title: Clinical, socio-demographic and psychological characteristics in individuals with persistent psychotic experiences with and without a "need for care".
abstract: Individuals reporting persistent psychotic experiences (PEs) in the general population, but without a "need for care", are a unique group of particular importance in identifying risk and protective factors for psychosis. We compared people with persistent PEs and no "need for care" (non-clinical, N=92) with patients diagnosed with a psychotic disorder (clinical, N=84) and controls without PEs (N=83), in terms of their phenomenological, socio-demographic and psychological features. The 259 participants were recruited from one urban and one rural area in the UK, as part of the UNIQUE (Unusual Experiences Enquiry) study. Results showed that the non-clinical group experienced hallucinations in all modalities as well as first-rank symptoms, with an earlier age of onset than in the clinical group. Somatic/tactile hallucinations were more frequent than in the clinical group, while commenting and conversing voices were rare. Participants in the non-clinical group were differentiated from their clinical counterparts by being less paranoid and deluded, apart from ideas of reference, and having fewer cognitive difficulties and negative symptoms. Unlike the clinical group, they were characterized neither by low psychosocial functioning nor by social adversity. However, childhood trauma featured in both groups. They were similar to the controls in psychological characteristics: they did not report current emotional problems, had intact self-esteem, displayed healthy schemas about the self and others, showed high life satisfaction and well-being, and high mindfulness. These findings support biopsychosocial models postulating that environmental and psychological factors interact with biological processes in the aetiology of psychosis. While some PEs may be more malign than others, lower levels of social and environmental adversity, combined with protective factors such as intact IQ, spirituality, and psychological and emotional well-being, may reduce the likelihood of persistent PEs leading to pathological outcomes. Future research should focus on protective factors and determinants of well-being in the context of PEs, rather than exclusively on risk factors and biomarkers of disease states.
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, London, UK.|NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Peters
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, London, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ward
authors.affiliation: Bangor University, School of Psychology, Bangor, North Wales, UK.|Betsi Cadwaladr University Health Board, Bangor, North Wales, UK.
authors.forename: Mike
authors.initials: M
authors.lastname: Jackson
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service & Population Research, London, UK.
authors.forename: Craig
authors.initials: C
authors.lastname: Morgan
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, London, UK.
authors.forename: Monica
authors.initials: M
authors.lastname: Charalambides
authors.affiliation: NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK.|King's College London, Institute of Psychiatry, Psychology and Neuroscience, Psychosis Studies Department, London, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: McGuire
authors.affiliation: University of Sheffield, Cognition and Neuroimaging Laboratory, Academic Psychiatry, Sheffield, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Woodruff
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, London, UK.
authors.forename: Pamela
authors.initials: P
authors.lastname: Jacobsen
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Chadwick
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, London, UK.|NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK.
authors.forename: Philippa A
authors.initials: PA
authors.lastname: Garety
keywords: Persistent psychotic experiences; childhood trauma; first-rank symptoms; hallucinations; need for care; protective factors; psychosis; psychosocial functioning; social adversity
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