title: Why are help-seeking subjects at ultra-high risk for psychosis help-seeking?
abstract: In addition to attenuated psychotic symptoms, individuals at high clinical risk of developing psychosis display a wide range of psychopathological features. Some of these may be subjectively perceived as more troubling than others and may therefore be more likely to trigger help-seeking behavior. We aimed at investigating the nature and prevalence of symptoms subjectively considered most distressing by high-risk individuals at the time of their presentation to early recognition services and to determine their impact on baseline and longitudinal functional and clinical outcomes. The clinical records of 221 clients meeting ultra-high risk (UHR) criteria and receiving care at a specialized early intervention service ("Outreach and Support in South London") between 2001 and 2011 were reviewed. Main outcome measures were reason to seek help as subjectively reported by the clients, comorbid DSM-IV SCID diagnoses, transition to psychosis, psychosocial functioning at baseline and after a median follow-up period of 4.5 years. Affective symptoms, i.e., depression and/or anxiety, were the most commonly reported subjective reasons to seek help (47.1%). Sub-threshold psychotic symptoms were reported by 39.8%. There was no significant association between subjective complaints at presentation and transition to psychosis. However, the group reporting affective symptoms as their main subjective reason to seek help at baseline had a significantly poorer longitudinal outcome in psychosocial functioning relative to the group reporting sub-threshold psychotic symptoms. Assessment of subjective complaints in UHR individuals at initial presentation may help to identify predictors of future functional outcome and tailor treatments accordingly.
authors.affiliation: Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom; Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany.
authors.forename: Irina
authors.initials: I
authors.lastname: Falkenberg
authors.affiliation: Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom.
authors.forename: Lucia
authors.initials: L
authors.lastname: Valmaggia
authors.affiliation: Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom.
authors.forename: Majella
authors.initials: M
authors.lastname: Byrnes
authors.affiliation: Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom; Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Frascarelli
authors.affiliation: Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom.
authors.forename: Ceri
authors.initials: C
authors.lastname: Jones
authors.affiliation: Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom.
authors.forename: Matteo
authors.initials: M
authors.lastname: Rocchetti
authors.affiliation: Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Straube
authors.affiliation: OASIS team, South London and the Maudsley NHS Foundation Trust, London, United Kingdom.
authors.forename: Steven
authors.initials: S
authors.lastname: Badger
authors.affiliation: Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom.
authors.forename: Philip
authors.initials: P
authors.lastname: McGuire
authors.affiliation: Department of Psychosis Studies, Institute of Psychiatry, King׳s College London, United Kingdom. Electronic address: paolo.fusar-poli@kcl.ac.uk.
authors.forename: Paolo
authors.initials: P
authors.lastname: Fusar-Poli
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D003159:Community-Institutional Relations; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D009042:Motivation; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult
keywords: Help-seeking; Psychosis; Psychosocial functioning; Transition; Ultra-high risk (UHR)