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Let’s start with an warning. Unusual thoughts and experiences are common, and having them is not necessarily a sign of ongoing crippling distress or a reason for intervention. We tend to ignore people who have such thoughts if they are functioning well. We do not want to intervene with everyone who has but one symptom. Because odd symptoms are, as this paper indicates, common.

Of the 1998 participants, the 12-month prevalence of auditory HEs was 14.0% (95% CI?=?[12.3, 15.8]). In terms of the other PE subtypes, 13.8% reported being spied upon (95% CI?=?[12.1, 15.6]), 10.6% reported visual HEs (95% CI?=?[9.1, 12.3]), 5.6% reported their thoughts being read (95% CI?=?[4.6, 6.8]), and 3.3% reported receiving special messages through the television or radio (95% CI?=?[2.6, 4.3]).

In terms of sociodemographics, thoughts being read (Table 4) and feeling spied upon (Table 6) were the only PEs to be associated with both age and sex; where younger, female respondents were more likely to endorse these items compared to their older, male counterparts. In terms of clinical and psychosocial variables, each subtype was associated with major depression, being bullied, psychological distress, low self-esteem, mental health service use, insufficient sleep, and substance use (except for thoughts being read, which was not associated with substance use at the bivariate level). None of the PE subtypes were associated with parental mental illness. Only auditory HEs and feeling spied upon were associated with social isolation. Two of the three DEs (thoughts read, spied upon) were associated with disordered eating behaviour, whereas HEs (both auditory and visual) were not.

Emily Hielscher and others. Prevalence and correlates of psychotic experiences in a nationally representative sample of Australian adolescents. Australian & New Zealand Journal of Psychiatry First Published July 11, 2018 https://doi.org/10.1177/0004867418785036

It is better to consider poor psychosocial functioning. A case control paper — using controls who were first degree relatives, showed that those who had poor social and/or academic performance in late adolescence were more likely to have psychosis. One should always approach case control studies with caution, but this one is fairly good. In the diagram, note that a high PAS score is a bad thing.

Statistically significant positive correlations were observed between both academic and social PAS domains and the three considered psychopathological indices (poor emotional expression, avolition, and positive symptoms; P ? 0.0001 for all of them), indicating that a worse premorbid adjustment is associated to more severe psychopathology. The association was slightly stronger for avolition (r = 0.16) with respect to the other two symptom dimensions (r = ?0.13), in particular in the subsample of patients without clinically significant depression and/or parkinsonism (n = 482; r = 0.32 for avolition, r ? 0.26 for the remaining two dimensions).

Bucci P. and others. Premorbid academic and social functioning in patients with schizophrenia and its associations with negative symptoms and cognition Acta Psychiatrica Scandinavica https://doi.org/10.1111/acps.12938 doi:10.1111/acps.12938

That’s enough for this week. Symptoms matter, but if you are worried, look more to function. If you have odd beliefs but you are coping well, you don’t have a psychiatric illness. You are eccentric, and you are making life better. If you are miserable, frightened, scared or find yourself damaging or damaged, then you may have a problem. But by then, many people will be worried about you.

For you don’t need to have a medical degree to know when someone is living in psychosis. What the continuum model misses is the cliff people fall off when the symptoms take over. And that, sadly, can lead to tragedy.

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