Background and Hypothesis The Structured Interview for Psychosis-Risk Syndromes (SIPS) and other assessments of psychosis risk define clinical high risk for psychosis (CHR) by the presence of attenuated psychotic symptoms. Despite extensive research on attenuated psychotic symptoms, substantial questions remain about their internal psychometric structure and relationships to comorbid non-psychotic symptoms. Study Design Hierarchical and bifactor models were developed for the SIPS in a large CHR sample (NAPLS-3, N = 787) and confirmed through preregistered replication in an independent sample (NAPLS-2, N = 1043). Criterion validity was tested through relationships with CHR status, comorbid symptoms/diagnoses, functional impairment, demographics, neurocognition, and conversion to psychotic disorders. Study Results Most variance in SIPS items (75%–77%) was attributable to a general factor. Hierarchical and bifactor models included a general factor and five specific/lower-order factors (positive symptoms, eccentricity, avolition, lack of emotion, and deteriorated thought process). CHR participants were elevated on the general factor and the positive symptoms factor. The general factor was associated with depressive symptoms; functional impairment; and mood, anxiety, and schizotypal personality diagnoses. The general factor was the best predictor of psychotic disorders (d ≥ 0.50). Positive symptoms and eccentricity had specific effects on conversion outcomes. The deteriorated thought process was least meaningful/replicable. Conclusions Attenuated psychotic symptoms, measured by the SIPS, have a complex hierarchical structure with a strong general factor. The general factor relates to internalizing symptoms and functional impairment, emphasizing the roles of general psychopathological distress/impairment in psychosis risk. Shared symptom variance complicates the interpretation of raw symptom scores. Broad transdiagnostic assessment is warranted to model psychosis risk accurately.

中文翻译：

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减轻精神病症状的复杂潜在结构：在临床精神病高风险的两个大样本中复制 SIPS 症状的分层和双因素模型


背景和假设精神病风险综合征的结构化访谈（SIPS）和其他精神病风险评估通过减轻精神病症状的存在来定义精神病的临床高风险（CHR）。尽管对减轻精神病症状进行了广泛的研究，但关于其内部心理测量结构以及与共病非精神病症状的关系仍然存在实质性问题。研究设计 在大型 CHR 样本（NAPLS-3，N = 787）中为 SIPS 开发了分层和双因子模型，并通过独立样本（NAPLS-2，N = 1043）中的预注册复制进行了确认。通过与 CHR 状态、共病症状/诊断、功能障碍、人口统计学、神经认知和转化为精神障碍的关系来测试标准有效性。研究结果 SIPS 项目中的大部分差异 (75%–77%) 可归因于一般因素。分层和双因素模型包括一个一般因素和五个特定/低阶因素（阳性症状、怪癖、意志力、缺乏情感和恶化的思维过程）。 CHR 参与者的一般因素和阳性症状因素均有所提高。一般因素与抑郁症状有关；功能障碍；以及情绪、焦虑和精神分裂型人格诊断。一般因素是精神障碍的最佳预测因子（d ≥ 0.50）。阳性症状和怪癖对转化结果有特定的影响。恶化的思维过程最没有意义/最不可复制。结论 通过 SIPS 测量的减轻精神病症状具有复杂的层次结构，具有很强的一般因素。 一般因素与内化症状和功能障碍有关，强调一般精神病理痛苦/损伤在精神病风险中的作用。共同的症状方差使原始症状评分的解释变得复杂。需要进行广泛的跨诊断评估来准确地模拟精神病风险。