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Adolescents and adults at clinical high-risk for psychosis: age-related differences in attenuated positive symptoms syndrome prevalence and entanglement with basic symptoms

Published online by Cambridge University Press:  16 December 2015

M. Gerstenberg ,
A. Theodoridou ,
N. Traber-Walker ,
M. Franscini ,
D. Wotruba ,
S. Metzler ,
M. Müller ,
D. Dvorsky ,
C. U. Correll  and
S. Walitza
...Show all authors
M. Gerstenberg*
Affiliation:
The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland University Clinics for Child and Adolescent Psychiatry Zurich, Zurich, Switzerland
A. Theodoridou
Affiliation:
The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
N. Traber-Walker
Affiliation:
University Clinics for Child and Adolescent Psychiatry Zurich, Zurich, Switzerland
M. Franscini
Affiliation:
University Clinics for Child and Adolescent Psychiatry Zurich, Zurich, Switzerland
D. Wotruba
Affiliation:
The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland Department of Neuroradiology, University Hospital of Zurich, Zurich, Switzerland Collegium Helveticum, A Joint Research Institute, University of Zurich and the Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
S. Metzler
Affiliation:
The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
M. Müller
Affiliation:
The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
D. Dvorsky
Affiliation:
The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
C. U. Correll
Affiliation:
The Zucker Hillside Hospital, Psychiatry Research, North Shore – Long Island Jewish Health System (LIJ), Glen Oaks, NY, USA Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA The Feinstein Institute for Medical Research, Manhasset, NY, USA Albert Einstein College of Medicine, Bronx, NY, USA
S. Walitza
Affiliation:
University Clinics for Child and Adolescent Psychiatry Zurich, Zurich, Switzerland
W. Rössler
Affiliation:
The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland Collegium Helveticum, A Joint Research Institute, University of Zurich and the Swiss Federal Institute of Technology Zurich, Zurich, Switzerland Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
K. Heekeren
Affiliation:
The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
*
*Address for correspondence: M. Gerstenberg, M.D., University Clinics for Child and Adolescent Psychiatry Zurich, Neumunsterallee 3, CH-8032 Zurich, Switzerland. (Email: miriam.gerstenberg@kjpdzh.ch)
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Abstract

Background

The attenuated positive symptoms syndrome (APSS) is considered an at-risk indicator for psychosis. However, the characteristics and developmental aspects of the combined or enriched risk criteria of APSS and basic symptom (BS) criteria, including self-experienced cognitive disturbances (COGDIS) remain under-researched.

Method

Based on the Structured Interview of Prodromal Syndromes (SIPS), the prevalence of APSS in 13- to 35-year-old individuals seeking help in an early recognition program for schizophrenia and bipolar-spectrum disorders was examined. BS criteria and COGDIS were rated using the Schizophrenia Proneness Instrument for Adults/Children and Youth. Participants meeting APSS criteria were compared with participants meeting only BS criteria across multiple characteristics. Co-occurrence (APSS+/BS+, APSS+/COGDIS+) was compared across 13–17, 18–22 and 23–35 years age groups.

Results

Of 175 individuals (age = 20.6 ± 5.8, female = 38.3%), 94 (53.7%) met APSS criteria. Compared to BS, APSS status was associated with suicidality, higher illness severity, lower functioning, higher SIPS positive, negative, disorganized and general symptoms scores, depression scores and younger age (18.3 ± 5.0 v. 23.2 ± 5.6 years, p < 0.0001) with age-related differences in the prevalence of APSS (ranging from 80.3% in 13- to 17-year-olds to 33.3% in 23- to 35-year-olds (odds ratio 0.21, 95% confidence interval 0.11–0.37). Within APSS+ individuals, fewer adolescents fulfilled combined risk criteria of APSS+/BS+ or APSS+/COGDIS+ compared to the older age groups.

Conclusions

APSS status was associated with greater suicidality and illness/psychophathology severity in this help-seeking cohort, emphasizing the need for clinical care. The age-related differences in the prevalence of APSS and the increasing proportion of APSS+/COGDIS+ may point to a higher proportion of non-specific/transient, rather than risk-specific attenuated positive symptoms in adolescents.

Keywords

Adolescentsat-risk for psychosisattenuated positive symptomsbasic symptomscognitive disturbancespsychosis
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 5 , April 2016 , pp. 1069 - 1078
Copyright
Copyright © Cambridge University Press 2015 

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