Predicting Attenuated Psychotic Symptoms Amongst Youth Endorsing Persistent Distressing Psychotic-like Experiences

Project Summary Psychosis disorders are amongst the most debilitating and difficulty to treat forms of psychopathology, necessitating the development of early identification and prevention efforts. The development of early screening and prevention efforts requires first identifying reliable early risk indicators of worsening psychosis spectrum symptoms. The development of psychosis is preceded by the presence psychotic “like” experiences (PLEs) and then attenuated psychotic symptoms (APS). Ideally, prevention efforts would identify youth prior to the functional decline associated with clinical high-risk states (e.g., APS). Theoretical models posit that in order for PLEs to worsen and develop into psychotic disorders, additional environmental exposures are required (termed the persistence-proneness-impairment model). However, this theoretical model has not been directly tested and therefore it is not yet clear how PLEs evolve into APS or what risk factors predict which youth with PLEs will develop APS. Early prevention efforts have developed risk calculators for conversion to psychosis, but questions remained regarding whether these developed calculators will translate to the development of APS. The current application will address these pressing questions by capitalizing on a unique and time-limited opportunity provided by the Adolescent Brain Cognitive Development (ABCD) study. Aim 1 will examine the prevalence of APS among youth in the ABCD Study sample, expanding initial data collection efforts to provide robust estimates of APS amongst youth endorsing PD-PLEs and compare these rates to persistent internalizing or externalizing symptoms, as well as compare rates of APS to other forms of diagnosable psychopathology. The application will also identify predictors of transition from PLEs to APS (Aim 2), including whether, consistent with the persistence- proneness-impairment model, worsening environmental exposures over time predict transition to APS. The applicant will also examine whether psychosis risk calculators developed for conversion to psychosis also predict APS amongst youth endorsing PD-PLEs (Aim 3). The PI and her team have the unique necessary experience to conduct this research. Thus, consistent with NIMH Strategic Objective 3: Strive for Prevention and Cures, the present proposal will fill several gaps in the extant literature, improving our understanding of the nature of early worsening psychosis spectrum symptoms, including rates of APS and reliable risk factors in comparison to other forms of psychopathology, information that will provide the foundation for screening and prevention efforts.