Across medicine there has been a concerted focus on early identification of disorders where rapid intervention can favorably impact disease course. In recent years, a similar approach has been applied to schizophrenia with studies of adolescents and young adults who present with attenuated psychotic symptoms and might be at the prodromal phase of illness (Yung et al., 2003; Cannon et al., 2008; Ruhrmann et al., 2010). While the possible inclusion of Attenuated Psychosis Syndrome in DSM-5 has been debated (Carpenter and van Os, 2011) it is noteworthy that the emphasis is on positive psychotic symptoms of delusions, hallucinations and disorganized speech. Yet, anxiety and depression are common features in the prodrome and the emergence of negative symptoms is, at times, misconstrued as depression (Rosen et al., 2006; Wigman et al., 2011). Not only are lack of social engagement and diminished expressivity early warning signs, but they are part of the emerging illness that may precede the onset of attenuated psychotic symptoms and portend poor outcome (Hafner et al., 2003; Marchesi et al., 2015).
