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Depression predicts persistence of paranoia in clinical high-risk patients to psychosis: results of the EPOS project



The link between depression and paranoia has long been discussed in psychiatric literature. Because the causality of this association is difficult to study in patients with full-blown psychosis, we aimed to investigate how clinical depression relates to the presence and occurrence of paranoid symptoms in clinical high-risk (CHR) patients.


In all, 245 young help-seeking CHR patients were assessed for suspiciousness and paranoid symptoms with the structured interview for prodromal syndromes at baseline, 9- and 18-month follow-up. At baseline, clinical diagnoses were assessed by the Structured Clinical Interview for DSM-IV, childhood adversities by the Trauma and Distress Scale, trait-like suspiciousness by the Schizotypal Personality Questionnaire, and anxiety and depressiveness by the Positive and Negative Syndrome Scale.


At baseline, 54.3 % of CHR patients reported at least moderate paranoid symptoms. At 9- and 18-month follow-ups, the corresponding figures were 28.3 and 24.4 %. Depressive, obsessive–compulsive and somatoform disorders, emotional and sexual abuse, and anxiety and suspiciousness associated with paranoid symptoms. In multivariate modelling, depressive and obsessive–compulsive disorders, sexual abuse, and anxiety predicted persistence of paranoid symptoms.


Depressive disorder was one of the major clinical factors predicting persistence of paranoid symptoms in CHR patients. In addition, obsessive–compulsive disorder, childhood sexual abuse, and anxiety associated with paranoia. Effective pharmacological and psychotherapeutic treatment of these disorders and anxiety may reduce paranoid symptoms in CHR patients.

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The International Advisory Board ‘European Prediction of Psychosis’ (EPOS) group comprises Patrick D. McGorry, Australia; Thomas H. McGlashan, USA; Martin Knapp, UK. The authors thank the following scientists for their work for EPOS: Reinaud van der Fliert, Rianne Klaassen (Department of Psychiatry, AMC, University of Amsterdam, The Netherlands); Heinz Picker, Meike Neumann, Anke Brockhaus-Dumke, Ralf Pukrop (Department of Psychiatry and Psychotherapy/FETZ, University of Cologne, Cologne, Germany); Jukka Huttunen, Terja Ristkari (Department of Psychiatry, University of Turku, Finland); Tanja Svirskis (Department of Psychiatry, University of Helsinki, Helsinki, Finland); Amanda Skeate (ED: IT, Early Intervention Service, Birmingham, UK); Yehonala Gudlowski (Charité, Berlin, Germany); Seza Ozgürdal, Henning Witthaus (Charité, Berlin, and Ruhr-University, Bochum, Germany); Shôn Lewis, Antony Morrisson (School of Psychological Sciences, University of Manchester, Manchester, UK).

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Correspondence to Raimo K. R. Salokangas.

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This study was funded by Grant QLG4-CT-2001-01081 from the 5th Framework Program Quality of Life and Management of Living Resources of the European Commission. Additional local funding was provided by the Social Insurance Institution of Finland, the Medical Faculty of Cologne (Köln Fortune Program), the Research Council of The Netherlands (ZorgOnderzoek Nederland/NWO-Medische Wetenschappen, project # 2630.0001), the National Institute for Health Research (NIHR) through the Collaborations for Leadership in Applied Health Research and Care for Birmingham and the Black Country (CLAHRC-BBC)’ and Oy H. Lundbeck AB, Finland.

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Salokangas, R.K.R., Schultze-Lutter, F., Hietala, J. et al. Depression predicts persistence of paranoia in clinical high-risk patients to psychosis: results of the EPOS project. Soc Psychiatry Psychiatr Epidemiol 51, 247–257 (2016).

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  • Depression
  • Anxiety
  • Paranoia
  • Persistence
  • Clinical high risk