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

Abstract

Objectives: To examine the incidence and 2-year stability and outcome of subclinical psychotic experiences in the general population.

Design: The Netherlands Mental Health Survey and Incidence Study (NEMESIS), a longitudinal general population study.

Methods: A representative population sample of 7,076 participants was interviewed with the composite international diagnostic interview at baseline, 1 year later at T(1) and again 2 years later at T(2). A sample of individuals was identified who had onset of a new, broadly defined psychotic experience between baseline and T(1) (N = 79; incidence = 2%). Stability and outcome of these incident positive psychotic experiences was reassessed by interview at T(2), at which 25 individuals had a CIDI rating of broadly defined psychotic experience (subclinical outcome) and 11 individuals had psychotic experiences with functional impairment and need for care (clinical outcome).

Results: The majority of individuals with an incident psychotic experience did not display persistence of the experience. Only 8% of individuals with a T1 incident psychotic experience had evidence of a T2 subclinical outcome, and only 8% had evidence of a T2 clinical outcome. The emotional context and the number of the T1 incident psychotic experiences were strong modifiers of predictive power for the clinical outcome, but not (or to a much lesser extent) for the subclinical outcome.

Conclusions: 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. The far most likely outcome for these experiences is discontinuity. For the small proportion who display continuity, there is an equally large likelihood of subclinical and clinical 2-year outcomes. Emotional appraisal and degree of intrusiveness of psychotic experiences are important modifiers not for continuity per se but for clinical outcome specifically.