Understanding the inverse relationship between age and psychotic symptoms: The role of borderline personality traits

Psychotic-like experiences in a nationally representative study of general population adolescents

BACKGROUND

Subclinical psychotic-like experiences (PLEs) are common among general population adolescents but have been found to correlate with various problems in well-being. Due to limited sample sizes these effects have not been well differentiated by sex and age.

METHODS

Using a nationally representative survey of almost 160,000 adolescents, we studied endorsement and correlates of PLEs by sex among middle adolescence pupils (ages 14-16) and late adolescence students (ages 16-20). PLEs were investigated with three questionnaire items: auditory and visual hallucinatory experiences and suspicious thought content, using a frequency response scale.

RESULTS

Weekly PLEs were reported by 14 % of the adolescents, more often in females (17 %) than males (11 %) and in the younger age group (17 %) compared to the older adolescents (10 %). A latent PLE factor represented the three assessed PLEs with good fit. Factor scores were highest for the younger females and lowest for the older males. The PLE factor correlated with two latent factors of other well-being, namely living environment ("adversity", loading most heavily on parental mental abuse; r = 0.63), and concurrent mental health ("distress", loading most heavily on depressive symptoms; r = 0.50). Adversity was associated especially strongly with PLEs in 14-16-year-old males.

CONCLUSIONS

This cross-sectional study reaching the whole 14-20 age group in schools in Finland offers data on the meaning and relevance of PLEs as general markers of vulnerability. Many adolescents experience PLEs recurrently and these experiences are associated with a wide variety of burden in the adolescent's everyday life.

Working alliance in treating staff and patients with Schizophrenia Spectrum Disorder living in Residential Facilities

OBJECTIVES

Working Alliance (WA) is important in the care of patients with Schizophrenia Spectrum Disorders (SSD). This study aims to determine which sociodemographic and clinical factors are associated with WA, as assessed by patients and staff members in Residential Facilities (RFs), and may predict WA dyads' discrepancies.

METHODS

Three hundred and three SSD patients and 165 healthcare workers were recruited from 98 RFs and characterized for sociodemographic features. WA was rated by the Working Alliance Inventory (WAI) for patients (WAI-P) and staff members (WAI-T). SSD patients were assessed for the severity of psychopathology and psychosocial functioning.

RESULTS

Pearson's correlation revealed a positive correlation (ρ = .314; p < .001) between WAI-P and WAI-T ratings. Linear regression showed that patients with higher education reported lower WAI-P ratings (β = -.50, p = .044), while not being engaged in work or study was associated with lower WAI-T scores (β = -4.17, p = .015). A shorter lifetime hospitalization was associated with higher WAI-P ratings (β = 5.90, p = .008), while higher psychopathology severity negatively predicted WAI-T (β = -.10, p = .002) and WAI-P ratings (β = -.19, p < .001). Better functioning level positively foresaw WAI-T (β = .14, p < .001) and WAI-P ratings (β = .12, p < .001). Regarding discrepancies, staff members' age was associated with higher dyads discrepancy in Total scale and Agreement subscale scores, which were also associated with more severe negative symptoms, while patients' age was negatively correlated to Relationship subscale discrepancy.

CONCLUSIONS

This study provides insight into the factors that influence WA in SSD patients and health workers in RFs. The findings address interventions to improve WA and ultimately patient outcomes.

Time to put aside the false dichotomy between personality disorders and psychotic symptoms

Unlike internalizing and externalizing symptoms, psychotic symptoms (e.g., hallucinations, delusions) are manifestations of personality disorders (PDs) that are more controversial and poorly understood. This leaves clinicians with very little guidance for clinical practice, especially for diagnosis. What is more, most reviews have focused strictly on the links between psychotic symptoms and the categorically defined borderline PD, which contrasts with the growing movement that emphasizes a dimensional perspective (especially in psychology). Thus, the objectives of this critical review will be to (a) expose typical cases where PDs and psychotic symptoms might cooccur; (b) assess the state of scientific knowledge surrounding PD and psychotic symptoms; and (c) provide clinicians and researchers with recommendations to keep the field moving forward. We conclude that researchers and clinicians should move past the false "PD or psychosis" dichotomy since they often cooccur, avoid (as far as possible) making psychotic symptoms an exclusion criterion in PD research to enhance ecological validity, and consider dimensional PD diagnosis as a potential unifying solution to the dilemma posed by this cooccurrence.

Psychopathology and psychosocial functioning among young people with first-episode psychosis and/or first-presentation borderline personality disorder

BACKGROUND

One in five young people with first-episode psychosis (FEP) also presents with borderline personality disorder (BPD) features. Among people diagnosed with BPD, auditory verbal hallucinations occur in 29-50 % and delusions in 10-100 %. Co-occurrence of psychotic symptoms and BPD is associated with greater clinical severity and greater difficulty accessing evidence based FEP care. This study aimed to investigate psychotic symptoms and psychosocial functioning among young people presenting to an early intervention mental health service.

METHOD

According to the presence or absence of either FEP or BPD, 141 participants, aged 15-25 years, were assigned to one of four groups: FEP, BPD, combined FEP + BPD, or clinical comparison (CC) participants with neither FEP nor BPD. Participants completed semi-structured diagnostic interviews and interviewer and self-report measures of psychopathology and psychosocial functioning.

RESULTS

The FEP + BPD group had significantly more severe psychopathology and poorer psychosocial functioning than the FEP group on every measure, apart from intensity of hallucinations. Comparing the FEP or BPD groups, the BPD group had greater psychopathology, apart from intensity of psychotic symptoms, which was significantly greater in the FEP group. These two groups did not significantly differ in their overall psychosocial functioning. Compared with CC young people, both the FEP + BPD and BPD groups differed significantly on every measure, with medium to large effect sizes.

CONCLUSIONS

Young people with co-occurring FEP and BPD experience more severe difficulties than young people with either diagnosis alone. This combination of psychosis and severe personality pathology has been longitudinally associated with poorer outcomes among adults and requires specific clinical attention.

Longitudinal Relation between Harsh Punishment and Psychoticism among Chinese Early Adolescents: Disentangling between‑ and within‑Family Effects

This longitudinal study examined bidirectional relations between parental harsh punishment and psychoticism at the between‑ and within‑family levels in Chinese adolescents. There were 3,307 Chinese youth (43.6% girls, Mage = 11.30 years, SD = 0.24) who participated in a 4-wave longitudinal study, spaced 12 months apart. The results of cross-lagged panel modeling (i.e. CLPM) found the significant bidirectional relations between parental harsh punishment and psychoticism at the between-family level. However, the within-person level analysis of random intercept cross-lagged panel modeling (i.e. RI-CLPM) only revealed parental harsh punishment significantly predicted youth psychoticism, but not vice versa. Moreover, no sex differences were observed in the bidirectional relations between parental harsh punishment and psychoticism at the between- or within-family level. These results suggest parental harsh parenting could exacerbate the psychoticism trait at both the between- and within-family level, whereas the influence of young people's psychoticism on harsh parenting response from parents occurs only at the between-family level. The findings help to understand the nature of the dynamic process of change between psychoticism and harsh parenting among Chinese adolescents.

Prevalence of psychotic-like experiences and its predictors among early adolescents from rural areas in Indonesia

Background: Psychotic symptoms are present in a wide range of both clinical and non-clinical populations. Psychotic symptoms in adolescents often take the form of psychotic-like experiences (PLEs), which are considered a risk factor for numerous serious mental illnesses. Socioeconomic disadvantages are across rural areas, and poverty is known as the third most important risk factor of PLEs. However, there have been limited studies on PLEs which focus on populations in rural areas.Objective: The aim of this study was to assess the prevalence of PLEs and investigate their predictors among early adolescents living in rural areas.Method: Data from 629 early adolescents from two rural areas in Indonesia were analysed using descriptive statistics to determine the prevalence of PLEs. Multiple logistic regression analysis was used to assess the predictors of PLEs. This was a school-based cross-sectional study, and data were collected using a paper questionnaire.Results: The results showed that the prevalence of PLEs among early adolescents in rural areas is 24.5%. Four significant predictors of PLEs were identified after controlling for sex: emotional problems, age, the number of caregivers in daily life, and psychological well-being.