Rinaldi, Giulia (2025). A dimensional outlook on clinical high-risk of psychosis. Reframing community data on CHR-P and its transdiagnostic correlates. (Thesis). Universität Bern, Bern
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Abstract
The clinical high-risk for psychosis (CHR-P) paradigm is an internationally established approach to psychosis prevention and early intervention, developed to address the major public health challenge posed by the severe personal, social, and economic impact of psychosis. Over the last few decades, both clinical and epidemiological research have provided consistent evidence of the psychological and social burden of CHR-P, supporting its association with a highly increased risk of psychosis, general psychopathology, and functional impairment, while identifying concurrent risk factors and etiological mechanisms. In light of the clinical significance of CHR-P, diagnostic and intervention guidelines were developed and specialized programs emerged, showing efficacy in improving general outcomes and delaying psychosis onset. However, CHR-P research faces persistent challenges, including high heterogeneity in symptom presentation and long-term outcomes, declining conversion rates to full-blown psychosis, and a high prevalence of comorbidities. Consequently, it has been proposed that the CHR-P conceptualization be extended beyond its role in psychosis prediction, embracing a broader, more transdiagnostic framing, which has sparked debate in the field. This can be further contextualized within a general shift toward dimensional models in psychopathology, as reflected in recent updates to diagnostic classifications of psychotic and personality disorders in the DSM-5 and ICD-11. The present thesis illustrates the advantages of a dimensional conceptualization of psychosis, spanning the general population, CHR-P and the full psychosis continuum. Specifically, it explores how integrating CHR-P into the transdiagnostic and dimensional Hierarchical Taxonomy of Psychopathology (HiTOP) may not only address key challenges within the CHR-P paradigm – facilitating phenotyping, risk stratification and consideration of transdiagnostic outcomes – while maintaining a focus on psychosis specificity, but also enrich HiTOP itself by incorporating a stronger developmental and cognitive dimension. To illustrate this, the present work discusses the findings from three publications on CHR-P which, while not originally framed within HiTOP, share its transdiagnostic perspective, lending themselves to a conceptual integration into the model. The three publications are largely based on data from two longitudinal community studies, complemented in one case by clinical data from a specialized early detection service. Specifically, they explore CHR-P symptom trajectories (Publication 1), the interactions of core beliefs and coping strategies with CHR-P symptoms and broader mental health quality (Publication 2), and the associations between personality functioning, cognitive biases, and (non-)perceptive CHR-P symptoms (Publication 3), respectively. Their contextualization within HiTOP informs the proposal of a hypothetical extension to the current HiTOP model, synthesizing and speculatively integrating their findings into its structure while highlighting open questions and future directions for empirical testing. By illustrating the reciprocal benefits of integrating the HiTOP and CHR-P paradigms, this work offers a framework for future efforts to extend the CHR-P conceptualization in alignment with its dimensional, transdiagnostic value, bridging the gap between psychosis risk research and broader psychopathology.
| Item Type: | Thesis |
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| Dissertation Type: | Cumulative |
| Date of Defense: | 2 July 2025 |
| Subjects: | 600 Technology > 610 Medicine & health |
| Institute / Center: | 07 Faculty of Human Sciences |
| Depositing User: | Hammer Igor |
| Date Deposited: | 22 Sep 2025 14:59 |
| Last Modified: | 23 Sep 2025 17:31 |
| URI: | https://boristheses.unibe.ch/id/eprint/6731 |
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