Basic Symptoms Are Associated With Age in Patients With a Clinical High-Risk State for Psychosis: Results From the PRONIA Study

Clinical high-risk criteria of psychosis in 8–17-year-old community subjects and inpatients not suspected of developing psychosis

“…Thus, visual perception disturbances that longitudinally had been significantly linked to the development of psychosis in adults[ 14 ] might be a more general expression of severe mental problems in childhood and early adolescence. This view is supported by reports that visual hallucinations were more frequent in children and adolescents with psychosis compared to adult psychosis patients[ 76 ], and that attenuated and transient hallucinations as well as perceptual disturbances were more frequent and less clinically relevant in children and adolescents[ 22 , 23 ], who likely grow out of them over time due to progressing neurocognitive and brain maturation[ 52 ].…”

“…Both community and clinical studies on the effect of age on CHR symptoms and criteria indicated an age threshold around age of 16 years for APS and BIPS, with perceptual APS/BIPS being more prevalent below this age and all APS/BIPS being less clinically relevant[ 22 , 23 , 51 , 53 ]. For perceptual and cognitive basic symptoms, the age thresholds for prevalence and clinical significance were around age of 18 and 23 years, respectively[ 23 , 52 ]. Thus, all participants were at an age below the threshold suggested for basic symptoms, while the suggested age threshold for APS/BIPS was within the age range of our sample.…”

“…As for the basic symptoms, affected persons can commonly cope with these mostly fleeting experiences (e.g., by increased willpower or concentration) for as long as their number or frequency does not exceed their coping capacities, and for as long as the employed coping strategies are not maladaptive (such as social withdrawal or other avoidance strategies)[ 44 , 52 , 89 ]. Thus, for their subjective perception as not normal, basic symptoms may induce distress and worries about one’s own mental health[ 52 , 89 ] but not necessarily impairment in psychosocial functioning. Consequently, functional impairment is not a general prerequisite for symptoms or syndromes, in particular in the prevention of disorders that, within psychiatry, also aims for the prevention of functional impairment[ 90 ].…”

(Attenuated) hallucinations join basic symptoms in a transdiagnostic network cluster analysis

“…Furthermore, hallucinations and other perceptual disturbances occur more frequently in children and adolescents compared to adults in both community and clinical samples (Maijer et al, 2019;Schimmelmann et al, 2015;Schultze-Lutter et al, 2017, 2020a, 2020bWalger et al, 2020). Thus, it was cautioned that, in children and adolescents, the presence of hallucinations does not always justify a psychosis diagnosis (Driver et al, 2020;Maijer et al, 2019;Schultze-Lutter and Schmidt, 2016), not least because they would frequently spontaneously remit (Brink et al, 2020).…”

“…The clinical and diagnostic significance of perceptual aberrations, in particular of hallucinatory experiences, for psychosis has been challenged by their association with age and developmental stage in both clinical and community samples (Maijer et al, 2019;Brink et al, 2020;Schimmelmann et al, 2015;Schultze-Lutter and Schmidt, 2016;Schultze-Lutter et al, 2017, 2020a, 2020bWalger et al, 2020), their occurrence in a broad range of other mental and somatic disorders (Carota and Bogousslavsky, 2019;Coerver and Subramanian, 2020;Jean et al, 2020;Thakur and Gupta, 2020;Waters and Fernyhough, 2017) and their unclear psychosis-predictive value (Zhang et al, 2020;Niles et al, 2019;Marshall et al, 2019). It was suggested that hallucinations might better be regarded as a common endpoint of multiple processes and that, by assessing hallucinations in different modalities together as one, as done in SIPS and PANSS, meaningful differences in etiology and phenomenology may be ignored (Pienkos et al, 2019).…”