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Aim: We sought to explore the complex phenomenological overlap between obsessive and compulsive symptoms (OCS), and attenuated positive symptoms among 156 young people at clinical high‐risk (CHR) for psychosis. Methods: In order to explore the hypothesis that OCS of an implausible nature might optimally predict future transition to syndromal psychosis, ideas associated with obsessive and compulsive experiences elicited by clinical measures were thematically categorized as "plausible" or "implausible." Results: While OCS were found to be common in our CHR sample, we did not find that implausible OCS themes were predictive of conversion. Conclusion: Given the absence of qualitative differences between OCS and early psychotic symptoms, we propose that clinicians encountering adolescent or young adult patients with new‐onset OCD or OCS in the past year should monitor such symptoms for a minimum of 2 years to assess for the possible emergence of psychosis. [ABSTRACT FROM AUTHOR]

• Subthreshold positive symptoms begin in late childhood. • Positive symptoms emerge at a significantly younger age than negative symptoms. • There was no onset age difference between those who did and did not develop psychosis. Research in individuals at clinical high-risk (CHR) for psychosis has traditionally focused on the relationship between the severity of positive and negative symptoms and development of syndromal psychosis. In this study, we examined the temporal order of emergence of positive and negative symptoms in 116 CHR individuals who met criteria for the Attenuated Positive Symptom Syndrome defined in the Structured Interview for Psychosis-Risk Syndromes (SIPS). We found that positive symptoms emerged at a significantly younger age than negative symptoms with no significant differences between converters and non-converters. These findings may provide important information about the temporal phenomenology of CHR symptoms. [ABSTRACT FROM AUTHOR]