Adolescent emotion unravels social impact of psychotic symptoms

By Lucy Piper, Senior medwireNews Reporter

Emotional or behavioral problems may explain why some adolescents with psychotic symptoms find it hard to interact socially, researchers highlight.

They found that 12-year-olds with psychotic symptoms were a significant 1.4 times more likely to have poor social functioning at 13 years of age than were their peers without such symptoms. But this crude association was largely explained by emotional problems, including depression at age 12 years, and emotional symptoms, hyperactivity, and conduct problems at age 11 years.

“There are two potential explanations for this finding,” the team says. “Emotional problems may act as a confounder of the association between psychotic symptoms and social functioning. Alternatively, emotional symptoms may be on the causal pathway from psychotic symptoms to poor social functioning.”

Lead researcher Laura Asher (London School of Hygiene and Tropical Medicine, London, UK) and colleagues say that if emotional or behavioral symptoms are part of the cause, then it is important to assess these in adolescents with psychotic symptoms in order to identify those in most need of intervention for poor social functioning.

However, if emotional problems are having a confounding effect on the association between psychotic symptoms and poor social functioning, then “the impact of psychotic symptoms on adolescents in the community is likely to be minimal and does not require input from health services,” they note in Schizophrenia Research.

“This may indicate that rather than consider psychotic symptoms as a health concern they are merely a marker for other emotional and behavioural symptoms that in turn are leading to problems such as poor social functioning.”

The findings are based on 5250 adolescents, aged 12.9 years on average, who were participating in the Avon Longitudinal Study of Parents and Children.

These children had experienced one or more psychotic symptoms, mainly auditory and visual hallucinations, in the previous 6 months. At 13 years of age, 8.8% of the children had poor social functioning, as indicated by a score of at least 4 on the Peer Problems subscale of the Strengths and Difficulties Questionnaire.

Emotional or behavioral symptoms at 11 years were significantly more common among adolescents with psychotic symptoms at 12 years of age, affecting 32.6%, compared with just 10.8% of adolescents without psychotic symptoms.

But the team notes that as 67.4% of children with psychotic symptoms did not have emotional or behavioral symptoms, “the burden of poor social functioning as a result of these processes may be relatively small.”

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