title: Frequency and correlates of DSM-5 attenuated psychosis syndrome in a sample of adolescent inpatients with nonpsychotic psychiatric disorders.
abstract: OBJECTIVE
  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 (r(2) = 0.302, P < .0001). Although psychotic disorders were excluded, 65.2% (APS = 57.1%, non-APS = 67.7%, P = .38) received antipsychotics.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT01383915.
authors.affiliation: University Clinics for Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland.
authors.forename: Miriam
authors.initials: M
authors.lastname: Gerstenberg
authors.forename: Marta
authors.initials: M
authors.lastname: Hauser
authors.forename: Aseel
authors.initials: A
authors.lastname: Al-Jadiri
authors.forename: Eva M
authors.initials: EM
authors.lastname: Sheridan
authors.forename: Taishiro
authors.initials: T
authors.lastname: Kishimoto
authors.forename: Yehonatan
authors.initials: Y
authors.lastname: Borenstein
authors.forename: Ditte L
authors.initials: DL
authors.lastname: Vernal
authors.forename: Lisa
authors.initials: L
authors.lastname: David
authors.forename: Ema
authors.initials: E
authors.lastname: Saito
authors.forename: Sara E
authors.initials: SE
authors.lastname: Landers
authors.forename: Morgan
authors.initials: M
authors.lastname: Carella
authors.forename: Sukhbir
authors.initials: S
authors.lastname: Singh
authors.forename: Maren
authors.initials: M
authors.lastname: Carbon
authors.forename: Sara
authors.initials: S
authors.lastname: Jiménez-Fernández
authors.forename: Michael L
authors.initials: ML
authors.lastname: Birnbaum
authors.forename: Andrea
authors.initials: A
authors.lastname: Auther
authors.forename: Ricardo E
authors.initials: RE
authors.lastname: Carrión
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Cornblatt
authors.forename: John M
authors.initials: JM
authors.lastname: Kane
authors.forename: Susanne
authors.initials: S
authors.lastname: Walitza
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
mesh_terms: D000293:Adolescent; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D010554:Personality Disorders / Q000453:epidemiology*; D011618:Psychotic Disorders / Q000453:epidemiology*; D012720:Severity of Illness Index; D013577:Syndrome