Comorbid Depressive and Anxiety Disorders in 509 Individuals With an At-Risk Mental State: Impact on Psychopathology and Transition to Psychosis
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BACKGROUND: The current diagnostic system for subjects at enhanced clinical risk of psychosis allows concurrent comorbid diagnoses of anxiety and depressive disorders. Their impact on the presenting high-risk psychopathology, functioning, and transition outcomes has not been widely researched. METHODS: In a large sample of subjects with an At-Risk Mental State (ARMS, n = 509), we estimated the prevalence of DSM/SCID anxiety or depressive disorders and their impact on psychopathology, functioning, and psychosis transition. A meta-analytical review of the literature complemented the analysis. RESULTS: About 73% of ARMS subjects had a comorbid axis I diagnosis in addition to the "at-risk" signs and symptoms. About 40% of ARMS subjects had a comorbid diagnosis of depressive disorder while anxiety disorders were less frequent (8%). The meta-analysis conducted in 1683 high-risk subjects confirmed that baseline prevalence of comorbid depressive and anxiety disorders is respectively 41% and 15%. At a psychopathological level, comorbid diagnoses of anxiety or depression were associated with higher suicidality or self-harm behaviors, disorganized/odd/stigmatizing behavior, and avolition/apathy. Comorbid anxiety and depressive diagnoses were also associated with impaired global functioning but had no effect on risk of transition to frank psychosis. Meta-regression analyses confirmed no effect of baseline anxiety and/or depressive comorbid diagnoses on transition to psychosis. CONCLUSIONS: The ARMS patients are characterized by high prevalence of anxiety and depressive disorders in addition to their attenuated psychotic symptoms. These symptoms may reflect core emotional dysregulation processes and delusional mood in prodromal psychosis. Anxiety and depressive symptoms are likely to impact the ongoing psychopathology, the global functioning, and the overall longitudinal outcome of these patients.
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The majority of CHR-P individuals have comorbid non-psychotic mental disorders (which do not increase the risk for psychosis but tend to persist over time), mostly common mental disorders: 41% depressive disorders and 15% anxiety disorders.
“The majority of CHR-P individuals have comorbid non-psychotic mental disorders (which do not increase the risk for psychosis but tend to persist over time 229 ), mostly common mental disorders: 41% depressive disorders and 15% anxiety disorders 72,230”
From Preventive psychiatry: a blueprint for improving the mental health of young people (2021) · cites this paper as [230]
The development of a psychiatric disorder significantly increases the risk of psychiatric comorbidity.
“For example, the development of a psychiatric disorder significantly increases the risk of psychiatric comorbidity (Fusar-Poli et al., 2014; Avenevoli et al., 2015).”
From Aerobic Exercise as a Tool to Improve Hippocampal Plasticity and Function in Humans: Practical Implications for Mental Health Treatment (2016) · cites this paper as Fusar-Poli et al., 2014
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Self-citationFusar-Poli, P., Frascarelli, M., Valmaggia, L., Byrne, M., Stahl, D., Rocchetti, M., Codjoe, L., Weinberg, L., Tognin, S., Xenaki, L., et al. (2015) · Psychological Medicine · doi:10.1017/s003329171400244x · Cited by 73 · see citing works
Self-citationAbnormalities in sleep patterns in individuals at risk for psychosis and bipolar disorder
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Fusar-Poli, P., Spencer, T., De Micheli, A., Curzi, V., Nandha, S., & McGuire, P. (2020) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2020.08.002 · Cited by 57 · see citing works
Self-citationAttitudes towards help-seeking and stigma among young people at risk for psychosis
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Schizophrenia — an anxiety disorder?
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Winton-Brown, T., Schmidt, A., Roiser, J. P., Howes, O. D., Egerton, A., Fusar-Poli, P., Bunzeck, N., Grace, A. A., Duzel, E., Kapur, S., et al. (2017) · Translational Psychiatry · doi:10.1038/tp.2017.174 · Cited by 51 · see citing works
Self-citationPredicting Remission in Subjects at Clinical High Risk for Psychosis Using Mismatch Negativity
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Combined cognitive, psychomotor and electrophysiological biomarkers in major depressive disorder
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Biofeedback to treat anxiety in young people at clinical high risk for developing psychosis
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The critical need for help-seeking controls in clinical high-risk research
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Why do some Mexicans with psychosis risk symptoms seek mental health care and others do not?
Domínguez, T., Puebla, D. P., Fresán, A., Sheinbaum, T., Nieto, L., Robles, R., López, S. R., de la Fuente-Sandoval, C., Lara Muñoz, M. D. C., Barrantes-Vidal, N., et al. (2024) · Psychiatry Research · doi:10.1016/j.psychres.2024.116199 · Cited by 1 · see citing works
- Authors
- Fusar-Poli, P., Nelson, B., Valmaggia, L., Yung, A. R., & McGuire, P. K.
- Affiliations
- The University of Melbourne (AU)
- King's College London (GB)
- Venue
- Schizophrenia Bulletin
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-11-22
- Volume
- 40
- Issue
- 1
- Pages
- 120-131
- ISSN
- 0586-7614 (ISSN-L)
- 1745-1701
- PMC
- PMC3885287
- OpenAlex
- W2105347849
- Cited by
- 589
- References
- 49
- Citations by year
- 2026: 14 · 2025: 29 · 2024: 31 · 2023: 35 · 2022: 38 · 2021: 53 · 2020: 73 · 2019: 49 · 2018: 50 · 2017: 68 · 2016: 48 · 2015: 46 · 2014: 35 · 2013: 19 · 2012: 1
- FWCI
- 4.36
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by-nc
- Locations
- Schizophrenia Bulletin (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc)
- Figshare (submittedVersion, cc-by-nc)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Research Explorer (The University of Manchester) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- clinical high risk for psychosis, prodromal psychosis
- MeSH terms
- Adolescent, Adult, Anxiety Disorders, Depressive Disorder, Female, Humans, London, Male, Psychotic Disorders, Risk, Victoria, Comorbidity, Prevalence, Disease Progression, Young Adult, Prodromal Symptoms
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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