follow-up study Course of auditory vocal hallucinations in childhood: 5-year permissions Reprints/ permissions@rcpsych.ac.uk write to To obtain reprints or permission to reproduce material from this paper, please to this article at You can respond http://bjp.rcpsych.org/cgi/eletter-submit/199/4/296 from Downloaded The Royal College of Psychiatrists Published by on December 13, 2011 http://bjp.rcpsych.org/ http://bjp.rcpsych.org/site/subscriptions/ go to: The British Journal of Psychiatry To subscribe to Subclinical psychotic experiences in the general population are prevalent in both children and adults, and not generally associated with persistence over time or onset of psychiatric disorder. Nevertheless, literature reviews suggest that a small number will make the transition to a clinical psychotic disorder. 1,2 In a previous study on a representative sample of 7-and 8-year-old children in The Netherlands, the prevalence of auditory vocal hallucinations was 9%. 3 Although auditory vocal hallucinations in these children were mostly of limited functional impact, a subgroup with serious suffering was considered at risk for more severe psychotic outcomes. The current study presents a 5-year follow-up of this sample (now 12 and 13 years of age) and examines the persistence and new incidence of auditory vocal hallucinations, as well as their clinical relevance in terms of problem behaviour, severity and associations with aetiological variables. In view of the baseline results and previous work in this area, it was hypothesised that: (1) severity of auditory vocal hallucinations at baseline would predict persistence; 4-6 (2) auditory vocal hallucinations would show associations with behavioural problems 7-9 and other psychotic symptoms; 10 (3) incidence and severity of auditory vocal hallucinations would be associated with environmental factors such as cannabis use 11-13 and urbanicity; 14-16 (4) baseline characteristics of auditory vocal hallucinations suggesting external attribution and higher level of intrusion would be predictive of persistence; 4-6 (5) auditory vocal hallucinations would be associated negatively with cognitive ability. 17-20 Method Procedure From the case-control sample of the first wave (n = 694, of which 347 children with auditory vocal hallucinations), parents of 605 children (87%, of which 50% with auditory vocal hallucinations) gave informed consent for follow-up. These parents were sent a notification letter by mail. Non-responders were sent a reminder followed by a second letter, if necessary. In case of persisting non-response, parents were contacted by telephone if their numbers could be traced. Seven female interviewers (six students (bachelor degree) from the Department of Orthopedagogy and one psychology graduate, all from the University of Groningen) received extensive training by A.A.B.-V., G.v.d.W. and J.A.J. in conducting the interviews. First, they were introduced to the topic of auditory hallucinations, and then, with consent, observed several therapeutic sessions of patients r...

Auditory vocal hallucinations in 7- and 8-year-olds are prevalent but mostly of limited functional impact. Nevertheless, there may be continuity with more severe psychotic outcomes given the serious suffering in a subgroup of children and there is evidence for a poorer prognosis in an urban environment.

BACKGROUND: Disentangling psychopathological heterogeneity in schizophrenia is challenging, and previous results remain inconclusive. We employed advanced machine learning to identify a stable and generalizable factorization of the Positive and Negative Syndrome Scale and used it to identify psychopathological subtypes as well as their neurobiological differentiations. METHODS: Positive and Negative Syndrome Scale data from the Pharmacotherapy Monitoring and Outcome Survey cohort (1545 patients; 586 followed up after 1.35 6 0.70 years) were used for learning the factor structure by an orthonormal projective non-negative factorization. An international sample, pooled from 9 medical centers across Europe, the United States, and Asia (490 patients), was used for validation. Patients were clustered into psychopathological subtypes based on the identified factor structure, and the neurobiological divergence between the subtypes was assessed by classification analysis on functional magnetic resonance imaging connectivity patterns. RESULTS: A 4-factor structure representing negative, positive, affective, and cognitive symptoms was identified as the most stable and generalizable representation of psychopathology. It showed higher internal consistency than the original Positive and Negative Syndrome Scale subscales and previously proposed factor models. Based on this representation, the positive-negative dichotomy was confirmed as the (only) robust psychopathological subtypes, and these subtypes were longitudinally stable in about 80% of the repeatedly assessed patients. Finally, the individual subtype could be predicted with good accuracy from functional connectivity profiles of the ventromedial frontal cortex, temporoparietal junction, and precuneus. CONCLUSIONS: Machine learning applied to multisite data with cross-validation yielded a factorization generalizable across populations and medical systems. Together with subtyping and the demonstrated ability to predict subtype membership from neuroimaging data, this work further disentangles the heterogeneity in schizophrenia.