Hallucinations and delusions, the classic symptoms of psychosis, have recently been documented to occur at a much higher prevalence in the general population than clinically diagnosed psychotic disorder.1 A meta-analysis of prevalence studies of psychotic symptoms in young people demonstrated a median prevalence of 17% in children aged 9-12 years and 7.5% in adolescents aged 13-18 years.2 As the term suggests, psychotic symptoms have typically been considered to relate to psychotic disorder. Indeed, research has shown that members of the general population who report psychotic symptoms share a wide range of risk factors with people with schizophrenia (see Kelleher & Cannon for review), [3][4][5][6][7][8][9] and young people who report psychotic symptoms have been found to be at increased risk of psychotic disorder in adulthood.10,11 Individuals who report psychotic symptoms are also more likely to report non-psychotic psychopathological symptoms, especially symptoms of depression; [12][13][14][15][16] Yung et al, for example, reported that individuals who had a diagnosed depressive disorder endorsed an increased number of psychotic symptoms on the Community Assessment of Psychic Experiences questionnaire compared with controls.17 Bartels-Velthuis et al found that young adolescents who disclosed psychotic symptoms were approximately 3-5 times more likely to score in the clinical psychopathology range on the parent-completed Child Behavior Checklist. Community-based studies to date, however, have relied mainly upon questionnaires to assess psychotic symptoms and have involved limited data on non-psychotic psychopathology. In addition, although research suggests that psychotic symptoms are more common in younger than in older children, 2 there is a lack of information on whether there are differences in the clinical significance of psychotic symptoms across different stages of adolescence. In an attempt to improve our understanding of the clinical significance of psychotic symptoms in the general population we examined data from four population studies, comprising two large population surveys and two in-depth clinical interview studies of psychotic symptoms. The aims of this work were to investigate whether psychotic symptoms predicted nonpsychotic clinical diagnoses, and if so, which disorders; to investigate whether psychotic symptoms predicted more clinically severe disorder in terms of comorbid psychopathology (i.e. having more than one diagnosis); and to investigate whether the significance of psychotic symptoms varied as a function of age. MethodSurvey studies Background Epidemiological research has shown that hallucinations and delusions, the classic symptoms of psychosis, are far more prevalent in the population than actual psychotic disorder. These symptoms are especially prevalent in childhood and adolescence. Longitudinal research has demonstrated that psychotic symptoms in adolescence increase the risk of psychotic disorder in adulthood. There has been a lack of research, however, on the immediate clini...

While a great deal of research has been conducted on prodromal risk syndromes in relation to help-seeking individuals who present to the clinic, there is a lack of research on prodromal risk syndromes in the general population. The current study aimed first to establish whether prodromal risk syndromes could be detected in non-help-seeking community-based adolescents and secondly to characterize this group in terms of Axis-1 psychopathology and general functioning. We conducted in-depth clinical interviews with a population sample of 212 school-going adolescents in order to assess for prodromal risk syndromes, Axis-1 psychopathology, and global (social/occupational) functioning. Between 0.9% and 8% of the community sample met criteria for a risk syndrome, depending on varying disability criteria. The risk syndrome group had a higher prevalence of co-occurring nonpsychotic Axis-1 psychiatric disorders (OR 5 4.77, 95% CI 5 1.81-12.52; P < .01) and poorer global functioning (F 5 24.5, df 5 1, P < .0001) compared with controls. Individuals in the community who fulfill criteria for prodromal risk syndromes demonstrate strong similarities with clinically presenting risk syndrome patients not just in terms of psychotic symptom criteria but also in terms of co-occurring psychopathology and global functioning.

Traumatic brain injury (TBI) is known to lead to a range of adverse psychiatric sequelae but the question of whether TBI is a risk factor for psychosis and, in particular, schizophrenia remains unclear. Studies examining this issue have yielded conflicting results. We carried out a systematic review of the literature on TBI and psychosis in order to identify all population-based controlled studies which provide estimates of risk for schizophrenia following TBI. Odds ratios (ORs) were combined using random effects meta-analysis. Our literature search yielded 172 studies which were considered to be potentially relevant. From these, we identified 9 studies that could provide estimates of risk in the form of ORs. The pooled analysis revealed a significant association between TBI and schizophrenia (OR = 1.65; 95% CI = 1.17-2.32), with significant heterogeneity between the studies. Estimates from the family studies (OR = 2.8: 95% CI =1.76-4.47) were higher than those from the cohort/nested case-control studies (OR = 1.42: 95% CI = 1.02-1.97) by a factor of almost 2. There did not appear to be a dose-response relationship between severity of head injury and subsequent risk of schizophrenia. This meta-analysis supports an increased risk of schizophrenia following TBI, with a larger effect in those with a genetic predisposition to psychosis. Further epidemiological and neuroscientific studies to elucidate the mechanisms underlying this association are warranted.

CONTEXT Recent evidence from both clinical and population research has pointed to psychotic symptoms as potentially important markers of risk for suicidal behavior. However, to our knowledge, there have been no epidemiological studies to date that have reported data on psychotic symptoms and suicidality in individuals who have been clinically assessed for suicidal behavior. OBJECTIVES To explore associations between psychotic symptoms in nonpsychotic adolescents and risk for suicidal behavior in (1) the general population, (2) adolescents with psychiatric disorder, and (3) adolescents with suicidal ideation. DESIGN Two independently conducted case-control clinical interview studies. SETTING Population-based studies in Ireland. PARTICIPANTS Study 1 included 212 adolescents aged 11 to 13 years. Study 2 included 211 adolescents aged 13 to 15 years. Participants were recruited from schools. MAIN OUTCOME MEASURES Suicidal behavior and psychotic symptoms, assessed by semi-structured diagnostic clinical interview. RESULTS Psychotic symptoms were associated with a 10-fold increased odds of any suicidal behavior (ideation, plans, or acts) in both the early and middle adolescence studies (odds ratio [OR], 10.23; 95% CI, 3.25-32.26; P < .001 and OR, 10.5; 95% CI, 3.14-35.17; P < .001, respectively). Adolescents with depressive disorders who also experienced psychotic symptoms were at a nearly 14-fold increased odds of more severe suicidal behavior (suicide plans and suicide acts) compared with adolescents with depressive disorders who did not experience psychotic symptoms (OR, 13.7; 95% CI, 2.1-89.6). Among all adolescents with suicidal ideation, those who also reported psychotic symptoms had a nearly 20-fold increased odds of suicide plans and suicide acts compared with adolescents with suicidal ideation who did not report psychotic symptoms (OR, 19.6; 95% CI, 1.8-216.1). CONCLUSIONS Psychotic symptoms are strongly associated with increased risk for suicidal behavior in the general adolescent population and in adolescents with (nonpsychotic) psychiatric disorder. In both studies, an absolute majority of adolescents with more severe suicidal behavior (suicidal plans and acts) reported psychotic symptoms when directly questioned about this as part of a psychiatric interview. Assessment of psychotic symptoms should form a key part of suicide risk assessment.

BackgroundThis study investigated the prevalence of DSM‐IV Axis 1 mental disorders, deliberate self‐harm and suicidal ideation in a sample of Irish adolescents aged 11–13 years.MethodsA total of 1131 students was surveyed for general psychopathology using the Strengths and Difficulties Questionnaire. Following this, a representative sample of 212 adolescents was assessed for mental disorders, deliberate self‐harm and suicidal ideation using the Schedule for Affective Disorders and Schizophrenia for School‐Aged Children.Results14.6% of the sample met criteria for a borderline score and 6.9% for an abnormal score on the Strengths and Difficulties Questionnaire. Following clinical diagnostic interviews, 27.4% of participants received a current diagnosis of an Axis 1 disorder and 36.8% received a lifetime diagnosis, those rates falling to 15.4% and 31.2% respectively when specific phobias were excluded.ConclusionsFindings from this study reveal that Irish adolescents aged 11–13 years are experiencing high levels of mental ill‐health.

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Dear Editor, Cowden syndrome (CS) is a rare autosomal dominant disorder characterised by multiple hamartomas, an increased risk of multiple solid cancers and a mutation in the PTEN gene. Although CS is strongly associated with the development of solid tumours, we are unaware of any previous reports of chronic lymphocytic leukaemia (CLL) occurring in association with CS. Here, we report the case of a 29-year-old male who developed CLL on a background of CS with a mutation in the PTEN gene (heterozygous for c.1003C > Tp. (Arg335Ter)). The PTEN gene on chromosome 10q23.2 displays tumour-suppressor function by coding for a lipid phosphate mediating cell cycle arrest and apoptosis via inhibition of the P13K/AKT pathway with 13-80 % of CS families harbouring germline nonsense, missense, and frameshift mutations in the PTEN gene [1].A 28-year-old Caucasian male patient presented with abdominal pain, and endoscopy revealed multiple small bowel and colonic polyps consistent with a hamartomatous polyposis syndrome. Further investigations revealed hypothyroidism, a large head circumference (62 cm) as well as multiple papillomatous papules, all of which are recognised features of CS. A full blood count revealed a lymphocytosis of 18.6 × 10 9 /L with morphology and immunophenotyping fully in keeping with CLL. There was no expression of CD38, and FISH analysis showed the presence of 13q deletion but no evidence of poor prognostic abnormalities (17pdel, 11qdel). Computed tomography (CT) scan did not show any organomegaly or lymphadenopathy, and remaining cell lineages (haemoglobin and platelets) were within normal range resulting in Rai stage 0 and Binet stage A disease. Thymidine kinase, ZAP-70, and IgHV mutational status were not measured. Interestingly, the patient's father also had a colonic polyposis syndrome and had undergone a total colectomy to reduce his cancer risk whilst his sister had died aged 17 from a sudden cardiac death. Genetic testing for PTEN mutation analysis revealed heterozygosity for the nonsense mutation c.1003C > Tp. (Arg335Ter), confirming a diagnosis of CS based on current criteria [2]. The patient's WCC then rose to 286 × 10 9 /L in December 2014, so anti-CLL therapy was commenced with fludarabine, cyclophosphamide, and rituximab (FCR) to which he achieved a complete morphological remission which continues.CLL is the commonest leukaemia in the Western world with a median age at diagnosis of 65-70 years. CLL is rare in younger persons with just 11 % of all US patients diagnosed with CLL in 2009 being less than 55 years of age [3]. Previous studies have shown that PTEN is mutated or inactivated in many types of cancer [4][5][6][7]; however, PTEN mutations have only been reported sporadically in haematological cancers [8][9][10]. In recent years, a high frequency of PTEN mutations/deletions was found in paediatric T cell acute lymphoblastic leukaemia (ALL) [11][12][13]; however, further studies failed to find similar PTEN mutations in CLL patients. Interestingly, low expression of PTEN has been documen...

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