Abstract
In community studies, both attenuated psychotic symptoms (APS) and basic symptoms (BS) were more frequent but less clinically relevant in children and adolescents compared to adults. In doing so, they displayed differential age thresholds that were around age 16 for APS, around age 18 for perceptive BS, and within the early twenties for cognitive BS. Only the age effect has previously been studied and replicated in clinical samples for APS. Thus, we examined the reported age effect on and age thresholds of 14 criteria-relevant BS in a patient sample at clinical-high risk of psychosis (N = 261, age 15–40 yrs.), recruited within the European multicenter PRONIA-study. BS and the BS criteria, “Cognitive Disturbances” (COGDIS) and “Cognitive-perceptive BS” (COPER), were assessed with the “Schizophrenia Proneness Instrument, Adult version” (SPI-A). Using logistic regressions, prevalence rates of perceptive and cognitive BS, and of COGDIS and COPER, as well as the impact of social and role functioning on the association between age and BS were studied in three age groups (15–18 years, 19–23 years, 24–40 years). Most patients (91.2%) reported any BS, 55.9% any perceptive and 87.4% any cognitive BS. Furthermore, 56.3% met COGDIS and 80.5% COPER. Not exhibiting the reported differential age thresholds, both perceptive and cognitive BS, and, at trend level only, COPER were less prevalent in the oldest age group (24–40 years); COGDIS was most frequent in the youngest group (15–18 years). Functional deficits did not better explain the association with age, particularly in perceptive BS and cognitive BS meeting the frequency requirement of BS criteria. Our findings broadly confirmed an age threshold in BS and, thus, the earlier assumed link between presence of BS and brain maturation processes. Yet, age thresholds of perceptive and cognitive BS did not differ. This lack of differential age thresholds might be due to more pronounced the brain abnormalities in this clinical sample compared to earlier community samples. These might have also shown in more frequently occurring and persistent BS that, however, also resulted from a sampling toward these, i.e., toward COGDIS. Future studies should address the neurobiological basis of CHR criteria in relation to age.
Highlights
Despite their low lifetime prevalence of between 0.2 and 3.5% [1], schizophrenia-spectrum and other psychotic disorders are among the most severe and costly neuropsychiatric diseases [2,3,4]
Compared to univariate analyses of age effects, age was less frequently selected as a significant predictor in the multivariate analyses (Tables 5, 6). This is the first study to examine the effect of age and developmental aspects in a clinical high-risk (CHR) sample, alternatively defined by UHR criteria and Cognitive disturbances (COGDIS)
Within our clinical CHR sample, 91.2% reported the presence of any of the 14 BS included in the definition of COGDIS and Cognitive-perceptive basic symptoms (COPER)
Summary
Despite their low lifetime prevalence of between 0.2 and 3.5% [1], schizophrenia-spectrum and other psychotic disorders are among the most severe and costly neuropsychiatric diseases [2,3,4]. The early detection and prevention of psychosis, which aims to reduce the burden of the disorder [9,10,11], has increasingly moved from adult patients into ever younger patient groups. This has been done without full consideration of potentially influential developmental issues [6, 12, 13]. One is the ultra-highrisk (UHR) approach that was developed to detect an imminent risk of psychosis. It includes [1] the attenuated psychotic symptoms (APS) syndrome characterized by recently developed or worsened symptoms that resemble positive symptoms of psychosis, yet with still some insight being maintained; [2] the brief limited intermittent psychotic symptoms (BLIPS) syndrome with frank positive psychotic symptoms that spontaneously remit within a couple of days; and [3] the genetic risk plus functional decline (GRFD) syndrome that combines a significant recent functional decline with a genetic risk factor of psychosis, i.e., a first-degree relative with psychosis or a schizotypal personality disorder in the patient [9, 14]
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