Subclinical and attenuated negative symptoms in the prediction of psychosis in children and adolescents: sample composition matters
8 affiliations
- 1Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, LVR Clinic Düsseldorf, Clinics of the Heinrich-Heine University, Düsseldorf, Germany
- 2Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Hospital of the Ludwig-Maximilians-University (LMU) Munich, Nußbaumstraße 5a, 80336 Munich, Germany
- 3Department of Psychiatry and Psychotherapy, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- 4University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- 5Department of Child and Adolescent Psychiatry and Psychotherapy, University of Zürich, Zürich, Switzerland
- 6University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg- Eppendorf, Hamburg, Germany
- 7Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, LVR Clinic Essen, University of Duisburg-Essen, Essen, Germany
- 8Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
Abstract
In children and adolescents, subjective and attenuated negative symptoms were hypothesized to best differentiate clinical-high risk for psychosis (CHR-P) from other conditions, and to be most predictive of psychosis. To examine this, we analysed data from 8-17-year-old CHR-P in-/outpatients (n = 183), and inpatients not clinically suspected of developing psychosis (n = 277) based on cross-sectional and two-year naturalistic follow-up data from a Swiss-German study. CHR-P criteria and other symptoms were assessed using the Schizophrenia Proneness Instrument, Child & Youth version, and the Structured Interview for Psychosis-Risk Syndromes. Pairwise comparisons, two-step cluster analyses and Cox regression models were applied to identify cluster profiles and the best predictors of psychosis. In pairwise comparisons, cognitive and perceptive basic symptoms, and attenuated positive symptoms better distinguished CHR-P patients from non-CHR-P patients and converters from non-converters than the negative symptom subscales “Adynamia” and “Negative symptoms. In the stable two-cluster solution of patients scoring high (n = 338) and low (n = 122) on all scales, “Adynamia” was most important (importance = 1.0) whereby the high-scorer cluster included most of CHR-P (86.9%) and converters (84.6%), and was predictive of psychosis. Cox models of subscales differed in the selected predictors depending on the analysed samples (total sample, CHR-P and ultra-high risk only (UHR)), whereby the earlier report of “Negative symptoms” predicting conversion in UHR was replicated when only SIPS subscales were considered. While our findings partially support the significance of subjective and attenuated negative symptoms in CHR-P and psychosis prediction, they also suggest that the role of negative symptoms is highly dependent on sample composition.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00787-026-03042-2.
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BibTeX
@article{cabrera2026subclinical,
title = {{Subclinical and attenuated negative symptoms in the prediction of psychosis in children and adolescents: sample composition matters}},
author = {Santiago Cabrera and Naweed Osman and Chantal Michel and Maurizia Franscini and Petra Walger and Nina Traber-Walker and Benno G. Schimmelmann and Rahel Flückiger and Volker Reissner and Frauke Schultze-Lutter},
journal = {European Child \& Adolescent Psychiatry},
year = {2026},
month = jun,
doi = {10.1007/s00787-026-03042-2},
url = {https://doi.org/10.1007/s00787-026-03042-2},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Subclinical and attenuated negative symptoms in the prediction of psychosis in children and adolescents: sample composition matters
AU - Santiago Cabrera
AU - Naweed Osman
AU - Chantal Michel
AU - Maurizia Franscini
AU - Petra Walger
AU - Nina Traber-Walker
AU - Benno G. Schimmelmann
AU - Rahel Flückiger
AU - Volker Reissner
AU - Frauke Schultze-Lutter
PY - 2026
DA - 2026/06/06
JO - European Child & Adolescent Psychiatry
DO - 10.1007/s00787-026-03042-2
UR - https://doi.org/10.1007/s00787-026-03042-2
AB - In children and adolescents, subjective and attenuated negative symptoms were hypothesized to best differentiate clinical-high risk for psychosis (CHR-P) from other conditions, and to be most predictive of psychosis. To examine this, we analysed data from 8-17-year-old CHR-P in-/outpatients (n = 183), and inpatients not clinically suspected of developing psychosis (n = 277) based on cross-sectional and two-year naturalistic follow-up data from a Swiss-German study. CHR-P criteria and other symptoms were assessed using the Schizophrenia Proneness Instrument, Child & Youth version, and the Structured Interview for Psychosis-Risk Syndromes. Pairwise comparisons, two-step cluster analyses and Cox regression models were applied to identify cluster profiles and the best predictors of psychosis. In pairwise comparisons, cognitive and perceptive basic symptoms, and attenuated positive symptoms better distinguished CHR-P patients from non-CHR-P patients and converters from non-converters than the negative symptom subscales “Adynamia” and “Negative symptoms. In the stable two-cluster solution of patients scoring high (n = 338) and low (n = 122) on all scales, “Adynamia” was most important (importance = 1.0) whereby the high-scorer cluster included most of CHR-P (86.9%) and converters (84.6%), and was predictive of psychosis. Cox models of subscales differed in the selected predictors depending on the analysed samples (total sample, CHR-P and ultra-high risk only (UHR)), whereby the earlier report of “Negative symptoms” predicting conversion in UHR was replicated when only SIPS subscales were considered. While our findings partially support the significance of subjective and attenuated negative symptoms in CHR-P and psychosis prediction, they also suggest that the role of negative symptoms is highly dependent on sample composition. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00787-026-03042-2.
SN - 1018-8827
SN - 1435-165X
ER -