Terminology and assessment tools of psychosis: A systematic narrative review

Abstract

Aim Phenomena within the psychosis continuum that varies in frequency/duration/intensity have been increasingly identified. Different terms describe these phenomena, however there is no standardization within the terminology. This review evaluated the definitions and assessment tools of seven terms – (i) ‘psychotic experiences’; (ii) ‘psychotic‐like experiences’; (iii) ‘psychotic‐like symptoms’; (iv) ‘attenuated psychotic symptoms’; (v) ‘prodromal psychotic symptoms’; (vi) ‘psychotic symptomatology’; and (vii) ‘psychotic symptoms’. Methods EMBASE, MEDLINE, and CINAHL were searched during February–March 2019. Inclusion criteria included 1989–2019, full text, human, and English. Papers with no explicit definition or assessment tool, duplicates, conference abstracts, systematic reviews, meta‐analyses, or no access were excluded. Results A total of 2238 papers were identified and of these, 627 were included. Definitions and assessment tools varied, but some trends were found. Psychotic experiences and psychotic‐like experiences were transient and mild, found in the general population and those at‐risk. Psychotic‐like symptoms were subthreshold and among at‐risk populations and non‐psychotic mental disorders. Attenuated psychotic symptoms were subthreshold but associated with distress, risk, and help‐seeking. Prodromal psychotic symptoms referred to the prodrome of psychotic disorders. Psychotic symptomatology included delusions and hallucinations within psychotic disorders. Psychotic symptoms was the broadest term, encompassing a range of populations but most commonly involving hallucinations, delusions, thought disorder, and disorganization. Discussion A model for conceptualizing the required terms is proposed and future directions needed to advance this field of research are discussed.

Longitudinal Structural MRI Findings in Individuals at Genetic and Clinical High Risk for Psychosis: A Systematic Review

“…In general, neuroimaging studies examine three types of high risk cohorts; (i) help-seeking individuals who exhibit a reduction in functioning as well as attenuated psychotic symptoms or genetic risk for schizophrenia (clinical high risk; CHR, also known as an ultra-high risk of developing psychosis; UHR, or at-risk mental state; ARMS), (ii) individuals who exhibit attenuated psychotic symptoms and are not help seeking (psychotic experiences group; PE), and (iii) those with at least one relative diagnosed with schizophrenia (genetic high risk group; GHR) (2). The highest rate of transition is seen in the CHR group (36% after 3 years) (3), whereas transition rates are lower in the GHR (10-15%) (4) and PE groups (10%) (5).…”

Rethinking of ‘psychosis’ in the era of early intervention in mental health

“…Along with the development of the psychosis concept, new terminology is being used to express a wide range of symptoms within the psychosis continuum. As pointed out by Seiler et al 1 in this issue, there is currently no consensus on definitions or boundaries among different terminology. Seiler et al 1 conducted a systematic and narrative review on psychotic terminology to determine definitions and assessment tools for seven terms, specifically: 'psychotic experiences,' 'psychotic-like experiences,'…”

“…Along with the development of the psychosis concept, new terminology is being used to express a wide range of symptoms within the psychosis continuum. As pointed out by Seiler et al . in this issue, there is currently no consensus on definitions or boundaries among different terminology.…”

“…in this issue, there is currently no consensus on definitions or boundaries among different terminology. Seiler et al . conducted a systematic and narrative review on psychotic terminology to determine definitions and assessment tools for seven terms, specifically: ‘psychotic experiences,’ ‘psychotic‐like experiences,’ ‘psychotic‐like symptoms,’ ‘attenuated psychotic symptoms,’ ‘prodromal psychotic symptoms,’ ‘psychotic symptomatology,’ and ‘psychotic symptoms.’ The reviewed information and the model presented are informative, and will help facilitate further discussion and a better understanding of the psychotic dimension.…”

“…As the first step toward future standardization of terms, they propose a model with two dimensions: (i) psychotic threshold level; and (ii) distress/help‐seeking behaviors. The distinctions that Seiler et al . make according to this model among ‘experiences,’ ‘symptoms,’ and ‘signs’ are essential for establishing clear definitions of psychotic terms.…”