{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T18:48:19Z","timestamp":1787510899202,"version":"build-2736575974"},"reference-count":61,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2021,7,6]],"date-time":"2021-07-06T00:00:00Z","timestamp":1625529600000},"content-version":"unspecified","delay-in-days":186,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epidemiol Psychiatr Sci"],"published-print":{"date-parts":[[2021]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S204579602100041X_sec_a1\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>\n                      Although attenuated psychotic symptoms in the psychosis clinical high-risk state (CHR-P) almost always occur in the context of a non-psychotic disorder (NPD), NPD is considered an undesired \u2018comorbidity\u2019 epiphenomenon rather than an integral part of CHR-P itself. Prospective work, however, indicates that much more of the clinical psychosis incidence is attributable to prior mood and drug use disorders than to psychosis clinical high-risk states\n                      <jats:italic>per se<\/jats:italic>\n                      . In order to examine this conundrum, we analysed to what degree the \u2018risk\u2019 in CHR-P is indexed by co-present NPD rather than attenuated psychosis\n                      <jats:italic>per se<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S204579602100041X_sec_a2\" sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We examined the incidence of early psychotic experiences (PE) with and without NPD (mood disorders, anxiety disorders, alcohol\/drug use disorders), in a prospective general population cohort (\n                      <jats:italic>n<\/jats:italic>\n                      = 6123 at risk of incident PE at baseline). Four interview waves were conducted between 2007 and 2018 (NEMESIS-2). The incidence of PE, alone (PE-only) or with NPD (PE + NPD) was calculated, as were differential associations with schizophrenia polygenic risk score (PRS-Sz), environmental, demographical, clinical and cognitive factors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S204579602100041X_sec_a3\" sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The incidence of PE + NPD (0.37%) was lower than the incidence of PE-only (1.04%), representing around a third of the total yearly incidence of PE. Incident PE + NPD was, in comparison with PE-only, differentially characterised by poor functioning, environmental risks, PRS-Sz, positive family history, prescription of antipsychotic medication and (mental) health service use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S204579602100041X_sec_a4\" sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      The risk in \u2018clinical high risk\u2019 states is mediated not by attenuated psychosis\n                      <jats:italic>per se<\/jats:italic>\n                      but specifically the combination of attenuated psychosis and NPD. CHR-P\/APS research should be reconceptualised from a focus on attenuated psychotic symptoms with exclusion of non-psychotic DSM-disorders, as the \u2018pure' representation of a supposedly homotypic psychosis risk state, towards a focus on poor-outcome NPDs, characterised by a degree of psychosis admixture, on the pathway to psychotic disorder outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s204579602100041x","type":"journal-article","created":{"date-parts":[[2021,7,6]],"date-time":"2021-07-06T03:17:04Z","timestamp":1625541424000},"source":"Crossref","is-referenced-by-count":20,"title":["What makes the psychosis \u2018clinical high risk\u2019 state risky: psychosis itself or the co-presence of a non-psychotic 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