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Psychotic experiences in a mental health clinic sample: implications for suicidality, multimorbidity and functioning

Published online by Cambridge University Press:  12 September 2013

I. Kelleher ,
N. Devlin ,
J. T. W. Wigman ,
A. Kehoe ,
A. Murtagh ,
C. Fitzpatrick  and
M. Cannon
I. Kelleher*
Affiliation:
Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland Karolinska Institute, National Centre for Suicide Research and Prevention of Mental Ill-Health, Stockholm, Sweden
N. Devlin
Affiliation:
Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
J. T. W. Wigman
Affiliation:
Maastricht University, Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
A. Kehoe
Affiliation:
University College Dublin, Catherine McAuley Research Centre, Dublin, Ireland
A. Murtagh
Affiliation:
Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
C. Fitzpatrick
Affiliation:
University College Dublin, Catherine McAuley Research Centre, Dublin, Ireland Department of Child and Family Psychiatry, Mater Misericordiae University Hospital, Metropolitan Building, Dublin, Ireland
M. Cannon
Affiliation:
Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland Department of Psychiatry, Beaumont Hospital, Dublin, Ireland
*
*Address for correspondence: Ian Kelleher, Ph.D., Karolinska Institute, National Centre for Suicide Research and Prevention of Mental Ill-Health, World Health Organization Collaborating Centre, Granits vag 4, 17177 Stockholm, Sweden. (Email: iankelleher@rcsi.ie)
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Abstract

Background

Recent community-based research has suggested that psychotic experiences act as markers of severity of psychopathology. There has, however, been a lack of clinic-based research. We wished to investigate, in a clinical sample of adolescents referred to a state-funded mental health service, the prevalence of (attenuated or frank) psychotic experiences and the relationship with (i) affective, anxiety and behavioural disorders, (ii) multimorbid psychopathology, (iii) global functioning, and (iv) suicidal behaviour.

Method

The investigation was a clinical case–clinical control study using semi-structured research diagnostic psychiatric assessments in 108 patients newly referred to state adolescent mental health services.

Results

Psychotic experiences were prevalent in a wide range of (non-psychotic) disorders but were strong markers of risk in particular for multimorbid psychopathology (Z = 3.44, p = 0.001). Young people with psychopathology who reported psychotic experiences demonstrated significantly poorer socio-occupational functioning than young people with psychopathology who did not report psychotic experiences, which was not explained by multimorbidity. Psychotic experiences were strong markers of risk for suicidal behaviour. Stratified analyses showed that there was a greatly increased odds of suicide attempts in patients with a major depressive disorder [odds ratio (OR) 8.89, 95% confidence interval (CI) 1.59–49.83], anxiety disorder (OR 15.4, 95% CI 1.85–127.94) or behavioural disorder (OR 3.13, 95% CI 1.11–8.79) who also had psychotic experiences compared with patients who did not report psychotic experiences.

Conclusions

Psychotic experiences (attenuated or frank) are an important but under-recognized marker of risk for severe psychopathology, including multimorbidity, poor functioning and suicidal behaviour in young people who present to mental health services.

Keywords

Child and adolescent psychiatrymultimorbiditypsychosispsychotic experiencessuicide
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 8 , June 2014 , pp. 1615 - 1624
Copyright
Copyright © Cambridge University Press 2013 

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