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Abstract: “Transition to psychosis” has been the outcome of interest in Ultra High Risk (UHR) and “prodromal” studies. However, the point at which an individual crosses the line from high risk or prodromal state to psychosis threshold is arbitrary. There have been few attempts to examine whether this threshold has any validity in terms of biological markers or course and outcome. More research is needed to determine if the current point at which a person is declared “psychotic” is valid. Indeed some persons labeled as having developed psychosis may quickly recover. In such a situation their transition could be seen as “trivial”. Others who do not make “transition” may have worse outcomes. Validation of the transition point is an important issue as “risk syndrome for psychosis” (psychosis prodrome) is being considered for inclusion in the DSMV. Further, much research attempts to distinguish markers for psychotic disorders by examining the differences between UHR individuals who do and do not develop psychosis. Thus it behooves us not just to have this risk syndrome validated, but to have the hypothetical endpoint of psychosis validated as well. [Copyright &y& Elsevier]

Abstract: Background: Baseline functioning has been found to be a strong predictor of transition to psychosis in ultra high risk populations. However, the time course of functioning may enhance prediction. We investigated whether there were different patterns of functioning over time and whether particular temporal patterns were related to baseline characteristics and psychosis outcome. Method: Functional data was assessed at baseline and after 3 to 6year follow-up in an ultra high risk sample (n=158; 92 female, mean age=19.28 (SD=3.33), range=14–29). Using the median score of the GAF and the QLS scale, a ‘High’ and ‘Low’ group (comprising of subjects functioning above or below median at both baseline and follow-up) and a ‘Deterioration’ group and ‘Improving’ group were created. Results: Chi-square analyses showed that the Low and Deteriorating functioning groups were the most likely to develop first-episode psychosis (FEP). Importantly, UHR individuals with deteriorating functioning were at higher risk of transition than those whose functioning was low at baseline but improved over time (GAF: X 2 =5.10, df=1, p=.02; QLS: X 2 =9.13, df=1, p=.003). Binary logistic regression analyses showed that a decline in functioning was more strongly associated with FEP (GAF: p=<.0001; QLS: p<.0001) than the level of baseline functioning (GAF: p=.005; QLS: p=.09). The deteriorating group could not be distinguished from the High group in terms of baseline symptomatology. Discussion: With the addition of the ‘low functioning’ criterion to the UHR criteria, we may miss out on some true positive cases. Limiting our attention to baseline poor functioning may therefore distort the picture in terms of risk for psychosis. [Copyright &y& Elsevier]

Abstract: Individuals at “ultra high risk” (UHR) for psychosis have been found to experience high rates of sexual trauma. An aetiological role for sexual trauma has been proposed for psychotic disorders and may influence psychotic symptom content. We aimed to investigate the relationship between previous sexual trauma and reported psychotic-like experiences, in particular psychotic symptoms with a sexual content in a UHR sample. We investigated the prevalence of “attenuated” or “subthreshold” psychotic symptoms with a sexual content in a consecutive series of patients recruited to a specialist UHR clinic. Patient''s experience of general and sexual trauma was rated separately using a trauma questionnaire based on the list of events qualifying as traumas under DSM IV. The sample consisted of 92 patients, 14 (15.2%) had experienced an attenuated psychotic symptom with sexual content. The most common symptom was overvalued ideas/delusions of being watched in the shower/toilet or undressing. A considerable proportion of the sample (36.2%) had experienced sexual trauma (sexually molested or raped). Presence of attenuated psychotic symptoms with sexual content was related to history of previous sexual trauma (OR 7.17, P <0.01). This relationship remained significant when other traumatic experiences, PTSD diagnosis, age and sex were adjusted for. Further research into this relationship with regard to outcome and treatment is warranted. [Copyright &y& Elsevier]