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Background <p>While the clinical high-risk for psychosis (CHR-P) has been extensively studied and the clinical high-risk for bipolar disorder (CHR-BD) has gained increasing attention, overlapping symptoms—such as mood instability and subclinical psychotic features—complicate diagnostic boundaries. We aimed to investigate the psychopathological characteristics of high-risk individuals to address the feasibility of early-stage diagnostic differentiation. We hypothesized that CHR-P and CHR-BD could co-occur and that symptom structure would differ depending on overlap status.</p> Methods <p>We recruited 231 participants without formal psychiatric diagnoses from a prospective cohort established at the psychiatry clinic of Seoul National University Hospital. We identified CHR-P and CHR-BD using the Structured Interview for Psychosis-Risk Syndromes (SIPS) and the Bipolar Prodrome Symptom Interview and Scale (BPSS), respectively. Participants were classified into CHR-P-only, CHR-BD-only, and CHR-P/BD-overlap groups. Participants were then evaluated across multiple psychopathological domains, including delusional ideation, obsessive-compulsive symptoms, perceptual abnormalities, depressive and manic symptoms, and global clinical severity. Symptom severity, inter-domain correlations, and symptom network structures were analyzed and compared across groups.</p> Results <p>The overlap was substantial: among 158 individuals meeting CHR-P criteria, 106 (67.1%) also met CHR-BD criteria, and among 179 individuals meeting CHR-BD criteria, 106 (59.2%) also met CHR-P criteria. The subgroup distribution was 52 CHR-P-only, 73 CHR-BD-only, and 106 CHR-P/BD-overlap. Symptom structures differed by overlap status. CHR-P-only showed significantly greater social withdrawal compared to other groups. CHR-P/BD-overlap had more severe mood, delusional, obsessive-compulsive, and hallucinatory symptoms. Correlation analysis showed weaker interconnections among symptom domains in CHR-P-only. Network analysis revealed four fragmented communities in CHR-P-only, two tightly integrated communities in CHR-BD-only, and partial integration across three communities in CHR-P/BD-overlap. Central symptoms varied: paranoia in CHR-P-only; mood symptoms and obsessive thoughts in CHR-BD-only; mood symptoms and perceptual abnormalities with religious themes in CHR-P/BD-overlap.</p> Conclusions <p>High-risk states for psychosis and bipolar disorder frequently co-occur, suggesting that early psychopathology extends beyond the prodrome of any single disorder. Distinct patterns of symptom networks across high-risk subgroups underscore the value of dimensional and spectrum-based approaches to early psychopathology.</p>

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Co-existence of clinical high-risk for psychosis and bipolar disorder: a multi-dimensional psychopathological analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月30日

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  • Hyunsu Jeong,
  • Jinhyeok Jang,
  • Heesoo Yoon,
  • Junggeun Ahn,
  • Jangmi Baek,
  • Jiu Kim,
  • Nuree Kang,
  • Jayoun Kim,
  • Jae Hoon Jeong,
  • Se Hyun Kim

摘要

Background

While the clinical high-risk for psychosis (CHR-P) has been extensively studied and the clinical high-risk for bipolar disorder (CHR-BD) has gained increasing attention, overlapping symptoms—such as mood instability and subclinical psychotic features—complicate diagnostic boundaries. We aimed to investigate the psychopathological characteristics of high-risk individuals to address the feasibility of early-stage diagnostic differentiation. We hypothesized that CHR-P and CHR-BD could co-occur and that symptom structure would differ depending on overlap status.

Methods

We recruited 231 participants without formal psychiatric diagnoses from a prospective cohort established at the psychiatry clinic of Seoul National University Hospital. We identified CHR-P and CHR-BD using the Structured Interview for Psychosis-Risk Syndromes (SIPS) and the Bipolar Prodrome Symptom Interview and Scale (BPSS), respectively. Participants were classified into CHR-P-only, CHR-BD-only, and CHR-P/BD-overlap groups. Participants were then evaluated across multiple psychopathological domains, including delusional ideation, obsessive-compulsive symptoms, perceptual abnormalities, depressive and manic symptoms, and global clinical severity. Symptom severity, inter-domain correlations, and symptom network structures were analyzed and compared across groups.

Results

The overlap was substantial: among 158 individuals meeting CHR-P criteria, 106 (67.1%) also met CHR-BD criteria, and among 179 individuals meeting CHR-BD criteria, 106 (59.2%) also met CHR-P criteria. The subgroup distribution was 52 CHR-P-only, 73 CHR-BD-only, and 106 CHR-P/BD-overlap. Symptom structures differed by overlap status. CHR-P-only showed significantly greater social withdrawal compared to other groups. CHR-P/BD-overlap had more severe mood, delusional, obsessive-compulsive, and hallucinatory symptoms. Correlation analysis showed weaker interconnections among symptom domains in CHR-P-only. Network analysis revealed four fragmented communities in CHR-P-only, two tightly integrated communities in CHR-BD-only, and partial integration across three communities in CHR-P/BD-overlap. Central symptoms varied: paranoia in CHR-P-only; mood symptoms and obsessive thoughts in CHR-BD-only; mood symptoms and perceptual abnormalities with religious themes in CHR-P/BD-overlap.

Conclusions

High-risk states for psychosis and bipolar disorder frequently co-occur, suggesting that early psychopathology extends beyond the prodrome of any single disorder. Distinct patterns of symptom networks across high-risk subgroups underscore the value of dimensional and spectrum-based approaches to early psychopathology.