Identification of the prodromes of psychosis in a population of psychiatric service users at their first contact: correlations between prodrome-specific and non-specific psychopathology scales and with socio-occupational functioning

Identificazione dei prodromi della psicosi in una popolazione di utenti di servizi psichiatrici al loro primo contatto: correlazioni tra scale di valutazione della psicopatologia prodrome-specifiche ed aspecifiche e con il funzionamento socio-lavorativo

A. Comparelli*, V. Savoja*, S.W. Woods**, G.D. Kotzalidis*, D. Pucci*, S.S. Caltagirone*, P. Girardi*, L. Conti***, R.Tatarelli*

* NESMOS Department (Neurosciences, Mental Health and Sensory Functions), Sapienza University, 2nd Medical School, Sant'Andrea Hospital, Rome, Italy; ** Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; *** Dipartimento di Psichiatria, Neurobiologia, Farmacologia e Biotecnologie, Università di Pisa, Italy


Background and Objectives

The Scale Of Prodromal Symptoms (SOPS) and its accompanying semistructured interview, the SIPS, have been developed to assess prodromal symptoms of psychosis. It has been correlated inversely with the Global Assessment of Functioning (GAF) in a number of studies, a DSM-IV-derived scale to assess personal, social and occupational functioning, which has been often shown to correlate inversely with general psychopathology, as assessed through the Brief Psychiatric Rating Scale (BPRS). Some items of the latter have been used in identifying at-risk cases in the past, but the SOPS and other screening tools for early detection of psychosis appear to be more specific at this respect. While the SOPS/SIPS are best complemented by the PANSS, the role of the BPRS at this respect has still to be assessed. We aimed to compare the Italian version of the SOPS with the BPRS in people at their first contact with a psychiatric service and to examine their concordance in inversely correlating with the GAF.


We collected sociodemographic and clinical data of 128 individuals seeking psychiatric help in a large Roman area, either as help-seekers at community facilities or as inpatients in psychiatric wards of two general hospitals (Table I). All included subjects were administered the Italian version of the SOPS, the Italian version of the 24-item BPRS, and the GAF. Data were analysed through Spearman’s correlation and the non-parametric Mann-Whitney U-test.


Scores on the Italian version of the SOPS correlated with those of the Italian version of the 24-item, expanded BPRS version, and both scales correlated inversely with GAF scores (Fig. 1). A higher proportion in the ultra-high risk group (UHR; n = 26) than in the clinically diagnosed aggregate group, composed of patients with established schizophrenia (SCHIZO), first episode psychosis (FEP), and other DSM-IV diagnoses (OTHER), were functionally impaired (GAF < 65). People in the UHR group scored higher on all SOPS scales and on all, but activity/excitement (EXC), BPRS scales (Table III). Compared to the clinical subsample, the UHR group showed fewer and weaker correlations betwixt the BPRS and SOPS and their scales. However, all SOPS dimensions correlated with total scores in the UHR group, but not in the combined clinical group (SCHIZO + FEP + OTHER). The BPRS and the SOPS revealed a “psychotic” and an “affective” pole, the former composed of the SOPS Positive, Negative, and Disorganisation scales and of the thought disorder, withdrawal, and hostility scales of the BPRS; only this pole showed inverse correlations with global functioning.


SOPS and BPRS are related dimensionally and conceptually. Clinical and preclinical psychopathologies correlate inversely with personal, social and occupational functioning in a first-contact population of psychological help-seekers. The UHR subsample differed from the clinical subsample in many respects and was more functionally impaired, thus it might represent a distinct, identifiable population, scoring higher on the SOPS and on the BPRS.

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