This work may not be copied, distributed, displayed, published, reproduced, transmitted, modified, posted, sold, licensed, or used for commercial purposes. By downloading this file, you are agreeing to the publisher’s Terms & Conditions.


Frequency and Correlates of DSM-5 Attenuated Psychosis Syndrome in a Sample of Adolescent Inpatients With Nonpsychotic Psychiatric Disorders

Miriam Gerstenberg, MDa,†¡; Marta Hauser, PhDb,c,d,†¡; Aseel Al-Jadiri, MDb; Eva M. Sheridan, MDb; Taishiro Kishimoto, MDb,e; Yehonatan Borenstein, MDf; Ditte L. Vernal, MSg; Lisa David, MDb; Ema Saito, MDb,c; Sara E. Landers, BSb; Morgan Carella, BSb; Sukhbir Singh, MDb; Maren Carbon, MDb; Sara Jiménez-Fernández, MDh,i; Michael L. Birnbaum, MDb,c; Andrea Auther, PhDb,c; Ricardo E. Carrión, PhDb,c,d; Barbara A. Cornblatt, PhDb,c,d; John M. Kane, MDb,c,d,j; Susanne Walitza, MDa; and Christoph U. Correll, MDb,c,d,j,*

Published: November 25, 2015

Article Abstract

Objectives: DSM-5 conceptualized attenuated psychosis syndrome (APS) as self-contained rather than as a risk syndrome, including it under “Conditions for Further Study,” but also as a codable/billable condition in the main section. Since many major mental disorders emerge during adolescence, we assessed the frequency and characteristics of APS in adolescent psychiatric inpatients.

Methods: Consecutively recruited adolescents hospitalized for nonpsychotic disorders (September 2009-May 2013) were divided into APS youth versus non-APS youth, based on the Structured Interview of Prodromal Syndromes (SIPS) and according to DSM-5 criteria, and compared across multiple characteristics.

Results: Of 89 adolescents (mean ± SD age = 15.1 ± 1.6 years), 21 (23.6%) had APS. Compared to non-APS, APS was associated with more comorbid disorders (2.7 ± 1.0 vs 2.2 ± 1.3), major depressive disorder (61.9% vs 27.9%), oppositional defiant disorder/conduct disorder (52.4% vs 25.0%), and personality disorder traits (57.1% vs 7.4%, the only diagnostic category surviving Bonferroni correction). APS youth were more severely ill, having higher SIPS total positive, negative, and general symptoms; Brief Psychiatric Rating Scale total and positive scores; depression and global illness ratings; and lower Global Assessment of Functioning (GAF). Conversely, Young Mania Rating Scale scores, suicidal behavior, prescribed psychotropic medications, and mental disorder awareness were similar between APS and non-APS groups. In multivariable analysis, lowest GAF score in the past year (odds ratio [OR] = 51.15; 95% confidence interval [CI], 2.46-2,439.0) and social isolation (OR = 27.52; 95% CI, 3.36-313.87) were independently associated with APS (r2 = 0.302, P < .0001). Although psychotic disorders were excluded, 65.2% (APS = 57.1%, non-APS = 67.7%, P = .38) received antipsychotics.

Conclusion: One in 4 nonpsychotic adolescent inpatients met DSM-5 criteria for APS. APS youth were more impaired, showing a complex entanglement with a broad range of psychiatric symptoms and disorders, including depression, impulse-control, and, especially, emerging personality disorders.

Trial Registration: identifier: NCT01383915

Volume: 76

Quick Links:

Continue Reading…

Subscribe to read the entire article


Buy this Article as a PDF