Formation of delusional ideation in adolescents hearing voices: A prospective study

Abstract

Previous work suggests that auditory hallucinations in children and adolescents occur frequently in the absence of psychotic illness, although a number of such children go on to develop more severe psychotic symptomatology and need for care. We examined prospectively what factors are associated with formation of delusions in adolescents who are hearing voices. Eighty adolescents (mean age 12.9 years, SD = 3.1) who reported hearing voices were examined at baseline and followed-up three times over a period of 3 years. Fifty percent were receiving professional care, but 50% were not in need of care. Baseline measurement of voice appraisals, attributions, psychopathology, global functioning, dissociation, stressful life events, coping mechanisms, and receipt of professional care were used as predictors of delusion formation, measured as a score of 6 or greater on the extended BPRS items: "suspiciousness," "unusual thought content" and "grandiosity." Thirteen children (16%) displayed evidence of delusional ideation over at least one of the three follow-up periods, of which seven (9%) de novo. Adjusting for presence of baseline delusional ideation, delusion formation over the follow-up period was associated with baseline voice appraisals and attributions such as tone of the voice (hazard ratio voice "variably friendly and hostile" compared to "always friendly": HR = 6.8, 95% CI: 1.1, 41.0), perceived location of the voice (outside vs. inside head: HR = 2.9, 95% CI: 1.0, 8.7), and whether the voice resembled that of a parent (HR = 3.5, 95% CI: 1.0, 12.0); baseline BPRS anxiety/depression (HR = 6.4, 95% CI: 1.9, 21.4), baseline BPRS disorganization (HR = 5.0, 95% CI: 0.98, 26.1) and the baseline amount of reported recent stressful life events (HR continuous life events score: 1.8, 95% CI: 1.0, 3.3). In addition, in older children, the perceived influence of the voices on emotions and behavior was strongly associated with delusion formation (HR = 5.1, 95% CI: 1.0, 25.9). Delusion formation in children hearing voices may be responsive to triggering events and facilitated by feelings of anxiety/depression. The results also highlight the role of attributions associated with external sources, authority figures, perceived influence or "power" over the person, as well as emotional appraisal processes and cognitive disorganization.

Cognitive factors maintaining persecutory delusions in psychosis: The contribution of depression.

“…High levels of depression in those with subclinical psychotic experiences predict subsequent precipitation of clinical psychotic symptoms (Yung, Phillips, Yuen, & McGorry, 2004;Escher, Romme, Buiks, Delespaul, & Van Os, 2002). The NEMESIS project, a three-year prospective study of a Dutch population sample of 7067 people, found that 34 out of 79 people with any psychotic symptoms at baseline assessment were also depressed (Hanssen, Bak, Bijl, Vollebergh, & van Os, 2005).…”

Are psychotic experiences among detained juvenile offenders explained by trauma and substance use?

“…Most clinicians working with juvenile offenders will not agree that these enumerated psy-chotic experiences indicate a clinical psychotic disorder. At present, it is still unclear whether such experiences are really psychotic, or phenomena that occur in the range of other disorders (Vermeiren et al, 2006) In addition, a substantial proportion of the general population have psychotic experiences without having any psychiatric diagnosis, or without being in need for care (Escher et al, 2002;Hanssen et al, 2005;Nishida et al, 2008), suggesting that such experiences do not need to be markers of poor mental health.…”

14:15 Persistence of the Extended Psychosis Phenotype in Young People: Link Between Vulnerability and Clinical Need

“…The finding that psychotic symptoms may differ qualitatively in clinical and non clinical individuals may also suggest that the nature of the symptoms may change (or influence changes) along the psychosis continuum. For example, voices heard by patients are often negative and hostile, whereas voices in non clinical individuals are mostly benign and friendly (Sommer, 2010;Escher, Romme, Buiks, Delespaul & van Os, 2002;Daalman et al, in press). …”