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07-04-2010 | Mental health | Article

Self-reported childhood psychotic symptoms ‘indicate impaired development’


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MedWire News: Self-reported psychotic symptoms in childhood are often a marker of an impaired developmental process and should be actively assessed by clinicians, say researchers.

The symptoms were associated with many of the same risk factors and correlates as adult schizophrenia, including genetic, social, neurodevelopmental, home-rearing, and behavioral risks.

The team suggests it is worthwhile to ask all preadolescent psychiatric patients about hallucinations and delusions, as the associated social risk factors and behavioral problems “should be a focus of attention.”

Avshalom Caspi, from Duke University in Durham, North Carolina, USA, and colleagues used the Dunedin Study age-11 study protocol to examine seven self-reported psychotic symptoms in 2232 UK children aged 12 years participating in the Environmental Risk Longitudinal Twin Study.

Psychotic symptoms were reported by 19.6% of the children, with 13.7% reporting only probable symptoms and 5.9% reporting one or more definite symptoms. Of those with at least one symptom, 28.8% had multiple definite symptoms and 60.8% also reported probable symptoms, the team notes in the Archives of General Psychiatry.

In all, 43% of the variance in psychotic symptoms was explained by genetic effects, while 57% was explained by child-specific environmental factors and error.

Children with psychotic symptoms were more likely than other children to have mothers with psychotic-spectrum disorders, as well as family members who had been admitted to psychiatric units and had attempted or completed suicide, at odds ratios of 2.5, 1.8, and 2.2, respectively.

Children with psychotic symptoms were more likely than other children to live in an urban environment, to come from disadvantaged families, have lower birth weights for their gestational age, have multiple perinatal complications, have lower IQs, greater executive deficits, and impaired theory of mind. They were also more likely to be raised by mothers with more negative expressed emotion toward them, live in more chaotic households, and to have been physically maltreated

The team also reports that children with psychotic symptoms were more likely than children without such symptoms to have behavioral, emotional, and educational problems at age 5 years, and comorbid conditions such as self-harm.

“Our findings suggest that the continuum model of psychosis may apply to preadolescents, as well as to the adults for which it was developed,” comment the authors.

They conclude: “Whether interventions focused on childhood psychotic symptoms will prove necessary, feasible, or cost-effective is an important and unanswered question.” .”

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