Progression from a Psychotic Episode to Psychosis is Rare

There are a number of things that distinguish a psychotic episode (PE) from psychosis—not the least of which is persistence. A large number of people experience a psychotic episode at some point in their lifetimes, but not all of these individuals go on to develop psychosis. Many occur only once, usually after an extremely stressful or traumatic event. But when PEs persist, they can lead to psychosis, either as schizophrenia or some other schizoaffective issue.

This persistence is what helps determine the ultimate form of treatment. However, the data on rate of progression is unclear and mostly based on self-reports. To get a more accurate assessment of how many individuals experience PEs and how many eventually develop psychosis, R.J. Linscott of the Department of Psychology at the University of Otago in New Zealand recently conducted a study on existing cohort data of PEs and psychosis.

Based on information from over 60 cohorts, Linscott found that PEs occurred in 2.5% of individuals on an annual basis, but the prevalence was 7.2%. This demonstrates a significantly high rate of PEs compared to psychosis in the general population, despite the fact that symptoms for both may be the same. Upon further examination, Linscott found that other risk factors that increased the likelihood of PE included youth, minority ethnicity, low income, low education, unemployment, and being single. Additionally, prior mental illness, trauma, stress, and drug or alcohol use also raised the likelihood of experiencing a PE. Interestingly, the rate of PEs obtained in this study was only one third that of PEs from studies based solely on self-reports.

Linscott also found that the majority, 80% of the individuals with PEs saw transient episodes while the only the remaining 20% saw persistent PEs. Baseline PEs were directly predictive of persistence and among those with PE at baseline, 7.4% eventually progressed to psychosis. Overall, these findings clearly demonstrate persistence in some cases of PE, but not all.

Linscott believes the clinical implications of this study are significant, and that clinicians should continue using existing criteria for identification of psychotic episodes, but should also consider symptomology and impairment as barometers for treatment. “Greater understanding of the nexus between PE and dysfunction, and careful maintenance of distinction between these, is warranted and may aid identification of alternative intervention targets,” added Linscott.

Linscott, R. J., and J. van Os. (2013). 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 43.6 (2013): 1133-49. ProQuest. Web.

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  • Mandy


    August 22nd, 2013 at 8:40 PM

    I’ve certainly experienced a psychotic episode in the past,although it was not too bad moving is the risk for persistent psychosis evaluated?and does a single episode so warrant treatment if any sort?because I think I am resilient enough to cope with it.

  • alexa


    August 23rd, 2013 at 3:54 AM

    At least this gives doctors something to be on the lookout for and to be aware of. If they know what they are looking for then that could make a diagnosis easier

  • Alana C

    Alana C

    August 23rd, 2013 at 10:29 AM

    I have been under the mistaken belief that if you have an episode like this then that’s it, you’re doomed, you are psychotic or at least that’s going to be your tendency.
    So you’re saying that’s not necessarily true?
    well, that’s good news for a whole lot of people who have had this happen to them and who have then freaked out because then they think that they are psychotic or their families think this about them when in actuality that does not have to be what this means for them at all.

  • Kelli


    August 26th, 2013 at 10:54 AM

    It might be rare but that still doesn’t mean that it should be ignored, right? I mean, this is still something pretty significant that could have serious implications that would need to be examined by a doctor.

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