16-Item Prodromal Questionnaire

The 16-Item Prodromal Questionnaire (PQ-16) is a validated, brief self-report measure developed to identify individuals who may be at an ultra-high risk…

Questions: 16
Duration: 5 min
Original title: PQ-16 — Prodromal Questionnaire
Adaptation: 16-Item Prodromal Questionnaire
Authors: Ising, H. K., Veling, W., Loewy, R. L., Rietveld, M. W., Rietdijk, J., Dragt, S., Klaassen, R. M. C., Nieman, D. H., Wunderink, L., Linszen, D. H., & van der Gaag, M.
Created: 2012

The 16-Item Prodromal Questionnaire (PQ-16) is a validated, brief self-report measure developed to identify individuals who may be at an ultra-high risk (UHR) for developing psychosis. Distilling the core components of the longer 92-item version, this clinical tool efficiently probes the attenuated positive and negative symptoms that frequently characterize the psychosis prodrome.

Designed for use in general help-seeking populations, the PQ-16 allows clinicians to detect early signs of perceptual anomalies and unusual thought content before they crystallize into a full clinical syndrome. Because early detection is critical to improving long-term outcomes and managing everyday 'unusual' experiences, this repeatable measure serves as a valuable first-step screening mechanism. It helps providers open grounded clinical conversations (using tools like a psychosis worksheet) and determine who would benefit from a more comprehensive diagnostic interview.

Example result

Fictitious result, computed from a sample set of answers.

Overall score

12/ 16

The PQ-16 is a brief self-report screening questionnaire for attenuated psychotic-like experiences (perceptual abnormalities, unusual thought content, negative symptoms) intended for adolescents and young adults seeking mental health care. It aims to identify at an early stage individuals with an at-risk mental state (Ultra High Risk / CHR) or emerging psychosis, in order to refer them for standardized clinical assessment (e.g., CAARMS) and early intervention. It comprises 16 True/False items; each item endorsed as "True" is then rated on a distress scale from 0 to 3.

0–5

Below screening threshold

6–16

Positive screening for psychosis risk

Referral threshold for a structured diagnostic interview in a help-seeking adult population.

For information

Cut-off≥ 6Positive screening for a risk of psychosis

Referral threshold for a structured diagnostic interview in a help-seeking adult population.

Ising et al. (2012)View the study ↗

Cut-off≥ 7Positive screening in adolescents

Threshold retained for 12–17-year-olds consulting in child and adolescent psychiatry, where attenuated psychotic experiences are more frequent.

de Jong et al. (2020)View the study ↗

Scoring

Sum of endorsed items (symptom score 0–16) and sum of distress scores (0–48), total score from 0 to 16, each item is rated on a 5-point scale (from 0 to 4).

Negative symptoms

1/ 2

Negative symptoms, namely social withdrawal and loss of initiative.

items 1, 7

Perceptual abnormalities / hallucinations

7/ 9

Perceptual abnormalities and hallucinatory experiences.

items 2, 3, 4, 6, 8, 9, 12, 13, 16

Unusual thought content / delusions / paranoia

4/ 5

Unusual thought content, delusional ideas, and paranoia.

items 5, 10, 11, 14, 15

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What the test measures

The PQ-16 assesses the presence and distressing nature of early attenuated psychotic experiences. It captures three core clinical dimensions:

Perceptual abnormalities and hallucinations: Anomalous sensory experiences, such as hearing unusual sounds, seeing things others cannot see, or feeling disconnected from reality in ways akin to depersonalization-derealization.
Unusual thought content and paranoia: Emerging delusional ideas, perplexity about reality, feeling out of control of one's own mind, and suspiciousness toward others.
Negative symptoms: Early signs of avolition, social withdrawal, and extreme social anxiety, which can sometimes masquerade as an underlying depression.

This measure is specifically designed for adolescents and adults seeking mental health support, to identify those experiencing prodromal psychological changes.

When and why to use it

Clinicians typically use the PQ-16 as an initial screening step to gauge the need for specialized early intervention or deeper assessment.

Initial intake and screening: To systematically check for attenuated psychotic symptoms in patients presenting with general distress, mood, or anxiety concerns.
Differential support: To clarify whether vague or unusual complaints might stem from a prodromal psychotic process rather than underlying personality disorders or severe generalized anxiety disorder.
Monitoring change: To track the evolution of symptoms and the subjective distress they cause, particularly during periods of increased stress or developmental transition.
Threshold for referral: To confidently decide when a patient requires a comprehensive, structured clinical interview to assess clinical high-risk states.

A validated score provides a standardized metric to support clinical judgment, distinguishing transient or benign phenomena from a clinically significant high-risk state that warrants further investigation.

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The questions

The following questions ask about unusual experiences or sensations that some people may have had. Please indicate whether each statement is True or False for you. If you answer "True", then specify how much distress or worry you experienced (None / Mild / Moderate / Severe).
1. I feel indifferent to things I usually enjoy.
Probes avolition and the loss of baseline interest in previously rewarding activities.
- False
- True — no distress
- True — mild distress
- True — moderate distress
- True — severe distress
2. I often feel like I'm experiencing events exactly as they've happened before (déjà vu).
Inquires about frequent, intense feelings of familiarity or timeline distortions.
- False
- True — no distress
- True — mild distress
- True — moderate distress
- True — severe distress
3. I sometimes smell or taste things that others can't.
Assesses the presence of olfactory or gustatory anomalies not shared by others.
- False
- True — no distress
- True — mild distress
- True — moderate distress
- True — severe distress
4. I often hear unusual sounds like taps, clicks, hisses, bangs, or ringing in my ears.
Screens for elementary auditory hallucinations and unshared acoustic perceptions.
- False
- True — no distress
- True — mild distress
- True — moderate distress
- True — severe distress
5. I sometimes get confused because I don't know if an experience was real or imaginary.
Examines reality testing and perplexity regarding the boundary between internal and external events.
- False
- True — no distress
- True — mild distress
- True — moderate distress
- True — severe distress
6. When I look at someone or at myself in the mirror, I've seen that face change right before my eyes.
Checks for visual distortions and perceptual instability involving faces.
- False
- True — no distress
- True — mild distress
- True — moderate distress
- True — severe distress
7. I feel very anxious when I meet people for the first time.
Captures intense, potentially paranoid or overwhelming social anxiety during new encounters.
- False
- True — no distress
- True — mild distress
- True — moderate distress
- True — severe distress
8. I have seen things that other people apparently can't see.
Probes for clear visual hallucinations or anomalous visual experiences.
- False
- True — no distress
- True — mild distress
- True — moderate distress
- True — severe distress
9. My thoughts are sometimes so loud that I can almost hear them.
Evaluates the presence of thought echoing or extremely loud internal mental activity.
- False
- True — no distress
- True — mild distress
- True — moderate distress
- True — severe distress
10. I sometimes see special meanings in advertisements, shop windows, or in the way things are arranged around me.
Inquires about ideas of reference and the tendency to extract hidden messages from the environment.
- False
- True — no distress
- True — mild distress
- True — moderate distress
- True — severe distress
11. Sometimes I have felt that I don't have control over my own ideas or thoughts.
Assesses thought insertion, withdrawal, or the feeling of losing agency over one's own mind.
- False
- True — no distress
- True — mild distress
- True — moderate distress
- True — severe distress
12. Sometimes I suddenly feel distracted by distant sounds that I'm not usually aware of.
Screens for hyperacusis or anomalous attention drawn to irrelevant background noise.
- False
- True — no distress
- True — mild distress
- True — moderate distress
- True — severe distress
13. I have heard things that others can't hear, like people's voices whispering or talking.
Directly questions the presence of complex auditory hallucinations, such as voices.
- False
- True — no distress
- True — mild distress
- True — moderate distress
- True — severe distress
14. I often feel that others are against me.
Captures persecutory ideation and generalized paranoia.
- False
- True — no distress
- True — mild distress
- True — moderate distress
- True — severe distress
15. I have had the feeling that people or forces are surrounding me, even though I can't see anyone.
Probes for the phenomenon of felt presence or invisible external forces.
- False
- True — no distress
- True — mild distress
- True — moderate distress
- True — severe distress
16. I feel like parts of my body have changed in some way or that some parts of my body are working differently than before.
Investigates somatic anomalies, physical distortions, or odd sensory experiences involving the body.
- False
- True — no distress
- True — mild distress
- True — moderate distress
- True — severe distress