Depression, anxiety not linked to psychosis transition

Depression and anxiety disorders are common in patients at increased clinical risk for psychosis, but do not appear to influence transition to full-blown psychosis, say UK researchers.

In a study of 509 individuals in an at-risk mental state (ARMS), the team found that almost three quarters had a comorbid axis I diagnosis, with 40% having depression alone (26%) or in association with anxiety disorders (14%). Anxiety alone was less common, at 8%.

Furthermore, the presence of depression and/or anxiety was associated with increased psychopathology and reduced functioning in ARMS patients, but not with transition to full-blown psychosis over a mean follow-up period of 3.65 years.

"The high prevalence of these comorbidities in ARMS subjects may phenomenologically reflect the delusional mood and emotional dysregulation processes predating the onset of attenuated positive symptoms," write Paolo Fusar-Poli (King's College London) and colleagues in Schizophrenia Bulletin.

All of the participants were aged between 14 and 35 years and were assessed for at-risk signs and symptoms at baseline using the Comprehensive Assessment of the At-Risk Mental State (CAARMS).

Over the follow-up period, 14.9% of the patients experienced a full-blown psychotic episode.

Depression and/or anxiety at baseline were associated with higher CAARMS subscale scores for suicidality and self-harm, disorganized/odd/stigmatizing behavior, and avolition/apathy.

In addition, comorbid anxiety was associated with higher CAARMS subscale scores for disorganized speech, while comorbid depression (alone or in combination with anxiety disorders) was associated with higher scores on the anhedonia subscale.

The presence of comorbid depressive and/or anxiety disorders was also associated with lower Global Assessment of Functioning scores.

However, comorbid anxiety, depression, or concurrent anxiety and depression had no impact on transition risk.

Fusar-Poli et al conclude: "A large majority of ARMS subjects present with comorbid axis I diagnoses, mainly depressive or anxiety disorders, in addition to their attenuated psychotic symptoms."

They add; "Anxiety and depressive symptoms are likely to influence presenting psychopathology and global functioning but do not affect the risk of transition to psychotic disorder."

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