تجارب روانی در جامعه: ارتباط با عملکرد و پریشانی روانی

Psychotic experiences are far more common in the population than psychotic disorder. They are associated with a number of adverse outcomes but there has been little research on associations with functioning and distress. We wished to investigate functioning and distress in a community sample of adolescents with psychotic experiences. Two hundred and twelve school-going adolescents were assessed for psychotic experiences, mental distress associated with these experiences, global (social/occupational) functioning on the Children's Global Assessment Scale, and a number of candidate mediator variables, including psychopathology, suicidality, trauma (physical and sexual abuse and exposure to domestic violence) and neurocognitive functioning. Seventy five percent of participants who reported psychotic experiences reported that they found these experiences distressing (mean score for severity of distress was 6.9 out of maximum 10). Participants who reported psychotic experiences had poorer functioning than participants who did not report psychotic experiences (respective means: 68.6, 81.9; OR = 0.25, 95% CI = 0.14–0.44). Similarly, participants with an Axis-1 psychiatric disorder who reported psychotic experiences had poorer functioning than participants with a disorder who did not report psychotic experiences (respective means: 61.8, 74.5; OR = 0.28, 95% CI = 0.12–0.63). Candidate mediator variables explained some but not all of the relationship between psychotic experiences and functioning (OR = 0.48, 95% CI = 0.22–1.05, P < 0.07). Young people with psychotic experiences have poorer global functioning than those who do not, even when compared with other young people with psychopathology (but who do not report psychotic experiences). A disclosure of psychotic experiences should alert treating clinicians that the individual may have significantly more functional disability than suggested by the psychopathological diagnosis alone.

Psychotic experiences are far more common in the population than psychotic disorder (Lin et al., 2011, Saha et al., 2011a, Laurens et al., 2012, Devylder et al., 2013 and Cullen et al., 2014). Amongst young people, these experiences most commonly occur in the form of auditory hallucinations, which may be frankly psychotic in nature or, more commonly, attenuated (that is, hallucinatory experiences with intact reality testing) (Kelleher et al., 2011). Psychotic experiences have been found to be important from a number of clinical perspectives. In addition to a relatively increased risk for psychosis (Poulton et al., 2000, Welham et al., 2009, Kaymaz et al., 2012 and Fisher et al., 2013), young people with psychotic experiences are at high risk for a range of psychopathological diagnoses (Scott et al., 2009, Yung et al., 2009, Barragan et al., 2011, Werbeloff et al., 2012, Wigman et al., 2012a and Downs et al., 2013). We recently demonstrated in multiple independent samples that the majority of community-based adolescents who reported psychotic experiences met criteria for at least one (non-psychotic) DSM-IV Axis-1 psychiatric disorder (Kelleher et al., 2012b). Similarly, results from the Dunedin longitudinal study showed that the majority of young people who reported psychotic experiences at age 11 had a DSM IV Axis-1 psychiatric disorder at age 38 (Fisher et al., 2013). Whilst there has been some research on functioning in individuals at ‘clinical high risk’ for psychosis (Carrion et al., 2011, Corcoran et al., 2011 and Grano et al., 2011), there has been little research to date on global functioning in community samples who report psychotic experiences. Therefore, we wished to investigate the relationship between psychotic experiences and functioning in a general population sample of adolescents. At a mechanistic level, there are a number of factors that might contribute to poorer functioning in individuals with psychotic experiences. Aside from an overall increased risk of having a diagnosable mental disorder, psychotic experiences are a strong marker of risk for multimorbidity (that is, the presence of more than one disorder), with the prevalence of psychotic experiences increasing in a dose–response manner with the number of diagnosable disorders (Kelleher et al., 2012b), a finding that has been replicated in clinical (Kelleher et al., 2013b) and heterogeneous population samples (DeVylder et al., 2014). What is more, suicidality is highly prevalent amongst individuals with psychopathology who report psychotic experiences, even compared to individuals with the same diagnoses (but who do not report psychotic experiences) (Kelleher et al., 2012c and Kelleher et al., 2014). Neurocognitive deficits have been reported in individuals with psychotic experiences, most notably in processing speed (Blanchard et al., 2010, Cullen et al., 2010, Barnett et al., 2012 and Kelleher et al., 2012a), a domain that has previously been highlighted as important more generally in terms of social/role functioning (Carrion et al., 2011). Furthermore, individuals with psychotic experiences have been shown to have significantly more exposure to childhood trauma (Janssen et al., 2004, Scott et al., 2007, Freeman and Fowler, 2009, Arseneault et al., 2011, Galletly et al., 2011, Saha et al., 2011b, Fisher et al., 2012, Wigman et al., 2012b and Kelleher et al., 2013c), something that might also contribute to long term dysfunction. We also wished to investigate the relationship between psychotic experiences and subjective mental distress. Whilst young people who report psychotic experiences are at increased risk for a range of distressing outcomes (Yung et al., 2006), there has been little research to examine whether psychotic experiences are, in themselves, distressing to the young people who experience them. Notably, Armando et al. found a strong correlation between the frequency of psychotic experiences in a population sample and reported levels of distress (Armando et al., 2010). However, their methodology did not allow them to report the proportion of individuals with psychotic experiences who were distressed by them, nor whether this distress impacted on overall functioning. Therefore, we also investigated what proportion of young people in the population reported feeling distressed by their psychotic experiences and whether distress was related to overall functioning. Specifically, our hypotheses were: (i) Individuals with psychotic experiences would have poorer global functioning than individuals without psychotic experiences. (ii) Individuals with psychopathology who reported psychotic experiences would have poorer global functioning than individuals with psychopathology who did not report psychotic experiences. (iii) Multimorbid psychopathology, suicidality, neurocognitive dysfunction and trauma exposure would at least partly explain the relationship between psychotic experiences and poorer global functioning. (iv) Psychotic experiences would be distressing for the majority of individuals. (v) The level of distress associated with psychotic experiences would be inversely related to global functioning.