Psychosis as a transdiagnostic and extended phenotype in the general population.
A large body of research indicates that weak expressions of positive psychotic symptoms ("psychotic experiences") can be measured in the general population, and likely represent the behavioural manifestation of distributed multifactorial (genetic and non-genetic) risk for psychosis. Psychotic experiences are a transdiagnostic phenomenon: the majority of individuals with these experiences have a diagnosis of non-psychotic disorder, particularly common mental disorder, in which psychotic experiences predict greater illness severity and poorer treatment response. Some of the people with common mental disorder and psychotic experiences will present to mental health services meeting criteria for "clinical high risk". Treatment of the transdiagnostic dimension of psychosis in individuals with common mental disorder who meet "clinical high risk" criteria thus may improve outcome (which cannot be interpreted as prevention of "schizophrenia"). Subthreshold psychotic experiences are transitory in about 80% of individuals, while around 20% go on to develop persistent psychotic experiences and 7% a psychotic disorder, with an annual transition rate of 0.5-1%. Persistence is associated, on the one hand, with environmental exposures, particularly childhood trauma, and, on the other, with network-type dynamic interactions between psychotic experiences themselves (e.g., interactions between hallucinatory experiences and delusional ideation) and between symptom dimensions (e.g., interactions between affective symptoms and psychotic experiences, or interactions between subthreshold negative symptoms and psychotic experiences). The study of psychotic experiences is helping to elucidate the mechanisms by which environmental and genetic influences shape the transdiagnostic expression of psychosis proneness, that is mostly transitory but may first become persistent over time and eventually give rise to transition to a psychotic disorder.
Department of Psychiatry and Psychology, Maastricht University Medical Centre, P.O. Box 616 (DOT12), 6200 MD Maastricht, The Netherlands.|King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK.
Jim
J
van Os
Department of Psychiatry and Psychology, Maastricht University Medical Centre, P.O. Box 616 (DOT12), 6200 MD Maastricht, The Netherlands.|King's College London, King's Health Partners, Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
Uli
U
Reininghaus
Psychotic experiences; aberrant salience; extended psychosis phenotype; genetic risk; network models of severity; neurocognition; socio-environmental factors; ultra-high-risk states