The heterogeneity of attenuated and brief limited psychotic symptoms::association of contents with age, sex, country, religion, comorbidities, and functioning


Introduction: The Attenuated Psychosis Symptoms (APS) syndrome mostly represents the ultra-high-risk state of psychosis but, as does the Brief Intermittent Psychotic Symptoms (BIPS) syndrome, shows a large variance in conversion rates. This may be due to the heterogeneity of APS/BIPS that may be related to the effects of culture, sex, age, and other psychiatric morbidities. Thus, we investigated the different thematic contents of APS and their association with sex, age, country, religion, comorbidity, and functioning to gain a better understanding of the psychosis-risk syndrome. Method: A sample of 232 clinical high-risk subjects according to the ultra-high risk and basic symptom criteria was recruited as part of a European study conducted in Germany, Italy, Switzerland, and Finland. Case vignettes, originally used for supervision of inclusion criteria, were investigated for APS/BIPS contents, which were compared for sex, age, country, religion, functioning, and comorbidities using chi-squared tests and regression analyses. Result: We extracted 109 different contents, mainly of APS (96.8%): 63 delusional, 29 hallucinatory, and 17 speech-disorganized contents. Only 20 contents (18.3%) were present in at least 5% of the sample, with paranoid and referential ideas being the most frequent. Thirty-one (28.5%) contents, in particular, bizarre ideas and perceptual abnormalities, demonstrated an association with age, country, comorbidity, or functioning, with regression models of country and obsessive-compulsive disorders explaining most of the variance: 55.8 and 38.3%, respectively. Contents did not differ between religious groups. Conclusion: Psychosis-risk patients report a wide range of different contents of APS/BIPS, underlining the psychopathological heterogeneity of this group but also revealing a potential core set of contents. Compared to earlier reports on North-American samples, our maximum prevalence rates of contents were considerably lower; this likely being related to a stricter rating of APS/BIPS and cultural influences, in particular, higher schizotypy reported in North-America. The various associations of some APS/BIPS contents with country, age, comorbidities, and functioning might moderate their clinical severity and, consequently, the related risk for psychosis and/or persistent functional disability.

Publication DOI:
Divisions: College of Health & Life Sciences > School of Psychology
College of Health & Life Sciences > Aston Institute of Health & Neurodevelopment (AIHN)
College of Health & Life Sciences
Additional Information: Copyright © 2023 Theisen, Rosen, Meisenzahl, Koutsouleris, Lichtenstein, Ruhrmann, Kambeitz, Kambeitz-Ilankovic, Riecher-Rössler, Chisholm, Upthegrove, Antonucci, Bertolino, Pigoni, Salokangas, Pantelis, Wood, Lencer, Falkai, Hietala, Brambilla, Schmidt, Andreou, Borgwardt, Osman and Schultze-Lutter. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Uncontrolled Keywords: Attenuated Psychotic Symptoms,hallucinatory experiences,clinical-high risk for psychosis,disorganized communication,delusional ideas
Publication ISSN: 1664-0640
Last Modified: 30 May 2024 07:31
Date Deposited: 24 Jul 2023 08:12
Full Text Link:
Related URLs: https://www.fro ... 23.1209485/full (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2023
Published Online Date: 2023-07-07
Accepted Date: 2023-06-13
Submitted Date: 2023-04-20
Authors: Theisen, Christian
Rosen, Marlene
Meisenzahl, Eva
Koutsouleris, Nikolaos
Lichtenstein, Theresa
Ruhrmann, Stephan
Kambeitz, Joseph
Kambeitz-Ilankovic, Lana
Riecher-Rössler, Anita
Chisholm, Katharine (ORCID Profile 0000-0002-0575-0789)
Upthegrove, Rachel
Antonucci, Linda A.
Bertolino, Alessandro
Pigoni, Alessandro
Salokangas, Raimo K. R.
Pantelis, Christos
Wood, Stephen J.
Lencer, Rebekka
Falkai, Peter
Hietala, Jarmo
Brambilla, Paolo
Schmidt, André
Andreou, Christina
Borgwardt, Stefan
Osman, Naweed
Schultze-Lutter, Frauke



Version: Published Version

License: Creative Commons Attribution

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