Schizotypy, social stress and the emergence of psychotic-like states - A case for benign schizotypy?

Developing and validating the Japanese version of the Referential Thinking Scale: A cross-sectional study

It has been shown that ideas of reference in the context of paranoia (IoR-P) and schizophrenia spectrum disorders (IoR-S) are caused by different psychological constructs. Although it is well known that both IoR-P and IoR-S are frequently evoked during the same period of life, how they interact with each other is unknown. The purpose of the present study was to develop the Japanese version of the Referential Thinking Scale (J-REF) to assess IoR-S, examine its validity and reliability, and explore the predictors of IoR-P and IoR-S. In this study, several subgroups of Japanese individuals in their 20s were included in the analysis. The J-REF had high internal consistency, high test-retest reliability, good convergent, and discriminant validity. Two hierarchical regression analyses showed that public self-consciousness predicted the manifestation of IoR-P, while the dimensions of schizotypy predicted that of IoR-S. Moreover, social anxiety and negative moods could cause IoR-P and IoR-S. This study directly showed the existence of two different types of ideas of reference in terms of their predictors. It is also significant in that it first examined referential thinking using the REF scale in the context of Asia and showed that there may not be much difference in the frequency of ideas of reference from other cultures. Future research directions are also discussed.

The moderating role of hair cortisol in the association of early and recent stress with stress-related phenotypes

Background

Increased hair cortisol concentrations (HCC) have been found in clinical samples of schizophrenia, first episode psychosis and clinical risk for psychosis, but evidence of such is scarce in schizotypy. High HCC are supposed to reflect elevated chronic stress. However, HCC were not directly associated with adversity measures and stress-related phenotypes in previous research. This study tested whether HCC moderated the association between a comprehensive range of psychosocial stressors with several stress-related phenotypes in a sample of nonclinical young adults. It was expected that stressors, either distal (i.e., early-life) or recent, would be associated with subclinical features, particularly for those with elevated HCC, reflecting the effects of a potential biological sensitization to stress.

Methods

The sample comprised 132 nonclinical young adults belonging to the Barcelona Longitudinal Investigation of Schizotypy Study (BLISS). Participants completed a questionnaire of childhood adversity and two complementary measures of recent life events, tapping threatening vs. more general life events. Both the frequency and subjective impact (positive vs. negative) of general life events were also assessed. Psychotic (i.e., schizotypy, suspiciousness) and non-psychotic (i.e., depression, anxiety) subclinical features as well as appraisals of perceived stress were examined. Hierarchical linear regressions and simple slope analyses were computed.

Results

HCC moderated the effects of both early and recent stress on suspiciousness as well as the effects of recent life events on perceived stress, such that those with higher HCC presented increased suspiciousness and perceived stress at higher levels of stress exposure. Positive, but not negative, recent life events were associated with decreased perceived stress and depression, and these associations were moderated by low HCC, indicating a buffering effect for those with a non-impaired HPA axis.

Conclusion

In line with the neural diathesis-stress model, results highlight the role of the interplay between the HPA axis and exposure to stressful experiences in exacerbating psychosis features and extend evidence to the nonclinical expression of the psychosis continuum. In addition, findings support the protective effect of positive experiences in decreasing stress appraisals and affective disturbances, which is consistent with emerging research about the relevance of positive factors in reducing the likelihood of psychopathological outcomes.

Neuroendocrine response to a psychosocial stress test is not related to schizotypy but cortisol elevation predicts inflexibility of semantic memory retrieval

An altered stress response can contribute to the transition from preclinical psychotic symptoms to the clinical manifestation of schizophrenia and other psychotic disorders. The present study was aimed at testing the hypotheses that (i) the autonomic and neuroendocrine responses under psychosocial stress are dysregulated in individuals with high psychosis proneness (schizotypy); (ii) the magnitude of post-stress autonomic activation and cortisol release predicts alterations in semantic memory retrieval. The study was performed in 73 healthy individuals of both sexes with either high or low schizotypal traits preselected out of 609 individuals using the Schizotypal Personality Questionnaire. A psychosocial stress procedure based on public speech was used as a stress model. We found that individuals with high schizotypy engaged in less adaptive emotional stress-coping strategies than low schizotypy individuals. Yet, the neuroendocrine, immune, and sympathetic activation in response to the stress test was not different between the groups. Irrespective of the exposure to the stressor, individuals with high schizotypy were less fluent when retrieving associations from semantic memory. In addition, we demonstrated that acute psychosocial stress reduced the flexibility of semantic memory retrieval. The post-stress mental inflexibility was reliably predicted by the concomitant elevation of cortisol concentrations in saliva. The present study thus brings novel evidence indicating that the acute psychosocial challenge impairs retrieval flexibility in the semantic domain, which may be due to neuroendocrine activation.

Aberrant adapting of beliefs under stress: a mechanism relevant to the formation of paranoia?

BACKGROUND

Difficulties in the ability to adapt beliefs in the face of new information are associated with psychosis and its central symptom - paranoia. As cognitive processes and psychotic symptoms are both known to be sensitive to stress, the present study investigated the exact associations between stress, adapting of beliefs [reversal learning (RL), bias against disconfirmatory evidence (BADE), and jumping to conclusions (JTC)] and paranoia. We hypothesized that paranoia would increase under stress and that difficulties in adapting of beliefs would mediate or moderate the link between stress and paranoia. Furthermore, we hypothesized that the investigated effects would be strongest in the group of individuals diagnosed with a psychotic disorder.

METHODS

We exposed 155 participants (38 diagnosed with a psychotic disorder, 40 individuals with attenuated psychotic symptoms, 39 clinical controls diagnosed with an obsessive-compulsive disorder, and 38 healthy controls) to a control condition and a stress condition, in which we assessed their levels of paranoia and their ability to adapt beliefs. We applied multilevel models to analyze the data.

RESULTS

Paranoia was higher in the stress condition than in the control condition, b = 1.142, s.e. = 0.338, t(150) = 3.381, p < 0.001. RL, BADE, and JTC did not differ between conditions and did not mediate or moderate the association between stress and paranoia (all p_s > 0.05).

CONCLUSIONS

The results support the assumption that stress triggers paranoia. However, the link between stress and paranoia does not seem to be affected by the ability to adapt beliefs.

Negative schizotypal traits predict the reduction of reward motivation in effort-reward imbalance

The schizotypy construct is useful for studying the effects of environmental stress on development of subclinical negative symptoms. The relationship among self-report motivation, effort-reward imbalance (ERI), and schizotypal features has seldom been studied. We aimed to examine the possible moderation effect of schizotypal traits on ERI and reward motivation. Eight-hundred-and-forty-three college students were recruited online to complete a set of self-reported measures capturing schizotypal traits, effort-reward imbalance and reward motivation, namely the Schizotypal Personality Questionnaire (SPQ), the Effort-Reward Imbalance-School Version Questionnaire (C-ERI-S) and the Motivation and Pleasure Scale-Self Report (MAP-SR). We conducted multiple linear regression to construct models to investigate the moderating effects of schizotypal traits on the relationship between ERI and reward motivation. Stressful ERI situation predicted the reduction of reward motivation. Negative schizotypal traits showed a significant negative moderating effect on the relationship between ERI and reward motivation, while positive and disorganized schizotypal traits had significant positive moderating effects. Schizotypal traits subtypes differently moderate the relationship between ERI and reward motivation. Only negative schizotypal traits and stressful ERI situation together have negative impact on reward motivation.

Paranormal belief, cognitive-perceptual factors, and well-being: A network analysis

By assessing interrelationships among variables within a specified theoretical framework, network analysis (NA) provides nuanced insights into how associations between psychological constructs are related to outcome measures. Noting this, the authors used NA to examine connections between Paranormal Belief, cognitive-perceptual factors (Schizotypy, Transliminality, and Manic-Depressive Experience), and well-being (Life Satisfaction, Meaning in Life, Somatic Complaints, Perceived Stress, Depressive Symptoms). Data derived from a sample of 3,090 participants (mean age = 50.30, standard deviation = 15.20; 46.5% male, 53.1% female) who completed standardised self-report measures capturing the study constructs online. Transliminality, Unusual Experiences (positive schizotypy), and Depressive Experience demonstrated high expected influence centrality. This indicated that these factors were the most strongly connected and influential in the network. Moreover, Transliminality was a connecting variable between Paranormal Belief, positive schizotypy, and psychopathology. Depressive Experience bridged the relationship between Transliminality and well-being. The conceptual implications of these outcomes are discussed with regards to better understanding relationships between Paranormal Belief, cognitive-perceptual factors, and well-being.

Investigating the relationship of COVID-19 related stress and media consumption with schizotypy, depression, and anxiety in cross-sectional surveys repeated throughout the pandemic in Germany and the UK

Background:

Studies report a strong impact of the COVID-19 pandemic and related stressors on the mental well-being of the general population. In this paper, we investigated whether COVID-19 related concerns and social adversity affected schizotypal traits, anxiety, and depression using structural equational modelling. In mediation analyses, we furthermore explored whether these associations were mediated by healthy (sleep and physical exercise) or unhealthy behaviours (drug and alcohol consumption, excessive media use).

Methods:

We assessed schizotypy, depression, and anxiety as well as healthy and unhealthy behaviours and a wide range of sociodemographic scores using online surveys from residents of Germany and the United Kingdom over 1 year during the COVID-19 pandemic. Four independent samples were collected (April/May 2020: N=781, September/October 2020: N=498, January/February 2021: N=544, May 2021: N=486). The degree of schizotypy was measured using the Schizotypal Personality Questionnaire (SPQ), anxiety, and depression symptoms were surveyed with the Symptom Checklist (SCL-27), and healthy and unhealthy behaviours were assessed with the Coronavirus Health Impact Survey (CRISIS). Structural equation models were used to consider the influence of COVID-19 related concerns and social adversity on depressive and anxiety-related symptoms and schizotypal traits in relation to certain healthy (sleep and exercise) and unhealthy behaviours (alcohol and drug consumption, excessive media use).

Results:

The results revealed that COVID-19 related life concerns were significantly associated with schizotypy in the September/October 2020 and May 2021 surveys, with anxiety in the September/October 2020, January/February 2021, and May 2021 surveys, and with depressive symptoms in all surveys. Social adversity significantly affected the expression of schizotypal traits and depressive and anxiety symptoms in all four surveys. Importantly, we found that excessive media consumption (>4 hr per day) fully mediated the relationship between COVID-19 related life concerns and schizotypal traits in the January/February 2021 survey. Furthermore, several of the surveys showed that excessive media consumption was associated with increased depressive and anxiety-related symptoms in people burdened by COVID-19 related life.

Conclusions:

The ongoing uncertainties of the pandemic and the restrictions on social life have a strong impact on mental well-being and especially the expression of schizotypal traits. The negative impact is further boosted by excessive media consumption, which is especially critical for people with high schizotypal traits.

Funding:

FK received funding from the European Union’s Horizon 2020 (Grant number 754,462). SN received funding from the Cundill Centre for Child and Youth Depression at the Centre for Addiction and Mental Health, Toronto, Canada and the Wellcome Trust Institutional Strategic Support Fund from the University of Cambridge.

The 2020 COVID-19 pandemic, and the measures different governments took to contain it, harmed many people’s mental well-being. The restrictions, combined with pandemic-related uncertainty, caused many individuals to experience increased stress, depression, and anxiety. Many people turned to unhealthy behaviours to cope, including consuming more alcohol or drugs, using media excessively, developing poor sleeping habits, or reducing the amount of exercise they did.

Stress, drugs, poor sleep, and uncertainty can increase an individual’s risk of developing psychotic symptoms, including delusions, hallucinations, or difficulty thinking clearly. These symptoms may be temporary or part of a more lasting condition, like schizophrenia. The risk of developing these symptoms increases in people with ‘schizotypal traits’, such as a lack of close relationships, paranoia, or unusual or implausible beliefs. These individuals may be especially vulnerable to the harmful mental health effects of the pandemic.

Daimer et al. demonstrated that people who were more worried about their life stability or financial situation during the 2020 COVID-19 pandemic had worse mental well-being than those who felt secure. In the experiments, volunteers completed a series of online mental health questionnaires at four different time points during the pandemic. People who reported feeling lonely, having negative thoughts, or experiencing fewer positive social interactions had more symptoms of mental illness. People who experienced more life disruptions also reported more anxiety or depression symptoms and more schizotypal traits. Daily consumption of at least four hours of digital media exacerbated negative mental health symptoms, and people with more pandemic-related life concerns also spent more time on digital media

Daimer et al. suggest that increased media consumption among people with pandemic-related hardships may have increased mental health symptoms and schizotypal traits in these individuals. The survey results suggest that maintaining a healthy lifestyle, including meaningful relationships, is essential to staying mentally healthy during extreme situations like a global pandemic. Protective interventions – such as strengthening social support networks, providing mental health education, or increasing mental healthcare provisions – are essential to prevent poor mental health outcomes during future crises.

Variations in Well-Being as a Function of Paranormal Belief and Psychopathological Symptoms: A Latent Profile Analysis

This study examined variations in well-being as a function of the interaction between paranormal belief and psychopathology-related constructs. A United Kingdom-based, general sample of 4,402 respondents completed self-report measures assessing paranormal belief, psychopathology (schizotypy, depression, manic experience, and depressive experience), and well-being (perceived stress, somatic complaints, and life satisfaction). Latent profile analysis identified four distinct sub-groups: Profile 1, high Paranormal Belief and Psychopathology (n = 688); Profile 2, high Paranormal Belief and Unusual Experiences; moderate Psychopathology (n = 800); Profile 3, moderate Paranormal Belief and Psychopathology (n = 846); and Profile 4, low Paranormal Belief and Psychopathology (n = 2070). Multivariate analysis of variance (MANOVA) found that sub-groups with higher psychopathology scores (Profiles 1 and 3) reported lower well-being. Higher Paranormal Belief, however, was not necessarily associated with lower psychological adjustment and reduced well-being (Profile 2). These outcomes indicated that belief in the paranormal is not necessarily non-adaptive, and that further research is required to identify the conditions under which belief in the paranormal is maladaptive.

Polygenic risk for schizophrenia and schizotypal traits in non-clinical subjects

BACKGROUND

Schizotypy is a putative risk phenotype for psychosis liability, but the overlap of its genetic architecture with schizophrenia is poorly understood.

METHODS

We tested the hypothesis that dimensions of schizotypy (assessed with the SPQ-B) are associated with a polygenic risk score (PRS) for schizophrenia in a sample of 623 psychiatrically healthy, non-clinical subjects from the FOR2107 multi-centre study and a second sample of 1133 blood donors.

RESULTS

We did not find correlations of schizophrenia PRS with either overall SPQ or specific dimension scores, nor with adjusted schizotypy scores derived from the SPQ (addressing inter-scale variance). Also, PRS for affective disorders (bipolar disorder and major depression) were not significantly associated with schizotypy.

CONCLUSIONS

This important negative finding demonstrates that despite the hypothesised continuum of schizotypy and schizophrenia, schizotypy might share less genetic risk with schizophrenia than previously assumed (and possibly less compared to psychotic-like experiences).

Does childhood trauma predict schizotypal traits? A path modelling approach in a cohort of help-seeking subjects

Schizotypy constitutes a susceptibility to beneficial and deleterious schizotypal traits, ranging from coping mechanisms to schizotypal personality disorder on a psychosis continuum. Growing evidence indicates a relationship between childhood adversity and trauma and schizotypy. However, the exact influence of childhood adversity and trauma on schizotypy and its relation to sex is not sufficiently understood. Therefore, we investigated sex-adjusted connections between childhood adversity and trauma subdomains (emotional/physical/sexual abuse, emotional/physical neglect) and positive (magical ideation, perceptual aberration) as well as negative schizotypy (physical/social anhedonia). In total, 240 outpatients of the Early Detection and Intervention Centre of the University Hospital Cologne were assessed with the Trauma and Distress Scale for childhood adversity and trauma and the Wisconsin Schizotypy Scales for schizotypy. Path analyses were performed to investigate sex-adjusted correlations. The well-fitting path model of the total sample linked emotional abuse to magical ideation (p = 0.03; SE = 0.20) and emotional neglect to social anhedonia (p = 0.01; SE = 0.26). In females, physical abuse predicted magical ideation (p = 0.01; SE = 0.33), while emotional neglect forecasted physical anhedonia (p = 0.03; SE = 0.34) and social anhedonia (p = 0.03; SE = 0.32). In males, sexual abuse predicted perceptive aberration (p = 0.04; SE = 0.19) and emotional abuse forecasted magical ideation (p = 0.03; SE = 0.27). Overall, the significance of sex-specific interrelations between trauma and schizotypy were highlighted. Magical ideation and perceptive aberration occurred prominently in the absence of negative and disorganized schizotypy, thus positive schizotypy could be discussed as a beneficial expression of coping with emotional, physical and sexual abuse. Furthermore, emotional neglect should be addressed particularly to prevent deleterious negative schizotypy in females.Trial registration number (20-1243), date of registration (May 19th 2020), retrospectively registered.

Nonclinical psychotic-like experiences and schizotypy dimensions: Associations with hippocampal subfield and amygdala volumes

Schizotypy and psychotic-like experiences (PLE) form part of the wider psychosis continuum and may have brain structural correlates in nonclinical cohorts. This study aimed to compare the effects of differential schizotypy dimensions, PLE, and their interaction on hippocampal subfields and amygdala volumes in the absence of clinical psychopathology. In a cohort of 367 psychiatrically healthy individuals, we assessed schizotypal traits using the Oxford-Liverpool Inventory of Life Experiences (O-LIFE) and PLE using the short form of the Prodromal Questionnaire (PQ-16). Based on high-resolution structural MRI scans, we used automated segmentation to estimate volumes of limbic structures. Sex and total intracranial volume (Step 1), PLE and schizotypy dimensions (Step 2), and their interaction terms (Step 3) were entered as regressors for bilateral amygdala and hippocampal subfield volumes in hierarchical multiple linear regression models. Positive schizotypy, but not PLE, was negatively associated with left amygdala and subiculum volumes. O-LIFE Impulsive Nonconformity, as well as the two-way interaction between positive schizotypy and PLE, were associated with larger left subiculum volumes. None of the estimators for right hemispheric hippocampal subfield volumes survived correction for multiple comparisons. Our findings support differential associations of hippocampus subfield volumes with trait dimensions rather than PLE, and support overlap and interactions between psychometric positive schizotypy and PLE. In a healthy cohort without current psychosis risk syndromes, the positive association between PLE and hippocampal subfield volume occurred at a high expression of positive schizotypy. Further studies combining stable, transient, and genetic parameters are required.

Home confinement during the COVID-19: day-to-day associations of sleep quality with rumination, psychotic-like experiences, and somatic symptoms

Due to the coronavirus disease 2019 (COVID-19) pandemic, populations from many countries have been confined at home for extended periods of time in stressful environmental and media conditions. Cross-sectional studies already evidence deleterious psychological consequences, with poor sleep as a risk factor for impaired mental health. However, limitations of cross-sectional assessments are response bias tendencies and the inability to track daily fluctuations in specific subjective experiences in extended confinement conditions. In a prospective study conducted across three European countries, we queried participants (N = 166) twice a day through an online interface about their sleep quality and their negative psychological experiences for two consecutive weeks. The focus was set on between- and within-person associations of subjective sleep quality with daytime experiences, such as rumination, psychotic-like experiences, and somatic complaints about the typical symptoms of the coronavirus. The results show that daily reports of country-specific COVID-19 deaths predicted increased negative mood, psychotic-like experiences, and somatic complaints during the same day and decreased subjective sleep quality the following night. Disrupted sleep was globally associated with negative psychological outcomes during the study period, and a relatively poorer night of sleep predicted increased rumination, psychotic-like experiences, and somatic complaints the following day. This temporal association was not paralleled by daytime mental complaints predicting relatively poorer sleep quality on the following night. Our findings show that night-to-night changes in sleep quality predict how individuals cope the next day with daily challenges induced by home confinement.

The effect of effort-reward imbalance on brain structure and resting-state functional connectivity in individuals with high levels of schizotypal traits

INTRODUCTION

Effort-reward imbalance (ERI) is a typical psychosocial stress. Schizotypal traits are attenuated features of schizophrenia in the general population. According to the diathesis-stress model, schizotypal traits and psychosocial stress contribute to the onset of schizophrenia. However, few studies examined the effects of these factors on brain alterations. This study aimed to examine relationships between ERI, schizotypal traits and brain structures and functions.

METHODS

We recruited 37 (13 male, 24 female) participants with high levels of schizotypal traits and 36 (12 male, 24 female) participants with low levels of schizotypal traits by the Schizotypal Personality Questionnaire (SPQ). The Chinese school version of the effort-reward imbalance questionnaire (C-ERI-S) was used to measure ERI. We conducted the voxel-based morphometry (VBM) and whole brain resting-state functional connectivity (rsFC) analysis using reward or stress-related regions as seeds.

RESULTS

Participants with high levels of schizotypal traits were more likely to perceive ERI. The severity of ERI was correlated with grey matter volume (GMV) reduction of the left pallidum and altered rsFC among the prefrontal, striatum and cerebellum in participants with high levels of schizotypal traits.

CONCLUSION

ERI is associated with GMV reduction and altered rsFC in individuals with high levels of schizotypal traits.

Mild-to-moderate schizotypal traits relate to physiological arousal from social stress

Schizotypy denotes psychosis-like experiences, such as perceptual aberration, magical ideation, and social anxiety. Altered physiological arousal from social stress is found in people with high schizotypal traits. Two experiments aimed to determine the relationship of schizotypy to physiological arousal from social stress. Experiment 1 tested the hypotheses that heart rate from social stress would be greater in high, than mild-to-moderate, schizotypal traits, and disorganized schizotypy would explain this effect because of distress from disorganisation. Experiment 1 tested social stress in 16 participants with high schizotypal traits and 10 participants with mild-to-moderate schizotypal traits. The social stress test consisted of a public speech and an informal discussion with strangers. The high schizotypal group had a higher heart rate than the mild-to-moderate schizotypal group during the informal discussion with strangers, but not during the public speech. Disorganized schizotypy accounted for this group difference. Experiment 2 tested the hypothesis that mild-to-moderate schizotypal traits would have a linear relationship with physiological arousal from social stress. Experiment 2 tested 24 participants with mild-to-moderate schizotypal traits performing the abovementioned social stress test while their heart rate and skin conductance responses were measured. Mild-to-moderate schizotypal traits had a linear relationship with physiological arousal during the discussion with strangers. Distress in disorganized schizotypy may explain the heightened arousal from close social interaction with strangers in high schizotypy than mild-to-moderate schizotypy. Mild-to-moderate schizotypal traits may have a linear relationship with HR during close social interaction because of difficulty with acclimatizing to the social interaction.

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.