The schizotypal ambivalence scale as a marker of schizotypy

The Schizotypal Ambivalence Scale: An Item Response Theory Analysis

Ambivalence has a prominent role in the historical formulations of schizotypy and schizophrenia, as well as borderline personality disorder. However, it has been overlooked by our current diagnostic nomenclature. The Schizotypal Ambivalence Scale (SAS) is a 19-item self-report scale developed to examine ambivalence relevant to schizotypy and schizophrenia-spectrum disorders. Questionnaire, interview, and ambulatory assessment studies support the construct validity of the measure as a predictor of schizophrenia-spectrum and borderline psychopathology. However, studies have not adequately examined the item properties and factor structure of the scale. To examine the psychometric features of the SAS, the present research applied item response theory and differential item functioning methods using a large sample of adults (n = 7096). Analyses of dimensionality were consistent with essential unidimensionality, and a 2PL IRT model found good item discrimination, an appropriate range of item difficulty, minimal local dependence, and excellent item fit. Analyses of differential item functioning found essentially no bias for gender on any items and very small effects for two items for racial/ethnic identity. Overall, the analyses reveal many psychometric strengths of the Schizotypal Ambivalence Scale and support its use a single-factor instrument for assessing ambivalence in diverse subgroups of adults.

Neural Basis of Ambivalence towards Ideal Self-Image in Schizophrenia

OBJECTIVE

Little has been explored about a reflection towards self-image in schizophrenia, though it can be related to heterogeneous symptoms of the illness. We identified the neural basis of ambivalence towards ideal self-image in patients with schizophrenia.

METHODS

20 patients with schizophrenia and 20 healthy controls underwent functional MRI while the self-image reflection tasks of determining whether to agree with sentences describing their actual or ideal self-image that contained one of the adjective pairs with opposite valence. The interaction between the group and ideal ambivalence score was examined, and group differences in functional connectivity related to ambivalence towards ideal self-image were further studied.

RESULTS

The interaction of group-by-ideal ambivalence score was shown in the dorsal anterior cingulate cortex and dorsolateral prefrontal cortex, where activities were positively correlated with the level of ideal self-image ambivalence in patients, but not in controls. Task-related decrease in functional connectivity was shown between the orbitofrontal cortex and cerebellum in patients.

CONCLUSION

The process of reflecting on ambivalent ideal self-image in schizophrenia may be related to aberrant prefrontal activity and connectivity. Abnormality in the prefrontal regions that take part in cognitive conflict monitoring and value judgment may underlie the pathophysiology of increased ambivalence towards ideal self-image.

The Continuum of Psychosis Proneness and Schizotypal Traits: A Comment on Loas, et al. (2013)

Loas, Dimassi, Monestes, and Yon (2013) studied a version of the Cognitive Slippage Scale and the Schizotypal Ambivalence Scale in support of the view that thought disorder and withdrawal are highly correlated with schizotypy, a central concept in investigations of the vulnerability for schizophrenia. As a brief comment on Loas, et al., I will draw attention to the need for expanding studies of schizotypal traits and the possibility of using these scales with adolescents and young adults who are developing personality disorders as well as with individuals who have experienced prodromal phases of psychosis. Investigations of the Cognitive Slippage Scale and the Schizotypal Ambivalence Scale might be enhanced by conducting studies with individuals at different points on the psychosis continuum, including those who have developed schizophrenia and other psychotic disorders, as well as with their first-degree relatives.

First treatment contact for ADHD: predictors of and gender differences in treatment seeking

OBJECTIVES

For attention-deficit hyperactivity disorder (ADHD), treatment seeking is a critical first step in treatment initiation and remains insufficiently understood. The aims of this study were to estimate ADHD treatment-seeking probabilities over the lifetime and to identify predictors of treatment seeking for ADHD separately for males and females.

METHODS

Data were drawn from 2001 to 2005 as part of the National Epidemiologic Survey on Alcohol and Related Conditions, a two-wave face-to-face survey conducted by the National Institute on Alcohol Abuse and Alcoholism (N=34,653).

RESULTS

The lifetime cumulative probability of ADHD treatment seeking was estimated at 55%. Males identifying as African American, with less than 12 years of education, or paranoid personality disorder or in an older cohort (>30 years old) at the time of interview were more likely to experience delays, whereas males with comorbid alcohol dependence, dysthymic disorder, borderline personality disorder, or histrionic personality disorder were less likely. Among females, older age (>44 years) was the only predictor of a delay to first treatment seeking, whereas bipolar disorder was associated with more rapid treatment seeking. Age of onset had opposite effects on treatment-seeking delays by gender; males but not females with early-onset ADHD were more likely to experience treatment-seeking delays.

CONCLUSIONS

A large proportion of persons with ADHD do not seek treatment. Furthermore, treatment seeking by males was affected by a greater number of identifiable characteristics, suggesting that males might be more responsive to efforts directed toward expediting treatment entry. Future research should explore how to facilitate early access to treatment for individuals with ADHD.

Emotional granularity and social functioning in individuals with schizophrenia: an experience sampling study

Previous research has shown that healthy individuals who fail to differentiate among emotional states (i.e., those with low emotional granularity; EG) have poorer social functioning (SF) than those with high EG. It is unknown, however, whether these associations extend to clinical disorders characterized by impaired SF, such as schizophrenia. In the present study, we compared SF and EG in individuals with schizophrenia and healthy controls, and then, within the schizophrenia group, we examined the links between EG and SF. Employing an Experience Sampling Method approach, 77 individuals with schizophrenia and 27 healthy controls rated their momentary emotions (sadness, anxiety, anger, and happiness) up to 10 times/day over a two-day period using mobile electronic devices. For each participant, we then calculated the within-subject average correlations among the momentary emotion ratings, producing two EG indices - EGIall for all emotions and EGIneg for negative ones. A subsample of participants with schizophrenia also completed self-report, interview, and ability-based measures of SF. Compared to healthy controls, individuals with schizophrenia displayed significantly poorer SF and lower EGIall, but comparable EGIneg. Within the schizophrenia group, hierarchical multiple regression analyses indicated that EGIall, but not EGIneg, significantly predicted social dysfunction after controlling for emotional awareness, symptoms, and emotional intensity and variability. Our findings indicate that individuals with schizophrenia have a relatively intact ability to differentiate among negative emotions in everyday life. However, they experience significant difficulties differentiating between positive and negative emotions, and this may contribute to their social difficulties.

Criterion validity of the cognitive slippage and schizotypal ambivalence scales

This study explored the criterion-validity of the Cognitive Slippage Scale (CSS) and the Schizotypal Ambivalence Scale (SAS). 27 first-degree relatives of individuals with schizophrenia (9 males, 18 females; M age=45.3 yr., SD=13) were compared with 30 first-degree relatives of non-psychotic patients (15 males, 15 females; M age = 44.6 yr., SD = 11.6) on the French versions of the CSS and SAS. The former group, who is at high risk for schizophrenia, had significantly higher scores than the latter group on both scales.

Self-reported ambivalence in schizophrenia and associations with negative mood

One instrument potentially useful for schizophrenia research is the Revised Schizotypal Ambivalence Scale (rSAmb). However, previous research has not examined the construct validity of this instrument in people with schizophrenia. In the current study, people with schizophrenia-spectrum disorders (n = 47) and bipolar disorder (BPD; n = 19) completed the rSAmb along with current symptom and other clinical data. As a group, the people with schizophrenia/schizoaffective disorder reported significantly less ambivalence on the rSAmb than did the people with BPD. In addition, the rSAmb was not significantly related to any schizophrenia symptom (all correlations < 0.15). Instead, the rSAmb was significantly associated with negative mood symptoms in the past week, a diagnosis of schizoaffective disorder rather than schizophrenia, and the number of negative terms used in speech. These results suggest that the rSAmb may be associated with negative mood and not with schizophrenia, although systematic examination of larger cohorts is warranted.

Perceived patient-parent relationships and neural representation of parents in schizophrenia

Having a relationship with one's parents is a fundamental social interaction and is a significant environmental factor in the long-term course of illness in schizophrenia. We explored subjective reports regarding the communicative relationship with parents and the implicit behavioral and neural responses of patients toward stimuli that referred to parents. Fourteen outpatients with schizophrenia and 15 healthy volunteers with living parents were scanned using a functional magnetic resonance imaging while performing an imaginary sentence completion test that involved contemplation of their mothers and fathers. In patients with schizophrenia, subjective reports of better communicative fluency with one's mother were associated with faster response time and lower incomplete rate, reflecting favorable responses toward mothers. Relative to control participants, patients with schizophrenia demonstrated greater neural activation in the superior temporal sulcus and the parahippocampal gyrus for parental stimuli. When patients with schizophrenia contemplated their mothers, activities in these regions were associated with a level of negative symptoms or affective ambivalence in patients. The results indicated that parental cues are processed in a more socially driven manner, and that perceived communicative relationships with one's parents can be used to estimate implicit responses, especially in relation to mothers in patients with schizophrenia. Furthermore, the findings of the current study suggest that affective ambivalence toward one's mother is one such implicit response and emphasize the importance of prudent family interventions in the psychiatric rehabilitation of patients with schizophrenia.

A framework for understanding experiential deficits in schizophrenia

The link between disruptions in emotional/motivational systems and chronic functional impairments in individuals with schizophrenia has been well substantiated. However, attempts to delineate the exact nature of these disruptions have been complicated by the reality that schizophrenia is a markedly heterogeneous disorder. In this article, we integrate findings from schizophrenia, neuroscience, and basic psychology literatures to advance the hypothesis that emotional deficits occur via two separate, mutually exclusive pathways: "ambivalence" - characterized by intact hedonic and abnormally co-activated negative emotion systems, and "apathy" - characterized by anhedonia and relatively sparse negative emotion. Further examination of how negative affect manifests differently across patients will be an important focus of future research, particularly given that the "downstream" social and occupational consequences of these abnormalities may appear similar but reflect dramatically divergent etiologies.

Anhedonia and ambivalence in schizophrenic patients with fronto-cerebellar metabolic abnormalities: a fluoro-d-glucose positron emission tomography study

OBJECTIVE

Prefrontal and cerebellar abnormalities have been associated with higher cognitive deficits in schizophrenia. The current study aimed to show whether or not schizophrenic patients with fronto-cerebellar functional abnormalities show more anhedonia or ambivalence.

METHODS

Regional cerebral metabolic activity was measured using fluoro-D-glucose positron emission tomography and was compared between 24 patients with chronic schizophrenia and 22 healthy normal volunteers. The existence of regional prefrontal hypofunction and regional cerebellar hyperfunction was investigated in each patient. Demographic and clinical variables including the emotional self-report scales were compared between the subgroups of the patients categorized according to the existence and the absence of the regional dysfunctions.

RESULTS

Comparisons between each patient and the total normal controls revealed that 14 of the total twenty-four patients had regional hypofrontal functions, whereas 11 patients had regional hypercerebellar functions. Patients with prefrontal hypofunction showed more severe anhedonia than those without prefrontal hypofunction, whereas patients with cerebellar hyperfunction compared to those without cerebellar hyperfunction had more severe ambivalence.

CONCLUSION

It seems that fronto-cerebellar abnormalities may be associated with cardinal emotional features of schizophrenia, such as anhedonia and ambivalence.