Typology of schizotypy in non-clinical young adults: Psychopathological and personality disorder traits correlates

A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the USA from 2016 to 2019

In 2017, a National Academies of Sciences, Engineering, and Medicine (NASEM) report comprehensively evaluated the body of evidence regarding cannabis health effects through the year 2016. The objectives of this study are to identify and map the most recently (2016-2019) published literature across approved conditions for medical cannabis and to evaluate the quality of identified recent systematic reviews, published following the NASEM report. Following the literature search from 5 databases and consultation with experts, 11 conditions were identified for evidence compilation and evaluation: amyotrophic lateral sclerosis, autism, cancer, chronic noncancer pain, Crohn's disease, epilepsy, glaucoma, human immunodeficiency virus/AIDS, multiple sclerosis (MS), Parkinson's disease, and posttraumatic stress disorder. A total of 198 studies were included after screening for condition-specific relevance and after imposing the following exclusion criteria: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome definition, intervention definition, sample size, study setting, and reported effect size. Few completed randomized controlled trials (RCTs) were identified. Studies classified as systematic reviews were graded using the Assessing the Methodological Quality of Systematic Reviews-2 tool to evaluate the quality of evidence. Few high-quality systematic reviews were available for most conditions, with the exceptions of MS (9 of 9 graded moderate/high quality; evidence for 2/9 indicating cannabis improved outcomes; evidence for 7/9 indicating cannabis inconclusive), epilepsy (3 of 4 graded moderate/high quality; 3 indicating cannabis improved outcomes; 1 indicating cannabis inconclusive), and chronic noncancer pain (12 of 13 graded moderate/high quality; evidence for 7/13 indicating cannabis improved outcomes; evidence from 6/7 indicating cannabis inconclusive). Among RCTs, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic noncancer pain). The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions, and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.

Borderline and schizotypal traits in college students: Relationship and personality profiles

The relationships between borderline and schizotypal traits are still debated. Borderline traits, schizotypal traits, and several psychopathological symptoms were assessed among 2,341 college students. A factor analysis was performed on borderline and schizotypal personality measures, leading to 10 factors. Borderline factors were largely intercorrelated, as were schizotypal factors. Moreover, borderline factors were weakly to largely correlated to schizotypal factors. Five factors were very strongly correlated (r > .50). Dissociation was strongly related to Odd Beliefs/Unusual Perceptive Experiences and Anxious-Depressive factors. Social Anxiety was strongly related to Suspiciousness. Based on these 10 factors, a cluster analysis was conducted, and resulted in four clearly distinct groups: a Low Traits cluster, a Narcissistic cluster, a Social Anxiety cluster, and a High Traits cluster. This High Traits cluster had the lowest levels of academic achievement and the highest levels of internalizing behaviors and externalizing behaviors. The clinical implications of the results are discussed.

Cognitive Gain or Handicap: Magical Ideation and Self-Absorption in Clinical and Non-clinical Participants

Background: This study aimed to examine magical ideation and absorption traits across non-clinical and clinical groups to determine their potential adaptive and maladaptive functions.

Method: We enrolled 760 healthy participants from neighboring communities (female = 53.2%). Moreover, we recruited 318 patients (female = 66.5%), which included 25, 183, and 110 patients with schizophrenia spectrum disorders, anxiety disorders, and mood disorders, respectively. Potentially adaptive and maladaptive sociocognitive functions were measured to determine the role of magical ideation and self-absorption in patients with psychiatric disorders.

Results: The degree of magical ideation and absorption gradually increased in the following order: anxiety disorders, mood disorders, and schizophrenia spectrum disorders. Furthermore, enhanced self-absorption-related enhanced consciousness traits were essential indicators of the presence of self-integration weakness in patients with schizophrenia spectrum disorders.

Conclusion: Magical ideation and psychological absorption may be considered as mental model construction functions, which result in both gains and handicaps in social adaptation.

Exploring the Relationship Between Schizotypal Traits and Dispositional Mindfulness From a Network Perspective

Schizotypy has been associated with impairment in social cognition (e.g., emotional processing, social perception, Theory of Mind). To our knowledge, no study has investigated these processes in terms of dispositional mindfulness. This study aimed to use network theory to explore the relationship between dispositional mindfulness dimensions and schizotypal traits. Participants were 1572 college students who completed the Five Facet Mindfulness Questionnaire-Short Form (FFMQ-SF) and the Schizotypal Personality Questionnaire-Brief (SPQ-B). We first estimated a Gaussian Graphical Model including the FFMQ-SF and the SPQ-B dimensions. We then computed centrality indices and predictability, and we finally conducted a bootstrapping procedure to assess the accuracy of edge weights and the stability of the centrality indices. Describing was strongly and negatively related to interpersonal schizotypy. Acting with awareness and nonjudgment shared negative edges with interpersonal schizotypy. These results provide potential keys to understand alexithymia, decreased sense of self-agency, and emotion regulation in schizotypy.

Associations between schizotypal traits and antisocial behaviours in a sub-Saharan sample

Schizophrenic symptoms have often been associated with antisocial behaviours (ASBs). Most studies have focused on violence. The association between schizophrenia and violence is often confounded by socio demographic characteristics of patients. Overemphasis on diagnosis, rather than traits, and the traditional focus on violence may have obscured associations between psychotic features and antisocial behaviour. In this study, an analogue sample (n = 604, females = 54.4%, mean age = 21.46, SD = 5.89) completed self-report measures of schizotypy and antisocial behaviours. The aim was to identify the strength of associations between different schizotypal traits/symptoms (unusual experiences, cognitive disorganisation, impulsivity & introvertive anhedonia) and different forms of antisocial behaviour (rule breaking, physical aggression & social aggression). Differential patterns of association between genders were also considered. Traits akin to positive symptoms were more strongly associated with antisocial behaviours. Impulsive non-conformity was associated with rule breaking, physical aggression and social aggression for both males and females whilst unusual experiences traits were associated with physical and social aggression in both males and females but had only a weak (gender-nonspecific) association with rule breaking. Finally, cognitive disorganisation was not associated with any class of ASB for males but was associated with physical and social aggression in females. These specific associations could inform the development of more targeted treatment approaches for specific types of ASBs in males and females.

The importance of loneliness in psychotic-like symptoms: Data from three studies

Poor social connection or loneliness is a prominent feature of schizotypy and may exacerbate psychosis risk. Previous studies have examined the inter-relationships between loneliness and psychosis risk, but critically, they have largely been conducted in non-clinical samples or exclusively used laboratory questionnaires with limited consideration of the heterogeneity within schizotypy (i.e., positive, negative, disorganized factors). The present study examined links between loneliness and psychotic-like symptoms across the dimensions of schizotypy through cross-sectional, laboratory-based questionnaires (Study 1; N = 160), ambulatory assessment (Study 2; N = 118) in undergraduates, and ambulatory assessment in inpatients in a substance abuse treatment program (Study 3; N = 48). Trait positive schizotypy consistently predicted cross-sectional and state psychotic-like symptoms. Loneliness, assessed via cross-sectional and ambulatory means, was largely linked with psychotic-like symptoms. Importantly, psychotic-like symptoms were dynamic: psychotic-like symptoms largely increased with loneliness in individuals with elevated positive and disorganized schizotypal traits, though there were some inconsistency related to disorganized schizotypy and state psychotic-like symptoms. Negative schizotypy and loneliness did not significantly interact to predict psychotic-like symptoms, suggesting specificity to positive schizotypy. Ambulatory approaches provide the opportunity for ecologically valid identification of risk states across psychopathology, thus informing early intervention.

Revisiting the overlap between autistic and schizotypal traits in the non-clinical population using meta-analysis and network analysis

The present study aimed to explore the relationship between autistic and schizotypal traits in the non-clinical population. We first conducted a meta-analysis to quantify the correlation between self-reported autistic traits and the three dimensions of schizotypal traits (positive, negative and disorganization). The strongest correlation was found between autistic traits and negative schizotypal traits (r = 0.536, 95% CI [0.481, 0.586]), followed by the disorganization (r = 0.355, 95% CI [0.304, 0.404]) and positive (r = 0.256, 95% CI [0.208, 0.302]) dimensions. To visualize the partial correlations between dimensional behavioural traits, we constructed a network model based on a large sample of college students (N = 2469). Negative schizotypal traits were strongly correlated with autistic social/communicative deficits, whereas positive schizotypal traits were inversely correlated with autistic-like traits, lending support to the psychosis-autism diametrical model. Disentangling the overlapping and diametrical structure of autism and schizophrenia may help to elucidate the aetiology of these two neurodevelopmental disorders.

Personality disorder traits in young adults with subclinical obsessive-compulsive symptoms: Not just traits related to obsessive- compulsive personality

Research is scarce regarding personality disorder traits of individuals with subclinical obsessive-compulsive symptoms. Cluster analysis based on obsessional, schizotypal, and borderline personality and autism-spectrum features was conducted on the results for 118 students scoring above cutoff on the Obsessive Compulsive Inventory-Revised. This identified four groups: O, L, S, and A. One third of the sample was represented by individuals with obsessional traits (O), while another third was composed of individuals with low traits (L); the last two profiles corresponded to a cluster with autistic traits (A) and a group with schizotypal and borderline features (S), both clusters together comprising the remaining third. Significant differences were observed between groups, both on personality traits and on psychopathological symptoms. The S cluster displayed the highest scores of suicidality, depression, and obsessive-compulsive symptoms. This study identified meaningful profiles of personality disorder traits, distinct from obsessive-compulsive personality, in individuals with subclinical obsessive-compulsive symptoms.

Differential emotional abnormalities among schizotypy clusters

Schizotypy, a multidimensional personality organization that reflects liability to develop schizophrenia-spectrum disorders, has been associated with a number of emotional abnormalities. Yet, the exact nature of any emotional abnormalities in schizotypy is relatively unclear. Using an ethnically diverse nonclinical sample (N = 2637), the present study identified homogenous clusters of individuals based on positive and negative schizotypy dimensions and explored three interrelated domains of emotion traits closely tied to functional outcomes and quality of life: affective experience, emotional awareness, and meta-level emotions. Consistent with prior research, four schizotypy clusters were obtained: low ("nonschizotypic"), high positive, high negative, and mixed (high positive and high negative). Regarding emotion correlates of schizotypy clusters, the mixed cluster was found to be the most deviant on almost all emotion traits (e.g., heightened trait negative affect, diminished emotional clarity), suggesting that the effects of positive and negative schizotypy are additive. In addition, positive and negative schizotypy clusters were associated with differential abnormalities, with the negative cluster presenting a wider range of, and more severe, impairments compared to the low cluster (e.g., reduced trait positive affect and reduced attention to positive emotion). The current study highlights the heterogeneity in emotional traits among schizotypy dimensions and the importance of studying the mixed schizotypy in terms of emotional dysfunction.

Cognitive fusion and affective isolation: Blurred self-concept and empathy deficits in schizotypy

This is a cross-sectional nonclinical sample study to examine the different levels of the Ipsiety Disturbance Model (IDM) for schizophrenia spectrum disorders (introduced by Sass and Parnas, 2003). Three faces of schizotypy were studied: diminished self-presence, hyper-reflexivity, and distortion in experience of own self and another person's self-discrimination. A sample of college students (N = 1312) was provided a questionnaire packet that contained the Schizotypy Personality Questionnaire Brief-Revisited (SPQ-BR), the Self-Concept Clarity Sale, the Tellegen Absorption Scale, and Interpersonal Reactivity Index measures. Results: higher absorption capabilities predict higher scores on both the SPQ-BR cognitive and SPQ-BR disorganization factors. High scores in cognitive empathy predicted a low score on both SPQ-BR cognitive and SPQ-BR interpersonal scores. In contrast, higher affective empathy predicted high scores on the SPQ-BR interpersonal factor. The deficiency in self-concept clarity predicted an elevated score on the SPQ-BR cognitive, interpersonal, and disorganization schizotypy symptoms. We argue that a lack of self-concept clarity manifested in both the hyperreflexivity level (measured by absorption) and the metallization level (measured by empathy). We argue that the IDM is a reliable way to interpret functioning with different levels of schizotypy.

The association between schizotypal traits and social functioning in adolescents from the general population

Difficulties in social functioning have been linked to schizotypy, which may reflect vulnerability to psychotic disorders. We investigated these links in early adolescence, a developmental stage when many mental illnesses first emerge. Using the Strength and Difficulties Questionnaire and The Community Assessment of Psychic Experiences, we examined the association of peer-relationship problems and prosocial behavior with positive and negative schizotypy in a sample of 149 school children (70 girls, 79 boys) between 12 and 15 years old. The results showed that while increased positive schizotypy was significantly associated with increased peer-relationship problems, increased negative schizotypy was significantly associated with decreased prosocial behavior. These effects were observed after the potential effects of age, sex, general cognitive abilities, the ability to infer affective mental states, anxiety, and depression had been taken into account. These results suggest that different dimensions of schizotypy are associated with different aspects of social dysfunction in adolescents. Interventions aimed at improving social functioning in adolescence would benefit from considering these unique associations.

Could schizotypy protect against the negative outcomes of borderline traits on alcohol consumption? A cluster analytic study

Schizotypal and borderline personality traits seem to be differently associated to alcohol use in young adult. However, no study has explored co-occurring schizotypal and borderline traits in their link with alcohol consumption. Participants were 1572 students from different French universities who completed self-report questionnaires assessing these three dimensions. A cluster analysis based on the borderline and schizotypal traits scores yielded four distinct groups characterized by low schizotypal and borderline traits (LT), high borderline traits (HB), high schizotypal and borderline traits (HT) and high schizotypal traits (HS). The HS cluster had significantly lower alcohol use than the other three groups. LT and HT clusters did not differ significantly in their alcohol use. Comparison between clusters suggests that schizotypal traits may be protective against the negative impact of borderline traits on alcohol consumption. In the context of a co-occurrence between borderline and schizotypal traits, this study provides important information about their link with alcohol consumption.

The co-occurrence of autistic traits and borderline personality disorder traits is associated to increased suicidal ideation in nonclinical young adults

BACKGROUND

The co-occurrence of Autism Spectrum Disorder (ASD) and Borderline Personality Disorder (BPD) is not rare and has been linked to increased suicidality. Despite this significant comorbidity between ASD and BPD, no study had examined the co-occurrence of autistic traits and borderline personality disorder traits in the general population. The aim of the present study was to examine the co-occurrence of autistic and borderline traits in a non-clinical sample of young adults and its influence on the levels of suicidal ideation and depressive symptomatology.

PROCEDURES

Participants were 474 college students who completed self-report questionnaires. Data were analysed using correlation and cluster analyses.

MAIN FINDINGS

Borderline personality traits and autistic traits were weakly correlated. However, cluster analysis yielded four groups: a low traits group, a borderline traits group, an autistic traits group, and a group characterized by high levels of both traits. Cluster analysis revealed that autistic and borderline traits can co-occur in a significant proportion of young adults. The high autistic and borderline traits group constituted 17% of the total sample and had higher level of suicidal ideation than the borderline traits group, despite similar levels of depressive symptoms.

CONCLUSION

This result suggests that the higher suicidality observed in patients with comorbid ASD and BPD may extent to non-clinical individuals with high levels of co-occurrent autistic and borderline traits.

The relationship of categorical and phonological verbal fluency to negative schizotypy and social functioning in a non-clinical sample

INTRODUCTION

Research suggests that levels of schizotypy are related to cognitive and social functioning, with negative schizotypy being particularly related to deficits in verbal fluency (VF) and distinct social skills. Considering the possibility that different VF tasks may involve both shared and unique underlying processes, this study sought to examine the separate contributions of categorical and phonological forms of VF to social functioning in those with varying levels of negative schizotypy.

METHODS

Face-to-face interviews were conducted in which 228 college students completed VF tasks, the SPQ-BR, and a social functioning questionnaire.

RESULTS

Both phonological and categorical VF were inversely related to levels of negative schizotypy and inversely related to several social functioning domains. High and low levels of negative schizotypy groups were significantly different on elements of social engagement and interpersonal behaviour. In two instances, phonological VF appeared to moderate the relationships between negative schizotypy and specific elements of social functioning.

CONCLUSIONS

These findings support a general link between verbal processing and social functioning among those with greater negative schizotypy. Possible avenues of future research are discussed.