Persistent, distressing psychosis-like experiences associated with disability in youth

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Wednesday, November 17, 2021

An NIH-funded study highlights the need for early intervention and support for youth who report these experiences.

In a new study, researchers examined the association between annoying and persistent psychosis-like experiences (PLE) in youth and important risk factors for psychopathology. The researchers found that young people who indicate they have persistent, distressing PLEs show impairment in a variety of areas such as cognition and reported psychopathology, highlighting the long-term challenges these children may face and the need for early intervention and support. . The study, funded by the National Institutes of Health, appears in Molecular Psychiatry.

“Although we know that some children have psychotic experiences, it has remained unclear who will develop psychotic disorders later in life,” said Shelli Avenevoli, Ph.D., deputy director of the National Institute of Mental Health (NIMH). and author of the study. “This study shows that children who have persistent, distressing psychotic experiences face significant challenges during development, suggesting the value of early intervention for all children with these experiences, regardless of whether they continue to have psychotic disorders.”

More than 17% of children between the ages of 9 and 12 experience PLEs, such as mild perceptual abnormalities or delusional thoughts. However, only a small subset of these children will develop psychotic disorders. One factor that could help distinguish clinically significant PLEs from benign ones is whether the psychotic experiences are persistent and / or annoying. In this study, lead author Nicole Karcher, Ph.D., of the University of Washington School of Medicine, St. Louis, and colleagues examined how many constant and / or distressing PLEs were associated with risk factors for psychosis.

The researchers used data from the Adolescent Brain Cognitive Development (ABCD) study, a large-scale research effort that collects data on 9- and 10-year-olds across the United States. The researchers used data collected at three time points between September 1, 2016. and October 15, 2018. This included baseline data taken near the start of the study period and data collected one and two years later. At each of these time points, children were assessed for PLEs and a level of distress associated with the experiences.

The researchers used these data to form four groups: a constant distress PLE group, a transient distress PLE group, a constant non-distress PLE group, and a transient non-distress PLE group. PLEs were considered persistent if they were reported during at least 2 waves of data collection and misery was assessed by self-reporting survey.

They then examined differences in various risk factors for psychosis between these four groups. These factors, measured at the first baseline time point, included indicators of psychopathology, functioning (e.g., how children are doing in school and use of mental health services), cognitive abilities, developmental milestone achievement, environmental distress, adverse childhood experiences, and brain structure. and function.

Overall in the study, the greatest functional impairments and mental health utilization were seen in those with both distressing and persistent PLEs. In addition, young people who experienced persistent, distressing PLEs had greater bipolar, externalizing, and internalizing symptoms than youth without persistent, distressing PLEs. The most significant effects on cognitive functioning, such as greater deficits in fluid cognition, including working memory and receptive language, have also been seen in youth with persistent, distressing PLEs. Young people with persistent, distressing PLEs also experienced more significant environmental distress than their counterparts, such as higher overall grade levels and more unfavorable childhood experiences.

The researchers also found that young people who experienced distressed PLEs, whether transient or persistent, delayed developmental milestones, lower cortical and subcortical brain volumes, and differences in brain network connectivity compared with youth who had non-weak PLEs. .

“These new longitudinal data underscore that often only in the context of distress persistent PLE is related to defects,” Dr. Karcher said.

The findings of this study indicate that children with persistent, distressing PLEs show elevated risk factors in domains such as psychopathology, functioning, and cognitive activity. These results suggest that persistent, distressing PLEs represent an important screening indicator of youth who develop long-term challenges, regardless of whether they continue to develop psychotic disorders, and may indicate which children are prime candidates for early intervention.

Grants: DA041120, MH121792, MH120574, MH018261, AA017242

About the National Institute of Mental Health (NIMH): The mission of the NIMH is to transform the understanding and treatment of mental illness through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website.

About the National Institutes of Health (NIH):NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the leading federal agency conducting and supporting basic, clinical, and translation medical research, and investigates the causes, treatments, and cures for common and rare diseases. For more information about NIH and its programs, visit

NIH … Transforming Discovery into Health®


Karcher, NR, Loewy, RL, Savill, M., Avenevoli, S., Huber, RS, Makowski, C., Sher, KJ, Barch, DM (2021). Persistent and distressing psychosis-like experiences using data on Adolescent Brain Cognitive Development℠. Molecular Psychiatry. doi: 10.1038 / s41380-021-01373-x.



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