Background: Negative symptoms (NS) appear early in subjects at ultra-high risk (UHR) for psychosis and may increase the risk of conversion to psychotic disorders and poor outcome. Contrary to schizophrenia, there is no consensus on the conceptualization and factor structure of NS in UHR subjects. This study aims to explore NS prevalence, factor structure, and impact on the outcome of UHR state in children and adolescents. Methods: 71 UHR were recruited at the Neuropsychiatry Unit of the Hospital Bambino Gesù in Rome. We examined the prevalence of NS of at least moderate severity, the factor structure of NS by Principal Component Analysis (PCA) and Confirmatory Factor Analysis (CFA), and correlations between extracted factors and functioning. We also evaluated the severity of baseline NS in subjects who converted to psychosis (converters) and in those who did not convert (nonconverters) at 1-year follow-up. Results: At baseline, all participants showed at least one NS of at least moderate severity. PCA and CFA yielded a two-factor solution: An ''Expressive"and an "Experiential"factor. Only the Experiential factor was associated with functioning. At baseline, severity of NS did not differ between converters (N = 16) and nonconverters (N = 55). Conclusions: In UHR children and adolescents NS have a high prevalence, a significant impact on functioning, and cluster in two-factors. Replications by independent studies, with state-of-The-Art instruments and longer duration of follow-up, are needed to improve the characterization of NS in this population, clarify their impact on the outcome and enhance their early identification, prevention, and treatment.
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