title: Sources of clinical distress in young people at ultra high risk of psychosis.
abstract: BACKGROUND
  Substantial controversy has been generated since the proposal to include "Attenuated Psychosis Syndrome" in DSM-5, based on research criteria used to identify young people at "ultra high risk" (UHR) for psychosis. The syndrome was ultimately included in the section for further research. The criteria specified that the person experienced attenuated psychotic symptoms (APS) that were sufficiently distressing to warrant clinical attention. Although APS are the main means of determining whether a person meets UHR criteria, clinical experience suggests that such symptoms are often not the main source of clinical distress in this patient group. However, little is known about the sources of distress in the UHR group. We aimed to assess the main sources of clinical distress in UHR patients at the time of referral to a specialized UHR clinic.
  
  
  METHODS
  Sources and intensity of distress in 73 UHR patients were gathered from treating clinicians. The association with transition to psychosis was explored.
  
  
  RESULTS
  Of the total sample, 89.04% fulfilled the APS UHR criteria. APS symptoms were reported to be distressing for 58.5% of this subsample, but social and functioning difficulties (78.1%) and depressive symptoms (58.9%) were the highest sources of distress leading UHR patients to seek help. Intensity of distress associated with APS, anxiety symptoms and substance use was associated with transition to psychosis.
  
  
  CONCLUSIONS
  APS were reported to be distressing for approximately half of UHR patients. The intensity of distress associated to these symptoms may be associated with increased risk for subsequent transition to full threshold psychotic disorder.
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, Victoria, Australia; Melbourne Neuropsychiatry Centre, The University of Melbourne, Victoria, Australia; Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Insitituto de Investigacion Sanitaria Gregorio Marañon, IiSGM, CIBERSAM, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Rapado-Castro
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, Victoria, Australia.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: McGorry
authors.affiliation: Institute of Brain, Behaviour, and Mental Health, University of Manchester, Manchester, England, United Kingdom.
authors.forename: Alison
authors.initials: A
authors.lastname: Yung
authors.affiliation: Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Insitituto de Investigacion Sanitaria Gregorio Marañon, IiSGM, CIBERSAM, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Calvo
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, Victoria, Australia. Electronic address: nelsonb@unimelb.edu.au.
authors.forename: Barnaby
authors.initials: B
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D062706:Prodromal Symptoms; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000523:psychology*; D012307:Risk Factors; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult
keywords: Clinical distress; Prodrome; Psychosis; Ultra-high risk (UHR); Youth mental health