TY - JOUR
T1 - What makes the psychosis 'clinical high risk' state risky
T2 - psychosis itself or the co-presence of a non-psychotic disorder?
AU - Hasmi, Laila
AU - Pries, Lotta-Katrin
AU - Ten Have, Margreet
AU - de Graaf, Ron
AU - van Dorsselaer, Saskia
AU - Bak, Maarten
AU - Kenis, Gunter
AU - Richards, Alexander
AU - Lin, Bochao D
AU - O'Donovan, Michael C
AU - Luykx, Jurjen J
AU - Rutten, Bart P F
AU - Guloksuz, Sinan
AU - van Os, Jim
N1 - Publisher Copyright:
© The Author(s), 2021. Published by Cambridge University Press.
PY - 2021/7/6
Y1 - 2021/7/6
N2 - AIMS: Although attenuated psychotic symptoms in the psychosis clinical high-risk state (CHR-P) almost always occur in the context of a non-psychotic disorder (NPD), NPD is considered an undesired 'comorbidity' epiphenomenon rather than an integral part of CHR-P itself. Prospective work, however, indicates that much more of the clinical psychosis incidence is attributable to prior mood and drug use disorders than to psychosis clinical high-risk states per se. In order to examine this conundrum, we analysed to what degree the 'risk' in CHR-P is indexed by co-present NPD rather than attenuated psychosis per se.METHODS: We examined the incidence of early psychotic experiences (PE) with and without NPD (mood disorders, anxiety disorders, alcohol/drug use disorders), in a prospective general population cohort (n = 6123 at risk of incident PE at baseline). Four interview waves were conducted between 2007 and 2018 (NEMESIS-2). The incidence of PE, alone (PE-only) or with NPD (PE + NPD) was calculated, as were differential associations with schizophrenia polygenic risk score (PRS-Sz), environmental, demographical, clinical and cognitive factors.RESULTS: The incidence of PE + NPD (0.37%) was lower than the incidence of PE-only (1.04%), representing around a third of the total yearly incidence of PE. Incident PE + NPD was, in comparison with PE-only, differentially characterised by poor functioning, environmental risks, PRS-Sz, positive family history, prescription of antipsychotic medication and (mental) health service use.CONCLUSIONS: The risk in 'clinical high risk' states is mediated not by attenuated psychosis per se but specifically the combination of attenuated psychosis and NPD. CHR-P/APS research should be reconceptualised from a focus on attenuated psychotic symptoms with exclusion of non-psychotic DSM-disorders, as the 'pure' representation of a supposedly homotypic psychosis risk state, towards a focus on poor-outcome NPDs, characterised by a degree of psychosis admixture, on the pathway to psychotic disorder outcomes.
AB - AIMS: Although attenuated psychotic symptoms in the psychosis clinical high-risk state (CHR-P) almost always occur in the context of a non-psychotic disorder (NPD), NPD is considered an undesired 'comorbidity' epiphenomenon rather than an integral part of CHR-P itself. Prospective work, however, indicates that much more of the clinical psychosis incidence is attributable to prior mood and drug use disorders than to psychosis clinical high-risk states per se. In order to examine this conundrum, we analysed to what degree the 'risk' in CHR-P is indexed by co-present NPD rather than attenuated psychosis per se.METHODS: We examined the incidence of early psychotic experiences (PE) with and without NPD (mood disorders, anxiety disorders, alcohol/drug use disorders), in a prospective general population cohort (n = 6123 at risk of incident PE at baseline). Four interview waves were conducted between 2007 and 2018 (NEMESIS-2). The incidence of PE, alone (PE-only) or with NPD (PE + NPD) was calculated, as were differential associations with schizophrenia polygenic risk score (PRS-Sz), environmental, demographical, clinical and cognitive factors.RESULTS: The incidence of PE + NPD (0.37%) was lower than the incidence of PE-only (1.04%), representing around a third of the total yearly incidence of PE. Incident PE + NPD was, in comparison with PE-only, differentially characterised by poor functioning, environmental risks, PRS-Sz, positive family history, prescription of antipsychotic medication and (mental) health service use.CONCLUSIONS: The risk in 'clinical high risk' states is mediated not by attenuated psychosis per se but specifically the combination of attenuated psychosis and NPD. CHR-P/APS research should be reconceptualised from a focus on attenuated psychotic symptoms with exclusion of non-psychotic DSM-disorders, as the 'pure' representation of a supposedly homotypic psychosis risk state, towards a focus on poor-outcome NPDs, characterised by a degree of psychosis admixture, on the pathway to psychotic disorder outcomes.
KW - Anxiety Disorders
KW - Humans
KW - Mood Disorders
KW - Prospective Studies
KW - Psychotic Disorders/epidemiology
KW - Schizophrenia/epidemiology
KW - risk
KW - Epidemiology
KW - prevention
KW - psychosis
UR - http://www.scopus.com/inward/record.url?scp=85110965778&partnerID=8YFLogxK
U2 - 10.1017/S204579602100041X
DO - 10.1017/S204579602100041X
M3 - Article
C2 - 34225831
SN - 2045-7960
VL - 30
JO - Epidemiology and Psychiatric Sciences
JF - Epidemiology and Psychiatric Sciences
M1 - e53
ER -