A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness–persistence–impairment model of psychotic disorder

  title={A systematic review and meta-analysis of the psychosis continuum: evidence for a psychosis proneness–persistence–impairment model of psychotic disorder},
  author={Jim van os and Richard J Linscott and Inez Myin-Germeys and Phillipe Delespaul and Lydia Krabbendam},
  journal={Psychological Medicine},
  pages={179 - 195}
A systematic review of all reported incidence and prevalence studies of population rates of subclinical psychotic experiences reveals a median prevalence rate of around 5% and a median incidence rate of around 3%. A meta-analysis of risk factors reveals associations with developmental stage, child and adult social adversity, psychoactive drug use, and also male sex and migrant status. The small difference between prevalence and incidence rates, together with data from follow-up studies… 

An updated and conservative systematic review and meta-analysis of epidemiological evidence on psychotic experiences in children and adults: on the pathway from proneness to persistence to dimensional expression across mental disorders

Compelling support is found for the phenomenological and temporal continuity between PE and psychotic disorder and for the fundamental proposition that this relationship is probabilistic.

The impact of childhood adversity on the persistence of psychotic symptoms: a systematic review and meta-analysis

It is tentatively suggested that reported exposure to adverse events in childhood is associated with persistence of PE and clinically relevant psychotic symptoms, which partially strengthens the case for addressing the consequences of early adversity in individuals presenting with psychotic phenomena to improve long-term outcomes.

Testing the psychosis continuum: differential impact of genetic and nongenetic risk factors and comorbid psychopathology across the entire spectrum of psychosis.

Lability associated with respectively affective and nonaffective symptom domains, in interaction with environmental risks, may operate by impacting differentially over a quasi-continuous extended psychosis phenotype in the population.

Systematic Review and Meta-analysis: Psychosis Risk in Children and Adolescents With an At-Risk Mental State.

At risk for schizophrenic or affective psychoses? A meta-analysis of DSM/ICD diagnostic outcomes in individuals at high clinical risk.

The HRP state is heterogeneous in term of longitudinal diagnoses; however, the current HRP diagnostic criteria appear strongly biased toward an identification of early phases of SP rather than AP.

Evidence that onset of clinical psychosis is an outcome of progressively more persistent subclinical psychotic experiences: an 8-year cohort study.

A significant proportion of psychotic disorder may be conceptualized as the rare poor outcome of a common developmental phenotype characterized by persistence of psychometrically detectable subclinical psychotic experiences, described descriptively as a psychosis proneness-persistence-impairment model of psychotic Disorder.

A twin study of genetic and environmental determinants of abnormal persistence of psychotic experiences in young adulthood

  • J. WigmanR. van Winkel J. van os
  • Psychology, Medicine
    American journal of medical genetics. Part B, Neuropsychiatric genetics : the official publication of the International Society of Psychiatric Genetics
  • 2011
The findings suggest that persistence of subclinical psychosis is influenced by both genetic and environmental factors, providing the possibility to study the (possibly modifiable) etiology underlying the longitudinal process of persistence of the early expression of psychosis liability.

Evidence for a persistent, environment-dependent and deteriorating subtype of subclinical psychotic experiences: a 6-year longitudinal general population study

The results suggest that the outcome of early developmental deviation associated with later expression of psychotic experiences is contingent on the degree of later interaction with environmental risks inducing, first, persistence of psychosis experiences and, second, progression to onset of need for care and service use.



Does normal developmental expression of psychosis combine with environmental risk to cause persistence of psychosis? A psychosis proneness–persistence model

The findings suggest that environmental risks for psychosis act additively, and that the level of environmental risk combines synergistically with non-clinical developmental expression of psychosis to cause abnormal persistence and, eventually, need for care.

Psychosis prediction: 12-month follow up of a high-risk (“prodromal”) group

Evidence that the outcome of developmental expression of psychosis is worse for adolescents growing up in an urban environment

Findings support the suggestion that the outcome of the developmental expression of psychosis is worse in urban environments, as an indicator of psychosis-proneness.

Prevalence and correlates of self-reported psychotic symptoms in the British population

Self-reported psychotic symptoms are less common in this study than reported elsewhere, because of the measure used, but these symptoms have demographic and clinical correlates similar to clinical psychosis.

The association between psychosis and problematical drug use among Australian adults: findings from the National Survey of Mental Health and Well-Being

Ordinal logistic regressions revealed that regular tobacco use, cannabis and alcohol dependence, and opiate abuse were predictors of psychosis scores, and work is needed to develop effective treatment approaches for problematical substance use among persons with psychosis.

Impact of psychological trauma on the development of psychotic symptoms: relationship with psychosis proneness

Exposure to psychological trauma may increase the risk of psychotic symptoms in people vulnerable to psychosis.

The incidence and outcome of subclinical psychotic experiences in the general population.

The incidence of positive psychotic experiences in the general population is around 100 times greater than traditional estimates of incidence of psychotic disorder such as schizophrenia and the far most likely outcome for these experiences is discontinuity.

Impairment of self-monitoring: part of the endophenotypic risk for psychosis.

Alterations in self-monitoring are associated with psychosis with evidence of specificity for delusional ideation.