Original article Perceived negative attitude of others as an early sign of psychosis Raimo K.R. Salokangas a,b,c, * , Markus Heinimaa a , Tanja Svirskis a,c , Tiina Laine a , Jukka Huttunen a , Terja Ristkari a , Tuula Ilonen a , Jyrki Korkeila a,c , Leena Vaskelainen a , Jaakko Rekola a , Jarmo Hietala a,c , Joachim Klosterko ¨tter d , Stephan Ruhrmann d , Heinrich Graf von Reventlow d,e , Don Linszen f , Peter Dingemans f , Max Birchwood g , Paul Patterson g The EPOS Group a Department of Psychiatry, University of Turku, Turku, Finland b Psychiatric Clinic, Turku University Central Hospital, Turku, Finland c Turku Psychiatric Clinic, Turku Mental Health Centre, Turku, Finland d Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany e LWL-Universitaetsklinik Bochum, Ruhr-Universita ¨t Bochum, Bochum, Germany f Acadmic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands g Early Intervention Service, University of Birmingham, Birmingham, UK Received 26 August 2008; received in revised form 22 December 2008; accepted 30 December 2008 Available online 6 February 2009 Abstract Aim. e Risk of psychosis is defined by the presence of positive psychotic-like symptoms, by subtle self-perceived cognitive and perceptual deficiencies, or by decreased functioning with familial risk of psychosis. We studied the associations of psychiatric outpatients’ self-reported functioning and interpersonal relationships with vulnerability to and risk of psychosis. Methods. e A total of 790 young patients attending psychiatric outpatient care completed the PROD screen [Heinimaa M, Salokangas RKR, Ristkari T, Plathin M, Huttunen J, Ilonen T, et al. PROD-screen e a screen for prodromal symptoms of psychosis. Int J Meth Psychiatr Res 2003;12:92e04.], including questions on functioning, interpersonal relationships and subtle specific (psychotic-like) and non-specific symptoms. Vulnerability to psychosis was assessed employing the patient’s written descriptions of specific symptoms. Of the patients vulnerable to psychosis, those at current risk of psychosis were assessed using the Bonn Scale for Assessment of Basic Symptoms [Schultze-Lutter F, Klosterko ¨tter J. Bonn scale for assessment of basic symptoms e prediction list, BSABS-P. Cologne: University of Cologne; 2002] and the Structured Interview for Positive symptoms [Miller TJ, McGlashan TH, Rosen JL, Somjee L, Markovich PJ, Stein K, et al. Prospective diagnosis of the initial prodrome for schizophrenia based on the structured interview for prodromal syndromes: preliminary evidence of interrater reli- ability and predictive validity. Am J Psychiatry 2002;159:863e65.]. Results. e In all, 219 patients vulnerable to and 55 patients at current risk of psychosis were identified. Vulnerability to psychosis was associated with all items of functioning and interpersonal relationships. Current risk of psychosis, however, was associated only with the subjectively reported negative attitude of others. Negative attitude of others was also associated with feelings of reference at both vulnerability and risk levels. Conclusion. e The subjective experience of negative attitude of others towards oneself may be an early indicator of psychotic development. Ó 2009 Elsevier Masson SAS. All rights reserved. Keywords: Vulnerability to psychosis; Current risk of psychosis; Attitude of others; Psychoticism * Correspondence to: Department of Psychiatry, University of Turku, Kiinamyllynkatu 4-8, FIN-20520 Turku, Finland. Tel.: þ358 2 3131 740; fax: þ358 2 3132 730. E-mail address: raimo.k.r.salokangas@tyks.fi (R.K.R. Salokangas). 0924-9338/$ - see front matter Ó 2009 Elsevier Masson SAS. All rights reserved. doi:10.1016/j.eurpsy.2008.12.011 Available online at www.sciencedirect.com European Psychiatry 24 (2009) 233e238