Psychotic symptoms linked to poorer health in general population
MedWire News: The presence of at least one psychotic symptom has a significant negative effect on health status, even among individuals who do not meet diagnostic criteria for psychosis, research shows.
Lead author Somnath Chatterji (World Health Organization [WHO], Geneva, Switzerland) and team explain that "in the last few years, the traditional view of psychosis as a categorical entity… has been challenged for epidemiological, experimental, and theoretical reasons supporting the idea that psychotic symptoms may in fact be distributed along a continuum."
They add: "This would imply that psychotic symptoms are present in the community population without diagnosable disorders, and these symptoms could potentially impact daily functioning even when the symptoms do not reach the clinical threshold for a disorder."
To investigate the prevalence of psychotic symptoms in the general population and their impact on health status, the researchers studied data on 256,445 individuals (55.9% women) from 52 countries who participated in the WHO's World Health Survey.
The presence of psychotic symptoms, such as hallucinations and delusions, was based on responses to specific questions in the Composite International Diagnostic Interview.
Health status was assessed using 16 health-related questions grouped into eight domains: vision, mobility, self-care, cognition, interpersonal activities, pain and discomfort, sleep and energy, and affect. From this, a composite score for health status was calculated ranging from 0 (worst health) to 100 (best health).
The researchers found that, among participants without a previous diagnosis of schizophrenia, 5.8% reported experiencing one psychotic symptom, 2.9% two symptoms, 1.7% three symptoms, and 1.1% reported four symptoms in the past year.
The proportion of people reporting at least one psychotic symptom varied significantly between countries, from 0.8% in Vietnam to 31.4% in Nepal.
The presence of at least one psychotic symptom was associated with a significant reduction in health status scores, with an increasing number of symptoms associated with increasingly poorer scores.
Indeed, the mean health status score in participants without any psychotic symptoms was 76.2, compared with 68.5 in those with one symptom, 66.8 in those with two symptoms, 64.8 in those with three symptoms, and 63.0 in those reporting four symptoms.
Chatterji and colleagues conclude in Schizophrenia Bulletin: "Psychotic symptoms signal a problem of potential public health concern, independent of the presence of a full diagnosis of psychosis, as they are common and are related to a significant decrement in health status."
They add: "Within the framework of the current debate about the inclusion of a psychosis risk syndrome in the DSM-V, it is not clear if the presence of one symptom is indicative or not of an incipient clinical disorder, but it does signal the need for a more detailed evaluation."
By Mark Cowen