Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4

Psychotic disorders are characterised by severe disturbances in perception, belief, and thought, including hallucinations and delusions. Examples of psychotic disorders include schizophrenia, schizoaffective disorder, acute and transient psychotic disorder, and delusional disorder.

Participants were identified with ‘psychotic disorder in the past year’ using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), administered during the phase two examination. Because psychotic disorders have a low prevalence, data from the 2007, 2014 and 2023/4 Adult Psychiatric Morbidity Surveys (APMS) were combined to increase the number of positive cases for analysis.

• Prevalence of psychotic disorder in the past year remained at less than one in a hundred adults across the 2007, 2014 and 2023/4 surveys (0.4%, 0.7% and 0.4%, respectively), indicating broad stability among adults living in private households in England.
• Psychotic disorder was associated with deprivation. Adults living in the most deprived fifth of neighbourhoods were more likely to be identified with psychotic disorder (1.0%) than adults living in the least deprived fifth of neighbourhoods (close to 0.0%). Adults with problem debt were more likely to have a psychotic disorder (1.7%) than those without problem debt (0.4%).
• Most participants identified by the SCAN examination with psychotic disorder did not think they have/had the condition. Among those identified with psychotic disorder in the past year, about one in three (37.1%) reported that they thought they have had psychotic disorder or schizophrenia at some point in their life.
• There was a strong association between psychotic disorder and common mental health conditions. Adults with a common mental health condition were much more likely to be identified with a psychotic disorder in the past year (2.1%) than those without (0.1%).

Psychotic disorders are characterised by experiences and symptoms that involve disturbances in thoughts and perception. Symptoms include hallucinations, delusional beliefs, and disorganised thinking. People with psychotic disorders also often experience a range of negative symptoms, such as flattened affect (reduced outward expression of emotions), social withdrawal, and anhedonia (lack of interest/enjoyment in activities). Fervaha and colleagues noted how primary negative symptoms significantly contribute to the functional impairment seen in people with schizophrenia (Fervaha et al. 2014).

The course and outcome of psychotic disorders over the short, medium, and long-term are varied. While many people experience periods of sustained symptomatic remission, social outcomes tend to be poor (Morgan et al. 2014). Psychotic disorders can be serious and debilitating conditions, associated with high rates of suicide (Fu et al. 2023; Appleby et al. 2025) and increased mortality; people with schizophrenia die on average 15 to 20 years prematurely (Correll et al. 2022). 

The Adult Psychiatric Morbidity Surveys (APMS) measure psychosis by assessing the presence of symptoms of disorders such as schizophrenia, schizoaffective disorder, and affective psychosis (Singleton et al. 2001; McManus et al. 2016; McManus et al. 2009). Psychotic disorders due to another medical condition, such as those associated with dementia and Alzheimer’s disease, are not discussed in this chapter. Systematic reviews of the incidence (Kirkbride et al. 2012) and prevalence (Moreno-Küstner et al. 2018) of psychotic disorders show considerable variation in methodology, quality, and results, which makes them difficult to pool for meta-analyses. In a meta-analysis of psychotic disorder prevalence (Moreno-Küstner et al. 2018) the pooled median point and 12-month prevalence was 3.89 and 4.30 per 1,000 individuals respectively, and the median lifetime prevalence was 7.49 per 1,000. However, specific general population surveys have estimated a higher lifetime prevalence of psychotic disorder, such as over 3% (Perälä et al. 2007).

Despite being less common than anxiety and mood disorders, psychotic disorders are associated with high levels of service and societal costs (Knapp 2003; Jinn and Mosweu 2017). Findings from the 2016 Global Burden of Disease Study estimated that around 21 million people were living with schizophrenia worldwide, with schizophrenia contributing to 13.4 million years of life lived with disability (Charlson et al. 2018). People with a psychotic illness who live in the community have low rates of employment (Morgan et al. 2014), and when employed are often in poorly paid and less secure jobs (Marwaha et al. 2007). A recent meta-analysis reported employer discrimination towards people with psychosis, where they are frequently viewed as less employable compared to people with other health conditions or no disabilities (Crestois et al. 2025). People living with schizophrenia experience greater social adversity than those without the condition (Moffa et al. 2023), and subgroup variations in prevalence are evident, such by ethnicity (Qassem et al. 2015).

Treatment for psychotic disorders includes antipsychotic medication and cognitive behavioural therapy, with important additional ancillary management measures, such as monitoring physical health, promotion of healthy eating, physical activity and smoking cessation, employment support, family interventions and support for carers and families (National Institute for Health and Care Excellence (NICE) 2015). One key recommendation has been for the early delivery of intervention services to people experiencing their first psychotic episode (NICE 2014), as early intervention services have been shown to be superior to treatment as usual, across a wide range of outcomes, including all-cause treatment discontinuation, risk of psychiatric hospitalization, involvement in school or work, and total symptom severity (Correll et al. 2018).

In this chapter, we present estimates of the prevalence of past year psychotic disorder in the general population. Variation by factors such as age, sex, ethnicity and socioeconomic circumstance are discussed, as well as levels of treatment and service use.

Psychotic disorders

The disorders discussed in this chapter are based on the World Health Organization (WHO) International Classification of Diseases chapter on Mental and Behavioural Disorders Diagnostic Criteria for Research (ICD-10-DCR), including conditions coded under the category of ‘schizophrenia, schizotypal, and delusional disorders (F20-29)’ (WHO 1993).

There could be participants with co-occurring conditions that manifest with psychotic symptoms. For example, if all conditions were examined in phase two, a participant might have been assessed with bipolar affective disorder with psychotic symptoms (e.g. F31.2). However, co-occurring conditions were not assessed during the phase two examination so will instead be classified as having conditions falling under F20-29. 

The reference period for psychotic disorder was the 12 months prior to interview.

Case assessment

To produce estimates of the prevalence of psychotic disorder in the past year among adults living in private households in England, a two-phase approach was adopted consisting of a phase one screen followed by a phase two clinical examination for a subset of participants, as described in the sections below.

Phase one screen

Participants who met one or more of the following screening criteria in the phase one interview were identified as having experiences or symptoms possibly indicative of psychosis:

• Currently taking any antipsychotic medication (orally or by injection). See the Glossary in the APMS 2023/4 Methods documentation for a list of antipsychotic medications.
• Reporting an inpatient stay for a mental or emotional problem in the past three months or having been admitted to a hospital or a ward specialising in mental health problems at any time.
• A positive response to question 5a in the Psychosis Screening Questionnaire (PSQ) (Bebbington and Nayani 1995). The PSQ is a series of five probe and five secondary questions about mania, thought insertion, paranoia, strange experiences, and hallucinations in the past year. Question 5a refers to auditory hallucinations, where the participant is asked, ‘Did you at any time hear voices saying quite a few words or sentences when there was no one around that might account for it?’
• Reporting symptoms suggestive of possible psychotic disorder (such as severe depression, manic depression, mood swings, hallucinations and psychosis) and/or discussing such symptoms with a GP in the past year.
• Self-reported identification with having had a ‘nervous breakdown’ was included as a phase one psychosis screening criterion in APMS 2023/4 only. In APMS 2023/4 127 people were selected for psychosis based on this single criterion, who wouldn’t have been selected using the APMS 2014 selection criteria.

Phase two assessment

Overall, 678 participants (10%) reported at least one phase one screening criterion indicative of psychosis and so were eligible for a phase two assessment. Not all, however, were examined at phase two. A quarter (26%) of phase one participants meeting at least one phase one psychosis criterion refused to be contacted for a phase two examination and were thus not assessed in phase two. Of the 504 eligible participants who agreed to be contacted about phase two, 20% refused the University of Leicester interviewer and 13% could not be contacted. Because much was known about the characteristics of non-responders to phase two, a nuanced psychosis specific weighting strategy was developed to address non-response bias and enable the generation of prevalence estimates that could be generalised to the whole population. In total, 276 participants (41%) who met at least one phase one criterion indicative of psychosis in phase one took part in a phase two examination. Participants could also be selected for phase two if they met the screening criteria for other conditions. See the APMS 2023/4 Methods documentation for more information.

The phase two assessment of psychosis was made using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) version 2.1, a semi-structured examination that provides outputs in the form of ICD-10 diagnostic categories of psychotic disorder (WHO 1999). Because the SCAN involves interviewer judgement of whether symptoms are present (hence an ‘examination’ as opposed to reliance on self-reports or on a fixed set of interview questions), the assessments were conducted by clinically trained interviewers from the University of Leicester (Brugha et al. 1999). The presence of psychotic disorder in the year before examination was established by applying ICD-10 diagnostic algorithms to the SCAN generated symptom ratings. Using combinations of phase one and phase two data, two differently calculated measures of psychotic illness were generated ‘psychotic disorder in the past year’ and ‘probable psychotic disorder’, as detailed below.

The full SCAN examination was administered to all participants who took part in phase two, regardless of the condition(s) they were selected for.

Measuring ‘psychotic disorder in the past year’

For the identification of psychotic disorder in the past year, the following approach was used:

• For those who screened positive for psychosis at phase one and had a SCAN examination, the results of the SCAN were used.
• For those who screened negative for psychosis at phase one, it was assumed that these were true negatives, regardless of whether they were identified with psychosis in the SCAN examination.
• For those who screened positive for psychosis at phase one but did not have a SCAN assessment (e.g. due to refusal or non-contact) a weighting strategy was applied to take account of non-response. The weighting strategy meant that the SCAN results for the participants assessed at phase two were weighted to reflect the profile of all participants identified as eligible.

Measuring ‘probable psychotic disorder’

For the identification of an alternative measure of probable psychotic disorder, phase one screening criteria for psychosis were used where there was an absence of phase two data. This reduces missing data and avoids the need for specific psychosis weights to be used. The difference between the ‘psychotic disorder in the past year’ and the ‘probable psychotic disorder’ variables is the way in which non-response to phase two is accounted for. A positive categorisation was only possible for ‘psychotic disorder in the past year’ if the participant had a positive SCAN examination; while a positive categorisation of ‘probable psychotic disorder’ could also be made based on phase one screening questions, where no SCAN examination was carried out.

For the measure of probable psychotic disorder, the following approach was used:

• For those who screened positive for psychotic disorder at phase one and had a SCAN examination, the results of the SCAN were used.
• For those who screened negative for psychotic disorder at phase one, it was assumed that these were true negatives, regardless of whether they were identified with psychosis in the SCAN examination.
• For those who screened positive for psychotic disorder at phase one but did not have a SCAN examination (e.g. due to refusal or non-contact), those meeting just one psychosis screen criterion at phase one were assigned a negative probable psychotic disorder outcome, and those meeting two or more psychosis screening criteria were assigned a positive outcome. A limitation of this approach is that some of the psychosis screening criteria may be more reliable predictors of psychotic disorder than others. For more detail see the section below on ‘Whether to use psychotic disorder in the past year or probable psychotic disorder’.

There have been changes to the psychosis screening criteria used in the 2007, 2014 and 2023/4 surveys. Firstly, in APMS 2007 and 2014 prompt cards were used that listed psychotropic medications. In 2023/4 the interviewer asked the participant what medication they were currently taking for a mental health condition and recorded the medication directly into the Computer Assisted Personal Interviewing (CAPI) questionnaire, which contained a database of medications listed in the British National Formulary (BNF). Secondly, a different screening criterion was included in the 2023/4 survey (self-reported 'nervous breakdown’ at some point in their life). These changes, alongside the steep increases in prescribing of antipsychotic medication (Newman et al. 2025) and the fact that the probable psychotic disorder variable is less tied to experiences in the past year, mean that the ‘probable psychotic disorder’ measure is less suitable for looking at trends over time than the ‘psychotic disorder in the past year’ measure.

Whether to use ‘psychotic disorder in the past year’ or ‘probable psychotic disorder’

There are concerns about the validity of assigning a positive assessment to those meeting two or more phase one screening criteria but not having a SCAN examination (as in ‘probable psychotic disorder’). For example, some of the psychosis screening criteria relate to:

• events that happened long ago (such as having ever been admitted to a ward specialising in mental health, even if this was decades ago)
• the presence of symptoms that could also be linked to different disorders (such as mood swings)
• taking particular medication (which while indicated as an antipsychotic, could also have been prescribed for other reasons, such as for acute delirium, bipolar disorder, tic disorder or nausea and vomiting) e.g. haloperidol (British National Formulary 2025).

The ‘probable psychotic disorder’ variable may also be more likely to exclude those at an early stage of development of psychosis (and thus possibly not yet in contact with services).

The ‘probable psychotic disorder’ outcome is likely to include people with a history of psychosis who are currently stable on treatment, even where there had been no symptoms in the past year (and thus they may have not been assessed as positive for psychotic disorder using the SCAN, which specifically enquires about the past year).

The ‘psychotic disorder in the past year’ measure has been used as the main psychosis outcome in APMS 2007, 2014 and 2023/4. However, the ‘psychotic disorder in the past year’ variable does have drawbacks.

• It is likely to be a conservative estimate of the size of the population affected by psychosis, as the definition of psychotic disorder in the past year based on the SCAN examination is quite narrow (although appropriate for a study such as this).
• The phase one screening criteria still have the same drawbacks as covered for the ‘probable psychotic disorder’ variable.
• It requires a disorder-specific weighting variable (due to non-response to phase two) and the number of positive cases identified is small.

It was decided to prioritise use of the ‘psychotic disorder in the past year’ measure in this chapter, to present prevalence estimates, perform subgroup comparisons, and examine treatment use for psychotic disorder in the past year using 2007, 2014 and 2023/4 data combined.

Prevalence of psychotic disorder in the past year in 2007, 2014 and 2023/4

In 2007, 2014 and 2023/4, fewer than one adult in a hundred was identified with a psychotic disorder in the past year: 0.4% (95% CI 0.3, 0.6) in 2007, 0.7% (CI 0.4, 1.1) in 2014 and 0.4% (CI 0.2, 0.7) in 2023/4. These figures show a continued trend of broad stability in the past-year prevalence of psychotic disorder in adults living in private households in England. Any conclusions about trends should be treated with caution considering the numbers of confirmed cases were low (23 adults in 2007; 26 in 2014; and 16 in 2023/4). See How to interpret the findings for information on how changes over time were assessed.

Pooling data from the 2007, 2014 and 2023/4 surveys created a larger sample. Estimates drawing on the combined dataset can be considered more robust, and are used in the rest of this chapter where consistency over the survey years allows. Using the combined dataset, overall past-year prevalence of psychotic disorder was estimated at 0.5% of the adult general population. We are 95% confident that the ‘true’ population prevalance, based on our sampling design and methodology, would lie between 0.4% and 0.7%. This is equivalent to an estimated 190 thousand adults living in private households in England.

Prevalence of ‘probable psychotic disorder’, which includes both those assessed as positive using the SCAN or who screened positive for psychosis in phase one (by meeting two or more psychosis criteria) but did not complete a SCAN interview, was 0.8% using the combined dataset.

For more information: Table 12.1 and Table B1 for confidence intervals, Table 12.2 and Table A1 for confidence intervals

Prevalence of psychotic disorder in the past year and probable psychotic disorder (2007, 2014 and 2023/4 combined), by age and sex

Where data on demographic and socioeconomic characteristics were collected consistently since 2007, the results in this chapter draw on a dataset that combines the 2007, 2014 and 2023/4 samples and are analysed by sex (male and female).

Using data pooled from 2007, 2014 and 2023/4 surveys, the prevalence of psychotic disorder in the past year was 0.5% (95% CI 0.4, 0.7); and was similar in males (0.4%, CI 0.3, 0.7) and females (0.6%, CI 0.4, 0.8).

The prevalence of psychotic disorder in the past year using data pooled across the surveys varied by age and was highest in adults aged 35 to 44 (0.9%, CI 0.5, 1.4) and lowest in adults aged 75 and over (0.1%, CI 0.0, 0.5).

For more information: Table 12.2 and Table A1 for confidence intervals

Variation in psychotic disorder in the past year by other characteristics in combined 2007, 2014 and 2023/4 data

Ethnic group

Using age-standardised analyses, the prevalence of psychotic disorder in the past year did not vary significantly by ethnic group. However, the number of adults with psychotic disorders in some groups was very small and the confidence intervals around estimates were wide.

For more information: Table 12.3 and Table A2 for confidence intervals

Employment status

In age-standardised analyses, the prevalence of psychotic disorder in the past year among working age adults (aged 16 to 64) varied by employment status. Economically inactive adults were more likely to be identified with psychotic disorder in the past year (2.6%) than those in employment (0.1%). The corresponding figure for adults classified as unemployed was 0.5%.

For more information: Table 12.4

Problem debt

In age-standardised analyses, being seriously behind on at least one debt repayment or having utilities cut off was associated with psychotic disorder in the past year. See the APMS 2023/4 Methods documentation for more information on how problem debt was derived. Adults who reported having problem debt were more likely to have a psychotic disorder (1.7%) than those who did not report problem debt (0.4%). 

For more information: Table 12.5

Area-level deprivation

In age-standardised analyses, being identified with psychotic disorder was associated with area-level deprivation. Adults living in the most deprived neighbourhoods were more likely to be assessed as positive for psychotic disorder in the past year than adults living in the least deprived neighbourhoods (based on quintiles) (1.0% and close to 0.0%, respectively).

For more information: Table 12.6

Region

Although there were apparent differences in the prevalence of psychotic disorder (age-standardised) and English regions, these did not meet the required levels of significance. This could be due to the small number of adults assessed with psychotic disorder.

For more information: Table 12.7

Comorbidity

Physical health conditions

In age-standardised analysis of APMS 2023/4 data, those with a limiting physical health condition (0.9%) were more likely to be identified with psychotic disorder than those without (0.2%).

For more information: Table 12.8

Common mental health conditions

Age-standardised analyses of combined data from 2007, 2014 and 2023/4 showed that adults with a common mental health condition (CMHC) were more likely than those without to be identified with psychotic disorder in the past year. 2.1% of adults with a CMHC were assessed as positive for psychotic disorder, compared with 0.1% without a CMHC.

For more information: Table 12.8

Self-diagnosis and professional diagnosis of psychotic disorder

Participants were asked whether they thought they had ever experienced ‘psychotic disorder or schizophrenia’. Those who said yes were asked whether this had been diagnosed by a professional, and if so, whether this had occurred in the past 12 months.

Of adults included in the 2014 and 2023/4 surveys, 0.7% reported that they thought that they have had a psychotic disorder or schizophrenia at some point in their life, and 0.5% (a subset of the 0.7%) of adults stated that this had been diagnosed by a professional.

Among those identified with psychotic disorder in the past year, 17 people (37.1%) reported that they thought they have had psychotic disorder or schizophrenia at some point in their life, all of whom (37.1%) reported that they have had this diagnosed by a professional. 15 people (31.9%) who reported that a health professional had diagnosed psychotic disorder or schizophrenia had experienced symptoms in the past year.

Base sizes of those identified with psychotic disorder in the past year by the survey are fairly small and these figures should be treated with some caution.

For more information: Table 12.9

Treatment and service use

Mental health treatment and service use

Participants were asked about different types of mental health treatment and service use. These included current psychotropic medication or psychological therapy for any mental or emotional problem (not necessarily related to psychotic disorder). Participants were also asked about their use of a range of health, community and day care services over the past year.

In combined data from 2007, 2014, and 2023/4, a fifth (21.0%) of adults identified with psychotic disorder in the past year (based on SCAN examination) were not receiving any treatment for a mental or emotional problem. Three in four adults identified with psychotic disorder were in receipt of psychotropic medication (74.6%) and nearly half were in receipt of psychological therapy (43.3%).

Adults identified with psychotic disorder in the past year were more likely to use health care services for a mental or emotional problem (68.4%) than those without psychotic disorder (12.3%). Among those identified with psychotic disorder, two in three (62.7%) had used community care services and about one in three (36.3%) had used day care services in the past year.

For more information: Table 12.10

Psychotropic medication

Participants were asked which (if any) psychotropic medications they were currently taking for a mental health reason. These were not necessarily medications being taken for symptoms related to psychotic disorder. For further information about how medication data was collected, see the APMS 2023/4 Methods documentation. Overall, 12.5% of all adults were taking some form of psychotropic medication, with the most common medication types being those primarily used to treat depression (11.7%) and anxiety (10.7%). See Chapter 2 Mental health treatment and service use for more details.

Three quarters of people with psychotic disorder in the past year were taking psychotropic medication (74.6%). This was eight times higher than in those without psychotic disorder (9.6%).  

Among those with psychotic disorder, psychotropic medications taken were those primarily used to treat:  

• depression (53.4%)
• bipolar disorder (46.1%)
• psychosis (43.2%)
• anxiety (39.0%) 

Use of substance dependence medication was more prevalent among those with psychotic disorder (9.4%) than in those without psychotic disorder (0.6%).  

For more information: Table 12.11

Less than one in a hundred adults met diagnostic criteria for a psychotic disorder in the past year in 2007, 2014, and 2023/4. The approach to psychosis measurement across the APMS series has remained largely consistent over time, and the estimated prevalence across surveys has ranged from 0.4 to 0.7, indicating relative stability or at most modest variation over time in the annual prevalence of psychotic disorders among adults living in private households in England. This is despite evidence of more substantive increases in the prescribing of antipsychotic medication (Shoham et al. 2021) and some evidence of increases in the incidence (rate of new cases) of these conditions over time in some populations (Oduola et al. 2021). One possible explanation is that this increased incidence may be offset by more adults being in recovery from their psychotic disorder as a consequence of heightened levels of antipsychotic prescribing.

APMS may underestimate the prevalence of psychotic disorder in the adult population. Studies drawing on medical notes as well as interview data tend to identify more cases of psychotic disorder than studies like APMS, which rely on interview information alone (Kirkbride et al. 2012; Isohanni et al. 1997). People experiencing a psychotic episode may also be less likely to take part in a survey, either because they feel too unwell to take part or because of a heightened guardedness (Subotnik et al. 2005). The relatively rare and complex nature of psychosis makes it harder to recruit a representative sample of people with the disorder, especially given their higher likelihood of being homeless (Chilman et al. 2024), in prison (Bebbington et al. 2021), or in other non-household settings.

People with psychotic disorder often experienced disadvantage and deprivation. This is consistent with evidence from Sweden that has shown that people who grow up in more deprived areas are more likely to be diagnosed with a psychotic disorder later in life (Logeswaran et al. 2023); this association is stronger than the reverse pattern where people with psychotic disorders may move into more deprived areas due to their condition. In APMS, adults identified with a psychotic disorder were also more likely to be experiencing problem debt. Across the 2007, 2014, and 2023/4 surveys, the prevalence of psychotic disorder was highest in adults who were economically inactive. These findings are broadly consistent with a Swedish nationwide population-based study, which reported that only 3-4% of people with schizophrenia were in paid employment (Holm et al. 2021). A systematic review by Bouwmans et al. (2015) found that employment of people with schizophrenia was associated with better health-related quality of life, although the direction of causality of this relationship is unclear. Unlike studies of incidence which have reported large disparities in psychotic disorder by ethnicity (Kirkbride et al. 2012), we did not find significant differences in the prevalence of psychotic disorder in the past year between ethnic groups. This may be due to differences between ethnic groups in factors that influence prevalence estimates (incidence, remission and recovery, emigration, death), small sample sizes in some ethnic groups in APMS, and methodological differences in case ascertainment and identification between clinical studies of incidence and population-based surveys such as APMS. Further research is required to understand these processes in more detail.

People with psychotic disorder often had other physical and mental health conditions. High prevalence of anxiety disorders (Achim et al. 2011) and major depressive disorder (Etchecopar-Etchart et al. 2021) has previously been reported among patients with schizophrenia. This demonstrates a need for many people with psychotic disorders to have a comprehensive treatment plan that addresses the presence of multiple co-occurring mental health conditions. Overlapping mental health conditions may also partially account for their higher usage of psychotropic medication (eight times higher than for adults without psychotic disorder), including medications prescribed for depression (53.4%), bipolar disorder (46.1%), psychosis (43.2%), and anxiety (39.0%). The strong associations found with physical health conditions are also consistent with wider evidence, including elevated rates of sensory impairment among people with psychotic disorder (e.g. Shoham et al. 2020).

Most survey participants identified with psychotic disorder did not think they had the condition. Among those identified with psychotic disorder in the past year, around a third reported that they thought they have had ‘psychotic disorder or schizophrenia’ at some point in their life, all of whom reported that a professional had told them they had the condition. The fact that most people identified with the condition did not report thinking they have had it may reflect stigma and a reluctance to disclose, or poor mental-illness related insight, which has been observed in almost half of all participants with a first episode of psychosis in a previous study (Ayesa-Arriola et al. 2014).

While limited by sample size, APMS data provides unique context on psychosis in England. The findings in this chapter provide support for a continued focus on improving community services, including early intervention and support for people with a first episode of psychosis (NHS England 2023; De Girolamo et al. 2012; Kahn et al. 2015), and ensuring they have access to support around their finances, employment (Carmona et al. 2017), and physical health needs (Teh et al. 2021).

Achim, A. M., Maziade, M., Raymond, É., Olivier, D., Mérette, C., & Roy, M. A. (2011). How prevalent are anxiety disorders in schizophrenia? A meta-analysis and critical review on a significant association. Schizophrenia Bulletin, 37(4), 811-821.

Appleby, L., Kapur, N., Turnbull, P., Hunt, I. M., Saied I., et al.  (2025). The National Confidential Inquiry into Suicide and Safety in Mental Health. Annual Report 2025. University of Manchester. https://sites.manchester.ac.uk/ncish/reports/annual-report-2025/

Ayesa-Arriola, R., Moríñigo, J. D. L., David, A. S., Pérez-Iglesias, R., Rodríguez-Sánchez, J. M., & Crespo-Facorro, B. (2014). Lack of insight 3 years after first-episode psychosis: an unchangeable illness trait determined from first presentation? Schizophrenia Research, 157(1-3), 271-277.

Bebbington, P. E., McManus, S., Coid, J. W., Garside, R., & Brugha, T. (2021). The mental health of ex-prisoners: analysis of the 2014 English National Survey of Psychiatric Morbidity. Social Psychiatry and Psychiatric Epidemiology, 56(11), 2083-2093.

Bebbington, P., & Nayani, T. (1995). The psychosis screening questionnaire. International Journal of Methods in Psychiatric Research. 5: 11–19.

Bouwmans, C., de Sonneville, C., Mulder, C. L., & Hakkaart-van Roijen, L. (2015). Employment and the associated impact on quality of life in people diagnosed with schizophrenia. Neuropsychiatric Disease and Treatment, 2125-2142.

British National Formulary (2025). Haloperidol. https://bnf.nice.org.uk/drugs/haloperidol/#indications-and-dose

Brugha, T. S., Nienhuis, F., Bagchi, D., Smith, J., & Meltzer, H. (1999). The survey form of SCAN: the feasibility of using experienced lay survey interviewers to administer a semi-structured systematic clinical assessment of psychotic and non-psychotic disorders. Psychological Medicine, 29(3), 703-711.

Carmona, V. R., Gomez-Benito, J., Huedo-Medina, T. B., & Rojo, J. E. (2017). Employment outcomes for people with schizophrenia spectrum disorder: A meta-analysis of randomized controlled trials. International Journal of Occupational Medicine and Environmental Health, 30(3), 345-366.

Charlson, F. J., Ferrari, A. J., Santomauro, D. F., Diminic, S., Stockings, E., Scott, J. G., ... & Whiteford, H. A. (2018). Global epidemiology and burden of schizophrenia: findings from the global burden of disease study 2016. Schizophrenia Bulletin, 44(6), 1195-1203.

Chilman, N., Schofield, P., McManus, S., Ronaldson, A., Stagg, A., & Das-Munshi, J. (2024). The public health significance of prior homelessness: findings on multimorbidity and mental health from a nationally representative survey. Epidemiology and Psychiatric Sciences, 33, e63.

Correll, C. U., Galling, B., Pawar, A., Krivko, A., Bonetto, C., Ruggeri, M., ... & Kane, J. M. (2018). Comparison of early intervention services vs treatment as usual for early-phase psychosis: a systematic review, meta-analysis, and meta-regression. JAMA Psychiatry, 75(6), 555-565.

Correll, C. U., Solmi, M., Croatto, G., Schneider, L. K., Rohani‐Montez, S. C., Fairley, L., ... & Tiihonen, J. (2022). Mortality in people with schizophrenia: a systematic review and meta‐analysis of relative risk and aggravating or attenuating factors. World Psychiatry, 21(2), 248-271.

Crestois, N., Kempton, M. J., & Twumasi, R. (2025). A systematic review and meta-analysis of employer discrimination towards people living with psychosis. Schizophrenia Research, 278, 35-46.

De Girolamo, G., Dagani, J., Purcell, R., Cocchi, A., & McGorry, P. D. (2012). Age of onset of mental disorders and use of mental health services: needs, opportunities and obstacles. Epidemiology and Psychiatric Sciences, 21(1), 47-57.

Etchecopar-Etchart, D., Korchia, T., Loundou, A., Llorca, P. M., Auquier, P., Lançon, C., ... & Fond, G. (2021). Comorbid major depressive disorder in schizophrenia: a systematic review and meta-analysis. Schizophrenia Bulletin, 47(2), 298-308.

Fervaha, G., Foussias, G., Agid, O., & Remington, G. (2014). Impact of primary negative symptoms on functional outcomes in schizophrenia. European Psychiatry, 29(7), 449-455.

Fu, X. L., Qian, Y., Jin, X. H., Yu, H. R., Wu, H., Du, L., ... & Shi, Y. Q. (2023). Suicide rates among people with serious mental illness: a systematic review and meta-analysis. Psychological Medicine, 53(2), 351-361.

Holm, M., Taipale, H., Tanskanen, A., Tiihonen, J., & Mitterdorfer‐Rutz, E. (2021). Employment among people with schizophrenia or bipolar disorder: A population‐based study using nationwide registers. Acta Psychiatrica Scandinavica, 143(1), 61-71.

Isohanni, M., Mäkikyrö, T., Moring, J., Räsanen, P., Hakko, H., Partanen, U., ... & Jones, P. (1997). A comparison of clinical and research DSM-III-R diagnoses of schizophrenia in a Finnish national birth cohort: clinical and research diagnoses of schizophrenia. Social Psychiatry and Psychiatric Epidemiology, 32, 303-308.

Jinn, H., & Mosweu, I. (2017). The societal cost of schizophrenia: a systematic review. Pharmacoeconomics, 35, 25-42.

Kahn, R. S., Sommer, I. E., Murray, R. M., Meyer-Lindenberg, A., Weinberger, D. R., Cannon, T. D., ... & Insel, T. R. (2015). Schizophrenia (primer). Nature Reviews. Disease Primers, 1(1).

Kirkbride, J. B., Errazuriz, A., Croudace, T. J., Morgan, C., Jackson, D., Boydell, J., ... & Jones, P. B. (2012). Incidence of schizophrenia and other psychoses in England, 1950–2009: a systematic review and meta-analyses. PloS One, 7(3), e31660.

Knapp, M. (2003). Hidden costs of mental illness. The British Journal of Psychiatry, 183(6), 477-478.

Logeswaran, Y., Dykxhoorn, J., Dalman, C., & Kirkbride, J. B. (2023). Social deprivation and population density trajectories before and after psychotic disorder diagnosis. JAMA Psychiatry, 80(12), 1258-1268.

Marwaha, S., Johnson, S., Bebbington, P., Stafford, M., Angermeyer, M. C., Brugha, T., ... & Toumi, M. (2007). Rates and correlates of employment in people with schizophrenia in the UK, France and Germany. The British Journal of Psychiatry, 191(1), 30-37.

McManus, S., Bebbington, P., Jenkins, R., Brugha, T. (eds) (2016). Adult Psychiatric Morbidity Survey 2014. Leeds: NHS Digital. https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey/adult-psychiatric-morbidity-survey-survey-of-mental-health-and-wellbeing-england-2014

McManus, S., Meltzer, H., Brugha, T., Bebbington, P., Jenkins, R. (2009). Adult psychiatric morbidity in England: results of a household survey. NHS Information Centre: Leeds. https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey/adult-psychiatric-morbidity-in-england-2007-results-of-a-household-survey

Moffa, G., Kuipers, J., Kuipers, E., McManus, S., & Bebbington, P. (2023). Sexual abuse and psychotic phenomena: a directed acyclic graph analysis of affective symptoms using English national psychiatric survey data. Psychological Medicine, 53(16), 7817-7826.

Moreno-Küstner, B., Martín, C., & Pastor, L. (2018). Prevalence of psychotic disorders and its association with methodological issues. A systematic review and meta-analyses. PloS One, 13(4), e0195687.

Morgan, C., Lappin, J., Heslin, M., Donoghue, K., Lomas, B., Reininghaus, U., ... & Dazzan, P. (2014). Reappraising the long-term course and outcome of psychotic disorders: the AESOP-10 study. Psychological Medicine, 44(13), 2713-2726.

National Institute for Health and Care Excellence. (2014). Psychosis and schizophrenia in adults: prevention and management – Clinical guideline [CG178]. https://www.nice.org.uk/guidance/cg178/chapter/Recommendations

National Institute for Health and Care Excellence. (2015). Psychosis and schizophrenia in adults - Quality standard [QS80]. https://www.nice.org.uk/guidance/qs80

Newman, H., Branford, D., Laugharne, R., Byng, R., & Shankar, R. (2025). Twenty-five year trend in antipsychotic medication prescribing in England: challenges and opportunities. BJPsych Open, 11(4), e151.

NHS England. (2023). Implementing the early intervention in psychosis access and waiting time standard. B1954-implementing-the-early-intervention-in-psychosis-access-and-waiting-time-standard.pdf

Oduola, S., Das-Munshi, J., Bourque, F., Gayer-Anderson, C., Tsang, J., Murray, R. M., ... & Morgan, C. (2021). Change in incidence rates for psychosis in different ethnic groups in south London: findings from the Clinical Record Interactive Search-First Episode Psychosis (CRIS-FEP) study. Psychological Medicine, 51(2), 300-309.

Perälä, J., Suvisaari, J., Saarni, S. I., Kuoppasalmi, K., Isometsä, E., Pirkola, S., ... & Lönnqvist, J. (2007). Lifetime prevalence of psychotic and bipolar I disorders in a general population. Archives of General Psychiatry, 64(1), 19-28.

Qassem, T., Bebbington, P., Spiers, N., McManus, S., Jenkins, R., & Dein, S. (2015). Prevalence of psychosis in black ethnic minorities in Britain: analysis based on three national surveys. Social Psychiatry and Psychiatric Epidemiology, 50(7), 1057-1064.

Shoham, N., Cooper, C., Lewis, G., Bebbington, P., & McManus, S. (2021). Temporal trends in psychotic symptoms: repeated cross-sectional surveys of the population in England 2000–14. Schizophrenia Research, 228, 97-102.

Shoham, N., Lewis, G., Hayes, J., McManus, S., Kiani, R., Brugha, T., ... & Cooper, C. (2020). Psychotic symptoms and sensory impairment: Findings from the 2014 adult psychiatric morbidity survey. Schizophrenia Research, 215, 357-364.

Singleton, N., Bumpstead, R., O’Brien, M., Lee, A., & Meltzer, H. (2001). Psychiatric morbidity among adults living in private households. National Statistics 154. London: The Stationery Office. https://doc.ukdataservice.ac.uk/doc/4653/mrdoc/pdf/4653userguide2.pdf

Subotnik, K. L., Nuechterlein, K. H., Irzhevsky, V., Kitchen, C. M., Woo, S. M., & Mintz, J. (2005). Is unawareness of psychotic disorder a neurocognitive or psychological defensiveness problem?. Schizophrenia Research, 75(2-3), 147-157.

Teh, W. L., Cetty, L., Jeyagurunathan, A., Devi, F., Roystonn, K., Tang, C., ... & Subramaniam, M. (2021). Comorbid physical illnesses in adult outpatients with psychotic disorders: risk factors, psychological functioning, and quality of life outcomes. Social Psychiatry and Psychiatric Epidemiology, 56(9), 1633-1643. 

World Health Organization. (1993). The ICD-10 classification of mental and behavioural disorders. World Health Organization. 

World Health Organization, Division of Mental Health. (1999). SCAN Schedules for Clinical Assessment in Neuropsychiatry (Version 2.1). World Health Organization. 

Please cite this chapter as:

Brown, A.,  Liubertiene, G., Morris, S., Timpe, A., McManus, S., Kirkbride, J., Morgan, C., Morgan, Z., Tromans, S., Brugha, T. (2025). Psychotic disorder. In Morris, S., Hill, S., Brugha, T., McManus, S. (Eds.). Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4. NHS England.