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Self-reported attenuated psychotic symptoms as forerunners of severe mental disorders later in life.
Arch Gen Psychiatry. 2012 May; 69(5):467-75.AG

Abstract

CONTEXT

It has been suggested that attenuated psychotic symptoms (APSs) reported by people who do not have psychotic disorders signal risk for later severe mental illness.

OBJECTIVE

To investigate this suggestion using follow-up assessments of hospitalization for clinical diagnoses of nonaffective psychotic and other psychiatric disorders.

DESIGN

Longitudinal cohort study of self-reported APSs with outcome assessment of severe mental illness obtained through linkage with a national hospitalization case registry.

SETTING

Israel.

PARTICIPANTS

A stratified full probability sample of 4914 persons aged 25 to 34 years who were screened for psychopathology in the 1980s.

MAIN OUTCOME MEASURE

Subsequent psychiatric hospitalization was ascertained using the psychiatric hospitalization registry, with a mean follow-up of 24 years.

RESULTS

After removing subjects with diagnosable psychotic disorders at baseline, 57.2% of the remaining sample reported at least 1 weak (infrequent) APS and 14.3% reported at least 1 strong (frequent) APS in the year preceding the assessment. Self-reported APSs predicted risk of later hospitalization for nonaffective psychotic disorders, mostly during the 5 years after baseline (adjusted odds ratio = 4.31; 95% CI, 2.21-8.41; positive predictive value = 1.27%; population attributable risk fraction = 33%). Also, APSs increased the risk of later hospitalization for other psychiatric disorders, albeit to a lesser extent (adjusted odds ratio = 2.21; 95% CI, 1.02-4.82).

CONCLUSIONS

Self-reported APSs signal risk for later nonaffective psychotic disorders but are not clinically useful as predictors. The difference between these population-based data and the high-risk literature in terms of the positive predictive value (1% vs 10%, respectively) and the time window of transition (5 years vs 12 months, respectively) can be attributed to the selective enrichment strategies that produce high-risk samples.

Authors+Show Affiliations

Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Ramat Gan, 52621, Israel.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22213772

Citation

Werbeloff, Nomi, et al. "Self-reported Attenuated Psychotic Symptoms as Forerunners of Severe Mental Disorders Later in Life." Archives of General Psychiatry, vol. 69, no. 5, 2012, pp. 467-75.
Werbeloff N, Drukker M, Dohrenwend BP, et al. Self-reported attenuated psychotic symptoms as forerunners of severe mental disorders later in life. Arch Gen Psychiatry. 2012;69(5):467-75.
Werbeloff, N., Drukker, M., Dohrenwend, B. P., Levav, I., Yoffe, R., van Os, J., Davidson, M., & Weiser, M. (2012). Self-reported attenuated psychotic symptoms as forerunners of severe mental disorders later in life. Archives of General Psychiatry, 69(5), 467-75. https://doi.org/10.1001/archgenpsychiatry.2011.1580
Werbeloff N, et al. Self-reported Attenuated Psychotic Symptoms as Forerunners of Severe Mental Disorders Later in Life. Arch Gen Psychiatry. 2012;69(5):467-75. PubMed PMID: 22213772.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Self-reported attenuated psychotic symptoms as forerunners of severe mental disorders later in life. AU - Werbeloff,Nomi, AU - Drukker,Marjan, AU - Dohrenwend,Bruce P, AU - Levav,Itzhak, AU - Yoffe,Rinat, AU - van Os,Jim, AU - Davidson,Michael, AU - Weiser,Mark, Y1 - 2012/01/02/ PY - 2012/1/4/entrez PY - 2012/1/4/pubmed PY - 2012/6/28/medline SP - 467 EP - 75 JF - Archives of general psychiatry JO - Arch Gen Psychiatry VL - 69 IS - 5 N2 - CONTEXT: It has been suggested that attenuated psychotic symptoms (APSs) reported by people who do not have psychotic disorders signal risk for later severe mental illness. OBJECTIVE: To investigate this suggestion using follow-up assessments of hospitalization for clinical diagnoses of nonaffective psychotic and other psychiatric disorders. DESIGN: Longitudinal cohort study of self-reported APSs with outcome assessment of severe mental illness obtained through linkage with a national hospitalization case registry. SETTING: Israel. PARTICIPANTS: A stratified full probability sample of 4914 persons aged 25 to 34 years who were screened for psychopathology in the 1980s. MAIN OUTCOME MEASURE: Subsequent psychiatric hospitalization was ascertained using the psychiatric hospitalization registry, with a mean follow-up of 24 years. RESULTS: After removing subjects with diagnosable psychotic disorders at baseline, 57.2% of the remaining sample reported at least 1 weak (infrequent) APS and 14.3% reported at least 1 strong (frequent) APS in the year preceding the assessment. Self-reported APSs predicted risk of later hospitalization for nonaffective psychotic disorders, mostly during the 5 years after baseline (adjusted odds ratio = 4.31; 95% CI, 2.21-8.41; positive predictive value = 1.27%; population attributable risk fraction = 33%). Also, APSs increased the risk of later hospitalization for other psychiatric disorders, albeit to a lesser extent (adjusted odds ratio = 2.21; 95% CI, 1.02-4.82). CONCLUSIONS: Self-reported APSs signal risk for later nonaffective psychotic disorders but are not clinically useful as predictors. The difference between these population-based data and the high-risk literature in terms of the positive predictive value (1% vs 10%, respectively) and the time window of transition (5 years vs 12 months, respectively) can be attributed to the selective enrichment strategies that produce high-risk samples. SN - 1538-3636 UR - https://www.unboundmedicine.com/medline/citation/22213772/Self_reported_attenuated_psychotic_symptoms_as_forerunners_of_severe_mental_disorders_later_in_life_ L2 - https://jamanetwork.com/journals/jamapsychiatry/fullarticle/10.1001/archgenpsychiatry.2011.1580 DB - PRIME DP - Unbound Medicine ER -