title: Declining transition rates to psychosis: the role of diagnostic spectra and symptom overlaps in individuals with attenuated psychosis syndrome.
abstract: Transition to psychosis in at-risk individuals has markedly declined in recent years. So far it has never been discussed in detail that with the growing awareness and increasing availability of early psychosis services, a much broader diagnostic spectrum is now being seen in these services. Subsequently, subjects present with symptoms that meet psychosis risk on a purely psychometric basis but may be the phenotypical expression of another underlying mental disorder. Here we critically review four groups of symptoms and clinical features that are frequently reported by individuals with suspected psychosis risk states, yet share strong commonalities with other mental disorders and conditions: isolated hallucinations; unusual bodily perceptions, hypochondriatic fears and cenesthetic psychotic symptoms; depersonalization; obsessive-compulsive, overvalued and delusional ideas. Of the 616 individuals so far assessed in the Bruderholz Early Psychosis Outpatient Service for Adolescents and Young Adults, 218 (30.5%) met ultra-high risk (UHR) criteria, 188 (86.2%) of whom suffered from one of the four above-mentioned symptom groups. The appraisal of the diagnostic spectra and their overlapping symptoms constitute a tremendous challenge in the clinical assessment of each referred individual. The final conclusion of a clinical assessment should not end with the mere assignment - or non-assignment - to a presumed psychosis risk group, but needs to take into account the 'Gestalt' of these particular symptoms and clinical features and thus be based on many more facets than solely a psychometric or nosological approach. Such an approach may break down the heterogeneous psychosis risk group and enable appropriate treatment regimes.
authors.affiliation: Department of Psychiatry and Psychotherapy (UPK), University of Basel, Basel 4056, Switzerland; Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Department of Psychiatry, 4101 Bruderholz, Switzerland; University Hospital of Psychiatry, University of Bern, 3010 Bern, Switzerland. Electronic address: andor.simon@bluewin.ch.
authors.forename: Andor E
authors.initials: AE
authors.lastname: Simon
authors.affiliation: Pharmaceutical Division, Neuroscience, Hoffmann-La Roche Ltd., Basel, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Umbricht
authors.affiliation: Department of Psychiatry and Psychotherapy (UPK), University of Basel, Basel 4056, Switzerland.
authors.forename: Undine E
authors.initials: UE
authors.lastname: Lang
authors.affiliation: Department of Psychiatry and Psychotherapy (UPK), University of Basel, Basel 4056, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Borgwardt
mesh_terms: D000293:Adolescent; D000328:Adult; D005239:Fear / Q000523:psychology; D005260:Female; D006212:Hallucinations / Q000503:physiopathology; D006801:Humans; D008297:Male; D010465:Perception / Q000502:physiology*; D010554:Personality Disorders / Q000503:physiopathology; D062706:Prodromal Symptoms; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D012306:Risk; D012307:Risk Factors; D055815:Young Adult
keywords: At-risk state; Diagnostic spectra; Prodrome; Ultra-high-risk