Date of Award

2021

Document Type

Dissertation

Degree Name

Philosophy (Ph.D)

Department

Psychology

First Advisor

Andrea Bergman

Second Advisor

Andrea Auther

Third Advisor

Wilson McDermut

Abstract

The detrimental impact of psychosis on individuals and society has sparked interest in early detection and intervention strategies to improve outcomes for those who are high-risk for developing psychosis. This study used data collected by the Recognition and Prevention (RAP) program to explore the progression of Axis I and Axis II disorders, clinical and functional characteristics, and predictors of conversion in a Clinical High Risk (CHR) sample. Using the RAP Program’s classification system, participants were assigned to the following subgroups based on symptom presentation: Clinical High Risk Positive (CHR+) which is defined by the presence of attenuated positive symptoms and Clinical High Risk Negative (CHR-) which requires the presence of attenuated negative symptoms. Participants consisted of 156 subjects (110 males and 46 females) who participated in the RAP Program during Phase I (2000-2006) and were separated into the high-risk groups: CHR+ and CHR-. These results indicated that Axis I disorders (mood, anxiety, substance use, and attention-deficit and disruptive behavior disorders) presented similarly at baseline in the CHR subgroups, however there were significant differences in the prevalence rates of paranoid personality disorder, borderline personality disorder, and schizoid personality disorder. In exploring the relationships between psychiatric disorders, attenuated symptoms, and functioning, it was found that lower levels of role functioning were associated with mood disorders for CHR- participants. Additionally, social functioning and attenuated negative symptoms were found to have an impact on Cluster A personality presentation in both CHR subgroups. This study also explored the progression of psychiatric disorders, and results demonstrated that mood, anxiety, attention-deficit and disruptive behavior disorders, and personality disorders were persistent and recurrent from baseline to follow-up in both subgroups. Additionally, in examining predictors of conversion, positive symptoms were found to be the strongest predictor of conversion to psychosis and mood disorders were found to be a significant predictor of non-conversion. The results from this study convey that CHR adolescents present with a constellation of diagnoses and symptoms. The findings suggest that it may be beneficial to continue to screen individuals diagnostically to develop specific intervention strategies based on how participants are assigned to high-risk groups.

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