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Tijdschrift voor Psychiatrie 49 (2007) 3, 145 - 155

New research

Coping matters in psychosis. Coping and the need for professional care in cases of subclinical psychosis

M. Bak, PH. Delespaul, I. Myin-Germeys, J. van Os

Changes in the amount of care required in cases of subclinical psychosis are examined in relation to (1) the level of patient distress and (2) the level of dysfunctional coping.
method The Netherlands Mental Health Survey and Incidence Study (nemesis) is a longitudinal investigation into the occurrence of psychopathology in the general population. In the first two measurements of the nemesis study 4722 individuals had not been diagnosed as having a psychotic disorder according to dsm-iii-r. In the third measurement, 83 of those 4.722 were found to have had at least one subclinical psychotic experience. A panel of experts decided on the level of care that patients required.
results Of the various types of psychotic experiences it was only 'passivity phenomena', hearing voices' and 'non-verbal hallucinations' which were associated with the need for care. These associations were largely explained by distress associated with the psychotic experience, with the exception of hearing voices. There were qualitative differences between the various types of coping: in particular, 'symptomatic coping' with psychotic experiences was associated with less perceived control over the psychotic experience (or = 0,79; 95% CI (confidence interval) 0,63-0,98) and an increased probability of the need for care (or = 6,07; 95% CI 1,95-18,95).
conclusion Various types of psychotic experiences require different levels of care. The need for care can arise when psychotic experiences begin to cause patient distress and/or dysfunctional coping. These factors may well play a role in turning an individual with subclinical psychotic experiences into a psychiatric patient.

keywords assessment of health care, general, population, psychotic disorder, coping behaviour