Menu
  • CPD online - National Elf Service
  • Take your event #BeyondTheRoom
  • Training
  • #ElfHelp
  • Contact us
  • News

No bias. No misinformation. No spin. Just what you need!

The Mental Elf

  • Home
  • About
  • Categories
      • Cost effectiveness
      • Evaluation and impact assessment
      • Financial management
      • Financial sustainability
      • Integration
      • Needs assessment
      • Outcomes based commissioning
      • Partnership working
      • Population health
      • Resource allocation
      • Service reconfiguration
      • Service review and improvement
      • Specialised commissioning
      • Strategy development and planning
      • Technology
      • Urgent care
      • Variation
      • caries
      • cleft lip and palate
      • dental workforce
      • endodontics
      • oral and maxillofacial surgery
      • oral cancer
      • oral health
      • oral medicine and pathology
      • orthodontics
      • periodontal disease
      • restorative dentistry
      • temporomandibular joint disorders
      • tooth surface loss
    • Diagnosis
      • brain imaging
      • diagnostic test
      • risk factors
      • screening programme
      • screening test
      • behaviour
      • ICT
      • learning styles
      • numeracy
      • phonics
      • reading
      • science
      • social emotional
      • social skills
      • wellbeing
      • autistic spectrum disorder
      • challenging behaviour
      • communication
      • down syndrome
      • parents with learning disabilities
      • prader-willi syndrome
      • profound and multiple learning disability
    • Mental health
      • ADHD
      • anxiety
      • bipolar disorder
      • dementia
      • depression
      • eating disorders
      • OCD
      • panic disorder
      • personality disorders
      • psychosis
      • PTSD
      • schizophrenia
      • self-harm
      • sleep disorders
      • substance misuse
      • suicide
      • autoimmune and inflammatory diseases
      • fibromyalgia
      • fractures and dislocations
      • musculoskeletal pain
      • neck and back pain
      • osteoarthritis
      • osteoporosis
      • rheumatoid arthritis
      • soft tissue injuries
      • spinal conditions
      • spondyloarthropathies
    • Other health conditions
      • blood-borne viruses
      • cancer
      • cardiovascular disease
      • chronic fatigue syndrome
      • comorbidity
      • epilepsy
      • multiple sclerosis
      • sleep apnoea
      • traumatic brain injury
    • Populations and settings
      • advocacy
      • black and minority ethnic
      • caregivers
      • child and adolescent
      • commissioning
      • community settings
      • crime
      • deinstitutionalisation
      • employment
      • end of life
      • family carers
      • hospital admissions
      • housing
      • later life
      • LGBTQ+
      • liaison psychiatry
      • loneliness
      • older adult
      • parenting
      • patient safety
      • perinatal mental health
      • poverty
      • pregnancy
      • primary care
      • quality of life
      • schools
      • secondary care
      • service user involvement
      • shared care
      • sport
      • training
      • vulnerable people
      • young adult
    • Publication types
      • appraisal
      • audit
      • case study
      • case-control
      • cohort study
      • consultation
      • cross-sectional
      • economic analysis
      • economic evaluation
      • guideline
      • legislation
      • literature review
      • meta-analysis
      • mixed methods
      • observational study
      • patient information
      • policy
      • prospective study
      • qualitative
      • questionnaire
      • randomised controlled trial
      • report
      • scoping review
      • statistics
      • survey
      • systematic review
      • technology assessment
      • training resource
      • umbrella review
      • website
      • coproduction
      • equality and diversity
      • evidence based social care
      • home care
      • integration
      • local authorities
      • nursing homes
      • personal budgets and direct payments
      • personalisation
      • reablement
      • residential care
      • safeguarding
      • social care decision making
      • social care training
      • social care workforce
      • social work
      • support planning
      • user led organisations
      • voluntary and community sector
    • Treatment
      • antidepressants
      • antipsychotics
      • CBT
      • cognitive bias modification (cbm)
      • complementary and alternative
      • digital health
      • exercise
      • medicines
      • mental illness prevention
      • mindfulness
      • other
      • psychotherapy
      • rehabilitation
      • self-management
      • surgical
      • systems
      • telehealth
      • topical
  • Podcasts
Search

Home » Posts » Mental health » psychosis » Psychotic experiences: how common are they and how can we predict their onset, course and consequences?

Psychotic experiences: how common are they and how can we predict their onset, course and consequences?

110 Responses »
Jun 10 2015
Profile photo of Farhana Mann
Posted by
Farhana Mann
shutterstock_146510915

Many have grappled with the question of where ‘normal’ ends and ‘madness’ begins. After all, one is surely either ‘psychotic’ or ‘not psychotic’? Yet, a growing body of evidence would suggest psychosis or ‘psychotic-like symptoms’ exist in the general population on a sort of continuum.

For example, we know from a 2013 meta-analysis (Linscott et al, 2013), the estimated prevalence of so-called psychotic-like experiences was 7.2%, clearly much higher than the lifetime morbid risk for actual psychotic disorder. Thus, it appears the reality of psychosis (and indeed ‘normality’) is far from all or nothing.

In a recent JAMA Psychiatry paper (McGrath et al, 2015) the authors report on psychotic experiences (PEs) in the general population, drawing on data from an impressively large international sample of 31,261 adult respondents from 18 countries.

In their own words, this is ‘the most comprehensive description of the epidemiological landscape of PEs published to date’.

Many published surveys have found that otherwise healthy individuals report histories of hallucinations and delusions.

Published community surveys have found that otherwise healthy individuals report histories of hallucinations and delusions.

Methods

This study aimed to capture detailed information on particular psychotic-like experiences (prevalence, frequency and correlates) including differences by age, gender, country of origin and level of income.

How did they go about it?

The authors collated data from the World Health Organisation (WHO) Mental Health Surveys, conducted from 2001-2009. These are described as rigorously implemented general population surveys aimed at addressing the global burden of mental disorders. Further details on the global plan can be found at http://www.hcp.med.harvard.edu/wmh/.

Which countries were included?

18 of the 26 countries surveyed included the Composite International Diagnostic Interview (CIDI) psychosis module. They are: low and middle income countries (Colombia, Iraq, Nigeria, Peoples Republic of China and Peru); upper middle income countries (Brazil, Lebanon, Mexico and Romania); and high income countries (Belgium, France, Germany, Italy, Netherlands, New Zealand, Portugal, Spain and the United States).

Previous studies using general population surveys have tended to focus on higher income countries, with some exceptions (Nuevo et al, 2012).

The response rate (weighted mean) was fairly high overall at 72.1%, with the lowest response rates in France (45.9%) and Belgium (50.6%).

The sample

All respondents were adults (age range 18-100) and most countries used nationally representative samples.

People who reported having an existing mental disorder (asked as part of the interview) were excluded.

What was asked?

This is a key area where the authors argue that their data is superior to similar surveys conducted in the past. Six questions covering different PEs were asked. This was considered to be an improvement on previous work because:

  • Importantly, they distinguished between HEs (visual and auditory hallucinations), DEs (bizarre delusional items), and paranoid delusional items, moving beyond crude dichotomous ‘PE Vs non-PE’ categorisations
  • The survey explored not only lifetime prevalence but also frequency of the above experiences (once, 2-5x, 6-10x, 11-100x and >100)
  • They asked separately about experiences in the LAST 12 MONTHS
  • There were questions to ‘rule out’ PEs secondary to drug or alcohol use (though organic disorders/physical illness was not considered, potentially a cause of visual hallucinations or other phenomena)

Data Analysis

They calculated weighted prevalence estimates for the various PE types, and provided odds ratios and 95% confidence intervals. The multivariate regression model was adjusted for country, age at interview, sex, employment status, marital status, education level, household income and nativity.

This

This study used WHO survey data (2001-9) of 31,261 adults from across 18 countries.

Results

  • The mean lifetime prevalence (SE) of having a PE was 5.8% (0.2%)
  • Hallucinatory experiences were more common than other types (HEs were at 5.2% [0.2%] and DEs at only 1.3% [0.1%])
  • The vast majority of people with PEs had only one such experience (72%)
  • The more different types of PEs you experienced, the more episodes you are likely to have
  • Women experience significantly more PEs than men (6.6% [0.2%] vs 5.0% [0.3%]) – this is true for hallucinations but interestingly not for DEs
  • The lifetime prevalence estimates were significantly higher in middle/high income countries (7.2% [0.4%], 6.8% [0.3%]) than low income ones (5.0% [0.3%])
  • Being non-married, unemployed and on low income also increased your rates of PE
This study suggests that more than 1 in 20 people have psychotic experiences at some point during their lifetime.

This study suggests that more than 1 in 20 people have psychotic experiences at some point during their lifetime.

Strengths

  • Sample: this is a very large, international sample, covering high and low income countries (notably more than half European, but the results are weighted)
  • Statistical analysis appears to be solid (from my understanding of it!)
  • Survey: more detailed questions than many other studies, steps to exclude drugs/alcohol, yielding much more meaningful results

Limitations

  • Of course, with cross-sectional data no inferences can be made on causality (i.e. are unemployed people more at risk of having PEs or are people with PEs more at risk of being unemployed?)
  • They used lay interviewers with basic training, which could affect the quality of the interviews
  • While they aimed to exclude people who reported a diagnosis of mental disorder, cases could easily have been missed, and therefore not excluded
  • These are not the easiest symptoms to report to a stranger face-to-face; there is likely to be underreporting, making estimates conservative
  • The questions focus on lifetime prevalence, so there is a risk of recall bias
  • There is no mention of missing data levels, and accordingly no explanation for how this was handled
  • There is evidence (for example from the ALSPAC cohort) that young people present with PEs before their teens, and a large group of interest will not have been studied by focusing solely on adults – but this may well be something that can be looked at in future
  • Studies of ‘ultra high risk’ of psychosis populations have found those that do convert to psychosis tended to have negative symptoms, poor functioning and disorders of thought content (Nelson et al, 2013), none of which are captured in this survey

Conclusions and further thoughts

This is an important paper, which highlights the need to think more carefully about what we mean by psychotic experiences and indeed psychosis.

The authors have demonstrated different types of PE behave differently, and there is variation by gender and country of origin. Quite how these experiences fit in with psychotic illness itself is unclear at present, and work with ultra-high risk for psychosis groups suggest most people don’t actually go on to develop psychotic illness over time (Nelson et al, 2013).

Crucially, this adds to the debate over what should be done about such experiences, and future work looking at how having these experiences influence health/functioning/quality of life outcomes will be of interest. As a psychiatrist, I am cautious about overmedicalising experiences, and hope any calls for treating PEs in otherwise healthy, functioning people will be met with sensible scepticism, while we gather better evidence.

This research provides an empirical foundation on which to investigate factors that influence the persistence of psychotic experiences.

This research provides an empirical foundation on which to investigate factors that influence the persistence of psychotic experiences.

Links

Primary paper

McGrath JJ, Saha S, Al-Hamzawi A, et al. Psychotic Experiences in the General Population: A Cross-National Analysis Based on 31 261 Respondents From 18 Countries. JAMA Psychiatry. Published online May 27, 2015. doi:10.1001/jamapsychiatry.2015.0575. [PubMed abstract]

Other references

Linscott RJ, van Os J. 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. Psychological Medicine. 2013;43(6):1133-49. Epub 2012/08/02.

Nuevo R, Chatterji S, Verdes E, Naidoo N, Arango C, Ayuso-Mateos JL. The continuum of psychotic symptoms in the general population: a cross-national study. Schizophrenia Bulletin. 2012;38(3):475-85. Epub 2010/09/16.

Nelson B, Yuen HP, Wood SJ, Lin A, Spiliotacopoulos D, Bruxner A, et al. Long-term follow-up of a group at ultra high risk (“prodromal”) for psychosis: the PACE 400 study. JAMA Psychiatry. 2013;70(8):793-802. Epub 2013/06/07.

Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+
Mark as read

Share this post:

Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+ Share via email
Create a personal elf note about this blog
Tagged with: delusional-like experiences, hallucinations, prevalence, psychosis, psychotic-like experiences, survey
Profile photo of Farhana Mann

Farhana Mann

Farhana is a Wellcome Trust Research Training Fellow at University College London. She is also a Specialist Registrar (ST6) in General Adult Psychiatry in North London. She studied Medicine at UCL, where she also completed a BSc in Immunology and Cell Pathology. She holds an MSc in Psychiatric Research and is a Member of the Royal College of Psychiatrists. In 2012 she was selected as a BBC Expert Woman. Her main research interest is in ‘loneliness’ and its impact on mental health. She is always keen to promote better public understanding of psychiatry and mental disorder.

More posts

Follow me here –

  • Twitter
Logging In...

Profile cancel

Sign in with Twitter Sign in with Facebook
or

Not published

  • 110 Replies
  • 1 Comment
  • 77 Tweets
  • 22 Facebook
  • 0 Pingbacks
Last reply was June 12, 2015
MuddledWorld retweeted thisHelenMcAvoy2 retweeted thiscynthiafogoe retweeted thissteveknash retweeted thisSCIE_sco retweeted thispcmis retweeted thisIMAGOTrainingUK retweeted thisDrAndreMorris retweeted thisBuffDavis retweeted thisMHLonline retweeted this
Paul Taylor liked thisSusanne Hart liked thisAndrew Philip Holden liked thisChris Quainton liked thisIlario Mammone liked thisLisa Couperthwaite liked thisFlo Rianabu liked thisMuhammad Moaaz Arif liked thisAngela Hartley liked thisLynnzie Stirling liked thisBrian Cargill liked thisArt Therapy Study liked thisCatherine Forfar liked thisDenise Evangelista liked thisAmanda Lailey liked thisMelisande Hill liked thisFiona McGarry liked thisDulcie Fleming liked thisAlix Daley liked thisLynn Staffylover liked thisZoie Waddingham liked thisBrian J Nuth liked this... and 12 more
  1. @aghoury79
    View June 10, 2015

    Psychotic experiences: how common are they and how can we predict their onset, course and consequences?: Farha… http://t.co/1wAISOTLFY

    Reply
  2. @ian_hamilton_
    View June 10, 2015

    @Mental_Elf interesting gender differences i.e. more female report PE’s yet more males are admitted to hospital due to #psychosis

    Reply
    • @menhealukreplied:
      View June 10, 2015

      @ian_hamilton_ @Mental_Elf Is the diagnostic criteria missing men’s presentation or is this because men don’t seek help early on?

      Reply
      • @ian_hamilton_replied:
        View June 10, 2015

        @menhealuk @Mental_Elf I’m not sure as for some individuals they may not seek help but come to attention of services & are then admitted

        Reply
  3. @iVivekMisra
    View June 10, 2015

    Psychotic experiences: how common are they and how can we predict their onset,… http://t.co/k4tekOKWxY #MentalHealth http://t.co/XJRJogGLNI

    Reply
  4. @Jude_Graham_
    View June 10, 2015

    Psychotic experiences: how common are they and how can we predict their onset, course and consequences? https://t.co/HmsU2BgvL3

    Reply
  5. @MentalhealthMSc
    View June 10, 2015

    How common are psychotic experiences in the general population? http://t.co/7DiohB3KEF @UCLPsychiatry’s @FarhanaMann for @Mental_Elf

    Mental_Elf retweeted thispsychnursingdcu retweeted thisCharAtWork retweeted thisrgraham120 retweeted thismiss_banwell retweeted this
    Reply
  6. @UCLPsychiatry
    View June 10, 2015

    How common are psychotic experiences worldwide? @FarhanaMann of @UCLPsychiatry makes her @mentalelf debut http://t.co/S4qB8O0BbA

    VKatDH retweeted thisdrcastone retweeted thisHelenLFisher retweeted thisviscidula retweeted thissoniajohnson retweeted thisdaceituno retweeted thisbetteraccess retweeted thisdjp1974 retweeted thisDr_JB_Kirkbride retweeted thissjblakemore retweeted thisParkvilleGeek retweeted this_imaginatrix retweeted thisThinkVsShrink retweeted thislauriebayet retweeted thisEmirEfen retweeted this... and 5 more
    Reply
  7. @Mental_Elf
    View June 10, 2015

    Welcome to the woodland @FarhanaMann Great debut blog on psychotic-like experiences http://t.co/Ur8SxFevgL

    niadla retweeted thisFarhanaMann retweeted thisrgraham120 retweeted thisDrGilMyers retweeted this
    Reply
    • @FarhanaMannreplied:
      View June 10, 2015

      @Mental_Elf Thanks for letting me join the club :)

      Reply
    • @docbloomfieldreplied:
      View June 10, 2015

      @Mental_Elf nice write up @FarhanaMann ! Can’t wait to talk it over with you later… With chocolate

      Reply
  8. @HHLibService
    View June 10, 2015

    Psychotic experiences: how common are they and how can we predict their onset, course and consequences? http://t.co/uOGAApFP4u

    Reply
  9. @AlderbrookC
    View June 10, 2015

    Psychotic experiences: how common are they? http://t.co/4vtNQ4RTwE

    DrSherryRoth retweeted this
    Reply
  10. @NHFTNHSLibrary
    View June 10, 2015

    Psychotic experiences: how common are they & how can we predict their onset & consequences? http://t.co/3geTyPqGhl #epidemiology #psychosis

    Reply
  11. @Mental_Elf
    View June 10, 2015

    New international @JAMAPsych study finds a mean lifetime prevalence of having a psychotic experience was 5.8% http://t.co/Ur8SxFevgL

    NeedMoreCourage retweeted this
    Reply
  12. @playlablondon
    View June 10, 2015

    A study into the prevalence of psychosis. V. interesting read. http://t.co/Z2LxlLrAcI @BipolarUKYouth #mentalhealth @Mental_Elf

    Reply
    • @BipolarUKyouthreplied:
      View June 10, 2015

      @playlablondon @Mental_Elf – That *is* interesting. So it seems psychosis, like Bipolar Disorder et al., covers a spectrum of experiences?

      Reply
  13. @Mental_Elf
    View June 10, 2015

    “An empirical foundation on which to investigate factors that influence the persistence of psychotic experiences” http://t.co/Ur8SxFevgL

    Reply
  14. @Mental_Elf
    View June 10, 2015

    Don’t miss: How common are psychotic experiences in the general population? http://t.co/Ur8SxFevgL #EBP

    KayFSheldon retweeted thisNeil7253 retweeted thishullodave retweeted thisLiaisonLawson retweeted thisalliomack retweeted thisNatHuggens retweeted thispsychnursingdcu retweeted thisGreen311Gideon retweeted thisDavidSmith940 retweeted thisJorgeTurner1894 retweeted thisJ3ssicawilliam retweeted this... and 1 more
    Reply
  15. @RickBrad1ey
    View June 10, 2015

    Interesting @Mental_Elf piece by @FarhanaMann on concepts and prevalence of psychosis / psychotic episodes http://t.co/BsIaFQwVV6

    Reply
  16. @mikebenton66
    View June 10, 2015

    This article furthers the theory that “normality” and “consensual reality” are not always in agreement
    http://t.co/cqToDoX7a8

    Reply
  17. @psychiatrist81
    View June 10, 2015

    Psychotic experiences how common are they and how can we predict their onset,course and consequences? https://t.co/zqOrnGQhaZ via @sharethis

    Reply
  18. @aghoury79
    View June 10, 2015

    Mental Elf: Psychotic experiences: how common are they and how can we predict their onset, course and consequences? http://t.co/nio4mC85TB

    Reply
  19. Michael Smith
    View June 11, 2015

    Interesting article. Lay ‘hospital managers’ also need to have an idea of what is ‘normal’ and this article is helpful. I’ve started a blog for them at http://www.hospitalmanagersforum.wordpress.com

    Reply
  20. @BobBrotchie
    View June 11, 2015

    Psychotic experiences: how common are they and how can we predict their onset, course and consequences? https://t.co/O5HtrRlx3k

    PositiveSimply retweeted this
    Reply
  21. @rossiter1497
    View June 13, 2015

    RT @Mental_Elf: Most popular blog this week? It’s @FarhanaMann How common are psychotic experiences in the general population? http://t.co/…

    LiesvandenAssum retweeted thisSysReviews retweeted thisTrishLane13 retweeted thisFarhanaMann retweeted thisMetanoiaGaliano retweeted thisDrGilMyers retweeted thisrorymb retweeted thisSameiHuda retweeted thisKayFSheldon retweeted this
    Reply
  22. @hermitsholiday
    View June 13, 2015

    Psychotic experiences: how common are they and how can we predict their onset, course and consequences? https://t.co/2R41SB8QY8

    Reply
  23. @HWOldham
    View June 13, 2015

    How common are psychotic experiences in the general population? http://t.co/rOuocjI3Jk #EBP via @Mental_Elf

    HealthwatchTame retweeted thisbengilchrist retweeted this
    Reply
  24. @MentalhealthMSc
    View June 13, 2015

    Debut @Mentalelf blog by @MentalhealthMSc graduate @FarhanaMann on psychotic experiences in general population – http://t.co/7DiohBllwd …

    Reply
Try out our members features!

Sign up now. It’s free! Or Sign in

We can help you:

  • 1Keep up to date with the latest research
  • 2Connect with experts and colleagues
  • 3Contribute to your professional development
Tell me more about the benefits of membership

FOLLOW the Mental Elf

  • Find us on Facebook
  • Follow us on Twitter
  • Follow us on Google+
  • Read our RSS feed
  • Find us on LinkedIn

Twitter

  • @drdomthompson @sthompsonjones @DrSdeG No, I’ve never seen any research on this, but I agree it’s an important issue. about 7 hours ago Reply Retweet Favorite
  • @n_higsonsweeney We elves are so pleased that you've agreed to join the woodland team Nina 🌳🌤🍄 Can't wait to get st… https://t.co/LgXFj9R17D about 10 hours ago Reply Retweet Favorite
  • RT @n_higsonsweeney: Very excited to share that I am joining the team over at the @Mental_Elf as an Elf Coordinator! 🥳 My main role will be… about 10 hours ago Reply Retweet Favorite
  • A *very* exciting new funding opportunity from the @wellcometrust "Understanding and unpacking debates in mental… https://t.co/JoEs3UELig about 16 hours ago Reply Retweet Favorite
  • RT @DafniK10: Great blog by @donamatthews today on the elevated suicide risk after a diagnosis of severe physical health condition. Posing… about 18 hours ago Reply Retweet Favorite
Mental_Elf

Recent Posts

  • Does a diagnosis of severe physical illness elevate suicide risk?
  • Trauma transmission in the children of trauma-affected refugees: risk and protective factors
  • Ketamine and suicidal ideation: French trial finds modest short-term effects
  • Mental disorder and homicide: are rates and sentencing patterns changing?
  • Can social recovery therapy improve social disability in young people?

Recent Comments

  • julian on Mental disorder and homicide: are rates and sentencing patterns changing?
  • Lorna on Is it bipolar disorder or borderline personality disorder?
  • Jean Sellar-Edmunds on Antidepressant withdrawal or depression relapse? International guidelines on antidepressant discontinuation are unclear

Suggest a paper

Do you have a suggestion for a paper? Then let us know.

Click here

Watch our 2 minute promo video!

Visit our other Elf blogs

  • Commissioning
  • Dentistry
  • Education
  • Learning Disabilities
  • Mental Health
  • Musculoskeletal
  • Social Care

Free trial

Close
Ready to get started? It's free!
Sign up now No thanks Tell me more about the benefits of membership

Free email newsletter

FOLLOW the Mental Elf

  • Find us on Facebook
  • Follow us on Twitter
  • Follow us on Google+
  • Read our RSS feed
  • Find us on LinkedIn
© 2023 National Elf Service is brought to you by Minervation Ltd
Email: info@nationalelfservice.net
  • About
  • Evaluation
  • Site Map
  • Terms
  • Privacy
  • Cookies
  • Log In