title: Depression predicts persistence of paranoia in clinical high-risk patients to psychosis: results of the EPOS project.
abstract: BACKGROUND
  The link between depression and paranoia has long been discussed in psychiatric literature. Because the causality of this association is difficult to study in patients with full-blown psychosis, we aimed to investigate how clinical depression relates to the presence and occurrence of paranoid symptoms in clinical high-risk (CHR) patients.
  
  
  METHODS
  In all, 245 young help-seeking CHR patients were assessed for suspiciousness and paranoid symptoms with the structured interview for prodromal syndromes at baseline, 9- and 18-month follow-up. At baseline, clinical diagnoses were assessed by the Structured Clinical Interview for DSM-IV, childhood adversities by the Trauma and Distress Scale, trait-like suspiciousness by the Schizotypal Personality Questionnaire, and anxiety and depressiveness by the Positive and Negative Syndrome Scale.
  
  
  RESULTS
  At baseline, 54.3% of CHR patients reported at least moderate paranoid symptoms. At 9- and 18-month follow-ups, the corresponding figures were 28.3 and 24.4%. Depressive, obsessive-compulsive and somatoform disorders, emotional and sexual abuse, and anxiety and suspiciousness associated with paranoid symptoms. In multivariate modelling, depressive and obsessive-compulsive disorders, sexual abuse, and anxiety predicted persistence of paranoid symptoms.
  
  
  CONCLUSIONS
  Depressive disorder was one of the major clinical factors predicting persistence of paranoid symptoms in CHR patients. In addition, obsessive-compulsive disorder, childhood sexual abuse, and anxiety associated with paranoia. Effective pharmacological and psychotherapeutic treatment of these disorders and anxiety may reduce paranoid symptoms in CHR patients.
authors.affiliation: Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland. raimo.k.r.salokangas@utu.fi.
authors.forename: Raimo K R
authors.initials: RK
authors.lastname: Salokangas
authors.affiliation: University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
authors.forename: Frauke
authors.initials: F
authors.lastname: Schultze-Lutter
authors.affiliation: Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland.|Psychiatric Clinic, Turku University Central Hospital, Turku, Finland.|Turku Psychiatric Clinic, Turku Mental Health Centre, Turku, Finland.
authors.forename: Jarmo
authors.initials: J
authors.lastname: Hietala
authors.affiliation: Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland.
authors.forename: Markus
authors.initials: M
authors.lastname: Heinimaa
authors.affiliation: Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland.
authors.forename: Tiina
authors.initials: T
authors.lastname: From
authors.affiliation: Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland.
authors.forename: Tuula
authors.initials: T
authors.lastname: Ilonen
authors.affiliation: Department of Biostatistics, University of Turku, Turku, Finland.
authors.forename: Eliisa
authors.initials: E
authors.lastname: Löyttyniemi
authors.affiliation: Ev. Zentrum für Beratung und Therapie am Weißen Stein, Evangelischer Regionalverband Frankfurt am Main, Frankfurt Am Main, Germany.
authors.forename: Heinrich Graf
authors.initials: HG
authors.lastname: von Reventlow
authors.affiliation: Department of Psychiatry, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Juckel
authors.affiliation: Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.|Department of Psychiatry and Psychology, University of Maastricht, Maastricht, The Netherlands.
authors.forename: Don
authors.initials: D
authors.lastname: Linszen
authors.affiliation: Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.|Mediant, Enschede, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Dingemans
authors.affiliation: School of Psychology, University of Birmingham, Birmingham, UK.
authors.forename: Max
authors.initials: M
authors.lastname: Birchwood
authors.affiliation: Youthspace, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Patterson
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Klosterkötter
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Ruhrmann
mesh_terms: D000293:Adolescent; D000328:Adult; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D010259:Paranoid Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D010555:Personality Inventory; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
keywords: Anxiety; Clinical high risk; Depression; Paranoia; Persistence