Attenuated Psychosis Symptoms Research Articles

Attenuated psychosis symptoms are related to working alliance between therapist and service user.

Many trials have demonstrated the efficacy of specific therapy modalities for individuals with attenuated psychosis symptoms (APS). Less is known regarding mechanisms behind positive outcomes, including the role of nonspecific therapeutic factors. This study explored working alliance (WA) in a clinic serving individuals with APS to see how WA changed across the course of treatment and its relation to APS. Session level APS and WA data was available for 12 individuals of diverse racial and gender identity, (M = 48 sessions each). Multilevel models with random intercepts tested change in WA and APS over time, and cross-sectional and prospective relations. WA increased and APS decreased over time. Cross sectionally, WA and APS were inversely related. Prospective relations were non-significant. When symptoms increase, therapists for individuals with APS should be attentive to potential disruptions in WA, though strong WA may be a cross-sectional protective factor.

The associations between attenuated psychosis symptoms and functioning in Black and White youth at clinical high-risk for psychosis.

Extensive research has demonstrated racial disparities, particularly among Black individuals, in both presentation and course of psychosis spectrum disorders. Few studies, however, have examined racial differences in the clinical high-risk (CHR) phase of illness. It is unclear if functional deficits seen in association with CHR symptoms generalize to marginalized racial groups, or whether race may play a role in the link between symptoms and functioning. In a sample of youth at CHR (N=46), the present study examined the effect of race (Black and White represented in this sample) on the relation between CHR symptoms and social/role functioning. Race had a moderating effect on the relation between CHR symptoms and social functioning for total positive symptom score (p<.04, f2=0.10). Although positive symptoms were associated with worse social functioning for White participants, no association was found for Black participants. Follow up analyses indicated suspiciousness was a statistically significant predictor of social functioning for White participants but was unrelated to functioning for Black participants. Results may be indicative of phenomenon experienced by individuals within racial minority groups (e.g., "healthy suspiciousness") or potential measurement validity concerns. Findings further the understanding of racial differences in the CHR phase of illness among White and Black youth and highlight limitations of the existing CHR literature and assessment tools for diverse youth.

Using automatic acoustic analysis to reveal disruptions to speech articulation in individuals at risk for psychosis

Individuals who are experiencing attenuated psychosis symptoms (placing them at clinical high risk for developing psychosis) exhibit disruptions to cortico-cerebellar circuits that manifest as difficulties in motor control of the face and limbs. These motor dysfunctions are predictive of the onset and progression of psychosis, making them a potential biomarker for this devastating disease. We examine whether these motor abnormalities disrupt speech production, leading to greater variability in speech acoustics. Clinical high risk (CHR) individuals and matched healthy control (HC) individuals produced diadochokinetic speech (rapid, repeated syllable production, e.g., papapa…, pataka…) and read aloud a paragraph. Consonant and vowel onsets and offsets were automatically segmented from diadochokinetic speech using a deep-learning model trained on human annotators. Read speech was automatically segmented at the word level using forced alignment. Vowel segmentation from read speech was based on forced aligner output; stop consonant onset/offsets were segmented by a deep-learning model. The segmentations from each task were then used to estimate speech rate, voice onset time (VOT), vowel durations and formant trajectories. CHR individuals produced more variable VOTs and exhibited greater speech rate variability than HC individuals in both tasks. This suggests that speech acoustics may provide a window into disruptions in this at-risk population.

Sensed Presence, Attenuated Psychosis, and Transliminality: At the Threshold of Consciousness

Introduction: The experience of “sensed presence” or “felt presence” in the absence of “other” has been described as a complex multimodal experience to which meaning is given. Sensed presence (SenP) is a transdiagnostic experience that exists along a continuum that can appear during isolation, spirit quests, exposure to extreme elements, bereavement, anxiety, and psychosis. Given the prevalence and vast heterogeneity of SenP, in addition to a surprising lack of targeted research into this phenomenon, this research examined the interrelationship of SenP, attenuated psychosis symptoms (APS), and transliminality. Transliminality is composed of absorption, fantasy proneness, paranormal belief, mystical experiences, increased creativity, and hyperaesthesia. Methods: A completely anonymous online survey of unusual experiences and mental health was distributed via social media (i.e., Twitter, Facebook, Reddit, and mass emailing lists) to recruit participants. Demographic data were analyzed using χ² tests and one-way ANOVAs. A two-step cluster analysis was conducted to identify distinct sub-categories of transliminality followed by ANOVAs with bootstrapping at 1,000 iterations to compare SenP, increased APS, and transliminality. Pearson’s bivariate correlations were conducted to determine the association between SenP, APS, and transliminality. Results: Together with descriptive findings, we show distinct characteristics between clusters. T1 cluster consisted of individuals with few SenP experiences, low APS, and low transliminality. T2 consisted of individuals with a moderate prevalence of SenP, low APS, moderate transliminality, and increased overall feeling of closeness to G-d. There was no significant difference in APS between T1 and T2 or in the level of distress associated with APS. T3 individuals showed a significantly higher prevalence of SenP in all domains (frequency, distress, vividness, and total score), higher APS, and higher transliminality, compared to T1 and T2. The T3 cluster met criteria for high risk to develop psychosis. Conclusion: Thus, our findings demonstrate a strong association and entanglement of these experiences which suggests that the interrelatedness of transliminality/absorption and APS may serve as a potentially provocative underlying structure in the phenomenology of SenP.

The heterogeneity of attenuated and brief limited psychotic symptoms: association of contents with age, sex, country, religion, comorbidities, and functioning.

The Attenuated Psychosis Symptoms (APS) syndrome mostly represents the ultra-high-risk state of psychosis but, as does the Brief Intermittent Psychotic Symptoms (BIPS) syndrome, shows a large variance in conversion rates. This may be due to the heterogeneity of APS/BIPS that may be related to the effects of culture, sex, age, and other psychiatric morbidities. Thus, we investigated the different thematic contents of APS and their association with sex, age, country, religion, comorbidity, and functioning to gain a better understanding of the psychosis-risk syndrome. A sample of 232 clinical high-risk subjects according to the ultra-high risk and basic symptom criteria was recruited as part of a European study conducted in Germany, Italy, Switzerland, and Finland. Case vignettes, originally used for supervision of inclusion criteria, were investigated for APS/BIPS contents, which were compared for sex, age, country, religion, functioning, and comorbidities using chi-squared tests and regression analyses. We extracted 109 different contents, mainly of APS (96.8%): 63 delusional, 29 hallucinatory, and 17 speech-disorganized contents. Only 20 contents (18.3%) were present in at least 5% of the sample, with paranoid and referential ideas being the most frequent. Thirty-one (28.5%) contents, in particular, bizarre ideas and perceptual abnormalities, demonstrated an association with age, country, comorbidity, or functioning, with regression models of country and obsessive-compulsive disorders explaining most of the variance: 55.8 and 38.3%, respectively. Contents did not differ between religious groups. Psychosis-risk patients report a wide range of different contents of APS/BIPS, underlining the psychopathological heterogeneity of this group but also revealing a potential core set of contents. Compared to earlier reports on North-American samples, our maximum prevalence rates of contents were considerably lower; this likely being related to a stricter rating of APS/BIPS and cultural influences, in particular, higher schizotypy reported in North-America. The various associations of some APS/BIPS contents with country, age, comorbidities, and functioning might moderate their clinical severity and, consequently, the related risk for psychosis and/or persistent functional disability.

Supplemental Material for A Randomized Trial of Telehealth Mindfulness-Based Cognitive Therapy and Cognitive Behavioral Therapy Groups for Adolescents With Mood or Attenuated Psychosis Symptoms

Supplemental Material for A Randomized Trial of Telehealth Mindfulness-Based Cognitive Therapy and Cognitive Behavioral Therapy Groups for Adolescents With Mood or Attenuated Psychosis Symptoms

Enhancing Psychosis Risk Prediction Through Computational Cognitive Neuroscience.

Research suggests that early identification and intervention with individuals at clinical high risk (CHR) for psychosis may be able to improve the course of illness. The first generation of studies suggested that the identification of CHR through the use of specialized interviews evaluating attenuated psychosis symptoms is a promising strategy for exploring mechanisms associated with illness progression, etiology, and identifying new treatment targets. The next generation of research on psychosis risk must address two major limitations: (1) interview methods have limited specificity, as recent estimates indicate that only 15%–30% of individuals identified as CHR convert to psychosis and (2) the expertise needed to make CHR diagnosis is only accessible in a handful of academic centers. Here, we introduce a new approach to CHR assessment that has the potential to increase accessibility and positive predictive value. Recent advances in clinical and computational cognitive neuroscience have generated new behavioral measures that assay the cognitive mechanisms and neural systems that underlie the positive, negative, and disorganization symptoms that are characteristic of psychotic disorders. We hypothesize that measures tied to symptom generation will lead to enhanced sensitivity and specificity relative to interview methods and the cognitive intermediate phenotype measures that have been studied to date that are typically indicators of trait vulnerability and, therefore, have a high false positive rate for conversion to psychosis. These new behavioral measures have the potential to be implemented on the internet and at minimal expense, thereby increasing accessibility of assessments.

S27. EXAMINING DISCREPANCIES BETWEEN SELF-REPORT AND CLINICIAN-RATED ASSESSMENTS OF PSYCHOSIS RISK: DOES INTERNALIZED STIGMA MATTER?

BackgroundPsychosis is one of the most highly stigmatized mental health conditions (Thornicroft et al., 2009). Compared to those with other mental health concerns, people diagnosed with schizophrenia spectrum disorders are more likely to be perceived by others as dangerous, violent, and unpredictable. As a result, they are often socially marginalized and discriminated against (Crisp et al., 2000; Martin et al., 2007).Individuals at clinical high risk (CHR) for psychosis may be at lower risk for experiencing public stigma, given that their symptoms are often less outwardly visible at this early stage of illness. However, evidence suggests that those at CHR experience high levels of self-stigma, as they may internalize negative stereotypes related to psychosis (Yang et al., 2010; Yang et al., 2015). Internalized stigma can negatively impact help-seeking behavior and has been associated with lower self-esteem and the underreporting of mental health symptoms (Corrigan, 2004; Corrigan, 2007; Saporito, Ryan, & Teachman, 2011; Rüsch, Angermeyer, & Corrigan, 2005). Despite these findings, no studies to-date have examined how internalized stigma may impact reporting of attenuated psychosis symptoms in the CHR population.The current study aims to examine whether discrepancies between self-report and clinician-rated measures of psychosis risk are associated with internalized stigma in a sample of help-seeking adolescents and young adults. We hypothesized that higher levels of self-stigma will predict inconsistencies between self-reported symptom severity and clinician-obtained diagnoses of psychosis risk.MethodsParticipants will include youth classified as either non-psychosis-related help-seeking controls or at clinical high risk (CHR) for psychosis, as determined by the Structured Interview for Psychosis-Risk Syndromes (SIPS; Miller et al., 2003). The SIPS is administered by trained raters and is currently considered the gold standard tool for diagnosing clinical high-risk syndromes (Thompson et al., 2018). In addition to SIPS diagnoses, psychosis risk will also be assessed using the Prime Screen – Revised (PS-R; Miller et al., 2004), a brief, 12-item self-report questionnaire designed to measure attenuated positive symptoms. Lastly, internalized stigma will be assessed using the Internalized Stigma of Mental Illness Inventory (ISMI; Ritsher, Otilingam, & Grajales, 2003), a 29-item self-report questionnaire designed to measure subjective experiences of stigma in adolescents (e.g., endorsement of negative stereotypes, social withdrawal and feelings of alienation due to mental health problems, etc.).ResultsPreliminary analyses demonstrate a significant interaction between Prime scores and internalized stigma in predicting SIPS diagnoses. Specifically, higher scores on the Prime were associated with increased odds of being diagnosed as CHR on the SIPS, but only for those participants who endorsed low and mean levels of stigma. For participants who endorsed high levels of stigma, there did not appear to be any relation between Prime scores and SIPS diagnoses.DiscussionAt the time of submission, participant recruitment is ongoing, and results and discussion will be presented on the final sample. Findings may inform efforts to improve detection and accurate diagnosis of psychosis risk syndromes in individuals at early stages of illness.

Serum d- and l-lactate, pyruvate and glucose levels in individuals with at-risk mental state and correlations with clinical symptoms.

Little information exists on the peripheral metabolite levels in individuals with at-risk mental state who meet the criteria for a high-risk state of psychosis. Here, we aimed to investigate serum levels of glucose, pyruvate and d- and l-lactate, which may act as a signalling molecule for learning and memory in neuronal cells. High performance liquid chromatography or commercial kits were used to assess serum metabolites in individuals with attenuated psychosis symptoms of at-risk mental state (n = 24, men = 12) who were not receiving antipsychotics. The metabolite levels of these individuals were compared with those of age- and sex-matched healthy individuals (controls, n = 23, men = 11). Correlations between the metabolites and clinical symptoms of at-risk mental state were also examined. Individuals with at-risk mental state had higher serum glucose levels than did controls (P = 2.18 × 10-3 ), while no significant difference in pyruvate levels were observed between the groups. Individuals with at-risk mental state had significantly lower serum l-lactate levels than did controls (P = 6.31 × 10-5 ), while no differences in d-lactate levels were observed. Furthermore, a negative correlation was identified between serum l-lactate levels and Positive and Negative Syndrome Scale negative symptoms scores (r = -0.5651, P = 4.01 × 10-3 ) in individuals with at-risk mental state. We found that, compared with controls, individuals with at-risk mental state have reduced serum l-lactate levels, which may predate psychosis onset, and may be involved in the related negative symptoms.

Differentiating implicit and explicit theory of mind and associated neural networks in youth at Clinical High Risk (CHR) for psychosis

BackgroundTheory of mind (ToM) has been shown to be impaired in Clinical High Risk (CHR) for psychosis populations and is linked to functional outcomes and symptom severity. Implicit versus explicit ToM has seldom been differentiated in this group, and underlying neural networks have also gone unexplored. Methods24 CHR and 26 healthy volunteers (HV) completed a behavioral ToM measure called the Short Story Task (SST), as well as a resting state functional MRI scan. SST performance was correlated to attenuated psychosis symptoms. Interactions between group and ToM variables (implicit, explicit, and comprehension) on global efficiency in the Mentalizing (MENT) and Mirror Neuron System (MNS) were also examined. ResultsCHR individuals made significantly fewer spontaneous mental state inferences. There were trend-level associations between ToM variables and symptoms, such that greater ToM performance predicted less severe symptoms. There was an interaction of group by spontaneous mental state inference within MENT bilateral dorsomedial prefrontal cortex (dmPFC), such that CHR individuals that made spontaneous mental state inferences showed greater global efficiency within the MENT network's bilateral dmPFC. DiscussionFindings suggest implicit ToM deficits are observable prior to psychotic disorder onset, and that these deficits implicate MENT network dmPFC efficiency. Explicit ToM performance was unaltered in the CHR group, and there were no interactions observed within MNS, suggesting specificity of implicit ToM associations with MENT network dmPFC global efficiency. Results identify potential treatment targets for the neural underpinnings of ToM, thus informing prevention and intervention efforts.

Perceptions of attenuated psychosis in a diverse sample of undergraduates.

Prior to the release of the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders, experts in the field of psychosis research considered including a psychosis high-risk syndrome-attenuated psychosis syndrome-as a formal diagnosis. Opponents argued that such a diagnosis may increase the risk of stigmatization of individuals whose symptoms often remit. Although previous research has examined provider perceptions of attenuated psychosis syndrome, little work has focused on lay perceptions. A total of 455 college students read three vignettes, each depicting a character with a different level of psychotic disorder (attenuated psychosis syndrome, schizophrenia or no psychosis). Following each vignette, participants responded to questions assessing: (1) identification of the character as mentally ill, (2) stigmatizing attitudes and (3) beliefs regarding the helpfulness of potential treatments. Compared to a character with no psychosis, participants identified the attenuated psychosis syndrome character as more likely to be experiencing mental illness, but endorsed only slightly more stigmatizing attitudes. Participants tended to rate psychological types of treatment as more helpful than other types for an attenuated psychosis syndrome character. Non-expert undergraduates appear to view attenuated psychosis symptoms as indicative of mental illness, though not as severe as schizophrenia symptoms. The minimal level of stigma endorsement indicates that college students may not be especially likely to spontaneously stigmatize peers with attenuated psychosis syndrome.

S1. THE ASSOCIATION BETWEEN WAR-RELATED STRESS, PTSD SYMPTOMS, AND SUB-CLINICAL PSYCHOSIS: A CROSS-CULTURAL POPULATION-BASED STUDY AMONG PALESTINIAN AND ISRAELI YOUNG ADULTS

BackgroundSub-clinical or attenuated psychosis symptoms (APS) in the general population has become a focus of considerable research interest over the past two decades, as they appear to index an increased risk for psychotic outcomes. Recent data from several community-based studies around the world provide convincing support for an association of APS with traumatic stress that is likely moderated by familial genetic risk and gender. However, relatively little is known about the degree to which APS are associated with terror/war-related stress. Moreover, relatively little is known about the degree to which cultural/religious factors moderate this association. Hence, the overarching goal of this study was to address this lacuna in the literature by examining the relationship between exposure to terror/war-related events, PTSD symptoms and familial genetic risk among Palestinian and Israeli youth.MethodsExposure to terror/war-related trauma, presence and severity of PTSD symptoms, perceived ability to cope with trauma, familial genetic-risk, and APS were assessed in a representative sample of 530 Israeli and 1100 Palestinian (451 from Israel, 264 from the West Bank, and 385 from the Gaza Strip) young adults with a mean age of 36.7 (SD=8.4). PTSD symptoms were assessed with the Post-traumatic Disorder Scale (PDS), perceived ability to cope with trauma with the Perceived Ability To Cope With Trauma Scale (PACT), and APS with the Community Assessments of Psychic Experiences (CAPE).ResultsAs hypothesized, there was a significant three-way interaction effect of exposure to terror-war-related trauma, religion, and familial genetic-risk on APS. The highest level of APS was among Palestinians who live in the Gaza strip, with no significant differences between Jews and Palestinians who live in Israel or in the West Bank. Also, consistent with our hypotheses, the three-way association between exposure to trauma, familial genetic risk and religion was mediated by PTSD symptoms and perceived ability to cope with trauma.DiscussionThese findings provide further support for the link between exposure to trauma, familial genetic-risk, and APS. Also, it provides further support for the mediating role that PTSD symptoms play in this link. Finally, it suggests that religious background moderates the link between exposure to trauma and APS.

T211. BASIC SELF-DISTURBANCE AS A PREDICTOR OF DETERIORATION IN ATTENUATED PSYCHOSIS: A 1-YEAR FOLLOW-UP STUDY AMONG COMMUNITY-DWELLING ADOLESCENTS

BackgroundPhenomenological research indicates that disturbance of the basic sense of self may be a core phenotypic marker of schizophrenia spectrum disorders. Basic self-disturbance (SD) refers to a disruption of the sense of first-person perspective and self-presence that is associated with a variety of anomalous subjective experiences. Recent studies including from our group provided first, preliminary support for the notion that SD is related to attenuated psychosis symptoms (APS) and depression among clinical (i.e., treatment-seeking) and non-clinical samples of non-psychotic adolescents. However, very few studies, if any at all, have looked at the ability of SD to predict change in APS and depression over time. The goal of this study was to address this lacuna in the literature by examining the unique and added contribution of SD to the prediction of change over time in APS and depression among community-dwelling adolescents.MethodsThe 1-year longitudinal relationship between SD and change in APS and depression were explored in a sample of 100 non-help-seeking adolescents (age 13–15) from the community. SD was assessed with the Examination of Anomalous Self-Experience (EASE), prodromal symptoms and syndromes were assessed with the Structured Interview for Prodromal Syndromes (SIPS), present and lifetime diagnoses of schizophrenia-spectrum and depression disorders were assessed with the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), level of distress with the Mood and Anxiety States Questionnaire (MASQ), and psychosocial functioning with the with the Strength and Difficulties Questionnaire (SDQ).ResultsSeventy-seven (77%) adolescents out of the 100 that had been assessed at baseline were available and agreed to participate in the 1-year follow-up (Mean=1.4, S.D.=0.8). Except for a diagnosis of an affective disorder, which was slightly less prevalent among those who returned for the follow-up assessment, there were no significant differences between those who were available and those who lost for the follow-up assessment on any of the major socio-demographic or clinical variables at baseline. Consistent with our first hypothesis, SD at baseline predicted a significant amount of variance in APS change over time (R-squared=0.10, F= 8.61, p=0.004). However, inconsistent with our second hypothesis, SD at baseline did not have a significant added contribution to the prediction of APS change when APS at baseline was controlled for (R-squared difference=0.02, F=1.83, p=0.18).DiscussionThese results provide preliminary support for a prospective association between SD and deterioration in prodromal symptoms among adolescents from the community. However, they fail to support an added value of SD over and above baseline APS for the prediction of APS deterioration. Because SD was assessed only at baseline, they leave unanswered the degree to which change in SD is associated with a change in APS and depression.

F217. BASIC SELF-DISTURBANCE IN ADOLESCENCE AND SCHIZOPHRENIA-SPECTRUM DISORDERS IN YOUNG ADULTHOOD: A 7-YEAR FOLLOW-UP STUDY AMONG TREATMENT-SEEKING ADOLESCENTS

BackgroundPhenomenological research indicates that disturbance of the basic sense of self may be a core phenotypic marker of schizophrenia spectrum disorders. Basic self-disturbance refers to a disruption of the sense of first-person perspective and self-presence that is associated with a variety of anomalous subjective experiences. Recent cross-sectional and prospective pilot studies provided preliminary support for the notion that SD may provide a means of further “closing in” on individuals truly at high-risk for psychosis, particularly of schizophrenia spectrum disorders (SSD). The goal of this study was to replicate and extend these pilot findings by examining the long-term persistence of SD and the degree to which their level in adolescence predicts SSD seven years later in young adulthood.MethodsThe 7-year stability of SD and their association with later in life SSD were explored in a sample of 40 young adults. SD was assessed with the Examination of Anomalous Self-Experience (EASE), prodromal symptoms and syndromes were assessed with the Structured Interview for Prodromal Syndromes (SIPS), present and lifetime diagnoses of schizophrenia-spectrum and other co-morbid disorders were assessed with the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) in adolescence and the Operational Criteria (OPCRIT) checklist for psychotic and affective illness in young adulthood, level of distress with the Mood and Anxiety States Questionnaire (MASQ), and psychosocial functioning with the Strength and Difficulties Questionnaire (SDQ).ResultsForty young adults (Mean age=23.7, S.D.=1.3) out of the 82 who had participated seven years earlier in a study on the association between SD and attenuated psychosis symptoms (APS) were available and agreed to participate in the 1-year follow-up (Mean=1.4, S.D.=0.8). There were no significant differences between those who were available and those who lost for the follow-up assessment on any of the major socio-demographic or clinical variables at baseline. Eight (20%) of the 40 participants in the present study met diagnostic criteria for an SSD (2 Schizophrenia, three non-organic psychotic disorder, and three schizotypal personality disorder). The total EASE score was slightly higher in young adulthood compared to seven years earlier. However, this can reflect a difference in the administration method of the EASE between the two occasions. Consistent with our first hypothesis, the correlation between the total EASE score at baseline and 7-year follow-up was moderate and significant (r=0.59, p<.001). Similarly, consistent with our second hypothesis, SD at baseline was a significant predictor of an SSD diagnosis in young adulthood.DiscussionThese results provide further support for the temporal stability of SD over time. Also, they provide further support for the notion that SD is a phenotypic indicator of risk for SSD.

Attenuated psychosis and basic self-disturbance as risk factors for depression and suicidal ideation/behaviour in community-dwelling adolescents.

Adolescents at clinical high risk (CHR) for psychosis, as defined by the presence of attenuated psychosis symptoms (APS), exhibit increased levels of suicidal ideation and behaviour. However, no research thus far has examined the link between basic self-disturbances (SDs), an established marker for CHR, and suicidality/self-harm in this population. The goal of this pilot study was to assess the association between SD, depression and suicidal ideation and behaviour among non-help-seeking adolescents from the community. A total of 100 community-dwelling adolescents (age range: 13-16) were assessed using the Examination of Anomalous Self-experience, Prodromal Questionnaire, Structured Interview for Prodromal Syndromes, Mood and Anxiety Symptom Questionnaire and the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). The K-SADS was used to derive a binary diagnosis of unipolar depression, as well as to measure suicidal ideation and behaviour and self-harm. In a multiple regression analysis, SD accounted for variance in depressive symptoms and suicidality/self-harm over and above that accounted for by APS. Moreover, SD accounted for variance in suicidality/self-harm over and above that accounted for by depression symptoms. These pilot results suggest that SD might be a unique dimension of vulnerability to depression and suicidality/self-harm in adolescence. Also, they encourage assessment of SD as part of a suicide risk assessment, particularly in the context of risk for subsequent psychosis.

Comorbid Mental Disorders and 6-Month Symptomatic and Functioning Outcomes in Chinese University Students at Clinical High Risk for Psychosis.

High rates of non-psychotic psychopathological symptoms have been observed in clinical population at clinical high risk (CHR) for psychosis. These comorbid disorders affected the baseline functional level of CHR patients. However, little is known about the comorbid mental disorder in CHR individuals in non-clinical adolescent population. This study aimed to investigate the comorbid mental disorder in non-clinical CHR adolescents and the impact on attenuated psychosis symptoms (APS) as well as clinical outcome. The sample consisted of 32 CHR students, who were screened from 2,800 university students. CHR status was evaluated with the Structured Interview of Prodromal Syndromes, comorbid mental disorder diagnoses with the International Neuropsychiatric Interview. In the CHR sample, 46.9% was found at least one non-psychotic comorbid mental disorder. The CHR participants presenting comorbid mental disorder had significantly more severity of APS than those without comorbid mental disorders, and the remission rate at 6-month follow-up is significantly higher in the individuals without comorbid mental disorders at baseline. In the non-clinical sample of individuals at CHR, non-psychotic comorbid mental disorders are common and anxiety disorder is most frequent. Copresence of anxiety and/or depression is related to higher level of attenuated psychotic symptoms and unfavorable clinical outcome at 6-month follow-up. Assessment and intervention in anxiety and depression for non-clinical CHR adolescents are suggested.

209. Risk of Violence in Attenuated Psychosis Symptoms Syndrome and its Relationship With Symptomology

Abstract Background: Contrary to popular belief the majority of patients with schizophrenia will never commit an act of severe violence. Highest risk for violent offending appears to be during the first episode of psychosis (FEP), a meta-analysis by Large and Nielssen (2010) reporting that about a third of patients in the FEP exhibited some violent behavior before initial treatment. However, most acts involve minor violence and fewer than 1 in 100 patients committed assaults resulting in serious injury. Risk of violence in clinical high risk populations, those with attenuated psychosis symptoms (APS) remains unexplored although recent findings by Marshall and colleagues (2016) suggest that a significant amount of APS involve violent content although most is self-directed violence. The aim of the current study was to explore risk of violence in individuals with attenuated psychosis symptom syndrome (APSS). We were also interested to investigate whether risk of violence as assessed was associated with symptomology. Methods: The Structured Assessment of Violence Risk in Youth (SAVRY) was completed for 285 individuals who met criteria for APSS as well as 44 Healthy Controls. The SAVRY is a clinician rated assessment tool and provides a clinical risk rating for each individual by assessing multiple domains including Historical Risk Factors, Social/Contextual Risk Factors, and Individual/Clinical Factors. Results: Violence risk was significantly different between the two groups with healthy controls assessed to be at a lower risk than individuals in the attenuated psychosis symptoms group, χ2(2) = 13.03, P < .001. Only 2 of the APSS group and none of the healthy controls were rated to be at high level of risk for violence. Violence risk was not different between men and women, χ2(2) = 4.58, P = 1.01. A between-group ANOVA conducted to compare severity of attenuated psychotic symptoms and risk of violence within the APSS group showed that symptom severity was significantly different across levels of violence risk, F(2, 235) = 6.32; P < .002. This was largely driven by negative symptoms severity. Individuals with low risk for violence as compared to moderate level of violence risk had lower negative symptoms, F(2, 235) = 13.42; P < .000. Severity of positive, disorganized, or general symptoms independently did not differ across levels of violence risk. This relationship remained unchanged when income level was adjusted. Level of income, age, ethnicity, or parental education was not associated with level of risk. Conclusion: To our knowledge this is the first study to assess violence risk in individuals with APSS. While, the APSS group was assessed to be at a higher risk for violence as compared to healthy controls, the majority were judged to be at a moderate risk and high risk ratings were rare. In the APSS group higher risk was associated with symptoms. Specifically, results suggest that negative symptoms uniquely contribute to risk of violence.

Longitudinal validation of psychosis risk screening tools

The development of widely used interview tools has helped to standardize the criteria for a “clinical high risk” syndrome, thus enabling advances in efforts to develop interventions for this phase of illness. These assessments, however, are burdensome to administer and not likely to be adopted for widespread use. Scalable early intervention depends on the availability of brief, low-cost assessment tools that can serve to screen populations of interest or triage treatment-seekers toward specialized care. The current study examines the sensitivity, specificity, and predictive strength of three self-report measures (Prime Screen—Revised, Prodromal Questionnaire—Brief, and Youth Psychosis at Risk Questionnaire—Brief) with regard to psychosis onset and symptom persistence over six months of follow-up within an indicated sample of 54 adolescents and young adults ages 12–22. Within this sample, all three measures demonstrated excellent sensitivity to emerging psychosis and strong agreement with clinician evaluations of attenuated psychosis symptoms. Additionally, all screeners obtained negative predictive values of 1.00 with regard to psychosis onset, indicating that an individual scoring below the recommended threshold score would be extremely unlikely to develop psychosis over the following six months. The longitudinal validation of psychosis risk screening tools constitutes an important step toward establishing a standard of care for early identification and monitoring in this vulnerable population.

Parent–adolescent agreement on psychosis risk symptoms

Despite practice guidelines recommending caregiver inclusion for assessment of mental health problems in adolescents, clinical high-risk (CHR) assessment tools that target attenuated psychosis symptoms rely solely on self-report. As many individuals in the clinical high-risk phase are expected to be adolescents, and programs of CHR research routinely recruit participants as young as twelve, parent input regarding adolescents' symptoms and functioning may help to inform clinical conceptualizations. No assessment tool targeting CHR symptoms has been developed for this purpose. We created a caregiver-report version of the 12-item Prime Screen-Revised and administered the measure to caregivers of 52 youth ages 12–19 referred by mental health providers for CHR study participation. Youth completed the Prime Screen-Revised as well as the Structured Interview for Psychosis Risk Syndromes (SIPS). Caregiver responses demonstrated poor agreement with youth ratings on Prime Screen-Revised (r=.09), but moderate agreement with clinician ratings (r=.41). The addition of caregiver screening data to youth self-report scores significantly improved a linear regression predicting clinician ratings. Using a threshold of four or more endorsements, the combined use of parent and adolescent responses accurately classified 75% of respondents with regard to SIPS-determined CHR status. Findings suggest that involving caregivers may help to improve the specificity of CHR screening and assessment procedures.

Defining Treatment as Usual for Attenuated Psychosis Syndrome: A Survey of Community Practitioners

Schizophrenia and related disorders are often preceded by attenuated psychosis symptoms, sometimes referred to as attenuated psychosis syndrome, but little is known about practitioners' current practices with regard to this population. This survey of clinical psychologists, psychiatrists, and general practitioners explored treatment as usual of attenuated psychosis syndrome. In 2008, a total of 1,500 practitioners were mailed surveys containing vignettes describing individuals with full, attenuated, and no psychotic symptoms and a checklist of possible interventions. Practitioners were asked to select interventions that would help or harm the individual. The responses (N=293, 20%) suggested that practitioners treated attenuated psychosis syndrome similarly to full-threshold psychosis. The use of antipsychotic medications to treat attenuated symptoms was endorsed by 69% of practitioners. Family support groups and family involvement were endorsed by 58% and 49% of respondents, respectively. Further development and dissemination of practice guidelines may help providers treat attenuated psychosis syndrome.