Clinical depression is present in 58% of patients at ultrahigh risk for psychosis, and 42% meet the criteria for social phobia, a study has shown.
Moreover, women with an at-risk mental state for psychosis showed significantly more depression than men, according to a study published online in Psychiatry Research (2013 [http://dx.doi.org/10.1016/j.psychres.2013.01.012]).
The finding means that "screening a help-seeking population with depression and anxiety may be effective in detecting patients at [ultrahigh risk] for developing psychosis," particularly in women, wrote the authors.
The study, led by Judith Rietdijk, Ph.D., of the VU University Amsterdam, and her colleagues, looked at patients at ultrahigh risk of psychosis, defined as those belonging to at least one of the following categories: having a schizotypal personality disorder or a first-degree relative with psychosis; experiencing attenuated positive symptoms, such as ideas of reference, odd beliefs, magical thinking, or unusual perceptual experiences; or experiencing a brief psychotic episode of less than or equal to 1 week that resolves without antipsychotic medication.
All patients had enrolled in the Dutch Early Detection and Intervention Evaluation (EDIE-NL) psychosis prevention study, a longitudinal, randomized controlled trial that compared treatment as usual to an add-on cognitive-behavioral therapy targeting psychosis risk symptoms.
Patients in the EDIE-NL study were help seeking, meaning they were from the general population who entered secondary mental health care services, or were patients referred to a specialized academic center offering tertiary care.
The current analysis included 201 patients from that study, with a mean age of 22.7 years. Just over half (51%) were female.
Overall, 117 (58.2%; 72, female) of these 201 patients met the Beck Depression Inventory–II (BDI-II) criteria for clinical depression, and 85 patients (42.3%; 50, female) met the criteria for social phobia, as measured on the Social Interaction Anxiety Scale (SIAS).
A separate analysis of gender found that while 45.5% of men met clinical depression criteria, that figure was 70.6% among ultrahigh-risk women (P less than .001).
Moreover, while only 35.4% of the men demonstrated social anxiety, 49.0% of the women met the SIAS criteria (P less than .05).
Dr. Rietdijk and her colleagues also assessed subclinical psychotic symptoms, as measured by the Comprehensive Assessment of At-Risk Mental State (CAARMS), which uses a semistructured interview to determine the presence, severity, frequency, and distress associated with, and the type of, at-risk mental state symptoms (such as unusual thought, nonbizarre ideas, perceptual abnormalities, and disorganized speech).
Using regression analysis, the investigators found that a higher total score on anxiety symptoms was associated with a higher score on the BDI-II (P = .000), as well as a higher score on the subclinical positive symptoms component of the CAARMS (P = .048).
The investigators also found a gender difference in anxiety symptoms: Among males, only age predicted higher positive symptom scores (P = .010), while among females, anxiety predicted positive symptoms on the CAARMS (P = .038).
"Having an at-risk mental state is often accompanied by depression and social anxiety," the authors concluded, although "anxiety and not depression is associated with the level of subclinical psychotic symptoms, particularly in female patients."
The researchers disclosed that their study was supported by the Netherlands Health Research Council. No individual conflicts of interest were disclosed in relation to this study.