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: Child and Adolescent , Populations

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