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Do subthreshold psychotic experiences predict clinical outcomes in unselected non-help-seeking population-based samples? A systematic review and meta-analysis, enriched with new results

Published online by Cambridge University Press:  20 January 2012

N. Kaymaz ,
M. Drukker ,
R. Lieb ,
H.-U. Wittchen ,
N. Werbeloff ,
M. Weiser ,
T. Lataster  and
J. van Os
N. Kaymaz
Affiliation:
Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands Mediant GGZ/Mental Health Care, Enschede, The Netherlands
M. Drukker
Affiliation:
Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands
R. Lieb
Affiliation:
Division of Clinical Psychology and Epidemiology, Max Planck Institute of Psychiatry, Munich, Germany Department of Psychology, Division of Epidemiology and Health Psychology, University of Basel, Switzerland
H.-U. Wittchen
Affiliation:
Division of Clinical Psychology and Epidemiology, Max Planck Institute of Psychiatry, Munich, Germany Institute of Clinical Psychology and Psychotherapy, Technical University Dresden, Germany
N. Werbeloff
Affiliation:
Department of Psychiatry, Sheba Medical Centre, Tel-Hashomer, Israel
M. Weiser
Affiliation:
Department of Psychiatry, Sheba Medical Centre, Tel-Hashomer, Israel
T. Lataster
Affiliation:
Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands
J. van Os*
Affiliation:
Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK
*
*Address for correspondence: J. van Os, Ph.D., Department of Psychiatry and Psychology, Maastricht University Medical Centre, PO Box 616 (DRT 12), 6200MD Maastricht, The Netherlands. (Email: [email protected])
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Abstract

Background

The base rate of transition from subthreshold psychotic experiences (the exposure) to clinical psychotic disorder (the outcome) in unselected, representative and non-help-seeking population-based samples is unknown.

Method

A systematic review and meta-analysis was conducted of representative, longitudinal population-based cohorts with baseline assessment of subthreshold psychotic experiences and follow-up assessment of psychotic and non-psychotic clinical outcomes.

Results

Six cohorts were identified with a 3–24-year follow-up of baseline subthreshold self-reported psychotic experiences. The yearly risk of conversion to a clinical psychotic outcome in exposed individuals (0.56%) was 3.5 times higher than for individuals without psychotic experiences (0.16%) and there was meta-analytic evidence of dose–response with severity/persistence of psychotic experiences. Individual studies also suggest a role for motivational impairment and social dysfunction. The evidence for conversion to non-psychotic outcome was weaker, although findings were similar in direction.

Conclusions

Subthreshold self-reported psychotic experiences in epidemiological non-help-seeking samples index psychometric risk for psychotic disorder, with strong modifier effects of severity/persistence. These data can serve as the population reference for selected and variable samples of help-seeking individuals at ultra-high risk, for whom much higher transition rates have been indicated.

Keywords

Delusionshallucinationsmeta-analysispreventionpsychotic disordersrisk
Type
Review Article
Information
Psychological Medicine , Volume 42 , Issue 11 , November 2012 , pp. 2239 - 2253
Copyright
Copyright © Cambridge University Press 2012

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