Psychosis-like experiences and distress among adolescents using mental health services

Although 'psychosis-like experiences' (PLEs) may reflect elevated risk for onset of serious mental illness, many individuals reporting PLEs are not truly at risk for developing clinical psychosis. Interview-based instruments that define and diagnose "clinical high risk" status attempt to distinguish between normative PLEs and attenuated symptoms indicating progression toward psychosis by probing whether such experiences create clinically relevant concerns. Two recently developed self-report measures, the Prodromal Questionnaire-Brief and the Prodromal Questionnaire-16, contain a 'distress scale' that helps assessors to gauge distress within a screening format. The aim of the current study is to examine the association of PLEs with distress within a sample of young people seeking mental health care and to investigate the usefulness of the distress scale in differentiating between participants who do and do not meet standardized criteria for a clinical high-risk syndrome. Sixty-six adolescents and young adults receiving mental health services completed the Prodromal Questionnaire-Brief and the Structured Interview for Psychosis Risk Syndromes. The screener was scored in ways that emphasized varying interpretations of respondents' distress ratings. Within this sample, focusing only on PLEs associated with distress yielded improved prediction of clinical high-risk status, and participants meeting high-risk clinical criteria were found to report more distress per PLE relative to participants with other psychiatric disorders. Findings suggest that including a distress scale within a screener aids in identifying a group more likely to meet clinical high-risk criteria. Further, PLEs that respondents describe as neutral or positive do not appear to be relevant for clinical high-risk screening.