A multidimensional network analysis in youth at ultra-high risk for psychosis.

Introduction: Individuals at Ultra-high risk (UHR) for psychosis present a large array of non-psychotic mental disorders which increasingly hinder psychotherapy process and outcome. The main goal of the present study was to analyze the network structure between UHR symptom domains (i.e., positive, negative and disorganization sub-clinical psychotic symptoms) and their most common comorbidities. Methods: Network analysis was applied on 157 UHR and 106 non-UHR help-seeking children and adolescents, assessed with the Structured Interview for Prodromal Symptoms (SIPS), Children Depression Inventory (CDI), Multidimensional Anxiety Scale for Children (MASC), Children's-General Assessment Scale (C-GAS), and Wechsler Intelligence Scale for Children (WISC). Using the R package qgraph, two network analyses were conducted, including, respectively, (a) the whole sample, (b) UHR individuals only. Results: In the network structure of the whole sample, "Depression" showed significant interrelations with "UHR condition,” "anxiety," and "functioning.” In the network structure of the UHR individuals only, "negative" symptoms had the highest node strength. The most relevant association was between "negative" and "disorganization" symptoms. "Functioning" bridged "negative" symptoms and "depression," which in turn bridged "functioning" and "anxiety." "Positive” symptoms and "IQ" were not associated with other nodes. Conclusion: This study highlights the relevance of assessing depressive symptoms in very young help-seeking individuals due to their association with both psychotic and non-psychotic symptoms. These findings suggest a significant association between negative and disorganization symptoms, as well as a path from negative symptoms to anxiety symptoms, bridged by functioning and depressive symptoms. Interestingly, the main treatment target of current preventive interventions (i.e., positive symptoms) did not show any association with other clinical variables. In this developmental phase, psychotherapeutic interventions targeting negative, disorganization, depressive symptoms, and functioning are warranted.