Effects of age and sex on clinical high-risk for psychosis in the community
Open accessAbstract
BACKGROUND: Recent reports of both heightened prevalence rates and limited clinical relevance of clinical high-risk (CHR) criteria and their relevant symptoms in children and adolescents indicate an important role of neurodevelopment in the early detection of psychoses. Furthermore, sex effects in CHR symptoms have been reported, though studies were inconclusive. As sex also impacts on neurodevelopment, we expected that sex might have an additional contribution to age in the prevalence and clinical relevance of CHR symptoms and criteria. AIM: To investigate age and sex effects on CHR criteria and symptoms and their association with psychosocial impairment and mental disorder. METHODS: = 2916 8- to 40-year-olds, randomly drawn from the population register of the Swiss canton Bern, were assessed in semi-structured interviews by phone or face-to-face for CHR symptoms and criteria using the Structured Interview for Psychosis-Risk Syndromes and the Schizophrenia Proneness Instrument in its child and youth, and adult version, respectively. Furthermore, social and occupational functioning and DSM-IV axis I disorders were assessed. Simple and interaction effects of age and sex on CHR symptoms and criteria, and interaction effects of age, sex, and CHR symptoms and criteria on presentation of functional impairment and of non-psychotic disorder were investigated using logistic regression analyses. RESULTS: < 0.05) associated with CHR symptoms and criteria, mostly by younger age and female sex. Though slightly differing between symptom groups, age thresholds were detected around the turn from adolescence to adulthood; they were highest for cognitive basic symptoms and CHR criteria. With the exception of the infrequent speech disorganization attenuated psychotic symptom, the interaction of age with CHR symptoms and criteria predicted functional impairment; whereas, independent of each other, sex and CHR symptoms mostly predicted mental disorders. CONCLUSION: Age and sex differentially impact on CHR symptoms and criteria; these differences may support better understanding of causal pathways. Thus, future CHR studies should consider effects of sex and age.
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Sex/gender differences are found in psychiatric comorbidities, with aggressive behavior and substance use disorder in men contrasting with eating disorders and depression in women.
“In some cases, sex/gender differences are found in the psychiatric comorbidities associated with a predominant mental disorder -e.g., aggressive behavior and substance use disorder in men, contrasting with eating disorders and depression in women (26–30).”
From Where Sex Meets Gender: How Sex and Gender Come Together to Cause Sex Differences in Mental Illness (2022) · cites this paper as [26]
The Discussion section on clinical relevance of CHR symptoms reports that females were more likely to have current non-psychotic mental disorders, supporting a general sex difference. It does not identify aggressive behavior or substance use disorder as more common in men, or eating disorders and depression as more common in women; searches for those specific conditions found no supporting passage. Page numbers were not available in our copy. (LLM, conf=0.84)
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Self-citationKosmidou, V. E., Adam, A., Papadaniil, C. D., Tsolaki, M., Hadjileontiadis, L. J., & Kompatsiaris, I. Y. (2015) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/embc.2015.7320145 · Cited by 5 · see citing works
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2 of the 87 references couldn’t be matched to a known paper.
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- [31]Addington J Schultze-Lutter F Romans S Seeman MV Prodromal Phase of Psychosis in Adolescent Women. In: Romans S, Seeman MV. Women's Mental Health: A Life Cycle Approach Philadelphia: Lippincott Williams Wilkins, 2006; 123-132
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ENIGMA Clinical High Risk for Psychosis Working Group, Jalbrzikowski, M., Hayes, R. A., Wood, S. J., Nordholm, D., Zhou, J. H., Fusar-Poli, P., Uhlhaas, P. J., Takahashi, T., Sugranyes, G., et al. (2021) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2021.0638 · Cited by 137 · see citing works
Self-citationWhere Sex Meets Gender: How Sex and Gender Come Together to Cause Sex Differences in Mental Illness
Christiansen, D. M., McCarthy, M. M., & Seeman, M. V. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.856436 · Cited by 65 · see citing works
Bora, E., Yalınçetin, B., Akdede, B. B., & Alptekın, K. (2019) · Schizophrenia Research · doi:10.1016/j.schres.2019.05.025 · Cited by 62 · see citing works
Flückiger, R., Michel, C., Grant, P. S., Ruhrmann, S., Vogeley, K. T., Hubl, D., SCHIMMELMANN, B. G., Klosterkötter, J., Schmidt, S. J., & Schultze‐Lutter, F. (2019) · Schizophrenia Research · doi:10.1016/j.schres.2018.12.039 · Cited by 36 · see citing works
Self-citationSchultze‐Lutter, F., Walger, P., Franscini, M., Traber‐Walker, N., Osman, N., Walger, H., SCHIMMELMANN, B. G., Flückiger, R., & Michel, C. (2022) · World Journal of Psychiatry · doi:10.5498/wjp.v12.i3.425 · Cited by 25 · see citing works
Self-citationMolecular and micro-architectural mapping of gray matter alterations in psychosis
García-San-Martín, N., Bethlehem, R. A. I., Mihalik, Á., Seidlitz, J., Sebenius, I., Alemán-Morillo, C., Dorfschmidt, L., Shafiei, G., de la Foz, V. O., Merritt, K., et al. (2024) · Molecular Psychiatry · doi:10.1038/s41380-024-02724-0 · Cited by 21 · see citing works
(Attenuated) hallucinations join basic symptoms in a transdiagnostic network cluster analysis
Bulnes, N. J., Gómez‐Pilar, J., Poza, J., Hornero, R., Vogeley, K. T., Meisenzahl, E. M., Lichtenstein, T., Rosen, M., Kambeitz, J. P., Klosterkötter, J., et al. (2022) · Schizophrenia Research · doi:10.1016/j.schres.2022.02.018 · Cited by 19 · see citing works
Self-citationSex differences in bipolar disorder: The dorsolateral prefrontal cortex as an etiopathogenic region
Zhang, L., & Swaab, D. F. (2023) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2023.101115 · Cited by 18 · see citing works
Núñez, D., Ordóñez-Carrasco, J. L., Fuentes-Ferrada, R., & Langer, A. I. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.05.028 · Cited by 16 · see citing works
Damiani, S., Rutigliano, G., Fazia, T., Merlino, S., Berzuini, C., Bernardinelli, L., Politi, P., & Fusar‐Poli, P. (2021) · Schizophrenia Bulletin · doi:10.1093/schbul/sbab070 · Cited by 16 · see citing works
Positive psychotic symptoms in childhood and adolescence
Schultze‐Lutter, F., Kindler, J., Ambarini, T. K., & Michel, C. (2021) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2021.11.007 · Cited by 18 · see citing works
Self-citationKristensen, T. D., Glenthøj, L., Ambrosen, K., Syeda, W., Ragahava, J. M., Krakauer, K., Wenneberg, C., Fagerlund, B., Pantelis, C., Glenthøj, B., et al. (2021) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13355 · Cited by 18 · see citing works
Schizophrenia Psychosis in Women
Seeman, M. (2020) · Women · doi:10.3390/women1010001 · Cited by 11 · see citing works
Walger, H., Antonucci, L. A., Pigoni, A., Upthegrove, R., Salokangas, R. K. R., Lencer, R., Chisholm, K., Riecher‐Rössler, A., Haidl, T. K., Meisenzahl, E. M., et al. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.552175 · Cited by 10 · see citing works
Self-citationCognitive-Developmental Mechanisms in Hallucinations
Fernyhough, C., de Boer, J. N., Davis, P. E., Schneider, M., Moriguchi, Y., Alderson‐Day, B., Brederoo, S., & Jardri, R. (2025) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaf144 · Cited by 8 · see citing works
Wu, J.-X., Long, X.-Y., Liu, F., Qi, A., Chen, Q., Guan, X.-F., Zhang, Q., Yao, Y.-H., Shi, J.-Y., Xie, S.-P., et al. (2020) · BMC Psychiatry · doi:10.1186/s12888-021-03229-8 · Cited by 7 · see citing works
Kuhney, F. S., Strauss, G. P., Walker, E. F., James, S. H., & Mittal, V. A. (2025) · Schizophrenia Bulletin · doi:10.1093/schbul/sbaf032 · Cited by 4 · see citing works
22q11.2 Deletion Syndrome: Cognitive, Visuomotor, and Adaptive Functioning Followed Longitudinally
Wallin, L., Gillberg, C., Knutsson, J., Fernell, E., Gillberg, I. C., & Billstedt, E. (2025) · Brain and Behavior · doi:10.1002/brb3.70638 · Cited by 4 · see citing works
Farina, E. A., Mourgues, C., Stimler, K., Kenney, J. G., Saxena, A., Mukhtar, H., Addington, J., Bearden, C. E., Cadenhead, K. S., Cannon, T. D., et al. (2025) · Schizophrenia · doi:10.1038/s41537-025-00663-5 · Cited by 3 · see citing works
Cabrera, S., Osman, N., Michel, C., Franscini, M., Walger, P., Traber‐Walker, N., SCHIMMELMANN, B. G., Flückiger, R., Reißner, V., & Schultze‐Lutter, F. (2026) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-026-03042-2 · Cited by 3 · see citing works
Self-citationTheisen, C., Rosen, M., Meisenzahl, E. M., Koutsouleris, N., Lichtenstein, T., Ruhrmann, S., Kambeitz, J. P., Kambeitz‐Ilankovic, L., Riecher‐Rössler, A., Chisholm, K., et al. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1209485 · Cited by 3 · see citing works
Self-citationBlose, B. A., Godleski, S. A., Houston, R. J., & Schenkel, L. S. (2022) · Journal of Interpersonal Violence · doi:10.1177/08862605221122832 · Cited by 3 · see citing works
Social Defeat, Psychotic Symptoms, and Crime in Young Caribbean Immigrants to Rotterdam
Vinkers, D. J., van de Vorst, M., Hoek, H. W., & van Os, J. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.498096 · Cited by 2 · see citing works
Stüble, M., Schultze‐Lutter, F., Kaess, M., Franscini, M., Traber‐Walker, N., Walger, P., SCHIMMELMANN, B. G., Vogeley, K. T., Kambeitz, J. P., Kindler, J., et al. (2024) · BJPsych Open · doi:10.1192/bjo.2024.815 · Cited by 4 · see citing works
Self-citationMichel, C., Osman, N., Rinaldi, G., SCHIMMELMANN, B. G., Kindler, J., & Schultze‐Lutter, F. (2025) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796024000891 · Cited by 1 · see citing works
Self-citationTor, J., Baeza, I., Alvarez‐Subiela, X., Rodríguez‐Pascual, M., Muñoz‐Samons, D., Sintes, A., de la Serna, E., Puig, O., Sugranyes, G., Ilzarbe, D., et al. (2025) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.14148 · Cited by 1 · see citing works
Aguado-Gracia, J., Borràs, R., & Escalona, R. C. (2026) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-026-07372-7 · Cited by 1 · see citing works
Gauld, C., Fourneret, P., Alderson‐Day, B., Palmer-Cooper, E. C., & Dondé, C. (2024) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-024-01876-y · Cited by 1 · see citing works
Teigset, C. M., Mohn, C., Mohn-Haugen, C. R., Larøi, F., & Rund, B. R. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1430805 · Cited by 1 · see citing works
Rinaldi, G., Lerch, S., Schultze‐Lutter, F., Schmidt, S. J., Cavelti, M., Kaess, M., & Michel, C. (2025) · European Psychiatry · doi:10.1192/j.eurpsy.2024.1812
Self-citationWu, J., Long, X., Liu, F., Qi, A., Chen, Q., Guan, X., Zhang, Q., Yao, Y., Shi, J., 谢世平, et al. (2021) · Figshare · doi:10.6084/m9.figshare.14608325
Bouter, D. C., Vecchio, A., Marika, O., de Neve-Enthoven, N. G. M., Hoogendijk, W. J. G., Borgatti, R., Mil, N. H. G., & Mensi, M. M. (2026) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-026-02990-z
Basic symptoms of psychosis—from historical foundations to current evidence
Schultze‐Lutter, F., Theisen, C., Ambarini, T. K., & Wrulich, M. (2026) · Neuropsychiatrie · doi:10.1007/s40211-026-00588-0
Self-citationMisinterpreting reality: cognitive insight, biases, and the risk for psychosis proneness
Barahmand, U., Davis, S. W., Gebril, A., Akhtar, S., Chai, Y., & Zhou, C. (2026) · Psychosis · doi:10.1080/17522439.2026.2704564
- Authors
- Schultze-Lutter, F., Schimmelmann, B. G., Flückiger, R., & Michel, C.
- Affiliations
- University of Bern (CH)
- Venue
- World Journal of Psychiatry
- Publisher
- Baishideng Publishing Group Inc.
- Published
- 2020-05-19
- Volume
- 10
- Issue
- 5
- Pages
- 101-124
- ISSN
- 2220-3206 (ISSN-L)
- PMC
- PMC7243619
- OpenAlex
- W3024194439
- Cited by
- 34
- References
- 87
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 4 · 2023: 2 · 2022: 4 · 2021: 8 · 2020: 2 · 2019: 2
- FWCI
- 2.92
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc
- Locations
- World Journal of Psychiatry (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- clinical high risk for psychosis, age effects, sex differences, psychosis risk syndromes, attenuated psychotic symptoms, functional disability, non-psychotic mental disorders, brain development, adolescence to adulthood transition, early detection of psychosis
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