Aggressive urges in schizotypy: Preliminary data from an ambulatory study

Predicting self-injurious thoughts in daily life using ambulatory assessment of state cognition

Self-injurious thoughts (SITs) fluctuate considerably from moment to moment. As such, "static" and temporally stable predictors (e.g., demographic variables, prior history) are suboptimal in predicting imminent SITs. This concern is particularly true for "online" cognitive abilities, which are important for understanding SITs, but are typically measured using tests selected for temporal stability. Advances in ambulatory assessments (i.e., real-time assessment in a naturalistic environment) allow for measuring cognition with improved temporal resolution. The present study measured relationships between "state" cognitive performance, measured using an ambulatory-based Trail Making Test, and SITs. Self-reported state hope and social connectedness was also measured. Data were collected using a specially designed mobile application (administered 4x/week up to 28 days) in substance use inpatients (N = 99). Consistent with prior literature, state hope and social connectedness was significantly associated with state SITs. Importantly, poorer state cognitive performance also significantly predicted state SITs, independent of hallmark static and state self-report risk variables. These findings highlight the potential importance of "online" cognition to predict SITs. Ambulatory recording reflects an efficient, sensitive, and ecological valid methodology for evaluating subjective and objectives predictors of imminent SITs.

Validating Biobehavioral Technologies for Use in Clinical Psychiatry

The last decade has witnessed the development of sophisticated biobehavioral and genetic, ambulatory, and other measures that promise unprecedented insight into psychiatric disorders. As yet, clinical sciences have struggled with implementing these objective measures and they have yet to move beyond "proof of concept." In part, this struggle reflects a traditional, and conceptually flawed, application of traditional psychometrics (i.e., reliability and validity) for evaluating them. This paper focuses on "resolution," concerning the degree to which changes in a signal can be detected and quantified, which is central to measurement evaluation in informatics, engineering, computational and biomedical sciences. We define and discuss resolution in terms of traditional reliability and validity evaluation for psychiatric measures, then highlight its importance in a study using acoustic features to predict self-injurious thoughts/behaviors (SITB). This study involved tracking natural language and self-reported symptoms in 124 psychiatric patients: (a) over 5-14 recording sessions, collected using a smart phone application, and (b) during a clinical interview. Importantly, the scope of these measures varied as a function of time (minutes, weeks) and spatial setting (i.e., smart phone vs. interview). Regarding reliability, acoustic features were temporally unstable until we specified the level of temporal/spatial resolution. Regarding validity, accuracy based on machine learning of acoustic features predicting SITB varied as a function of resolution. High accuracy was achieved (i.e., ~87%), but only when the acoustic and SITB measures were "temporally-matched" in resolution was the model generalizable to new data. Unlocking the potential of biobehavioral technologies for clinical psychiatry will require careful consideration of resolution.

Frontal alpha asymmetry in schizotypy: electrophysiological evidence for motivational dysfunction

Introduction: Schizotypy is defined as personality traits reflecting an underlying risk for schizophrenia-spectrum disorders. As yet, there is a dearth of suitable objective markers for measuring schizotypy. Frontal alpha asymmetry, characterised by reduced left versus right frontal region activity, reflects trait-like diminished approach-related systems and has been found in schizophrenia. Methods: The present study used electroencephalography (EEG) recorded on a consumer-grade mobile headset to examine asymmetric resting-state frontal alpha, beta, and gamma power within the multidimensional schizotypy (e.g. positive, negative, disorganised) during a three-minute "eyes closed" resting period in college undergraduates (n=49). Results: Findings suggest that schizotypy was exclusively related to reduced left versus right-lateralised power in the alpha frequency (8.1-12.9 Hz., R²= .16). Follow-up analysis suggested that positive schizotypy was uniquely associated with increased right alpha activity, indicating increased withdrawal motivation. Conclusions: Frontal asymmetry is a possible ecologically valid objective marker for schizotypy that may be detectable using easily accessible, consumer-grade technology.

The path from schizotypy to depression and aggression and the role of family stress

Background.

Schizotypy is a multidimensional construct that is linked to the vulnerability for psychosis. Positive schizotypy includes having paranormal beliefs. Negative schizotypy includes social anhedonia. Disorganized schizotypy includes social anxiety and communication disorder. Schizotypy relates to depression and aggression. Family stress from high expressed emotion (EE; a rating of criticism, hostility, and emotional overinvolvement in a close relative toward a person showing signs of mental disorder) may mediate the link between schizotypy, depression and aggression. This study tested, using path analyses, the hypotheses that schizotypy predicts depression and aggression through high perceived EE as criticism and irritability (hypothesis 1) and praise and intrusiveness in a close relative (hypothesis 2).

Methods.

One hundred and four healthy participants listened to and rated the self-relevance of standard criticism and standard praise that denote EE. Participants rated their level of schizotypy, depression, aggression, and perceived EE in self-report questionnaires. Two path models tested the hypotheses.

Results.

Disorganized schizotypy, more than positive schizotypy, predicted the path to depression and aggression when perceived criticism and perceived EE-irritability were mediators. Disorganised schizotypy, more than negative schizotypy, predicted the path to depression and aggression when perceived praise and perceived EE-intrusiveness were mediators.

Conclusions.

Greater perceived criticism and less perceived praise in family communication explain the path from disorganized schizotypy (more so than positive or negative schizotypy) to depression and aggression. These findings indicate a need to consider the thought disorder-EE link as a potential contributor to depression and aggression in people with schizophrenia.

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.