and psychotic disorder. Australasian Psychiatry 15, 4448.
Shaffer, D, Gould, MS, Brasic, J, Ambrosini, P, Fisher, P, Bird, H, Aluwahlia, S (1983). A Children's Global Assessment Scale (CGAS). Archives of General Psychiatry 40, 12281231.
Ulloa, RE, Birmaher, B, Axelson, D, Williamson, DE, Brent, DA, Ryan, ND, Bridge, J, Baugher, M (2000). Psychosis in a pediatric mood and anxiety disorders clinic: phenomenology and correlates. Journal of the American Academy of Child and Adolescent Psychiatry 39, 337345.
van Os, J, Linscott, RJ, Myin-Germeys, I, Delespaul, P, Krabbendam, L (2009). A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness–persistence–impairment model of psychotic disorder. Psychological Medicine 39, 179195.
van Os, J, Murray, RM (2013). Can we identify and treat ‘schizophrenia light’ to prevent true psychotic illness? British Medical Journal 346, f304.
Varghese, D, Scott, J, Welham, J, Bor, W, Najman, J, O'Callaghan, M, Williams, G, McGrath, J (2011). Psychotic-like experiences in major depression and anxiety disorders: a population-based survey in young adults. Schizophrenia Bulletin 37, 389393.
Welham, J, Scott, J, Williams, G, Najman, J, Bor, W, O'Callaghan, M, McGrath, J (2009). Emotional and behavioural antecedents of young adults who screen positive for non-affective psychosis: a 21-year birth cohort study. Psychological Medicine 39, 625634.
Werbeloff, N, Drukker, M, Dohrenwend, BP, Levav, I, Yoffe, R, van Os, J, Davidson, M, Weiser, M (2012). Self-reported attenuated psychotic symptoms as forerunners of severe mental disorders later in life. Archives of General Psychiatry 69, 467475.
Wigman, JT, van Nierop, M, Vollebergh, WA, Lieb, R, Beesdo-Baum, K, Wittchen, HU, van Os, J (2012). Evidence that psychotic symptoms are prevalent in disorders of anxiety and depression, impacting on illness onset, risk, and severity – implications for diagnosis and ultra-high risk research. Schizophrenia Bulletin 38, 247257.
Yung, AR, Buckby, JA, Cosgrave, EM, Killackey, EJ, Baker, K, Cotton, SM, McGorry, PD (2007). Association between psychotic experiences and depression in a clinical sample over 6 months. Schizophrenia Research 91, 246253.
Yung, AR, McGorry, PD, McFarlane, CA, Jackson, HJ, Patton, GC, Rakkar, A (1996). Monitoring and care of young people at incipient risk of psychosis. Schizophrenia Bulletin 22, 283303.

Keywords

Type Description Title
WORD
Supplementary materials

Kelleher Supplementary Material
Table

 Word (39 KB)
39 KB

Psychotic experiences in a mental health clinic sample: implications for suicidality, multimorbidity and functioning

  • I. Kelleher (a1) (a2), N. Devlin (a1), J. T. W. Wigman (a3), A. Kehoe (a4), A. Murtagh (a1), C. Fitzpatrick (a4) (a5) and M. Cannon (a1) (a6)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed