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Subclinical psychosis syndromes in the general population: results from a large-scale epidemiological survey among residents of the canton of Zurich, Switzerland

  • W. Rössler (a1) (a2) (a3), V. Ajdacic-Gross (a1) (a3), H. Haker (a1) (a4), S. Rodgers (a1), M. Müller (a1) and M. P. Hengartner (a1)...

Prevalence and covariates of subclinical psychosis have gained increased interest in the context of early identification and treatment of persons at risk for psychosis.


We analysed 9829 adults representative of the general population within the canton of Zurich, Switzerland. Two psychosis syndromes, derived from the SCL-90-R, were applied: ‘schizotypal signs’ and ‘schizophrenia nuclear symptoms’.


Only a few subjects (13.2%) reported no schizotypal signs. While 33.2% of subjects indicated mild signs, only a small proportion (3.7%) reported severe signs. A very common outcome was no ‘schizophrenia nuclear symptoms’ (70.6%). Although 13.5% of the participants reported mild symptoms, severe nuclear symptoms were very rare (0.5%). Because these two syndromes were only moderately correlated (r = 0.43), we were able to establish sufficiently distinct symptom clusters. Schizotypal signs were more closely connected to distress than was schizophrenia nuclear symptoms, even though their distribution types were similar. Both syndromes were associated with several covariates, such as alcohol and tobacco use, being unmarried, low education level, psychopathological distress and low subjective well-being.


Subclinical psychosis symptoms are quite frequent in the general population but, for the most part, are not very pronounced. In particular, our data support the notion of a continuous Wald distribution of psychotic symptoms in the general population. Our findings have enabled us to confirm the usefulness of these syndromes as previously assessed in other independent community samples. Both can appropriately be associated with well-known risk factors of schizophrenia.

Corresponding author
* Address for correspondence: Dr Wulf Rössler, Psychiatric University Hospital, University of Zurich, Militärstrasse 8, CH-8004 Zurich, Switzerland (Email:
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Angst, J, Gamma, A, Neuenschwander, M, Ajdacic-Gross, V, Eich, D, Rössler, W, Merikangas, KR (2005). Prevalence of mental disorders in the Zurich cohort study: a twenty year prospective study. Epidemiologia e Psichiatria Sociale 14, 6876.
Breetvelt, EJ, Boks, MP, Numans, ME, Selten, JP, Sommer, IE, Grobbee, DE, Kahn, RS, Geerlings, MI (2010). Schizophrenia risk factors constitute general risk factors for psychiatric symptoms in the population. Schizophrenia Research 120, 184190.
Compton, MT, Kelley, ME, Ramsay, CE, Pringle, M, Goulding, SM, Esterberg, ML, Stewart, T, Walker, EF (2009). Association of pre-onset cannabis, alcohol, and tobacco use with age at onset of prodrome and age at onset of psychosis in first-episode patients. American Journal of Psychiatry 166, 12511257.
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.
Derogatis, LR (1977). Symptom Checklist 90, R-Version Manual I: Scoring, Administration, and Procedures for the SCL-90. Johns Hopkins Press: Baltimore, MD.
Fach, W, Atmanspacher, H, Landolt, K, Wyss, T, Rössler, W (2013). A comparative study of exceptional experiences of clients seeking advice and of subjects in an ordinary population. Frontiers in Psychology 4, 65.
Fusar-Poli, P, Bonoldi, I, Yung, AR, Borgwardt, S, Kempton, MJ, Valmaggia, L, Barale, F, Caverzasi, E, McGuire, P (2012). Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Archives of General Psychiatry 69, 220229.
Gayer-Anderson, C, Morgan, C (2013). Social networks, support and early psychosis: a systematic review. Epidemiology and Psychiatric Sciences 22, 131146.
Hardt, J, Egle, UT, Kappis, B, Hessel, A, Brahler, E (2004). Symptom Checklist SCL-27: results of a representative German survey. Psychotherapie Psychosomatik Medizinische Psychologie 54, 214223.
Johns, LC, van Os, J (2001). The continuity of psychotic experiences in the general population. Clinical Psychology Review 21, 11251141.
Kelleher, I, Lynch, F, Harley, M, Molloy, C, Roddy, S, Fitzpatrick, C, Cannon, M (2012). Psychotic symptoms in adolescence index risk for suicidal behavior: findings from 2 population-based case-control clinical interview studies. Archives of General Psychiatry 69, 12771283.
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.
Loch, AA, Wang, YP, Rössler, W, Tofoli, LF, Silveira, CM, Andrade, LH (2011). The psychosis continuum in the general population: findings from the Sao Paulo Epidemiologic Catchment Area Study. European Archives of Psychiatry and Clinical Neuroscience 261, 519527.
McGrath, J, Saha, S, Chant, D, Welham, J (2008). Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiologic Reviews 30, 6776.
Rössler, W, Salize, HJ, van Os, J, Riecher-Rössler, A (2005). Size of burden of schizophrenia and psychotic disorders. European Neuropsychopharmacology 15, 399409.
Rössler, W, Riecher-Rössler, 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.
Rössler, W, Hengartner, MP, Ajdacic-Gross, V, Haker, H, Gamma, A, Angst, J (2011 a). Sub-clinical psychosis symptoms in young adults are risk factors for subsequent common mental disorders. Schizophrenia Research 131, 1823.
Rössler, W, Vetter, S, Mueller, M, Gallo, WT, Haker, H, Kawohl, W, Lupi, G, Ajdacic-Gross, V (2011 b). Risk factors at the low end of the psychosis continuum: much the same as at the upper end? Psychiatry Research 189, 7781.
Rössler, W, Hengartner, MP, Angst, J, Ajdacic-Gross, V (2012 a). Linking substance use with symptoms of sub-clinical psychosis in a community cohort over 30 years. Addiction 107, 11741184.
Rössler, W, Hengartner, MP, Ajdacic-Gross, V, Haker, H, Angst, J (2012 b). Sex differences in sub-clinical psychosis – results from a community study over 30 years. Schizophrenia Research 139, 176182.
Schultze-Lutter, F, Schimmelmann, BG, Ruhrmann, S (2011). The near Babylonian speech confusion in early detection of psychosis. Schizophrenia Bulletin 37, 653655.
Scott, J, Chant, D, Andrews, G, McGrath, J (2006). Psychotic-like experiences in the general community: the correlates of CIDI psychosis screen items in an Australian sample. Psychological Medicine 36, 231238.
Tsuang, MT, van Os, J, Tandon, R, Barch, DM, Bustillo, J, Gaebel, W, Gur, RE, Heckers, S, Malaspina, D, Owen, MJ, Schultz, S, Carpenter, W (2013). Attenuated psychosis syndrome in DSM-5. Schizophrenia Research 150, 2125.
van Os, J, Hanssen, M, Bijl, RV, Ravelli, A (2000). Strauss (1969) revisited: a psychosis continuum in the general population? Schizophrenia Research 45, 1120.
Wigman, JT, van Nierop, M, Vollebergh, WA, Lieb, R, Beesdo-Baum, K, Wittchen, HU, 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.
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Epidemiology and Psychiatric Sciences
  • ISSN: 2045-7960
  • EISSN: 2045-7979
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