Heterogeneity of clinical symptomatology among pediatric patients at clinical high risk for psychosis (CHR-P)
L. Sophia Rintell (1), Devon Carroll (1,2), Joseph Gonzalez-Heydrich (1,3) Eugene D’Angelo (1,3)
1. Department of Psychiatry & Behavioral Sciences, Boston Children’s Hospital, Boston, MA
2. College of Nursing, University of Rhode Island, Providence, RI
3. Department of Psychiatry, Harvard Medical School, Boston, MA
Abstract
Background: Clinical heterogeneity within the Clinical High Risk for Psychosis (CHR-P) population is a barrier to advancement of research on early identification and treatment. A possible cause may be the broad criteria for CHR-P, particularly the presence of at least one attenuated positive symptom as rated on the Structured Interview for Prodromal Symptoms (SIPS). CHR-P individuals, however, present with several symptoms, not limited to positive symptoms. The SIPS captures this range with the categories of Positive, Negative, Disorganization, and General symptoms. The purpose of this study is to investigate the utility of the non-positive (N, D, and G) symptoms as rated by the SIPS for risk assessment among youth with CHR-P.
Methods: Participants were 40 CHR-P youth ages 7-18 (M=12.78) who were evaluated with the SIPS and met criteria for Attenuated Positive Symptom Syndrome. Upon caregiver consent, SIPS ratings were used in this analysis.
Results: On average, participants endorsed 9.42 (SD=3.28) negative, disorganization, and general symptoms, in addition to an average of 2.78 (SD=1.12) positive attenuated symptoms. Mean total severity of symptoms was 36.32 (SD= 16.56) out of 114. Average severity per symptom was 1.91 (SD=0.87) out of 6. The most common symptoms were Perceptual Abnormalities/Hallucinations (P4), Avolition (N2), Trouble with Focus and Attention (D3), and Dysphoric Mood (G2). Number and severity of symptoms were similar across gender and age. The positive symptom sum was significantly correlated to each negative and general symptom, but only one of the disorganization symptoms: D3.
Conclusions: We sought to improve our understanding of the clinical heterogeneity within CHR-P youth by examining their prevalence and severity of clinical and attenuated symptoms. Improved understanding of the heterogeneity in this population is necessary as it could lead to advances in screening, predictive modelling, improved symptom monitoring, and targeted prevention and treatment of CHR-P individuals.