The aetiological continuum of psychosis

  • Inez Myin-Germeys
  • Janneke Spauwen
  • Nele Jacobs
  • Roselind Lieb
  • Hans-Ulrich Wittchen
  • Jim Van Os


In clinical practice, psychosis usually is conceived of as an all-or-none phenomenon, reflecting the necessarily dichotomous medical decision to either treat or not treat. Thus conceptually one either suffers from psychosis, indicating that one is in need of care, or one is healthy and symptom-free. While it is only natural that the binary decision to treat is reflected in clinical formulations of categories of mental illness, there is a growing body of research, conducted outside the realm of the psychiatric clinic, that suggests that the psychosis phenotype is expressed differently in Nature. Thus, there is evidence that the phenotype exists as a continuous distribution of psychotic experiences in the general population, the extreme of which constitutes psychotic disorder as seen in the clinic. Psychotic symptoms such as hallucinations and delusions are commonly reported in non-clinical population samples and the experiences resembling negative symptoms also appear to be distributed. Studies using structured diagnostic interviews have demonstrated that large proportions of the general population report psychosis-like experiences. In the National Comorbidity Study, 28.4% of all individuals from the general population reported one or more psychosis-like experience (Kendler et al. 1996). In the Dutch NEMESIS study, 17.5% of all general population subjects endorsed at least 1 of 17 Composite International Diagnostic Interview positive psychotic items (Van Os et al. 2000).


Negative Symptom Psychotic Symptom Psychotic Disorder Brief Psychiatric Rating Scale Composite International Diagnostic Interview 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2004

Authors and Affiliations

  • Inez Myin-Germeys
    • 1
    • 2
  • Janneke Spauwen
    • 1
  • Nele Jacobs
    • 1
  • Roselind Lieb
    • 3
  • Hans-Ulrich Wittchen
    • 3
  • Jim Van Os
    • 1
    • 4
  1. 1.Dept. Psychiatry and NeuropsychologyEuropean Graduate School of Neuroscience, Maastricht UniversityMaastrichtThe Netherlands
  2. 2.Mondriaan ZorggroepSection Social CognitionHeerlenThe Netherlands
  3. 3.Max Planck Institute of PsychiatryClinical Psychology and Epidemiology UnitMunichGermany
  4. 4.Division of Psychological MedicineInstitute of PsychiatryLondonUK

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