Psychosis High-Risk States in Adolescents

The increasing availability of early psychosis services has led to a much broader diagnostic spectrum now being seen in these services. Especially in adolescent age, mental state may meet psychosis risk on a purely psychometric basis, yet may be the phenotypical expression of another underlying mental disorder or a merely transient phenomenon. Five groups of symptoms and clinical features that are frequently reported by individuals with suspected psychosis risk states, yet share strong commonalities with other mental disorders and conditions and thus can be conceptualized as being part of diagnostic spectra, each reaching from nonpsychotic to psychotic symptom formation, are reviewed: isolated hallucinations; unusual bodily perceptions, hypochondriatic fears and cenesthetic psychotic symptoms; depersonalization; obsessive-compulsive, overvalued, and delusional ideas; and autism spectrum disorders. Of the 639 individuals so far assessed in the Bruderholz Early Psychosis Outpatient Service for Adolescents and Young Adults, 230 (36%) met ultra-high-risk criteria, 206 (89.6%) of whom suffered from one of the five symptom groups mentioned above. The present chapter highlights that with a purely psychometric approach, the above-mentioned diagnostic spectra may wrongly be attributed to a psychosis risk state. The final conclusion of a clinical assessment should take into account the gestalt of these particular symptoms and clinical features and consider the age-specific landscape on which the latter were able to develop. However, the appraisal of the diagnostic spectra and their overlapping symptoms constitute a tremendous challenge in the clinical assessment of each referred individual.