Differences Between Self-Reported Psychotic Experiences, Clinically Relevant Psychotic Experiences, and Attenuated Psychotic Symptoms in the General Population

Abstract

Purpose: Psychotic experiences in childhood (such as hearing voices or being suspicious) represent an important phenotype for early intervention. However, these experiences can be defined in several ways: self-reported psychotic experiences (SRPE) rely exclusively on the child’s report, clinically validated psychotic experiences (CRPE) are based on clinical assessment, and attenuated psychotic symptoms (APS) represents a categorization to do with clinical relevance in relation to severity. Very few studies have investigated how these distinctions impact clinical and other domains. The present study aims to compare SRPE, CRPE, and APS among children and adolescents.Methods: This study is part of the Brazilian High-Risk Cohort Study for Psychiatric Disorders, in which 2,241 individuals aged 6–14 years provided self-ratings of 20 psychotic experiences using the Community Assessment of Psychic Experiences (CAPE). A trained psychologist conducted an interview to validate or reject reported experiences and to rate the presence of APS and affective flattening. In parallel, parents provided information about child mental health to an independent interviewer. We tested the association of mutually exclusive categories of non-validated SRPE (nSRPE), clinically validated PE below the threshold for APS (nCRPE), and APS (nSRPE = 33%, nCRPE = 11%, APS = 6%), with parents’ information about the child’s positive attributes and levels of psychopathology and psychologist assessment of blunted affect.Results: Most associations were qualitatively similar, and there was a dose–response in the strength of associations across categories, such that APS > nCRPE > nSRPE. Experiences in all three categories were associated with female sex. nSRPE were associated with overall levels of psychopathology, but to a lesser degree than nCRPE and APS. APS and nCRPE were associated with less positive attributes, with APS more so than nCRPE. Only APS was associated with affective flattening.Conclusions: In children and adolescents, SRPE, CRPE, and APS all index liability for psychopathology, but as clinician rated relevance increases, associations get stronger and become evident across more domains.

Establishing a clinical service to prevent psychosis: What, how and when? Systematic review

“…This recommendation is also relevant for current operationalisations of at-risk syndromes, which require formulating a differential diagnosis between psychosis risk and other psychopathological dimensions such as the SIPS or the DSM-5-APS 2 . Although psychotic experiences are frequent in the general population 103 , 104 , clinical attenuated psychotic symptoms are infrequent and not normally distributed. Only 0.3% of the general young population meet DSM-5-APS criteria 2 , 105 .…”

Replication of Associations With Psychotic-Like Experiences in Middle Childhood From the Adolescent Brain Cognitive Development (ABCD) Study

“… 9 PLEs are considered a dimensional, 10 transdiagnostic marker of psychopathology 11 , 12 that is not necessarily specific to psychosis risk, as only a subset of these children is at risk for conversion to psychotic disorders 13 or other psychiatric disorders in adulthood. 14 Notably, research indicates that self-reported PLEs, even those not confirmed with clinical interview, are still clinically relevant and associated with higher rates of psychopathology 15–17 and reduced functioning. 17 , 18 Several large cross-sectional datasets over the past 2 decades have examined the correlates of PLEs, finding associations with racial/ethnic minority status, 19 internalizing symptoms, 20–22 externalizing symptoms, 20 developmental impairments, 23 and cognitive impairments, 23 , 24 including reading, 25 working memory, 26 , 27 and processing speed 28 impairments.…”

Inventário de Organização da Personalidade – Brasil: evidências de validade baseadas em critérios externos

“…As respostas a alguns itens do IPO-Br demandam maior autorreflexão e clareza acerca das emoções experimentadas e do modo como a pessoa vê a si mesma. Falhas nessa capacidade autorreflexiva, juntamente com prejuízos no julgamento, podem gerar escores em um instrumento de autorrelato que não representam adequadamente o paciente 25 . Ainda, ocorre o fato de a OP borderline ser amplamente estudada enquanto existem pouquíssimos estudos sobre a OP psicótica na perspectiva da teoria psicodinâmica das relações de objeto, resultando em lacunas no conhecimento e aprofundamento do funcionamento estrutural psicótico 26 .…”