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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

Published online by Cambridge University Press:  31 July 2012

R. J. Linscott  and
J. van Os
R. J. Linscott
Affiliation:
Department of Psychology, University of Otago, New Zealand Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, The Netherlands
J. van Os*
Affiliation:
Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, The Netherlands King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK
*
*Address for correspondence: Professor J. van Os, Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, P.O. Box 616 (DRT 10), 6200 MD Maastricht, The Netherlands. (Email: j.vanos@sp.unimaas.nl)
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Abstract

Background

The psychosis-proneness–persistence–impairment model of psychotic disorder incorporates notions of both phenomenological and temporal continuity (persistence) of psychotic experiences (PE), but not structural continuity. Specific testable propositions of phenomenological continuity and persistence are identified.

Method

Propositions are tested by systematic reviews of the epidemiology of PE, persistence of PE and disorder outcomes, and meta-analyses (including Monte Carlo permutation sampling, MCPS) of reported rates and odds ratios (ORs).

Results

Estimates of the incidence and prevalence of PE obtained from 61 cohorts revealed a median annual incidence of 2.5% and a prevalence of 7.2%. Meta-analysis of risk factors identified age, minority or migrant status, income, education, employment, marital status, alcohol use, cannabis use, stress, urbanicity and family history of mental illness as important predictors of PE. The mode of assessment accounted for significant variance in the observed rates. Across cohorts, the probability of persistence was very strongly related to the rate of PE at baseline. Of those who report PE, ∼20% go on to experience persistent PE whereas for ∼80%, PE remit over time. Of those with baseline PE, 7.4% develop a psychotic disorder outcome.

Conclusions

Compelling support is found for the phenomenological and temporal continuity between PE and psychotic disorder and for the fundamental proposition that this relationship is probabilistic. However, imprecision in epidemiological research design, measurement limitations and the epiphenomenological nature of PE invite further robust scrutiny of the continuity theory.

Keywords

Epidemiologypersistencepsychotic experiencesschizophreniaschizotypy
Type
Review Article
Information
Psychological Medicine , Volume 43 , Issue 6 , June 2013 , pp. 1133 - 1149
Copyright
Copyright © Cambridge University Press 2012 

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