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.

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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.

Two measures of implicit attitudes, the Implicit Relational Assessment Procedure (IRAP) and the Implicit Association Test (IAT), were compared with each other and with a measure of explicit attitudes in the assessment of implicit pro-slim/anti-fat bias. Results from both implicit tests indicated higher levels of bias than revealed by the explicit measure. The IRAP data suggested that it was participants' pro-slim rather than anti-fat bias, which was driving this effect. Explicit attitudes and feelings towards the overweight were significant predictors of behavioural intentions towards the overweight with the IRAP offering a greater contribution to predictive validity than the IAT.

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Facial electromyography (EMG) was used to gauge emotional responding towards images of slim and overweight individuals, and findings were compared with data from a series of alternative measures including two implicit attitudinal procedures, the Implicit Relational Assessment Procedure (IRAP) and the Implicit Association Test (IAT), and explicit measures of anti-fat prejudice and discriminatory behavior. Images of slim individuals elicited EMG responses consistent with more positive affect. Data from both the IRAP and IAT indicated higher levels of bias than were revealed on the explicit measures, and the IRAP also corroborated the EMG pattern by indicating responses consistent with pro-slim rather than anti-fat bias. The IRAP was moderately correlated with both EMG and the IAT and was the only measure to predict behavioral intentions. Copyright © 2011 John Wiley & Sons, Ltd.Weight-related attitudes, including pro-slim attitudes on the one hand and anti-fat on the other, have been linked with significant problems such as eating disorders (Pepper & Ruiz, 2007;Thompson & Stice, 2001) and discrimination, respectively (Gapinski, Schwartz, & Brownell, 2006;Puhl & Brownell, 2001) and as such constitute important domains of psychosocial research. Accurate measurement of these attitudes is key to assessment and potential intervention. However, social desirability effects have become a concern in relation to the explicit self-report measures employed in traditional research (e.g., Dittmar, Halliwell, & Stirling, 2009;Mills, Polivy, Herman, & Tiggemann, 2002). Hence, a recent trend in measurement is the use of alternative procedures, which circumvent sources of bias characterizing self-reports.Perhaps the most prominent of such measures is the Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998). The IAT has been employed as a measure of weight-related implicit attitudes in several previous studies (see Morrison, Roddy, & Ryan, 2009 for a review). In the critical phase of a typical IAT study of this phenomenon, participants are required to respond as rapidly as possible in accordance with two separate patterns: (i) categorize "Slim" with "Good" and "Fat" with "Bad" and (ii) categorize "Slim" with "Bad" and "Fat" with "Good". Several studies have found that participants are faster on average to demonstrate the first pattern than the second, which is taken as evidence of "anti-fat" bias (e.g., Brochu & Morrison, 2007;Roddy, Stewart and Barnes-Holmes, 2010). Furthermore, participants tend to produce higher levels of bias on the IAT than with self-report suggesting that the IAT is revealing levels of prejudice that might not otherwise become apparent.Despite its popularity as an implicit measure, several limitations of the IAT have been noted. Perhaps the most cited of these is that the associations found for any particular concept are always relative (De Houwer, 2002). For example, in the context of "anti-fat" bias, the standard IAT does not provide a measure of separate attitudes to "fat" and "slim",...

BackgroundPsychotic symptoms, also termed psychotic-like experiences (PLEs) in the absence of psychotic disorder, are common in adolescents and are associated with increased risk of schizophrenia-spectrum illness in adulthood. At the same time, schizophrenia is associated with deficits in social cognition, with deficits particularly documented in facial emotion recognition (FER). However, little is known about the relationship between PLEs and FER abilities, with only one previous prospective study examining the association between these abilities in childhood and reported PLEs in adolescence. The current study was a cross-sectional investigation of the association between PLEs and FER in a sample of Irish adolescents.MethodThe Adolescent Psychotic-Like Symptom Screener (APSS), a self-report measure of PLEs, and the Penn Emotion Recognition-40 Test (Penn ER-40), a measure of facial emotion recognition, were completed by 793 children aged 10–13 years.ResultsChildren who reported PLEs performed significantly more poorly on FER (β=−0.03, p=0.035). Recognition of sad faces was the major driver of effects, with children performing particularly poorly when identifying this expression (β=−0.08, p=0.032).ConclusionsThe current findings show that PLEs are associated with poorer FER. Further work is needed to elucidate causal relationships with implications for the design of future interventions for those at risk of developing psychosis.