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Early detection and prevention of psychosis has become an international priority. Much of this work has focused on youth presenting with attenuated symptoms of psychosis—those at clinical high risk for psychosis (CHR)—given their elevated probability of developing the full disorder in subsequent years. Individuals at CHR may be prone to exacerbated psychological distress during the coronavirus 2019 (COVID-19) pandemic and its subsequent physical isolation measures, as a result of heightened stress sensitivity and comorbid mental health problems. Telepsychotherapy holds promise for reaching this population, especially during the current COVID-19 outbreak. However, there are limited evidence-based guidelines or interventions for use of telepsychotherapy with this population. In this article, we review common clinical issues for individuals at CHR and how they might be exacerbated by the COVID-19 pandemic. We then review best practices for treatment and adaptations for telepsychotherapy for individuals at CHR, and highlight real clinical issues that we are currently experiencing in a United States–based specialized CHR clinic as we conduct telepsychotherapy via videoconferencing. We conclude with questions for those in the field to contemplate, as well as potential challenges and benefits in using telepsychotherapy with individuals at CHR and their families.

Sleep problems are prominent and pervasive clinical issues experienced by many people with psychotic disorders, often causing distress and functional impairment. Sleep problems are also related to psychosis-like experiences (PLE; non-diagnosable phenomenon such as transient perceptual disturbances, unusual thoughts, periodic suspiciousness) in epidemiological studies. Prior studies in this field have used brief measures that precluded the ability to test (1) whether risk for psychosis-like experiences are related to specific sub-types of sleep disturbance, and (2) whether sleep disturbance is specifically related to clinically significant (i.e., distressing) psychosis-like experiences. The current project examined the relation between specific sleep issues, and PLEs and distress associated with PLEs, in a college sample. Participants (N=420) completed the Prodromal Questionnaire-Brief (PQ-B), which assesses PLEs and associated distress, and the Iowa Sleep Disturbances Inventory - extended version (ISDI-E), which assesses thirteen separate disturbed sleep domains. Symptoms of fragmented sleep, sleep hallucinations, and night anxiety significantly correlated with PLEs, and several sleep domains were significantly associated with PLE-related distress.

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Autism and psychosis share overlapping clinical features and can occur comorbidly. Given growing recognition that early identification of psychosis risk symptoms may lead to better functional outcomes, the field needs valid tools for use in the assessment of psychosis risk symptoms within autism. This study employed a multi-method approach to evaluate the utility of a psychosis risk assessment tool, the Structured Interview for Psychosis-Risk Syndromes, for use with adolescents with autism. A total of 43 adolescents (N = 21 with autism, N = 22 typically developing) were interviewed using the positive symptom domain of the Structured Interview for Psychosis-Risk Syndromes. Study participant answers to interview questions were coded for verbal and behavioral responses, and error rates were compared between groups. Results indicate that adolescents with autism (all of whom had intact language skills) did not significantly differ from typically developing peers when answering questions about positive psychosis risk symptoms. A majority of verbal responses (93%) and behavioral responses (89%) to Structured Interview for Psychosis-Risk Syndrome items were rated as adequate for both groups, suggesting that the positive domain items from the Structured Interview for Psychosis-Risk Syndromes can be used with adolescents with autism. Regardless of diagnosis, higher rates of response errors were significantly correlated with greater difficulty understanding ambiguous language and increased interview times. Structured Interview for Psychosis-Risk Syndrome interviewers are cautioned to use follow-up probes to clarify items that might be confusing to participants and/or have higher response error rates for all adolescents, irrespective of autism status, to prevent false-positive responses for people with and without autism. Lay abstract Individuals with autism may experience a variety of psychiatric symptoms that may cause distress and difficulty functioning. The tools that exist to help evaluate symptoms for psychosis for individuals with autism are limited. We investigated whether a specialized interview for symptoms of psychosis risk could be used for adolescents with autism. We recruited 21 adolescents with autism and 22 typically developing adolescents and interviewed them using the Structured Interview for Psychosis-Risk Syndromes. Participants were asked to rephrase interview questions as a way to understand how they interpreted the question. Their responses were evaluated by clinicians and third-party raters to determine potential response errors. Results of the study showed that youth with autism who have intact language skills are able to answer questions about psychosis risk symptoms as well as their typically developing peers. In general, adolescents across both groups who had more difficulty with nonliteral language (understanding words with multiple meanings) had more difficulty completing the Structured Interview for Psychosis-Risk Syndromes. Problematic items that required more clarification by the clinician involved misinterpretation of words/phrases or questions. Care should be taken to ensure adolescents understand the intent of interviewer questions when assessing risk of psychosis.