Cluster profiles of distressing psychotic-like experiences among children and associations with genetic risk, prenatal cannabis exposure, and social-environmental characteristics.

BACKGROUND

Distressing psychotic-like experiences (PLEs) in children are associated with an increased risk for psychiatric disorders. Recent studies suggest that different domains of psychotic symptoms could be associated with distinct risk factors, but less is known about PLEs. This study clustered PLEs into subgroups and explored the genetic and environmental characteristics associated with these profiles.

METHODS

Data from children (N = 11,854) recruited as part of the Adolescent Brain and Cognitive Development Study v5.1 assessed PLEs using 21-items from the Prodromal-Questionnaire-Brief Child Version. K-medoid clustering of PLEs was conducted among children with at least one distressing PLE item at baseline (n = 3155). Associations of polygenic risk scores for schizophrenia (PRS-SCZ) and social-environmental characteristics with PLE subgroups were estimated using generalized multinomial mixed models, adjusting for age, sex, race/ethnicity, parental education, income-to-needs ratio, and family history of psychosis.

RESULTS

We identified three distressing PLE subgroups: hallucinatory-like (n = 1110), paranoid-like (n = 1229), and multiple PLE domains (n = 816). Compared to those without any distressing PLEs (n = 8699), those with hallucinatory-like PLE were more likely to have had prenatal cannabis exposure (Odds Ratio (OR) = 1.578, 95 % CI: 1.231-2.023); paranoid-like individuals had higher PRS-SCZ (OR = 1.080, 95 % CI: 1.001-1.166); those with multiple PLE domains participated in less physical activities (OR = 0.880, 95 % CI: 0.803-0.964). All groups were more likely to have experienced greater childhood adversity and worse school environments.

CONCLUSIONS

We found that those with different aspects of distressing PLEs had distinct and similar genetic and environmental characteristics. These results suggest that it may be important to consider the heterogeneity of PLE in conceptualizing the development of psychosis.