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‘False-positive’ self-reported psychotic experiences in the general population: an investigation of outcome, predictive factors and clinical relevance

  • Y. van der Steen (a1) (a2), I. Myin-Germeys (a2), M. van Nierop (a2), M. ten Have (a3), R. de Graaf (a3), S. van Dorsselaer (a3), J. van Os (a1) (a4) (a5) and R. van Winkel (a6) (a7)...
Abstract
Aims.

Self-reported psychotic experiences (SRPE) by individuals from the general population are often unconfirmed by clinical interview and referred to as ‘false-positive’ (FP) SRPE. FP SRPE have been suggested to represent the mildest form of risk along the extended psychosis continuum. However, little is known about their (clinical) outcome and evolution over time. Aims of this study were to prospectively examine, in individuals with FP SRPE, (1) the prevalence of remission, persistence and transition to validated PE at 3-year follow-up; (2) potential baseline psychopathological and psychosocial predictors of persistence of FP SRPE and transition to validated PE; and (3) whether those with persistent FP SRPE and validated PE already differed on psychopathology and psychosocial factors at baseline. We tested the hypotheses that (i) individuals with FP SRPE would be more likely to have SRPE and validated PE at follow-up; and (ii) that FP SRPE would be predictive of lower functioning and more psychopathology and help-seeking behaviour at follow-up.

Methods.

Baseline (n = 6646) and 3-year follow-up (n = 5303) data of the second the Netherlands Mental Health Survey and Incidence Study (NEMESIS-2), a general population research project on prevalence, incidence, course and consequences of psychiatric disorders was used. Self-report of PE was followed by clinical interview to determine clinical validity. The presence of mood, anxiety and substance use disorders, childhood adversity, help-seeking and functioning as well as PE characteristics (number, frequency, distress and impact) were used in the analyses which included only individuals with complete data for both assessments waves (n = 4683).

Results.

At baseline, 454 participants had any FP SRPE; of these 372 participants had complete follow-up data available. Those with baseline FP SRPE were significantly more likely to report SRPE (OR = 3.58; 95% CI 2.38–5.40, p < 0.001) and validated PE (OR = 6.26; 95% CI 3.91–10.02, p < 0.001) at follow-up. Baseline FP SRPE also predicted the presence of mood and anxiety disorders, reduced functioning and help-seeking at follow-up. Several baseline psychopathological, psychosocial and PE characteristics were predictive for the persistence of SRPE. These factors also differentiated groups with FP SRPE or validated PE from those with remitted FP SRPE at follow-up.

Conclusions.

‘FP SRPE’ are not truly ‘false’ as they index risk for the development of clinically relevant psychotic symptoms, development of mood and anxiety disorders and reduced functioning. Self-reported PE, even unconfirmed, warrant ‘watchful waiting’ and follow-up over time, especially when they are reported by individuals with reduced psychosocial functioning and general psychiatric problems.

Copyright
Corresponding author
*Address for correspondence: Ruud van Winkel, KU Leuven, Center for Clinical Psychiatry, Leuvensesteenweg 517, 3070 Kortenberg, Belgium. (Email: ruud.vanwinkel@kuleuven.be)
References
Hide All
Andrews, G, Peters, L (1998). The psychometric properties of the Composite International Diagnostic Interview. Social Psychiatry and Psychiatric Epidemiology 33, 8088.
Bak, M, Delespaul, P, Hanssen, M, de Graaf, R, Vollebergh, W, van Os, J (2003). How false are ‘false’ positive psychotic symptoms? Schizophrenia Research 62, 187189.
Bhavsar, V, Maccabe, JH, Hatch, SL, Hotopf, M, Boydell, J, McGuire, P (2017). Subclinical psychotic experiences and subsequent contact with mental health services. British Journal of Psychiatry Open 3, 6470.
Brugha, T, Bebbington, P, Tennant, C, Hurry, J (1985). The list of threatening experiences: a subset of 12 life event categories with considerable long-term contextual threat. Psychological Medicine 15, 189194.
de Graaf, R, Ten Have, M, van Dorsselaer, S (2010). The Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2): design and methods. International Journal of Methods in Psychiatric Research 19, 125141.
de Graaf, R, ten Have, M, van Gool, C, van Dorsselaer, S (2012). Prevalence of mental disorders and trends from 1996 to 2009. Results from the Netherlands Mental Health Survey and Incidence Study-2. Social Psychiatry and Psychiatric Epidemiology 47, 203213.
de Graaf, R, van Dorsselaer, S, Tuithof, M, ten Have, M (2013). Sociodemographic and psychiatric predictors of attrition in a prospective psychiatric epidemiological study among the general population. Result of the Netherlands Mental Health Survey and Incidence Study-2. Comprehensive Psychiatry 54, 11311139.
Degenhardt, L, Hall, W (2001). The association between psychosis and problematical drug use among Australian adults: findings from the National Survey of Mental Health and Well-Being. Psychological Medicine 31, 659668.
Dominguez, MDG, Wichers, M, Lieb, R, Wittchen, H-U, van Os, J (2011). Evidence that onset of clinical psychosis is an outcome of progressively more persistent subclinical psychotic experiences: an 8-year cohort study. Schizophrenia Bulletin 37, 8493.
Eysenck, SBG, White, O, Eysenck, HJ (1976). Personality and mental illness. Psychological Reports 39, 10111022.
Eysenck, SBG, Eysenck, HJ, Barrett, P (1985). A revised version of the psychoticism scale. Personality and Individual Differences 6, 2129.
Fusar-Poli, P, Nelson, B, Valmaggia, L, Yung, AR, McGuire, PK (2014). Comorbid depressive and anxiety disorders in 509 individuals with an at-risk mental state: impact on psychopathology and transition to psychosis. Schizophrenia Bulletin 40, 120131.
Hanssen, M, Peeters, F, Krabbendam, L, Radstake, S, Verdoux, H, van Os, J (2003). How psychotic are individuals with non-psychotic disorders? Social Psychiatry and Psychiatric Epidemiology 38, 149154.
Hanssen, M, Bak, M, Bijl, R, Vollebergh, W, van Os, J (2005). The incidence and outcome of subclinical psychotic experiences in the general population. British Journal of Clinical Psychology 44, 181191.
Helzer, JE, Robins, LN, McEvoy, LT, Spitznagel, EL, Stoltzman, RL, Farmer, A, Brockington, IF (1985). A comparison of clinical and diagnostic interview schedule diagnoses: physician reexamination of lay-interviewed cases in the general population. Archives of General Psychiatry 42, 657666.
Johns, LC, van Os, J (2001). The continuity of psychotic experiences in the general population. Clinical Psychology Review 21, 11251141.
Johns, LC, Cannon, M, Singleton, N, Murray, RM, Farrell, M, Brugha, T, Bebbington, P, Jenkins, R, Meltzer, H (2004). Prevalence and correlates of self-reported psychotic symptoms in the British population. British Journal of Psychiatry 185, 298305.
Kaymaz, N, Drukker, M, Lieb, R, Wittchen, HU, Werbeloff, N, Weiser, M, Lataster, T, van Os, J (2012). Do subthreshold psychotic experiences predict clinical outcomes in unselected non-help-seeking population-based samples? A systematic review and meta-analysis, enriched with new results. Psychological Medicine 42, 22392253.
Kelleher, I, Harley, M, Murtagh, A, Cannon, M (2011). Are screening instruments valid for psychotic-like experiences? A validation study of screening questions for psychotic-like experiences using in-depth clinical interview. Schizophrenia Bulletin 37, 362369.
Kelleher, I, Connor, D, Clarke, MC, Devlin, N, Harley, M, Cannon, M (2012). Prevalence of psychotic symptoms in childhood and adolescence: a systematic review and meta-analysis of population-based studies. Psychological Medicine 42, 18571863.
Linscott, RJ, van Os, J (2010). Systematic reviews of categorical versus continuum models in psychosis: evidence for discontinuous subpopulations underlying a psychometric continuum. Implications for DSM-V, DSM-VI, and DSM-VII. Annual Review of Clinical Psychology 6, 391419.
Linscott, RJ, van Os, J (2013). An updated and conservative systematic review and meta-analysis of epidemiological evidence on psychotic experiences in children and adults: on the pathway from proneness to persistence to dimensional expression across mental disorders. Psychological Medicine 43, 11331149.
Maijer, K, Begemann, MJH, Palmen, SJMC, Leucht, S, Sommer, IEC (2017). Auditory hallucinations across the lifespan: a systematic review and meta-analysis. Psychological Medicine, doi:10.1017/S0033291717002367, Published online 28 September 2017.
McGrath, J, Saha, S, Chant, D, Welham, J (2008). Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiologic Reviews 30, 6776.
McGrath, JJ, Saha, S, Al-Hamzawi, A, Alonso, J, Bromet, EJ, Bruffaerts, R, Caldas-de-Almeida, JM, Chiu, WT, de Jonge, P, Fayyad, J, Florescu, S, Gureje, O, Haro, JM, Hu, C, Kovess-Masfety, V, Lepine, JP, Lim, CW, Mora, MEM, Navarro-Mateu, F, Ochoa, S, Sampson, N, Scott, K, Viana, MC, Kessler, RC (2015). Psychotic experiences in the general population: a cross-national analysis based on 31,261 respondents from 18 countries. JAMA Psychiatry 72, 697705.
McGrath, JJ, Saha, S, Al-Hamzawi, A, Andrade, L, Benjet, C, Bromet, EJ, Browne, MO, Caldas de Almeida, JM, Chiu, WT, Demyttenaere, K, Fayyad, J, Florescu, S, de Girolamo, G, Gureje, O, Haro, JM, Ten Have, M, Hu, C, Kovess-Masfety, V, Lim, CC, Navarro-Mateu, F, Sampson, N, Posada-Villa, J, Kendler, KS, Kessler, RC (2016). The bidirectional associations between psychotic experiences and DSM-IV mental disorders. American Journal of Psychiatry 173, 9971006.
McGrath, JJ, Saha, S, Lim, CCW, Aguilar-Gaxiola, S, Alonso, J, Andrade, LH, Bromet, EJ, Bruffaerts, R, Caldas de Almeida, JM, Cardoso, G, de Girolamo, G, Fayyad, J, Florescu, S, Gureje, O, Haro, JM, Kawakami, N, Koenen, KC, Kovess-Masfety, V, Lee, S, Lepine, JP, McLaughlin, KA, Medina-Mora, ME, Navarro-Mateu, F, Ojagbemi, A, Posada-Villa, J, Sampson, N, Scott, KM, Tachimori, H, Ten Have, M, Kendler, KS, Kessler, RC (2017). Trauma and psychotic experiences: transnational data from the World Mental Health Survey. The British Journal of Psychiatry 211, 373380.
Murphy, J, Shevlin, M, Houston, J, Adamson, G (2012). A population based analysis of subclinical psychosis and help-seeking behavior. Schizophrenia Bulletin 38, 360367.
Navarro-Mateu, F, Alonso, J, Lim, CCW, Saha, S, Aguilar-Gaxiola, S, Al-Hamzawi, A, Andrade, LH, Bromet, EJ, Bruffaerts, R, Chatterji, S, Degenhardt, L, de Girolamo, G, de Jonge, P, Fayyad, J, Florescu, S, Gureje, O, Haro, JM, Hu, C, Karam, EG, Kovess-Masfety, V, Lee, S, Medina-Mora, ME, Ojagbemi, A, Pennell, BE, Piazza, M, Posada-Villa, J, Scott, KM, Stagnaro, JC, Xavier, M, Kendler, KS, Kessler, RC, McGrath, JJ (2017). The association between psychotic experiences and disability: results from the WHO World Mental Health Surveys. Acta Psychiatrica Scandinavica 136, 7484.
Rossler, W, Riecher-Rossler, A, Angst, J, Murray, R, Gamma, A, Eich, D, van Os, J, Gross, VA (2007). Psychotic experiences in the general population: a twenty-year prospective community study. Schizophrenia Research 92, 114.
Saha, S, Chant, D, Welham, J, McGrath, J (2005). A systematic review of the prevalence of schizophrenia. PLoS Medicine 2, e141.
Spitzer, RL, Williams, JW, Gibbon, M, First, MB (1992). The structured clinical interview for DSM-III-R (SCID): I: history, rationale, and description. Archives of General Psychiatry 49, 624629.
StataCorp. (2013). Stata Statistical Software: Release 13. StataCorp LP: College Station, TX.
Stewart, AL, Hays, RD, Ware, JE Jr. (1988). The MOS short-form general health survey. Reliability and validity in a patient population. Medical Care 26, 724735.
The ESEMeD/MHEDEA 2000 investigators, Alonso, J, Angermeyer, MC, Bernert, S, Bruffaerts, R, Brugha, TS, Bryson, H, de Girolamo, G, de Graaf, R, Demyttenaere, K, Gasquet, I, Haro, JM, Katz, SJ, Kessler, RC, Kovess, V, Lépine, JP, Ormel, J, Polidori, G, Russo, LJ, Vilagut, G, Almansa, J, Arbabzadeh-Bouchez, S, Autonell, J, Bernal, M, Buist-Bouwman, MA, Codony, M, Domingo-Salvany, A, Ferrer, M, Joo, SS, Martínez-Alonso, M, Matschinger, H, Mazzi, F, Morgan, Z, Morosini, P, Palacín, C, Romera, B, Taub, N, Vollebergh, WAM (2004). Sampling and methods of the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scandinavica 109, 820.
van Nierop, M, van Os, J, Gunther, N, Myin-Germeys, I, de Graaf, R, ten Have, M, van Dorsselaer, S, Bak, M, van Winkel, R (2012). Phenotypically continuous with clinical psychosis, discontinuous in need for care: evidence for an extended psychosis phenotype. Schizophrenia Bulletin 38, 231238.
van Os, J, Linscott, RJ (2012). Introduction: the extended psychosis phenotype – relationship with schizophrenia and with ultrahigh risk status for psychosis. Schizophrenia Bulletin 38, 227230.
van Os, J, Reininghaus, U (2016). Psychosis as a transdiagnostic and extended phenotype in the general population. World Psychiatry 15, 118124.
van Os, J, Linscott, RJ, Myin-Germeys, I, Delespaul, P, Krabbendam, L (2009). A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness-persistence-impairment model of psychotic disorder. Psychological Medicine 39, 179195.
Varghese, D, Scott, J, Welham, J, Bor, W, Najman, J, O'Callaghan, M, Williams, G, McGrath, J (2011). Psychotic-like experiences in major depression and anxiety disorders: a population-based survey in young adults. Schizophrenia Bulletin 37, 389393.
Ware, JE Jr., Sherbourne, CD (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care 30, 473483.
Werbeloff, N, Drukker, M, Dohrenwend, BP, Levav, I, Yoffe, R, van Os, J, Davidson, M, Weiser, M (2012). Self-reported attenuated psychotic symptoms as forerunners of severe mental disorders later in life. Archives of General Psychiatry 69, 467475.
Wigman, JTW, van Nierop, M, Vollebergh, WAM, Lieb, R, Beesdo-Baum, K, Wittchen, H-U, van Os, J (2012). Evidence that psychotic symptoms are prevalent in disorders of anxiety and depression, impacting on illness onset, risk, and severity – implications for diagnosis and ultra-high risk research. Schizophrenia Bulletin 38, 247257.
Wittchen, H-U (1994). Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): a critical review. Journal of Psychiatric Research 28, 5784.
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