Criterion validity of the Psychotic-Like Experiences Questionnaire for Children (PLEQ-C)

Transcranial sonography of subcortical structures in tic/tourette disorder

Functional neuroimaging studies demonstrate disinhibition of the cortico-striatal-thalamo-cortical circuit. However, structural imaging studies revealed conflicting results, some suggesting smaller volumes of the caudate nucleus (CN) in children with Gilles de la Tourette syndrome (TS). Here we wanted to find out whether transcranial sonography (TCS) detects alterations of raphe nuclei, substantia nigra, lenticular nucleus (LN), or CN in children with Tic disorder or TS (TIC/TS).The study included 25 treatment-naive children (age: 12.2 ± 2.5 years) with a DSM-V based diagnosis of Tic disorder or TS (10 subjects), without other psychiatric or neurologic diagnosis, and 25 healthy controls (age: 12.17 ± 2.57 years), matched for age and sex. Parental rating of behavioral, emotional abnormalities, somatic complaints and social competencies of the participants were assessed using the Child Behavior Check List (CBCL/4-18R). TCS of deep brain structures was conducted through the preauricular acoustic bone windows using a 2.5-MHz phased-array ultrasound system. Fisher's exact test and Mann-Whitney-U test were used for comparisons between TIC/TS patients and healthy volunteers. The number of participants with hyperechogenic area of left CN in the TIC/TS sample was increased, compared to the healthy control group. TIC/TS patients with hyperechogenic CN showed an increased occurrence of thought- and obsessive-compulsive problems. This TCS study revealed pathologic structural changes in CN, its higher occurrence in TIC/TS compared to healthy controls and the relation to comorbidity of thought problems. Further research should focus on the molecular cause of these alterations, probably the disturbed iron metabolism.

Developmental changes in the endorsement of psychotic-like experiences from middle childhood through young adulthood

BACKGROUND

Children tend to endorse psychotic-like experiences (PLEs) at higher rates than adults, although little is known about how specific symptom endorsement changes across the span of development. Here we take an observational approach to examine trends in PLE endorsement by age in two non-clinical samples: one of school-aged children and another of late adolescents and early adults.

METHODS

Prodromal Questionnaire-Brief (child and adult versions) responses were investigated in individuals ages 9-13 (n = 11865) and 16-24 (n = 3209) from the Adolescent Brain and Cognitive Development Study (ABCD) and the Multisite Assessment of Psychosis-risk Study (MAP), respectively. Item-level endorsement and distressing item frequencies were examined by age throughout both cohorts.

RESULTS

Unusual perceptual experiences were generally endorsed more heavily in childhood, while other PLEs were endorsed in adolescents and adults up to 4.8 times more frequently than in children. Additionally, certain experiences were endorsed by as many as 73 percent of the older sample.

CONCLUSIONS

Considerations for the measurement of PLEs in childhood and adolescence are underscored. Findings from these two samples provide a window into the course of these PLEs and may serve as a scaffold for future research investigating normative versus risk-related experiences during development.

Early life exposure to air pollution and psychotic-like experiences, emotional symptoms, and conduct problems in middle childhood

BACKGROUND

Air pollution has been linked to a variety of childhood mental health problems, but results are inconsistent across studies and the effect of exposure timing is unclear. We examined the associations between air pollution exposure at two time-points in early development and psychotic-like experiences (PLEs), and emotional and conduct symptoms, assessed in middle childhood (mean age 11.5 years).

METHODS

Participants were 19,932 children selected from the NSW Child Development Study (NSW-CDS) with available linked multi-agency data from birth, and self-reported psychotic-like experiences (PLEs) and psychopathology at age 11-12 years (middle childhood). We used binomial logistic regression to examine associations between exposure to nitrogen dioxide (NO2) and particulate matter less than 2.5 μm (PM2.5) at two time-points (birth and middle childhood) and middle childhood PLEs, and emotional and conduct symptoms, with consideration of socioeconomic status and other potential confounding factors in adjusted models.

RESULTS

In fully adjusted models, NO2 exposure in middle childhood was associated with concurrent PLEs (OR = 1.10, 95% CI = 1.02-1.20). Similar associations with PLEs were found for middle childhood exposure to PM2.5 (OR = 1.05, 95% CI = 1.01-1.09). Neither NO2 nor PM2.5 exposure was associated with emotional symptoms or conduct problems in this study.

CONCLUSIONS

This study highlights the need for a better understanding of potential mechanisms of action of NO2 in the brain during childhood.

Measurement invariance across age, gender, ethnicity, and psychopathology of the Psychotic-Like Experiences Questionnaire for Children in a community sample

OBJECTIVES

The current study aimed to assess the measurement invariance of the 9-item self-report Psychotic-Like Experiences Questionnaire for Children (PLEQ-C) across various demographic (age, gender, ethnicity) and psychopathology profiles in a community sample of children.

METHODS

Children aged 9-11 years (n = 613; M age = 10.4 years [SD = 0.8]; 50.9% female) completed questionnaire screening at school, with primary caregivers returning questionnaires by mail from home. Configural, metric, scalar, and residual invariance of the PLEQ-C scores were investigated across groups differentiated by age (9; 10; 11 years), gender (female; male), ethnicity (white; black; other), and by child-reported and caregiver-reported psychopathology (abnormal rating; not abnormal).

RESULTS

The PLEQ-C scores demonstrated good unidimensional model fit. Full configural, metric, scalar, and residual invariance were demonstrated across gender, ethnicity, and psychopathology (both child- and caregiver-reported). Across age groups, the PLEQ-C scores showed full configural and metric invariance, but only partial scalar and residual invariance (with a single item measuring differently among 11-year-olds).

CONCLUSIONS

In this community sample, the PLEQ-C was robust to age, gender, ethnicity, and psychopathology profiles, providing evidence of its capacity to identify children in the general population who might benefit from further assessment to determine the clinical significance of their psychotic experiences.

Evaluation of reliability and validity of the Persian version of Peters et al. delusions inventory (PDI-40) in iranian non-clinical and clinical samples

BACKGROUND

Some individuals may manifest psychotic symptoms that do not fulfill the requisite clinical criteria for a formal diagnosis of psychosis. The assessment of susceptibility to delusions, encompassing both clinical and non-clinical cohorts, frequently makes use of the Peters et al. Delusions Inventory (PDI-40). This study aimed to evaluate the reliability and validity of the Persian version of Peters et al. Delusions Inventory (PDI-40) in Iranian non-clinical and clinical samples.

METHODS

The present study employed a cross-sectional, correlational design in 2020. A total of 1402 Iranian participants were recruited for the study, which consisted of three distinct stages. The first stage involved an Exploratory Factor Analysis (EFA) conducted on a non-clinical sample of 512 participants. The second stage comprising different non-clinical sample 764 participants to perform a Confirmatory Factor Analysis (CFA). In the third stage, a clinical sample of 126 psychotic patients was compared to a non-clinical sample. All participants completed the PDI-40, the Community Assessment of Psychotic Experiences (CAPE-42), and the Depression, Anxiety, and Stress Scale (DASS-21). The internal structure of PDI-40 was examined through the analysis of its factor structure using LISREL 8.8.

RESULTS

The EFA analysis unveiled nine components within Persian version of PDI-40. The CFA analysis demonstrated an excellent fit of the nine-factor structure of Persian PDI-40 to the data. The total score exhibited high internal reliability, as indicated by Cronbach's alpha coefficient of 0.92. Moreover, Persian PDI-40 exhibited satisfactory evidence of convergent validity, as significant correlations were observed between dimensions of PDI-40 and subscales of CAPE-42 and DASS-21. Lastly, findings indicated that psychotic participants scored higher than non-clinical participants in all components of the PDI-40(p < 0.05).

CONCLUSION

Persian version of the PDI-40 demonstrates strong reliability and validity for assessing delusion proneness in both non-clinical and clinical samples in Iran. The observed distinctions between psychotic and non-clinical participants underscore its potential as a valuable tool for discerning delusion proneness in diverse contexts.

Increased likelihood of distressing and functionally impairing psychotic-like experiences among children with co-occurring internalising and externalising problems

Among children with psychotic-like experiences (PLEs), the presence of co-occurring psychopathology may distinguish children's self-report of clinically significant experiences (i.e., PLEs that are distressing and/or impairing of daily functioning) from reports of more benign experiences. The aim of this study was to examine whether the likelihood of distressing or impairing PLEs differed according to type of co-occurring psychopathology symptoms. A community sample of 5268 children aged 9-12 years were recruited from Greater London, UK. Participants completed the Psychotic-Like Experiences Questionnaire for Children, and the Strengths and Difficulties Questionnaire to measure internalising and externalising problems. Multinomial logistic regressions were used to determine the likelihood of PLEs being distressing and/or impairing (vs. not) among children with different co-occurring symptom profiles (PLEs only; PLEs with internalising problems only - PLE-I; PLEs with externalising problems only - PLE-E; and PLEs with both internalising and externalising problems - PLE-IE). Children with co-occurring internalising and/or externalising problems had greater odds of distressing and/or impairing PLEs compared to children without co-occurring psychopathology (PLEs only). These associations were moderate for PLE-E and strong for PLE-I and PLE-IE, with the greatest odds of distressing and impairing PLEs evident in the presence of internalising plus externalising comorbidities (odds ratios [with 99 % confidence intervals] for PLE-IE relative to PLE-I = 2.00 [1.34-2.99]; PLE-IE relative to PLE-E = 5.46 [3.78-7.90]). These results affirm the importance of screening for the presence and type of co-occurring psychopathology among children with PLEs to demarcate potentially different treatment needs.

Self-reported mental health of children known to child protection services: an Australian population-based record linkage study

Maltreated children are vulnerable to adverse mental health outcomes. Information about how children's mental health needs vary according to different levels of child protection contact (potentially culminating in out-of-home care [OOHC]) is valuable for the effective provision of services. This study aimed to examine associations between different levels of contact with child protection services before the age of 10 years and self-reported mental health difficulties at age 11 years. Participants (n = 26,960) were drawn from the New South Wales Child Development Study, a multiagency, multigenerational, longitudinal record linkage study that combines administrative records with cross-sectional survey data. We examined associations between four levels of child protection response (non-threshold reports, unsubstantiated reports, substantiated reports, OOHC; each relative to no report) and six domains of self-reported mental health difficulties (including internalising and externalising symptoms, and psychotic-like experiences). All levels of contact with child protection services were associated with increased odds of mental health difficulties in all domains. Children who had been placed in OOHC and children with substantiated reports had the highest odds of reporting clinical levels of mental health difficulties; 48.1% of children with an OOHC placement and 45.6% of those with substantiated child protection reports showed clinical levels of mental health difficulties in at least one domain. Children with child protection reports that were unsubstantiated, or determined not to meet the threshold for risk-of-significant harm, were also at increased risk of mental health difficulties in middle childhood. These findings underscore the importance of early detection and intervention for all children at risk of maltreatment.

Understanding Associations Between Race/Ethnicity, Experiences of Discrimination, and Psychotic-like Experiences in Middle Childhood

OBJECTIVE

The present study aimed to examine factors that may account for race/ethnicity differences in psychotic-like experiences (PLEs) in a middle childhood sample, including evidence for experiences of discrimination as a psychosocial mediator of these differences.

METHOD

In a sample of 9- to 10-year-olds (N = 10,839) from the Adolescent Brain Cognitive Development Study, we compared PLEs across racial/ethnic groups. We also examined whether experiences of discrimination indirectly linked racial/ethnic identity and PLEs and whether social support moderated this indirect association.

RESULTS

Differences between racial/ethnic groups were found in the endorsement of PLEs, such that Black and Hispanic participants endorsed higher levels of PLEs compared with Asian, multiracial/multiethnic, and White participants. These differences were accounted for in part by experiences of discrimination, an indirect effect that was in turn attenuated by increased social support.

CONCLUSION

This is the first study to suggest that the experience of discrimination may indirectly link the association between racial/ethnic differences and endorsement of PLEs using the Prodromal Questionnaire-Brief Child Version and additionally that social support may act as a moderator of this mediation. Results provide evidence that social inequities such as racial discrimination may contribute to increases in PLEs. These findings shed further light on the links between structural racism and mental health inequities for people in minoritized groups.

Dissociable impairments of verbal learning differentiate childhood risk profiles for schizophrenia

Poor verbal learning and memory function is well-documented among individuals with schizophrenia and those at clinical high-risk for psychosis. This study aimed to identify these impairments among children aged 9–12 years with different schizophrenia risk profiles (family history or antecedents of schizophrenia, each of higher^[H] or lower^[L] risk load) relative to typically developing peers. These three groups were recruited via community-screening, and differentiated for analysis into: typically developing children (TD = 45); children who had 1 first- or ≥2 second-degree affected relatives (FHx^H = 16) or one second-degree relative (FHx^L = 15); and children presenting multiple replicated antecedents of schizophrenia whose clinical symptoms persisted at 2- and/or 4-year follow-up (ASz^H = 16) or remitted during follow-up (ASz^L = 16). Verbal learning/memory measures assessed at baseline (age 9–12 years) included: (i) total recall; (ii) trial 1 recall; (iii) learning score; (iv) intrusions; (v) total words lost; and (vi) serial position patterns. Analyses of variance indicated that FHx^H and ASz^H youth demonstrated impaired total recall compared to TD and ASz^L children and lost significantly more words between trials than TD and FHx^L children. Learning score was impaired among both FHx^H and FHx^L relative to TD and ASz^L children. Thus, among putatively at-risk children, total words recalled and lost distinguished those with higher risk load (by family history or persistent antecedent symptomology), whereas learning score indexed familial vulnerability. Follow-up of the sample is needed to determine the capacity of verbal learning deficits to predict later illness and provide a potential avenue for early remediation to improve clinical or functional outcomes.

Cortisol Levels in Childhood Associated With Emergence of Attenuated Psychotic Symptoms in Early Adulthood

BACKGROUND

In individuals at clinical high-risk for psychosis, elevated cortisol levels predict subsequent onset of psychotic disorder. However, it is unclear whether cortisol alterations are evident at an earlier clinical stage and promote progression of psychosis expression. This study aimed to address this issue by investigating whether cortisol levels in childhood were associated with the emergence of attenuated psychotic symptoms in early adulthood. In exploratory analyses, we examined whether cortisol and psychosocial stress measures interacted in predicting attenuated psychotic symptoms.

METHODS

A sample of children (N = 109) enriched for psychosis risk factors were recruited at age 9-12 years and assessed at age 11-14 years (T1) and 17-21 years (T2). Measures of psychopathology, psychosocial stressors, and salivary cortisol were obtained at T1. Attenuated psychotic symptoms were assessed at T2 using the Prodromal Questionnaire.

RESULTS

Diurnal cortisol (β = 0.915, 95% CI: 0.062-1.769) and daily stressors (β = 0.379, 95% CI: 0.034-0.723) at T1 were independently associated with total Prodromal Questionnaire scores at T2 after accounting for demographic factors and T1 psychopathology. Exploratory analyses indicated a significant interaction between T1 diurnal cortisol and daily stressors (β = 0.743, 95% CI: 0.081-1.405), with the highest predicted T2 total Prodromal Questionnaire scores occurring when both diurnal cortisol and daily stressors were increased.

CONCLUSIONS

Our findings suggest that daily stressors and elevations in diurnal cortisol in late childhood/early adolescence increases risk for developing attenuated psychotic symptoms. These findings emphasize the importance of assessing environmental and biological risk factors for psychosis during neurodevelopmentally vulnerable time periods.

Distressing psychotic-like experiences, cognitive functioning and early developmental markers in clinically referred young people aged 8-18 years

PURPOSE

Neurocognitive difficulties and early childhood speech/motor delays are well documented amongst older adolescents and young adults considered at risk for psychosis-spectrum diagnoses. We aimed to test associations between unusual or psychotic-like experiences (PLEs), co-occurring distress/emotional symptoms, current cognitive functioning and developmental delays/difficulties in young people (aged 8-18 years) referred to Child and Adolescent Mental Health Services in South London, UK.

METHODS

Study 1 examined receptive language, verbal learning and caregiver-reported speech and motor delays/difficulties in a sample of 101 clinically-referred children aged 8-14 years, comparing those reporting no PLEs (n = 19), PLEs without distress (n = 16), and PLEs with distress (n = 66). Study 2 tested associations of severity of distressing PLEs with vocabulary, perceptual reasoning, word reading and developmental delays/difficulties in a second sample of 122 adolescents aged 12-18 years with distressing PLEs.

RESULTS

In Study 1, children with distressing PLEs had lower receptive language and delayed recall and higher rates of developmental delays/difficulties than the no-PLE and non-distressing PLE groups (F values: 2.3-2.8; p values: < 0.005). Receptive language (β = 0.24, p = 0.03) and delayed recall (β = - 0.17, p = 0.02) predicted PLE distress severity. In Study 2, the cognitive-developmental variables did not significantly predict PLE distress severity (β values = 0.01-0.22, p values: > 0.05).

CONCLUSION

Findings may be consistent with a cognitive-developmental model relating distressing PLEs in youth with difficulties in cognitive functioning. This highlights the potential utility of adjunctive cognitive strategies which target mechanisms associated with PLE distress. These could be included in cognitive-behavioural interventions offered prior to the development of an at-risk mental state in mental health, educational or public health settings.

Psychosocial predictors of distressing unusual experiences in adolescence: Testing the fit of an adult cognitive model of psychosis

BACKGROUND

For adults with psychosis, international guidelines recommend individual and family based cognitive behavioural therapy interventions. Recommendations are extended to children and adolescents, based on adult research. It is also recommended that psychological interventions are offered for childhood presentations of psychotic-like or Unusual Experiences (UE), in the absence of a formal diagnosis, when these are Distressing (UEDs). Cognitive models underpinning these interventions require testing in adolescent populations, to further refine therapies. We address this need, by testing for the first time, the application of the adult cognitive model of psychosis to adolescent UEDs.

METHODS

We used baseline data from the Coping with Unusual ExperienceS (CUES+) randomised controlled trial for 122 clinically referred adolescents (12-18 years) with self-reported UEDs. Known psychological mechanisms of adult cognitive models of psychosis; negative life events, affect (anxiety and depression), reasoning (jumping to conclusions bias), and schemas were investigated using multiple linear regression models, alongside variables particularly associated with the development and severity of adolescent UEDs and UE type (dissociation, externalising/behavioural problems, managing emotions).

RESULTS

The psychological mechanisms of adult cognitive models of psychosis explained 89% of the total variance of adolescent UED severity, F (10, 106) = 99.34, p < .0005, r² = 0.89, with schemas as the principal significant contributor. Variance explained 40 - 72% across each of the UE types (paranoia, hallucinations, delusions, paranormal thinking and grandiosity).

CONCLUSIONS

Findings suggest that the psychological components of adult cognitive models of psychosis, particularly schemas, are also implicated in adolescent UEDs.

The Community Assessment of Psychic Experiences-Positive scale (CAPE-P15) accurately classifies and differentiates psychotic experience levels in adolescents from the general population

Background

There is increasing interest in studying psychotic symptoms in non-clinical populations, with the Community Assessment of Psychic Experiences-Positive scale (CAPE-P15) being one of the self-screening questionnaires used most commonly for this purpose. Further research is needed to evaluate the ability of the scale to accurately identify and classify positive psychotic experiences (PE) in the general population.

Aim

To provide psychometric evidence about the accuracy of the CAPE-P15 for detecting PE in a sample of Chilean adolescents from the general population and classifying them according to their PE severity levels.

Method

We administered the CAPE-P15 to a general sample of 1594 students aged 12 to 19. Based on Item Response Theory (IRT), we tested the accuracy of the instrument using two main parameters: difficulty and discrimination power of the 15 items.

Results

We found that the scale provides very accurate information about PE, particularly for high PE levels. The items with the highest capability to determine the presence of the latent trait were those assessing perceptual anomalies (auditory and visual hallucinations), bizarre experiences (a double has taken the place of others; being controlled by external forces), and persecutory ideation (conspiracy against me).

Conclusions

The CAPE-P15 is an accurate and suitable tool to screen PE and to accurately classify and differentiate PE levels in adolescents from the general population. Further research is needed to better understand how maladaptive psychological mechanisms influence relationships between PE and suicidal ideation (SI) in the general population.

Translation and validation of Training Needs Analysis Questionnaire among reproductive, maternal and newborn health workers in Tanzania

Background

Continuous professional development (CPD) has been reported to enhance healthcare workers’ knowledge and skills, improve retention and recruitment, improve the quality of patient care, and reduce patient mortality. Therefore, validated training needs assessment tools are important to facilitate the design of effective CPD programs.

Methods

A cross-sectional survey was conducted using self-administered questionnaires. Participants were healthcare workers in reproductive, maternal, and neonatal health (RMNH) from seven hospitals, 12 health centers, and 17 dispensaries in eight districts of Mwanza Region, Tanzania. The training needs analysis (TNA) tool that was used for data collection was adapted and translated into Kiswahili from English version of the Hennessy-Hicks’ Training Need Analysis Questionnaire (TNAQ).

Results

In total, 153 healthcare workers participated in this study. Most participants were female 83 % (n = 127), and 76 % (n = 115) were nurses. The average age was 39 years, and the mean duration working in RMNH was 7.9 years. The reliability of the adapted TNAQ was 0.954. Assessment of construct validity indicated that the comparative fit index was equal to 1.

Conclusions

The adapted TNAQ appears to be reliable and valid for identifying professional training needs among healthcare workers in RMNH settings in Mwanza Region, Tanzania. Further studies with larger sample sizes are needed to test the use of the TNAQ in broader healthcare systems and settings.

Mapping psychotic-like experiences: Results from an online survey

Suggestions have been made that psychotic-like experiences (PLEs), such as hallucinatory and delusional experiences, exist on a continuum from healthy individuals to patients with a diagnosis of schizophrenia. We used the screening questions of the Questionnaire for Psychotic Experiences (QPE), an interview that captures the presence and phenomenology of various psychotic experiences separately, to assess PLEs in Norway. Based on data from an online survey in a sample of more than 1,400 participants, we demonstrated that the QPE screening questions show satisfactory psychometric properties. Participants with mental disorders reported more frequent lifetime and current hallucinatory experiences than participants without mental disorders. Childhood experiences were rather low and ranged from 0.7% to 5.2%. We further replicated findings that young age, illegal drug use, lower level of education, and having parents with a mental disorder are associated with higher endorsement rates of PLEs. Finally, a binomial regression revealed that the mere presence of PLEs does not discriminate between individuals with and without a mental disorder. Taken together, the findings of the present study support existing models that both hallucinations and delusions exist on a structural and phenomenological continuum. Moreover, we demonstrated that the QPE screening questions can be used by themselves as a complementary tool to the full QPE interview.