Abstract
An efficient indicated prevention of psychotic disorders requires valid risk criteria that work in both clinical and community samples. Yet, ultra-high risk and basic symptom criteria were recently recommended for use in clinical samples only. Their use in the community was discouraged for lack of knowledge about their prevalence, clinical relevance and risk factors in non-clinical, community settings when validly assessed with the same instruments used in the clinic. Using semi-structured telephone interviews with established psychosis-risk instruments, we studied the prevalence of psychosis-risk symptoms and criteria, their clinical relevance (using presence of a non-psychotic mental disorder or of functional deficits as proxy measures) and their risk factors in a random, representative young adult community sample (N=2683; age 16-40 years; response rate: 63.4%). The point-prevalence of psychosis-risk symptoms was 13.8%. As these mostly occurred too infrequent to meet frequency requirements of psychosis-risk criteria, only 2.4% of participants met psychosis-risk criteria. A stepwise relationship underlay the association of ultra-high risk and basic symptoms with proxy measures of clinical relevance, this being most significant when both occurred together. In line with models of their formation, basic symptoms were selectively associated with age, ultra-high risk symptoms with traumatic events and lifetime substance misuse. Psychosis-risk criteria were uncommon, indicating little risk of falsely labelling individuals from the community at-risk for psychosis. Besides, both psychosis-risk symptoms and criteria seem to possess sufficient clinical relevance to warrant their broader attention in clinical practice, especially if ultra-high risk and basic symptoms occur together.
Highlights
Psychotic disorders are frequently chronic disorders causing severe disability; incurring high direct and indirect costs and psychosocial burden (Gustavsson et al 2011)
In the case of psychotic disorders, risk criteria are available that were recommended for use in clinical samples but not for use in the community for lack of knowledge about their prevalence and clinical relevance in non-clinical settings (Schultze-Lutter et al 2015b)
The 6% prevalence rate of current APS/brief intermittent psychotic symptoms (BIPS) that were reported as a change from earlier thought contents and perceptions as well as the 0.6% prevalence rate of APS/BIPS criteria were below the reported median rate of psychotic-like experiences
Summary
Psychotic disorders are frequently chronic disorders causing severe disability; incurring high direct and indirect costs and psychosocial burden (Gustavsson et al 2011). These, in turn, require good knowledge about the prevalence and clinical relevance of the presumed psychosis-risk symptoms and criteria in the community. Using semi-structured telephone interviews with established psychosis-risk instruments, we studied the prevalence of psychosis-risk symptoms and criteria, their clinical relevance (using presence of a non-psychotic mental disorder or of functional deficits as proxy measures) and their risk factors in a random, representative young adult community sample (N=2683; age 16–40 years; response rate: 63.4%). Psychosis-risk criteria were uncommon, indicating little risk of falsely labelling individuals from the community at-risk for psychosis Both psychosisrisk symptoms and criteria seem to possess sufficient clinical relevance to warrant their broader attention in clinical practice, especially if ultra-high risk and basic symptoms occur together
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