title: 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.
abstract: BACKGROUND
  It is commonly assumed that there are clear lines of demarcation between anxiety and depressive disorders on the one hand and psychosis on the other. Recent evidence, however, suggests that this principle may be in need of updating.
  
  
  METHODS
  Depressive and/or anxiety disorders, with no previous history of psychotic disorder, were examined for the presence of psychotic symptoms in a representative community sample of adolescents and young adults (Early Developmental Stages of Psychopathology study; n = 3021). Associations and consequences of psychotic symptomatology in the course of these disorders were examined in terms of demographic distribution, illness severity, onset of service use, and risk factors.
  
  
  RESULTS
  Around 27% of those with disorders of anxiety and depression displayed one or more psychotic symptoms, vs 14% in those without these disorders (OR 2.23, 95% CI 1.89-2.66, P < .001). Presence as compared with nonpresence of psychotic symptomatology was associated with younger age (P < .0001), male sex (P < .0058), and poorer illness course (P < .0002). In addition, there was greater persistence of schizotypal (P < .0001) and negative symptoms (P < .0170), more observable illness behavior (P < .0001), greater likelihood of service use (P < .0069), as well as more evidence of familial liability for mental illness (P < .0100), exposure to trauma (P < .0150), recent and more distant life events (P < .0006-.0244), cannabis use (P < .0009), and any drug use (P < .0008).
  
  
  CONCLUSIONS
  Copresence of psychotic symptomatology in disorders of anxiety and depression is common and a functionally and etiologically highly relevant feature, reinforcing the view that psychopathology is represented by a network or overlapping and reciprocally impacting dimensional liabilities.
authors.affiliation: Department of Interdisciplinary Social Science, University of Utrecht, 3508 TC Utrecht, The Netherlands.
authors.forename: Johanna T W
authors.initials: JT
authors.lastname: Wigman
authors.forename: Martine
authors.initials: M
authors.lastname: van Nierop
authors.forename: Wilma A M
authors.initials: WA
authors.lastname: Vollebergh
authors.forename: Roselind
authors.initials: R
authors.lastname: Lieb
authors.forename: Katja
authors.initials: K
authors.lastname: Beesdo-Baum
authors.forename: Hans-Ullrich
authors.initials: HU
authors.lastname: Wittchen
authors.forename: Jim
authors.initials: J
authors.lastname: van Os
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult