Psychotic symptoms
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Prevalence and Impact of Psychotic Symptoms: A Comprehensive Overview
Prevalence of Psychotic Symptoms in Childhood and Adolescence
Psychotic symptoms are relatively common among children and adolescents, with a notable difference in prevalence between age groups. A systematic review found that the median prevalence of psychotic symptoms is 17% among children aged 9-12 years and 7.5% among adolescents aged 13-18 years1. This indicates that younger children are more likely to experience psychotic symptoms compared to older adolescents.
Psychotic Symptoms in Anxiety and Depression Disorders
Psychotic symptoms are not confined to psychotic disorders alone; they are also prevalent in individuals with anxiety and depression. Approximately 27% of those with anxiety and depressive disorders report experiencing psychotic symptoms, compared to 14% in those without these disorders2. These symptoms are associated with a younger age, male sex, and a more severe illness course, including greater persistence of schizotypal and negative symptoms, increased service use, and higher exposure to trauma and substance use2.
Psychotic Symptoms in Borderline Personality Disorder (BPD)
Individuals with Borderline Personality Disorder (BPD) frequently experience psychotic symptoms, such as auditory hallucinations and paranoid delusions. These symptoms often emerge or intensify in response to stressful events and are linked to a more severe course of BPD3. Adolescents with full-threshold BPD report more psychotic symptoms, including confusion, paranoia, and visual hallucinations, compared to those with sub-threshold BPD or no BPD features6.
Psychotic Symptoms in the General Population
In the general population, psychotic symptoms are not uncommon. A study in Great Britain found that 4.4% of the population reported new psychotic symptoms over an 18-month period, with risk factors including living in rural areas, having a small support group, experiencing adverse life events, smoking, and engaging in harmful drinking patterns4. Cross-national studies have shown that the prevalence of psychotic symptoms varies widely, from 0.8% to 31.4%, and these symptoms significantly impact health status5.
Psychotic Symptoms in Bipolar Disorder
Psychotic symptoms are prevalent in individuals with bipolar disorder (BD), particularly in those with Bipolar I Disorder (BDI). The lifetime prevalence of psychotic symptoms in BDI is around 63%, while it is 22% in Bipolar II Disorder (BDII)9. These symptoms are more common during manic episodes and are associated with a more severe illness course, including increased hospitalizations and poorer outcomes10.
Psychotic Symptoms in Primary Care Settings
In urban general medical practices, particularly those serving low-income populations, psychotic symptoms are highly prevalent. About 20.9% of patients report experiencing psychotic symptoms, with a higher prevalence among those with major depression, panic disorder, generalized anxiety disorder, and alcohol use disorder7. These patients often face significant social and occupational impairments, highlighting the need for routine screening for psychotic symptoms in primary care settings.
Mechanisms and Meaning of Psychotic Symptoms in Young People
Psychotic symptoms in young people are often associated with common mental disorders such as depression and anxiety rather than severe psychotic illnesses. Understanding the underlying mechanisms, such as the role of mesocorticostriatal circuitry in error-dependent learning, and differentiating factors related to social and emotional aspects, is crucial for clinicians8.
Conclusion
Psychotic symptoms are prevalent across various age groups and mental health conditions, significantly impacting individuals' health and functioning. Recognizing and addressing these symptoms in clinical practice, especially in non-psychotic disorders and primary care settings, is essential for improving patient outcomes. Further research is needed to better understand the mechanisms and develop effective treatments for psychotic symptoms in different populations.
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Most relevant research papers on this topic
Prevalence of psychotic symptoms in childhood and adolescence: a systematic review and meta-analysis of population-based studies
Psychotic symptoms are relatively common in young people, with a higher prevalence in younger (9-12 years) children compared to older (13-18 years) children.
Meta-Analysis
Very Rigorous Journal
Highly CitedEvidence 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.
Psychotic symptoms are common in anxiety and depression disorders, impacting illness onset, risk, and severity, and highlighting the need for a network-based approach to psychopathology.
Observational Study
Rigorous JournalHighly CitedPsychotic symptoms in borderline personality disorder: an update
Psychotic symptoms in borderline personality disorder (BPD) are common and related to stressful events, but their relationship with trauma processing, emotion regulation, distress tolerance, and interpersonal sensitivity remains unclear.
Literature ReviewSelf-reported psychotic symptoms in the general population
A small percentage of the population in Great Britain reported incident psychotic symptoms over 18 months, with factors like rural living, small support groups, adverse life events, smoking, neurotic symptoms, and harmful drinking patterns.
Observational StudyRigorous JournalHighly CitedThe continuum of psychotic symptoms in the general population: a cross-national study.
Psychotic symptoms are common and significantly impact health status, with a linear decline in health status based on the number of symptoms.
Observational StudyRigorous JournalHighly CitedPsychotic symptoms in adolescents with borderline personality disorder features
Adolescents with full-threshold borderline personality disorder (BPD) have significantly more psychotic symptoms than those with sub-threshold BPD features, and these symptoms predict BPD severity.
Observational StudyVery Rigorous JournalPsychotic symptoms in an urban general medicine practice.
Psychotic symptoms are highly prevalent in urban primary care practices, with low-income patients at higher risk for common mental disorders and impaired work and social functioning.
Observational StudyHighly CitedPsychotic symptoms in young people without psychotic illness: mechanisms and meaning
Psychotic symptoms in young people are more often associated with common mental disorders like depression and anxiety than severe psychotic illness.
Rigorous JournalLifetime and point prevalence of psychotic symptoms in adults with bipolar disorders: a systematic review and meta-analysis
The lifetime prevalence of psychotic symptoms in adults with bipolar disorders is 63% in type I and 22% in type II, with more studies needed for depressive and mixed episodes and community samples.
Meta-AnalysisRigorous JournalPsychotic symptoms in bipolar disorder and their impact on the illness: A systematic review
Psychotic symptoms are common in bipolar disorder patients, but their impact on the illness' course and outcome is not always negative.
Systematic ReviewVery Rigorous Journal