Negative self-reference as a component of subthreshold psychotic symptoms in clinical high-risk youth

Aim: Schizophrenia is a leading cause of disability worldwide; early detection and intervention are critical. Early in their illness, individuals at clinical high-risk (CHR) for psychosis have subthreshold psychotic symptoms that are often derogatory and self-directed. We hypothesized that CHR participants with negative self-reference (NSR) as a component of subthreshold psychosis would also have higher levels of social anxiety and depression, lower self-esteem and lower social/role/global functioning as compared with CHR participants without NSR. Methods: One hundred and sixty-eight participants from the National Institute of Mental Health (NIMH) funded Regroup Cognitive Behavioural Social Skills Training (CBSST) study were included. Clinical vignettes that included the Scale of Psychosis-Risk Symptoms were coded categorically to indicate whether NSR was present. t-tests were used to determine the association between NSR, symptom, and functional measures. Results: Participants with NSR demonstrated significantly more social interaction anxiety (p < .001), negative beliefs about the self (p <= .001), defeatist beliefs (p < .05), depressive symptoms (p < .05) and positive symptoms (p < .005). There were no significant differences in social self-efficacy, positive or negative beliefs about others, positive beliefs about the self or psychosocial functioning between the two groups. Conclusions: Clinically significant differences were found between CHR participants with and without NSR, suggesting that this may be a useful factor to identify and address. Follow-up studies are needed to determine whether NSR responds to CBSST and whether or not its resolution would be associated with improvement in other symptom domains.