title: Consistent etiology of severe, frequent psychotic experiences and milder, less frequent manifestations: a twin study of specific psychotic experiences in adolescence.
abstract: OBJECTIVE
  The onset of psychosis is usually preceded by psychotic experiences (PE). Little is known about the etiology of PE and whether the degree of genetic and environmental influences varies across different levels of severity. A recognized challenge is to identify individuals at high risk of developing psychotic disorders prior to disease onset.
  
  
  OBJECTIVE
  To investigate the degree of genetic and environmental influences on specific PE, assessed dimensionally, in adolescents in the community and in those who have many, frequent experiences (defined using quantitative cutoffs). We also assessed the degree of overlap in etiological influences between specific PE.
  
  
  METHODS
  Structural equation model-fitting, including univariate and bivariate twin models, liability threshold models, DeFries-Fulker extremes analysis, and the Cherny method, was used to analyze a representative community sample of 5059 adolescent twin pairs (mean [SD] age, 16.31 [0.68] years) from England and Wales.
  
  
  METHODS
  Psychotic experiences assessed as quantitative traits (self-rated paranoia, hallucinations, cognitive disorganization, grandiosity, and anhedonia, as well as parent-rated negative symptoms).
  
  
  RESULTS
  Genetic influences were apparent for all PE (15%-59%), with modest shared environment for hallucinations and negative symptoms (17%-24%) and significant nonshared environment (49%-64%) for the self-rated scales and 17% for parent-rated negative symptoms. Three empirical approaches converged to suggest that the etiology in extreme-scoring groups (most extreme scoring: 5%, 10%, and 15%) did not differ significantly from that of the whole distribution. There was no linear change in heritability across the distribution of PE, with the exception of a modest increase in heritability for increasing severity of parent-rated negative symptoms. Of the PE that showed covariation, this appeared to be due to shared genetic influences (bivariate heritabilities, 0.54-0.71).
  
  
  CONCLUSIONS
  These findings are consistent with the concept of a psychosis continuum, suggesting that the same genetic and environmental factors influence both extreme, frequent PE and milder, less frequent manifestations in adolescents. Individual PE in adolescence, assessed quantitatively, have lower heritability estimates and higher estimates of nonshared environment than those for the liability to schizophrenia. Heritability varies by type of PE, being highest for paranoia and parent-rated negative symptoms and lowest for hallucinations.
authors: Medical Research Council Social, Genetic and Developmental Psychiatry Centre, King's College London, Institute of Psychiatry, London, England.
authors: Helena M S
authors: HM
authors: Zavos
authors: Department of Psychiatry, University of Oxford, Oxford, England.
authors: Daniel
authors: D
authors: Freeman
authors: Department of Psychology, University of Warwick, Coventry, England.
authors: Claire M A
authors: CM
authors: Haworth
authors: Institute of Psychiatry, King's College London, London, England.
authors: Philip
authors: P
authors: McGuire
authors: Medical Research Council Social, Genetic and Developmental Psychiatry Centre, King's College London, Institute of Psychiatry, London, England.
authors: Robert
authors: R
authors: Plomin
authors: Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, Leeds, England.
authors: Alastair G
authors: AG
authors: Cardno
authors: Centre for Brain and Cognitive Development, Birkbeck, University of London, London, England.
authors: Angelica
authors: A
authors: Ronald
mesh_terms: D000293:Adolescent; D005260:Female; D020022:Genetic Predisposition to Disease / Q000453:epidemiology; D006212:Hallucinations / Q000235:genetics / Q000523:psychology; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics / Q000523:psychology; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014429:Twins, Dizygotic / Q000235:genetics / Q000523:psychology; D014430:Twins, Monozygotic / Q000235:genetics / Q000523:psychology