title: Prevalence and clinical significance of DSM-5-attenuated psychosis syndrome in adolescents and young adults in the general population: the Bern Epidemiological At-Risk (BEAR) study.
abstract: OBJECTIVE
  Section III of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists attenuated psychosis syndrome as a condition for further study. One important question is its prevalence and clinical significance in the general population.
  
  
  METHODS
  Analyses involved 1229 participants (age 16-40 years) from the general population of Canton Bern, Switzerland, enrolled from June 2011 to July 2012. "Symptom," "onset/worsening," "frequency," and "distress/disability" criteria of attenuated psychosis syndrome were assessed using the structured interview for psychosis-risk syndromes. Furthermore, help-seeking, psychosocial functioning, and current nonpsychotic axis I disorders were surveyed. Well-trained psychologists performed assessments using the computer-assisted telephone interviewing technique.
  
  
  RESULTS
  The symptom criterion was met by 12.9% of participants, onset/worsening by 1.1%, frequency by 3.8%, and distress/disability by 7.0%. Symptom, frequency, and distress/disability were met by 3.2%. Excluding trait-like attenuated psychotic symptoms (APS) decreased the prevalence to 2.6%, while adding onset/worsening reduced it to 0.3%. APS were associated with functional impairments, current mental disorders, and help-seeking although they were not a reason for help-seeking. These associations were weaker for attenuated psychosis syndrome.
  
  
  CONCLUSIONS
  At the population level, only 0.3% met current attenuated psychosis syndrome criteria. Particularly, the onset/worsening criterion, originally included to increase the likelihood of progression to psychosis, lowered its prevalence. Because progression is not required for a self-contained syndrome, a revision of the restrictive onset criterion is proposed to avoid the exclusion of 2.3% of persons who experience and are distressed by APS from mental health care. Secondary analyses suggest that a revised syndrome would also possess higher clinical significance than the current syndrome.
authors.affiliation: University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; and frauke.schultze-lutter@kjp.unibe.ch.
authors.forename: Frauke
authors.initials: F
authors.lastname: Schultze-Lutter
authors.affiliation: University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; and.
authors.forename: Chantal
authors.initials: C
authors.lastname: Michel
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Ruhrmann
authors.affiliation: University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; and.
authors.forename: Benno G
authors.initials: BG
authors.lastname: Schimmelmann
mesh_terms: D000293:Adolescent; D000328:Adult; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D012306:Risk; D013557:Switzerland / Q000453:epidemiology; D013577:Syndrome; D055815:Young Adult
keywords: attenuated psychosis syndrome; disability; distress; functional impairment; general population; prevalence