Validity and reliability of the CAPE: a self-report instrument for the measurement of psychotic experiences in the general population

Sex-specific association between schizophrenia polygenic risk and subclinical schizophrenia-related traits

BACKGROUND

According to the dimensional view of psychiatric disorders, psychosis is expressed as a continuum in the general population. However, the investigation of the putative genetic aetiological continuity between its clinical and subclinical phenotypes has yielded mixed results. We aimed to replicate previous findings regarding the association of polygenic risk for schizophrenia with subclinical traits (i.e., schizotypy traits and psychotic-like experiences), and to examine the role of sex in this association in a large nonclinical sample.

METHODS

The Multidimensional Schizotypy Scale and the Community Assessment of Psychic Experiences were assessed in 919 nonclinical participants. Polygenic Risk Scores for schizophrenia (SZ-PRSs) were computed using the PRS-CS method based on the latest genome-wide association study of schizophrenia. Summary statistics derived from the total GWAS sample and stratified by sex were used. Linear regression analyses tested the associations of the SZ-PRSs with the psychometric variables, both in the total sample and by sex.

RESULTS

No associations were found between the SZ-PRSs and the positive, negative or disorganized dimensions of schizotypy in the total sample. Likewise, no associations were found with psychotic-like experiences. However, the sex-stratified analyses revealed a male-specific association with positive schizotypy. Similar results were obtained with the PRSs derived from the sex-stratified summary statistics.

DISCUSSION

Our results are consistent with the lack of clear evidence of an association between SZ common genetic risk and its subclinical phenotypes. Nevertheless, the male-specific association found suggests that this PRS might explain better the male phenotype, as reported in previous studies. Future studies should put a focus on the role of sex in this association to unravel its sex specificities.

Psychotic experiences and psychological distress in adolescents: an examination of longitudinal bidirectional effects across sex

BACKGROUND

Although the co-occurrence of psychotic experiences (PEs) and psychological distress symptoms is growingly recognized in several previous studies, there is still a lack of literature, which clearly outlines how these two psychopathological entities affect each other over time. This study is intended to add to the literature by examining: (a) the longitudinal, bidirectional associations between PEs and psychological distress in a sample of Tunisian adolescents, and (b) whether these associations are moderated by sex.

METHODS

510 adolescent students (mean age of 16.05 ± 1.01 years, 61.2% females) took part in a prospective longitudinal study. PEs and psychological distress were measured at three occasions over a one-year period. The cross-lagged panel modeling approach was adopted.

RESULTS

The current results showed that the experience of PEs at baseline tended to temporally precede prospective increases in psychological distress (at 6 months), which had in turn led to further exacerbation of psychological distress at 12 months of follow-up. Temporally primary psychological distress symptoms were not a significant predictor for the development of later psychotic symptoms in the whole sample. However, temporal patterns between adolescent distress and psychotic symptoms differed for girls and boys. Endorsing PEs at baseline was followed by greater psychological distress at 6 months, which was in turn associated with a significant increased risk of subsequent exacerbation of PEs at 12 months in boys, whereas psychological distress at 12-month follow-up was significantly predicted by pre-existing PEs in girls.

CONCLUSION

These findings suggest that clinicians and support workers are recommended to take into account different social risk profiles for boys and girls when considering interventions to address PEs and distress in adolescents.

Changes in sleep patterns in people with a history of depression during the COVID-19 pandemic: a natural experiment

BACKGROUND

The COVID-19 pandemic, while a major stressor, increased flexibility in sleep-wake schedules.

OBJECTIVES

To investigate the impact of the pandemic on sleep patterns in people with a history of depression and identify sociodemographic, clinical or genetic predictors of those impacts.

METHODS

6453 adults from the Australian Genetics of Depression Study (45±15 years; 75% women) completed surveys before (2016-2018) and during the pandemic (2020-2021). Participants were assigned to 'short sleep' (<6 hours), 'optimal sleep' (6-8 hours) or 'long sleep' (>8 hours). We focused on those having prepandemic 'optimal sleep'.

FINDINGS

Pre pandemic, the majority (70%, n=4514) reported optimal sleep, decreasing to 49% (n=3189) during the pandemic. Of these, 57% maintained optimal sleep, while 16% (n=725) shifted to 'short sleep' and 27% (n=1225) to 'long sleep'. In group comparisons 'optimal-to-short sleep' group had worse prepandemic mental health and increased insomnia (p's<0.001), along with an elevated depression genetic score (p=0.002). The 'optimal-to-long sleep' group were slightly younger and had higher distress (p's<0.05), a greater propensity to being evening types (p<0.001) and an elevated depression genetic score (p=0.04). Multivariate predictors for 'optimal-to-short sleep' included reported stressful life events, psychological or somatic distress and insomnia severity (false discovery rate-corrected p values<0.004), while no significant predictors were identified for 'optimal-to-long sleep'.

CONCLUSION AND IMPLICATIONS

The COVID-19 pandemic, a natural experiment, elicited significant shifts in sleep patterns among people with a history of depression, revealing associations with diverse prepandemic demographic and clinical characteristics. Understanding these dynamics may inform the selection of interventions for people with depression facing major challenges.

The association between childhood trauma and tobacco smoking in patients with psychosis, unaffected siblings, and healthy controls

In patients with psychosis, rates of tobacco smoking and childhood trauma are significantly higher compared to the general population. Childhood trauma has been proposed as a risk factor for tobacco smoking. However, little is known about the relationship between childhood trauma and smoking in psychosis. In a subsample of the Genetic Risk and Outcome of Psychosis study (760 patients with psychosis, 991 unaffected siblings, and 491 healthy controls), tobacco smoking was assessed using the Composite International Diagnostic Interview and childhood trauma was measured with the Childhood Trauma Questionnaire. Logistic regression models were used to assess associations between trauma and smoking, while correcting for confounders. Positive associations were found between total trauma, abuse, and neglect, and an increased risk for smoking in patients, while correcting for age and gender (ORtrauma 1.77, 95% CI 1.30-2.42, p < 0.001; ORabuse 1.69, 95% CI 1.23-2.31, p = 0.001; ORneglect 1.48, 95% CI 1.08-2.02, p = 0.014). In controls, total trauma and abuse were positively associated with smoking, while correcting for age and gender (ORtrauma 2.40, 95% CI 1.49-3.88, p < 0.001; ORabuse 2.02, 96% CI 1.23-3.32, p = 0.006). All associations lost their significance after controlling for additional covariates and multiple testing. Findings suggest that the association between childhood trauma and tobacco smoking can be mainly explained by confounders (gender, cannabis use, and education) in patients with psychosis. These identified aspects should be acknowledged in tobacco cessation programs.

Individual differences in belief updating and phasic arousal are related to psychosis proneness

Many decisions entail the updating of beliefs about the state of the environment by accumulating noisy sensory evidence. This form of probabilistic reasoning may go awry in psychosis. Computational theory shows that optimal belief updating in environments subject to hidden changes in their state requires a dynamic modulation of the evidence accumulation process. Recent empirical findings implicate transient responses of pupil-linked central arousal systems to individual evidence samples in this modulation. Here, we analyzed behavior and pupil responses during evidence accumulation in a changing environment in a community sample of human participants. We also assessed their subclinical psychotic experiences (psychosis proneness). Participants most prone to psychosis showed overall less flexible belief updating profiles, with diminished behavioral impact of evidence samples occurring late during decision formation. These same individuals also exhibited overall smaller pupil responses and less reliable pupil encoding of computational variables governing the dynamic belief updating. Our findings provide insights into the cognitive and physiological bases of psychosis proneness and open paths to unraveling the pathophysiology of psychotic disorders.

The impact of subclinical psychotic symptoms on delay and effort discounting: Insights from behavioral, computational, and electrophysiological methods

BACKGROUND

The ability to value rewards is crucial for adaptive behavior and is influenced by the time and effort required to obtain them. Impairments in these computations have been observed in patients with schizophrenia and may be present in individuals with subclinical psychotic symptoms (PS).

METHODS

In this study, we employed delay and effort-discounting tasks with food rewards in thirty-nine participants divided into high and low levels of PS. We investigated the underlying mechanisms of effort-discounting through computational modelling of dopamine prefrontal and subcortical circuits and the electrophysiological biomarker of both delay and effort-discounting alterations through resting-state frontal alpha asymmetry (FAA).

RESULTS

Results revealed greater delay discounting in the High PS group compared to the Low PS group but no differences in the effort discounting task. However, in this task, the same levels of estimated dopamine release were associated with a lower willingness to exert effort for high-calorie food rewards in High PS participants compared to Low PS participants. Although there were no significant differences in FAA between the High PS and Low PS groups, FAA was significantly associated with the severity of participants' negative symptoms.

CONCLUSIONS

Our study suggests that the dysfunction in temporal and effort cost computations, seen in patients with schizophrenia, may be present in individuals with subclinical PS. These findings provide valuable insight into the early vulnerability markers (behavioral, computational, and electrophysiological) for psychosis, which may aid in the development of preventive interventions. These findings are preliminary and warrant further investigation.

The Association between Attention-Deficit-Hyperactivity Disorder and Autistic Traits with Psychotic-like Experiences in Sample of Youths Who Were Referred to a Psychiatric Outpatient Service

The aim of this study is to identify autism spectrum disorder (ASD) and attention-deficit-hyperactivity disorder (ADHD) traits in adolescents who experience psychotic-like experiences (PLEs), often ignored in clinical practice but widely prevalent in the general population. A total of 57 adolescents and young adults (aged between 16 and 24 years old) were recruited consecutively in the outpatient services. A total of 37 were females (64.9%), 18 were males (31.6%), and two participants (3.5%) were non-binary or gender non-conforming, with a mean age at referral of 18.26 ± 2.06. To investigate these symptoms, three sets of standardized questionnaires were used, as follows: the Autism Spectrum Quotient-short form (AQ-10), the Community Assessment of Psychic Experiences (CAPE-42), and the Adult ADHD Self-Report Scale (ASRS). We found significant associations between the ASRS and AQ-10 total scores and all CAPE scales. The model which explained the highest variance was CAPE Score's Total Frequency score (p < 0.001). Our findings underline the importance of investigating the presence of subthreshold ASD and ADHD symptoms in clinical populations, particularly in the period of adolescence and young adulthood, to promptly identify the presence of PLEs and, thus, prevent the onset of a frank psychotic disorder, particularly in the presence of a comorbid psychopathological condition, leading to better diagnosis and treatment for individuals with two or more of these conditions.

Internal consistency and temporal stability of the Community Assessment of Psychic Experiences (CAPE): A reliability generalization meta-analysis

Psychotic experiences (PE) are prevalent in general and clinical populations and can increase the risk for mental disorders in young people. The Community Assessment of Psychic Experiences (CAPE) is a widely used measure to assess PE in different populations and settings. However, the current knowledge on their overall reliability is limited. We examined the reliability of the CAPE-42 and later versions, testing the role of age, sex, test scores, and clinical status as moderators. A systematic search was conducted on the Scopus, Web of Science, PubMed, EBSCOhost, ProQuest, and GoogleScholar databases. Internal consistency and temporal stability indices were examined through reliability generalization meta-analysis (RGMA). Moderators were tested through meta-regression analysis. From a pool of 1,015 records, 90 independent samples were extracted from 71 studies. Four versions showed quantitative evidence for inclusion: CAPE-42, CAPE-20, CAPE-P15, and CAPE-P8. Internal consistency indices were good (α/ω≈.725-0.917). Temporal stability was only analyzed for the CAPE-P15, yielding a moderate but not-significant effect (r=0.672). The evidence for temporal stability is scant due to the limited literature, and definitive conclusions cannot be drawn. Further evidence on other potential moderators such as adverse experiences or psychosocial functioning is required.

Self-reported suicidal ideation among individuals with first episode psychosis and healthy controls: Findings from the international multicentre EU-GEI study

INTRODUCTION

Suicidal ideation is common among individuals with first episode psychosis (FEP), with prevalence estimates up to 56.5 %. Despite its high prevalence, relatively little is known about how sociodemographic, clinical and/or developmental characteristics contribute to the experience of suicidal ideation in individuals with FEP.

METHODS

In this cross-sectional study (FEP n = 551 and controls n = 857), univariate logistic regression analyses were performed to study the associations of sociodemographic, clinical, and developmental factors with suicidal ideation in individuals with FEP as well as controls. Suicidal ideation was assessed using the Community Assessment of Psychic Experiences (CAPE). In addition, multivariate logistic regression analyses were conducted based on a stepwise approach.

RESULTS

In FEP, only depressive symptoms remained significantly associated with suicidal ideation when all correlates were integrated into one model. In the multivariate model in controls, depressive symptoms, positive symptoms, and traumatic childhood experiences were significantly associated with suicidal ideation.

CONCLUSIONS

This study showed that depressive symptoms are an important factor relating to suicidal ideation in individuals with FEP, over and above other clinical, sociodemographic, and developmental factors. This underscores the relevance of screening for suicidal ideation in individuals with FEP, and highlights the need for a better understanding of the diagnostic uncertainty and course of mood symptoms in early psychosis.

LIMITATIONS

Cross-sectional study design, self-reported questionnaires.

Childhood trauma associated with psychotic-like experiences among people living with HIV: The chain mediation effect of stigma and resilience

BACKGROUND

Previous research established the associations between childhood trauma and psychosis, but the effects of childhood trauma on psychotic-like experiences (PLEs) among people living with HIV (PLWH) and the potential mediation mechanisms in these associations remain unclear.

OBJECTIVE

This study aimed to investigate the effects of childhood trauma on PLEs, as well as the chain mediation roles of stigma and resilience in this relationship. Furthermore, we explored whether the aforementioned associations differed when hallucinatory experiences (HEs) and delusional experiences (DEs) were separately modeled.

PARTICIPANTS AND SETTING

The sample included 333 outpatients participants (95.2 % males, Mage = 28.24 ± 7.12) living with HIV recruited from Hunan Province, China; and data were collected with a cross-sectional survey.

METHOD

The hypothesized chain mediation models were examined using SPSS PROCESS macro 3.3 software.

RESULTS

Various influencing mechanisms of childhood trauma on HEs and DEs were examined in this study. Our results showed that, (a) childhood trauma directly exerted negative effect on HEs, while the chain mediation effect of stigma and resilience were not statistically significant. Conversely, (b) childhood trauma exerted no direct influence on DEs but rather through the chain mediation effect of stigma and resilience.

CONCLUSIONS

The identification of two different routes between that childhood trauma can have on HEs and DEs highlighted the importance of tailored prevention and intervention among PLWH with a history of childhood trauma.

The role of psychotic-like experiences in the association between aberrant salience and anxiety: A psychopathological proposal based on a case-control study

AIM

Aberrant salience (AS) and psychotic-like experiences (PLEs) have been proven to be linked. Moreover, anxiety is a key symptom in psychosis-prone subjects and most psychotic patients. We propose a model that attempts to interpret the role of PLEs in the association between AS and anxiety among healthy controls and psychotic patients.

METHODS

Demographic and psychometric data (Aberrant Salience Inventory, Community Assessment of Psychic Experiences, Symptom Check List-90-revised) from 163 controls and 44 psychotic patients was collected. Descriptive statistics, correlations, a linear regression model and a mediation analysis with covariates were subsequently performed.

RESULTS

AS correlated with more frequent positive PLEs and higher anxiety levels in both patients and controls. However, positive PLEs' frequency mediated the relationship between AS and anxiety only among controls.

CONCLUSIONS

PLEs linked to AS appear to induce anxiety among the control group but not among psychotic patients. The progressive loss of both novelty and insight, which may, respectively, impair the somatic emotional reactivity to PLEs and the ability to recognize some bodily phenomena as the embodied correlates of anxiety, is seen as the most probable theoretical explanation.

The contributions of risk-taking and impulsivity to jumping to conclusions in the psychosis spectrum

The jumping to conclusions (JTC) bias has been linked to the formation and maintenance of delusions across the psychosis spectrum. However, it remains unclear whether this bias reflects a primary cognitive deviation or is secondary to other cognitive processes. To this end, we investigated the relationship between JTC, risk-taking, impulsivity, and sensation seeking in individuals with psychotic-like experiences (PLEs) and controls. A large online community sample (N = 1151) completed the Fish Task as a measure for the JTC bias, as well as the Balloon Analogue Risk Task (BART) and the Brief Risk-Taking Propensity Scale (R-1) as measures of the propensity to take risks. Measures assessing impulsivity (Impulsive Behavior Scale-8, I-8), sensation seeking (Brief Sensation Seeking Scale, BSSS-4), and verbal intelligence (12-item Wordsum test) were also administered. We dichotomized the sample into extreme groups based on the positive subscale of the Community Assessment of Psychotic Experiences (CAPE). The present study confirms the existence of a JTC bias in psychosis-prone individuals. Of note, PLE-high individuals self-reported higher risk-taking propensity in the R-1 while at the same time displaying higher objective risk aversion in the BART relative to controls, speaking for a dissociation of subjective versus objective risk-taking behavior. PLE-high individuals showed deviances in other psychological traits (impulsivity, sensation seeking), but these were not associated with hasty decision-making as measured by JTC or risk-taking propensity. The results speak against impulsivity, sensation seeking, or verbal intelligence as driving mechanisms of JTC and risky decision-making.

Bidirectional associations between short sleep duration, insomnia symptoms, and psychotic-like experiences in adolescents

This study investigates the prospective associations between short sleep duration, insomnia symptoms, and psychotic-like experiences (PLEs) in a large sample of Chinese adolescents. This study utilized a three-timepoint repeated cross-sectional survey with two nested longitudinal subsamples. A total of 17,722 adolescents were assessed at baseline (April 21 to May 12, 2021) and six months later (December 17 to 26, 2021). Out of these, 15,694 adolescents provided complete responses to the questions at baseline and one year later (May 17 - June 6, 2022). A self-administered questionnaire was used to measure sample characteristics (at baseline), sleep duration, insomnia symptoms, and PLEs (at each assessment), and negative life events (at two follow-ups). Baseline short sleep duration and insomnia symptoms predicted frequent PLEs at both follow-up assessments. Additionally, baseline frequent PLEs also predicted insomnia symptoms at six months and one year later. However, when controlling for confounders, PLEs at baseline only predicted short sleep duration at six months, and not at one year. This study reveals bidirectional prospective relationships between short sleep duration, insomnia symptoms, and PLEs, even after controlling for covariates. Therefore, it is crucial to assess both sleep patterns and PLEs in order to promote optimal sleep and mental health among adolescents.

Variation of subclinical psychosis across 16 sites in Europe and Brazil: findings from the multi-national EU-GEI study

BACKGROUND

Incidence of first-episode psychosis (FEP) varies substantially across geographic regions. Phenotypes of subclinical psychosis (SP), such as psychotic-like experiences (PLEs) and schizotypy, present several similarities with psychosis. We aimed to examine whether SP measures varied across different sites and whether this variation was comparable with FEP incidence within the same areas. We further examined contribution of environmental and genetic factors to SP.

METHODS

We used data from 1497 controls recruited in 16 different sites across 6 countries. Factor scores for several psychopathological dimensions of schizotypy and PLEs were obtained using multidimensional item response theory models. Variation of these scores was assessed using multi-level regression analysis to estimate individual and between-sites variance adjusting for age, sex, education, migrant, employment and relational status, childhood adversity, and cannabis use. In the final model we added local FEP incidence as a second-level variable. Association with genetic liability was examined separately.

RESULTS

Schizotypy showed a large between-sites variation with up to 15% of variance attributable to site-level characteristics. Adding local FEP incidence to the model considerably reduced the between-sites unexplained schizotypy variance. PLEs did not show as much variation. Overall, SP was associated with younger age, migrant, unmarried, unemployed and less educated individuals, cannabis use, and childhood adversity. Both phenotypes were associated with genetic liability to schizophrenia.

CONCLUSIONS

Schizotypy showed substantial between-sites variation, being more represented in areas where FEP incidence is higher. This supports the hypothesis that shared contextual factors shape the between-sites variation of psychosis across the spectrum.

Does insecure attachment lead to psychosis via dissociation? A systematic review of the literature

PURPOSE

Insecure attachment may constitute a vulnerability factor for psychosis, and dissociation may be a key mechanism in the development of auditory hallucinations specifically. While there is good evidence for the role of these processes in isolation, it is unclear whether dissociation accounts for the association between insecure attachment and psychosis. This systematic review takes a theory-driven approach to examine proposed causal relationships across the clinical and nonclinical literature.

METHODS

We searched five databases (PubMeD, Web of Science, PsycINFO, CINAHL and ETHOS) for published and unpublished research examining attachment, dissociation and psychosis. Two independent reviewers extracted the data and assessed the quality of all included studies.

RESULTS

We identified 242 potential articles and included 13 in the final review (2096 participants). We found that (1) disorganised attachment was consistently associated with dissociation and inconsistently associated with voices and paranoia, (2) dissociation was associated with voices and paranoia, and these links were stronger in clinical samples, and (3) dissociation played a role in the impact of insecure attachment on voice hearing and paranoia in clinical groups.

CONCLUSIONS

This is the first review to synthesise the research examining attachment, dissociation, and psychosis. The evidence is consistent with proposed causal hypotheses and raises conceptual and measurement issues, for example, the need to clarify the relative contributions of different insecure attachment styles, and utilise behavioural/observational measures to strengthen study designs. Most importantly, we need experimental and longitudinal studies to confirm causal links and targets for treatment.

Distal and proximal risk factors of problematic cannabis use associated with psychotic-like experiences

BACKGROUND

Problematic cannabis use is associated with endorsement of psychotic-like experiences (PLEs) in non-clinical samples. However, little is known in regard to predictors of this relationship, which may be relevant to prevention and intervention. In the present research, we investigate impulsivity and cannabis use motives as potential distal and proximal risk factors for PLEs using conditional process analysis.

METHODS

Using an online cross-sectional survey of N = 300 students, we assessed endorsement of PLEs using the Community Assessment of Psychic Experiences (CAPE), problematic cannabis use with the Cannabis Use Disorder Identification Test (CUDIT-R), motivations for using cannabis with the Substance Use Motives Measure, and impulsivity using the Urgency and Premeditation, Perseverance, Sensation Seeking, Positive Urgency Impulsive Behaviour Scale (UPPS-P).

RESULTS

All three subscales on the CAPE were associated with significantly higher scores on the CUDIT-R. Before and after covarying for sex, we found that higher CUDIT-R scores mediated the relations between lack of perseverance and negative urgency impulsivity with higher PLE symptoms. Furthermore, the indirect effect of cannabis use on the relationship between lack of perseverance and high negative PLE symptoms was only significant at high and moderate levels of depression-coping, but not at low depression-coping motives.

CONCLUSION

Impulsivity and depression-coping motives may be distal and proximal psychological risk factors for negative PLEs in the context of problematic cannabis use. Our findings are in line with the broader substance use and mental health literature and may be informative for cannabis use treatment targets.

Response to psychotic experiences: Impact of personality traits on perceived levels of distress

BACKGROUND

This study examined the influence of personality traits on (subclinical) positive symptom distress in patients with a psychotic disorder, their unaffected siblings and healthy controls.

METHODS

Data were obtained from the Genetic Risk and Outcome of Psychosis study (GROUP), a Dutch longitudinal multicenter cohort study. Data from 140 patients, 216 unaffected siblings and 102 healthy controls was available for baseline levels of Five Factor Model personality traits and frequency and distress due to psychotic experiences three years later, assessed with the Community Assessment of Psychic Experience questionnaire. Main effects of all five personality traits on symptom distress were investigated as well as moderating effects of Neuroticism, Extraversion and Openness on positive symptom frequency and positive symptom distress. Age, gender, symptom frequency and IQ were controlled for.

RESULTS

In both patients and siblings, the observed main effects of Neuroticism and Openness on (subclinical) positive symptom distress three years later either lost significance or had a very small effect size when controlling for covariates, mainly due to the correction for the effect of positive symptoms on personality traits at baseline. In both groups, levels of Openness at baseline moderated the association between positive symptom frequency and positive symptom distress three years later, in the direction that higher levels of Openness were associated with weaker associations between positive symptom frequency and - distress, even when covariates were controlled for.

DISCUSSION

The level of Openness to Experiences influences the perceived distress from (subclinical) positive symptoms in both patients and siblings.

Body image as a mediator in the relationship between psychotic experiences and later disordered eating: A 12-month longitudinal study in high school adolescents

BACKGROUND

The relationship between psychosis and disordered eating remains a challenging area of research to which little interest was paid. Using longitudinal data, we aimed to explore the hypothesis that the pathways from psychotic experiences (PEs) to disordered eating (DE) and body-mass index (BMI) are mediated by body-image disturbances.

METHODS

A prospective longitudinal study was performed. High-school students (N = 510, 61.2% females, mean age of 16.05 ± 1.01 years) were asked to complete three scheduled assessments (Baseline, 6 months, and 12 months).

RESULTS

Two body image components, that is, Overweight Preoccupation and Body Area Satisfaction, mediated the prospective association between baseline PEs and DE 12 months later. Direct effects were significant. After accounting for indirect effects through more severe body image concerns at 6 months, higher baseline PEs were significantly associated with greater DE at 12 months. Baseline PEs and 6-month body image explained a significant proportion of variance in 12-month DE. However, we did not find evidence of a direct prospective association between PEs and BMI.

CONCLUSION

This study is the first to assess the mediating role of body image between PEs and DE. Findings offer promising new avenues for early intervention to help mitigate the effects of PEs on DE in adolescents.

The associations between daily reports of loneliness and psychotic experiences in the early risk stages for psychosis

AIM

Bi-directional associations between loneliness and psychotic experiences (PEs) have been reported, but the mechanisms underlying these associations are unknown. This study aims to explore associations between daily reports of loneliness and PEs, and test differences in this association across young adult individuals at different levels of risk for psychosis.

METHODS

We analysed 90-day diary data on loneliness and PEs from N = 96 participants (mean age 24.7, range 18-35, 77% female) divided into 4 subgroups, each indexing increased levels of risk for psychosis according to the clinical staging model: 'psychometric' (n = 25), 'low' (n = 27), 'mild' (n = 24), and 'ultra-high'(n = 20) risk. Multilevel vector autoregressive models examined within-day (contemporaneous) and between-day (temporal) associations between loneliness and PEs for the total sample. Next, these associations were compared across subgroups.

RESULTS

Loneliness and PEs were significantly associated contemporaneously (partial correlation B = 0.14) but not temporally. Subgroup membership moderated both contemporaneous and temporal associations. The contemporaneous association between loneliness and PEs was stronger in the low-risk subgroup compared to the mild-risk (B = -0.35, p < .01) and ultra-high-risk (B = -0.36, p < .01) subgroups. The temporal association between loneliness on the previous day and PEs on the current day was stronger in mild-risk subgroup compared to the ultra-high-risk subgroup (B = -0.03, p = .03). After adjusting for multiple testing, only the contemporaneous-but not the temporal-associations remained statistically significant.

CONCLUSIONS

Loneliness is associated with PEs in individuals at risk for psychosis, particularly in those with low to mild symptoms. Our findings tentatively suggest that especially individuals with low expressions of PEs may be more sensitive to social context, but future studies are needed to replicate and further unravel the potentially stage-specific interplay between social context and PEs.

Association Between Psychotic and Dissociative Symptoms: Further Investigation Using Network Analysis

The association and overlap between psychotic and dissociative phenomena have been increasingly recognized. Previous studies found that psychotic symptoms are closely associated with post-traumatic and dissociative symptoms and that these trauma-related phenomena may mediate the relationship between trauma and psychotic symptoms. It remained less explored which specific post-traumatic and dissociative symptom clusters are particularly associated with psychotic symptoms. This cross-sectional study used a data-driven approach (network analysis) to explore the associations among different psychotic and post-traumatic/dissociative symptom clusters in an online convenience predominantly female sample (N = 468)(59.2% had ever seen a psychiatrist). Participants completed well-established multidimensional measures that assessed different symptom clusters of psychosis, dissociation, and PTSD. In addition, multiple mediation analysis was conducted to examine which post-traumatic/dissociative symptoms could mediate the relationship between childhood and adulthood trauma and different psychotic symptoms. Our results confirmed previous findings that PTSD and dissociative symptoms are closely associated with psychotic symptoms. More importantly, both data-driven and multiple mediation analysis results indicated that identity dissociation was particularly associated with perceptual anomalies and bizarre experiences, while emotional constriction was particularly associated with negative symptoms. It is important to screen for trauma and dissociation and provide trauma-and dissociation-informed care when working with people at risk of or experiencing psychosis. Further longitudinal studies using more representative samples are needed.

The relationship between cyberbullying perpetration/victimization and suicidal ideation in healthy young adults: the indirect effects of positive and negative psychotic experiences

BACKGROUND

Even though not all cyber bullies or victims think of (or consider) suicide, they clearly appear to be at an increased risk. One possible strategy to reduce suicide risk is to decrease cyberbullying occurrence; but this approach has its limitations, as it is certainly an illusion to believe that cyberbullying could be controlled or eliminated in a digitalized world. Another alternative and interesting strategy is to consider mediating factors that may indirectly affect suicidality. To this end, our purpose was to test the hypothesis that positive and negative psychotic experiences (PEs) mediate the relationship from cyberbullying perpetration/victimization to suicidal ideation (SI).

METHOD

The study followed a cross-sectional design, and was conducted during the period from June to September 2022. A total of 3103 healthy community participants from Lebanon were included (mean age 21.73 ± 3.80 years, 63.6% females).

RESULTS

After adjusting over potential confounders, mediation analysis models showed that both positive and negative PEs partially mediated the associations between cyberbullying victimization/perpetration and SI. Higher cyberbullying perpetration and victimization were significantly associated with greater positive and negative PEs; more severe positive and negative PEs were significantly associated with higher levels of SI. Higher cyberbullying victimization and perpetration were significantly and directly associated with higher levels of SI.

CONCLUSION

In light of our preliminary findings, there appears to be an urgent need for a new focus on carefully assessing and addressing attenuated psychotic symptoms in healthy individuals engaged in cyberbullying either as victims or bullies and who present with SI. It is important that school counselors and decision-makers consider a holistic approach taking into account both external/environmental (bullying) and internal/individual (PEs) factors in their suicide prevention programs. Future longitudinal research in larger samples are still required to confirm our findings and further elucidate the mechanisms underlying the relationship between cyberbullying and suicide.

The state-trait sense of self inventory: A psychometric study of self-experience and its relation to psychosis-like manifestations

The sense of self is a fundamental construct in the study of the mind, yet its psychological nature remains elusive. We introduce a novel 25-item inventory to investigate selfhood both as an enduring trait and a temporary state. We hypothesized two foundational aspects of the self: identity (related to self-referencing and continuity over time) and agency (the perception of controlling own's actions and thoughts). Results from two population studies highlight a singular self-trait factor combining agency and identity. In contrast, self-state measures revealed a bifactorial structure with a high-order factor and three lower-order subfactors: state-identity, state-agency, and state-technology. These factors were predictive of psychosis-like experiences, schizotypal traits, and hopelessness. Mediation analysis demonstrated that the negative association between the sense of self and hopelessness is mediated by depressive manifestations. Our research provides a tool to shed new light on the complexity of the sense of self and its mental health implications.

Childhood Anxiety Symptoms as a Predictor of Psychotic Experiences in Adolescence in a High-Risk Cohort for Psychiatric Disorders

Background and Hypothesis

When occurring in adolescence, psychotic experiences (PE), subclinical psychotic symptoms, can be an early marker of mental illnesses. Studies with high-risk populations for psychosis show that anxiety symptoms often precede the onset of psychosis. Although anxiety symptoms are frequently experienced across the continuum of psychosis, no previous study has analyzed this association using a cross-lagged panel model (CLPM) longitudinally to identify if anxiety can be a predictor of PE over time or vice versa. The aim of the current study was to investigate whether one symptom domain predicts the other over time.

Study Design

2194 children from the Brazilian High-Risk Cohort (BHRC) were evaluated at baseline (T 0), and 76.5% completed a 3-year follow-up (T 1) interview. Childhood anxiety symptoms and PE were assessed using a standardized self-report questionnaire at both time points. Cross-lagged panel models evaluated time-lagged associations between PE and anxiety longitudinally.

Study Results

Higher levels of anxiety in childhood predicted an increase in PE levels in adolescence. The cross-lagged effect of anxiety scores at T 0 on PE scores at T 1 was significant (β = .03, SE = 0.01, P ≤ .001) and PE in childhood did not increase levels of anxiety in adolescence, when controlling for sociodemographic and clinical characteristics.

Conclusions

Our findings reinforce that anxiety may represent an early marker of psychosis proneness, not a consequence of already presenting PE, which can help to develop better screening approaches. Therefore, future studies should focus on identifying biological or other clinical markers to increase prediction accuracy.

Association Between Juvenile Psychotic Experiences and Problematic Gaming

Background and Hypothesis

Problematic gaming (PG) is an emerging mental health condition associated with significant adverse outcomes. Even though PG has been linked to other psychiatric disorders, its association with psychotic experiences (PEs) remains poorly explored to date. The aim of our study was to examine the association between both conditions in a large Brazilian community sample. We hypothesized that adolescents with PG were more likely to report PE compared with those without the disorder.

Study Design

Our investigation was based on a cross-sectional subsample of a large Brazilian cohort (n = 1616; 13- to 21-year age range). Using the 7-item version of the Game Addiction Scale, participants were classified according to their gaming status: no PG, PG, or gaming addiction (GA). The association between PG, GA, and PE was assessed through linear regression analyses, which were adjusted for the presence of significant covariates, including other psychiatric conditions.

Study Results

9.5% (n = 154) presented PG and 2.7% (n = 43) had GA. 28.0% received any Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnosis and the mean PE score was 9.39 (SD = 4.35). Participants presenting PG had greater levels of PE, compared with participants with no PG, even controlled by sociodemographic variables and the presence of any DSM-IV diagnosis (b = 0.96, 95% CI = 0.17-1.75, P = .017).

Conclusions

According to our results, PG was significantly associated with PE, even in the presence of other covariates. Although preliminary, these results suggest that PG and PE may have shared neurobiological and/or behavioral pathways.

Effects of an eating club for people with a psychotic disorder on personal recovery: Results of a randomized controlled trial

BACKGROUND AND OBJECTIVES

Many people with a psychotic disorder are coping with severe psychosocial limitations related to their illness. The current randomized controlled trial (RCT) investigates the effects of an eating club intervention (HospitalitY (HY)) aimed to improve personal and societal recovery.

METHODS

In 15 biweekly sessions participants received individual home-based skill training and guided peer support sessions in groups of three participants from a trained nurse. A multi-center RCT was conducted (intended sample size: n = 84; n = 7 per block) in patients with a diagnosis of schizophrenia spectrum receiving community treatment. HospitalitY was compared to a Waiting List Control (WLC) condition at three time points (baseline, end-of-treatment (8 months) and follow-up (12 months)) using personal recovery as primary outcome and loneliness, social support, self-stigma, self-esteem, social skills, (social) functioning, independency competence, and psychopathology as secondary outcomes. Outcomes were evaluated with a mixed modeling statistical procedure.

RESULTS

The HY-intervention had no significant effects on personal recovery or secondary outcomes. More attendance was associated with higher scores on social functioning.

LIMITATIONS

With N = 43 participants included, power was insufficient. Seven HY-groups were started, from which three discontinued before the sixth meeting, one HY group stopped due the start of the COVID-19 pandemic.

CONCLUSIONS

Despite a promising pilot study on feasibility, the current RCT did not show any effects of the HY intervention. A mixed qualitative-quantitative research methods might be more appropriate for researching the HospitalitY-intervention to investigate what social and cognitive processes are at play in this peer guided social intervention.

Schizophrenia polygenic risk score in psychosis proneness

Schizophrenia (SZ) is a complex disorder with a highly polygenic inheritance. It can be conceived as the extreme expression of a continuum of traits that are present in the general population often broadly referred to as schizotypy. However, it is still poorly understood how these traits overlap genetically with the disorder. We investigated whether polygenic risk for SZ is associated with these disorder-related phenotypes (schizotypy, psychotic-like experiences, and subclinical psychopathology) in a sample of 253 non-clinically identified participants. Polygenic risk scores (PRSs) were constructed based on the latest SZ genome-wide association study using the PRS-CS method. Their association with self-report and interview measures of SZ-related traits was tested. No association with either schizotypy or psychotic-like experiences was found. However, we identified a significant association with the Motor Change subscale of the Comprehensive Assessment of At-Risk Mental States (CAARMS) interview. Our results indicate that the genetic overlap of SZ with schizotypy and psychotic-like experiences is less robust than previously hypothesized. The relationship between high PRS for SZ and motor abnormalities could reflect neurodevelopmental processes associated with psychosis proneness and SZ.

The dynamics of social activation and suspiciousness in individuals at ultra-high risk for psychosis

INTRODUCTION

Social functioning is often impaired during the ultra-high risk (UHR) phase for psychosis, but group-level studies regarding the role of social functioning in transition to psychosis are inconsistent. Exploring the inter-individual differences which underlie the association between social functioning and psychotic symptoms in this phase could yield new insights.

OBJECTIVE

To examine the idiographic and dynamic association between social activation and suspiciousness in individuals at UHR for psychosis using time-series analysis.

METHODS

Twenty individuals at UHR for psychosis completed a diary application every evening for 90 days. Two items on social activation (quantity: 'time spent alone' and quality: 'feeling supported') and two items on suspiciousness ('feeling suspicious' and 'feeling disliked') were used. Time series (T = 90) of each individual were analyzed using vector auto regression analysis (VAR), to estimate the lagged (over 1 day) effect of social activation on suspiciousness, and vice versa, as well as their contemporaneous associations.

RESULTS

Heterogeneous person-specific associations between social activation and suspiciousness were found in terms of strength, direction and temporal aspects.

CONCLUSIONS

The association between social activation and suspiciousness differs amongst individuals who are at UHR for psychosis. These findings underline the importance of tailoring psychosocial interventions to the individual. Future studies may examine whether using results of single-subject studies in clinical practice to personalize treatment goals leads to better treatment outcomes.

The effect of SARS-CoV-2 virus on resting-state functional connectivity during adolescence: Investigating brain correlates of psychotic-like experiences and SARS-CoV-2 related inflammation response

We first aimed to investigate resting-state functional connectivity (rs-FC) differences between adolescents exposed to SARS-CoV-2 and healthy controls. Secondly, the moderator effect of PLEs on group differences in rs-FC was examined. Thirdly, brain correlates of inflammation response during acute SARS-CoV-2 infection were investigated. Eighty-two participants aged between 14 and 24 years (SARS-CoV-2 (n = 35), controls (n = 47)) were examined using rs-fMRI. Seed-based rs-FC analysis was performed. The positive subscale of Community Assessment of Psychotic Experiences-42 (CAPE-Pos) was used to measure PLEs. The SARS-CoV-2 group had a lesser rs-FC within sensorimotor network (SMN), central executive network (CEN) and language network (LN), but an increased rs-FC within visual network (VN) compared to controls. No significant differences were detected between the groups regarding CAPE-Pos-score. However, including CAPE-Pos as a covariate, we found increased rs-FC within CEN and SN in SARS-CoV-2 compared to controls. Among the SARS-CoV-2 group, neutrophil/lymphocyte and thrombocyte*neutrophil/lymphocyte ratio was correlated with decreased/increased FC within DMN and SN, and increased FC within CEN. Our results showed rs-FC alterations within the SMN, CEN, LN, and VN among adolescents exposed to SARS-CoV-2. Moreover, changes in rs-FC associated with PLEs existed in these adolescents despite the absence of clinical changes. Furthermore, inflammation response was correlated with alterations in FC within the triple network system.

Relating stability of individual dynamical networks to change in psychopathology

One hypothesis flowing from the network theory of psychopathology is that symptom network structure is associated with psychopathology severity and in turn, one may expect that individual network structure changes with the level of psychopathology severity. However, this expectation has rarely been addressed directly. This study aims to examine (1) the stability of individual contemporaneous symptom networks over a one-year period and (2) whether network stability is associated with a change in psychopathology. We used daily diary data of n = 66 individuals, located along the psychosis severity continuum, from two separate 90-day periods, one year apart (t = 180). Based on the newly developed Individual Network Invariance Test (INIT) to assess symptom-network stability, participants were divided into two groups with stable and unstable networks and we tested whether these groups differed in their absolute change in psychopathology severity. The majority of the sample (n = 51, 77.3%) showed a stable network over time while most individuals showed a decrease in psychopathological severity. We found no significant association between a change in psychopathology severity and individual network stability. Our results call for further critical evaluation of the association between networks and psychopathology to optimize the implementation of clinical applications based on current methods.

Cross-sectional association between metabolic parameters and psychotic-like experiences in a population-based sample of middle-aged and elderly individuals

BACKGROUND

Metabolic alterations are often found in patients with clinical psychosis early in the course of the disorder. Psychotic-like experiences are observed in the general population, but it is unclear whether these are associated with markers of metabolism.

METHODS

A population-based cohort of 1890 individuals (mean age 58.0 years; 56.3% women) was included. Metabolic parameters were measured by body-mass index (BMI), concentrations of low-density and high-density lipoprotein cholesterol (LDL-C and HDL-C), total cholesterol, triglycerides, and fasting glucose and insulin in blood. Frequency and distress ratings of psychotic-like experiences from the positive symptom dimension of the Community Assessment of Psychic Experience questionnaire were assessed. Cross-sectional associations were analysed using linear regression analyses.

RESULTS

Higher BMI was associated with higher frequency of psychotic-like experiences (adjusted mean difference: 0.04, 95% CI 0.02-0.06) and more distress (adjusted mean difference: 0.02, 95% CI 0.01-0.03). Lower LDL-C was associated with more psychotic-like experiences (adjusted mean difference: -0.23, 95% CI -0.40 to -0.06). When restricting the sample to those not using lipid-lowering medication, the results of BMI and LDL-C remained and an association between lower HDL-C and higher frequency of psychotic-like experiences was found (adjusted mean difference: -0.37, 95% CI -0.69 to -0.05). We observed no significant associations between cholesterol, triglycerides, glucose, insulin or homeostatic model assessment and psychotic-like experiences.

CONCLUSIONS

In a population-based sample of middle-aged and elderly individuals, higher BMI and lower LDL-C were associated with psychotic-like experiences. This suggests that metabolic markers are associated with psychotic-like experiences across the vulnerability spectrum.

The added value of daily diary data in 1- and 3-year prediction of psychopathology and psychotic experiences in individuals at risk for psychosis

This study aimed to assess whether adding information on psychological experiences derived from a daily diary to baseline cross-sectional data could improve short- (1-year) and long-term (3-years) prediction of psychopathology and positive psychotic experiences (PEs). We used 90-day daily diary data from 96 individuals in early subclinical risk stages for psychosis. Stepwise linear regression models were built for psychopathology and PEs at 1- and 3-years follow-up, adding: (1) baseline questionnaires, (2) the mean and variance of daily psychological experiences, and (3) individual symptom network density. We assessed whether similar results could be achieved with a subset of the data (7-14- and 30-days). The mean and variance of the diary improved model prediction of short- and long-term psychopathology and PEs, compared to prediction based on baseline questionnaires solely. Similar results were achieved with 7-14- and 30-day subsets. Symptom network density did not improve model prediction except for short-term prediction of PEs. Simple metrics, i.e., the mean and variance from 7 to 14 days of daily psychological experiences assessments, can improve short- and long-term prediction of both psychopathology and PEs in individuals in early subclinical stages for psychosis. Diary data could be a valuable addition to clinical risk prediction models for psychopathology development.

Comparing two measures of schizotypy and their relationship with psychological distress in British university students

AIMS

Schizotypy reflects the vulnerability to schizophrenia in the general population. Different questionnaires have been developed to measure aspects of schizotypy. Higher schizotypy scores have also been linked with depression, anxiety, and stress sensitivity. Here we examine the associations of schizotypy with symptoms of depression and anxiety in a sample of university students, using two different measures (N = 271).

METHODS

A series of confirmatory factor analyses was used to examine two distinct and frequently employed measures of schizotypy: the Community Assessment of Psychic Experiences (CAPE), and the Schizotypy Personality Questionnaire (SPQ). We assessed their relationship with each other and their predictive validity for anxiety, depression, and stress sensitivity.

RESULTS

Our results indicated the brief 7-factor SPQ (SPQ-BR) factor solution for the SPQ and the 15-item and 3 factor solution for the CAPE (i.e., CAPE-P15) as best fitting models. Particularly the CAPE dimension of persecutory ideation was a strong predictor of anxiety, depression, and stress sensitivity, whereas the SPQ dimensions of no close friends and social anxiety predicted psychological distress and stress in our student sample.

CONCLUSIONS

Our findings extend earlier work in general and patient samples and point to the importance of understanding the contribution of particularly positive schizotypy symptoms and different interpersonal aspects to psychological distress.

Profile and mental health characterization of childhood overprotection/overcontrol experiences among Chinese university students: a nationwide survey

Introduction

The childhood experiences of being overprotected and overcontrolled by family members have been suggested to be potentially traumatic. However, the possible associated factors of these experiences among young people are still not well studied. This study aimed to partly fill such gaps by a relatively large, nationwide survey of Chinese university students.

Methods

A total of 5,823 university students across nine different provinces in China were included by the convenience sampling method in the data analyses. All participants completed the overprotection/overcontrol (OP/OC) subscale in a recently developed 33-item childhood trauma questionnaire (CTQ- 33). Data were also collected on all participants' socio-demographic profiles and characterization of mental health. Binary logistic regression was conducted to investigate the associated socio-demographic and psychological factors of OP/ OC.

Results

The prevalence of childhood OP/OC was estimated as 15.63% (910/5,823) based on a cutoff OP/OC subscale score of  ≥ 13. Binary logistic regression suggested that being male, being a single child, having depression, having psychotic-like experiences, lower family functioning, and lower psychological resilience were independently associated with childhood OP/OC experiences (all corrected-p < 0.05). The OP/OC was also positively associated with all the other trauma subtypes (abuses and neglects) in the CTQ-33, while there are both shared and unique associated factors between the OP/OC and other trauma subtypes. Post-hoc analyses suggested that OP/OC experiences were associated with depression in only females and associated with anxiety in only males.

Discussion

Our results may provide initial evidence that childhood OP/OC experiences would have negative effects on young people's mental health which merits further investigations, especially in clinical populations.

Being more satisfied with romantic relationship status is associated with increased mental wellbeing in people with experience of psychosis

Aims

Romantic relationships represent one of the most salient sources of social support. In general population studies, they are associated with both physical and psychological benefits. Research suggests that for people with psychosis, romantic relationships may also have a positive impact on a range of outcomes, but the reasons for these associations are still unclear. This study aims to investigate whether satisfaction with romantic relationships status is associated with better wellbeing outcomes in people with experience of psychosis and explore three possible psychological mediators of this relationship.

Methods

Participants who had previously sought support for psychosis (n = 190) completed an online survey including measures of relationship status satisfaction (the Satisfaction with Relationship Scale) as well as measures of psychotic symptoms (the CAPE-42), general well-being (Short Warwick-Edinburgh Mental Wellbeing Scale) and several psychological variables relevant to the pathway between romantic relationships and well-being outcomes, namely loneliness, internalised stigma, self-esteem and attachment.

Results

Fearful attachment and partner criticism were negatively associated with relationship status satisfaction. Having a partner was positively associated with relationship status satisfaction. Higher levels of relationship status satisfaction were associated with lower psychotic symptoms and higher mental wellbeing. This relationship was mediated by loneliness, internalised stigma, and self-esteem.

Conclusion

Mental health services should be mindful of the associations between romantic relationship satisfaction and wellbeing. Service users with a fearful attachment style may particularly benefit from support in this area.

Sexual orientation and psychotic-like experiences among Chinese college students: the role of gender

Objective

The mental health of sexual minorities has received increasing attention, but there are few studies on the risk of psychotic-like experiences (PLEs) among sexual minorities. The purpose of this study is to explore the relationship between different sexual orientations and PLEs among college students and the moderating effect of gender.

Methods

A total of 4,460 college students from seven provinces participated in this cross-sectional survey. The χ2 test and logistic regression were used to investigate the relationship between sexual orientation and PLEs.

Results

Of the participants, 4.9% identified as bisexual, 1.1% as lesbian/gay, and 5.6% were questioning/unsure; 60.1% of the sample experienced at least one PLE item, 59.2% reported delusional experiences (DEs), and 20.6% had hallucinatory experiences (HEs). Compared with heterosexual college students, bisexual and questioning students showed a higher risk of PLEs, DEs, and HEs, and lesbian/gay students showed a higher risk of HEs. Stratified analysis indicated that sexual orientation was significantly associated with PLEs only for female college students.

Conclusion

Sexual orientation is a predictive factor of PLEs. In particular, different sexual minority subgroups show the different effects on PLEs between male and female college students. Mental health interventions for PLEs could employ distinct strategies based on different sexual orientations and gender disparity.

Psychometric Properties and Diagnostic Associations of the Short-Form Community Assessment of Psychic Experiences in a Population-Based Sample of 29 021 Adult Men

BACKGROUND AND HYPOTHESIS

Around 5%-7% of the adult population are estimated to have lifetime psychotic experiences (PEs), which are associated with psychosis risk. PEs assessed with Community Assessment of Psychic Experiences (CAPE) are associated with psychosis but also non-psychotic disorders, which could be partly explained by CAPE indirectly capturing emotional symptoms. We investigated the psychometric properties of a shorter version, CAPE-9, and whether CAPE-9 scores are associated with lifetime psychotic or non-psychotic mental disorders after controlling for current anxiety and depressive symptoms.

DESIGN

CAPE-9 questionnaire data were obtained from 29 021 men (42.4 ± 5.6 yrs.) from the Norwegian Mother, Father, and Child Cohort Study. We investigated CAPE-9 reliability and factor structure. Logistic regression was used to test effects of current anxiety and depressive symptoms (SCL-12) on associations between CAPE-9 scores and psychiatric diagnoses.

RESULTS

CAPE-9 fit a previously reported 3-factor structure and showed good reliability. Twenty-six percent reported at least one lifetime PE. CAPE-9 scores were significantly associated with most psychiatric disorders (schizophrenia, depression, bipolar disorder, substance abuse, anxiety, trauma-related disorders, and ADHD). After controlling for concurrent emotional symptoms, only associations with schizophrenia (OR = 1.29; 95% CI = 1.18-1.38) and trauma-related disorders (OR = 1.09; CI = 1.02-1.15) remained significant.

CONCLUSIONS

CAPE-9 showed good psychometric properties in this large population-based adult male sample, and PEs were more clearly associated with psychotic disorders after controlling for current emotional symptoms. These results support the use of the short CAPE-9 as a cost-effective tool for informing public health initiatives and advancing our understanding of the dimensionality of psychosis.

Dissecting Schizotypy and Its Association With Cognition and Polygenic Risk for Schizophrenia in a Nonclinical Sample

Schizotypy is a multidimensional construct that captures a continuum of risk for developing schizophrenia-spectrum psychopathology. Existing 3-factor models of schizotypy, consisting of positive, negative, and disorganized dimensions have yielded mixed evidence of genetic continuity with schizophrenia using polygenic risk scores. Here, we propose an approach that involves splitting positive and negative schizotypy into more specific subdimensions that are phenotypically continuous with distinct positive symptoms and negative symptoms recognized in clinical schizophrenia. We used item response theory to derive high-precision estimates of psychometric schizotypy using 251 self-report items obtained from a non-clinical sample of 727 (424 females) adults. These subdimensions were organized hierarchically using structural equation modeling into 3 empirically independent higher-order dimensions enabling associations with polygenic risk for schizophrenia to be examined at different levels of phenotypic generality and specificity. Results revealed that polygenic risk for schizophrenia was associated with variance specific to delusional experiences (γ = 0.093, P = .001) and reduced social interest and engagement (γ = 0.076, P = .020), and these effects were not mediated via the higher-order general, positive, or negative schizotypy factors. We further fractionated general intellectual functioning into fluid and crystallized intelligence in 446 (246 females) participants that underwent onsite cognitive assessment. Polygenic risk scores explained 3.6% of the variance in crystallized intelligence. Our precision phenotyping approach could be used to enhance the etiologic signal in future genetic association studies and improve the detection and prevention of schizophrenia-spectrum psychopathology.

The effects of assessing character strengths vs. psychopathology on mood, hope, perceived stigma and cognitive performance in individuals with psychosis

OBJECTIVES

The main objective of the present study was to investigate whether assessments of psychopathology vs. character strengths were associated with systematic differences concerning transient psychological states (i.e., cognitive performance, state mood, optimism, therapy motivation, perceived stigma) in individuals with psychotic disorders. An additional goal was to evaluate the acceptance and appraisal of a subsequent online character-strength intervention, consisting of top-two strengths feedback, and to explore associations between character strengths and psychotic symptoms. The study thus aimed to contribute to the discussion on the extension of current treatment approaches for schizophrenia through positive psychological interventions.

METHODS

The study was implemented online applying a randomized within-subject cross-over design in N = 39 patients with self-reported psychosis. After a baseline assessment, briefly capturing psychological states (including cognition: TMT A/B, positive and negative affect, motivation for change/ therapy, optimism, and self-stigma) participants were randomly assigned to a first questionnaire block, which addressed either individual character strengths (VIA-IS) or psychopathology (CAPE & BSI). This was followed by a second, brief assessment of transient psychological states, whereafter the second questionnaire block was conducted, this time with the respective opposite (strengths or psychopathology) assessment. A final psychological states assessment was conducted. Afterwards, participants received feedback on their top-two strengths and a brief psycho-education, followed by a qualitative assessment.

RESULTS

Contrary to expectations, there were no differences between the psychological states after the pathology vs. character strengths assessment blocks. Character strengths mainly correlated negatively with negative symptoms, with medium to large effect sizes. Participants were generally satisfied with the intervention and rated a focus on personal strengths in psychotherapy as highly important.

CONCLUSION

Our main hypothesis stating that the assessment of character strengths (vs. psychopathology) is associated with differences in subsequent psychological states could not be confirmed. Qualitative findings indicate that the emphasis on individual character strengths interventions is well accepted and viewed as important. The associations of character strengths with negative symptoms are important from the background of the cognitive model or defeatist beliefs (e.g., amotivation due to perceiving the self as 'incapable'), which could be addressed in experimental or intervention studies targeting character strengths.

Insomnia and distress as mediators on the relationship from cyber-victimization to self-reported psychotic experiences: a binational study from Tunisia and Lebanon

BACKGROUND

While expansive research has accumulated concerning the association between traditional, face-to-face peer victimization and psychosis, a paucity of empirical research has been undertaken so far to investigate these associations with experiences of new and evolving ways of victimization through the digital world. Exploring these associations is highly relevant and timely, given that emerging adults are heavy users of digital technologies, highly exposed to online risks, and are at the peak age of onset of psychosis. This study aimed to test the hypothesis that psychological distress and insomnia symptoms have a significant indirect mediating effect on the association between cyber-victimization and self-reported positive psychotic experiences (SRPEs) in a binational sample of Tunisian and Lebanese community adults.

METHOD

The total sample was composed of 3766 participants; 3103 were from Lebanon (Mean age: 21.73 ± 3.80 years, 63.6% females) and 663 from Tunisia (Mean age: 26.32 ± 4.86 years, 59.9% females). Online anonymous self-report questionnaires were administered to all participants.

RESULTS

Higher SRPEs were found in Lebanese participants compared to Tunisians, in single participants compared to married ones, in those with a university level of education compared to secondary or less, in those who live in rural areas compared to urban, in those who do not smoke, do not drink alcohol and do not use marijuana or any other illegal drug. Furthermore, more cyber-victimization, a higher insomnia severity and psychological distress were significantly associated with higher SRPEs. After adjusting for potential confounders, mediation analysis demonstrated that higher cyber-victimization was significantly associated with more insomnia severity/psychological distress; which were, in turn, significantly associated with greater SRPEs. Finally, more cyber-victimization was significantly and directly associated with more positive dimension.

CONCLUSION

Identifying insomnia and distress as mediators could provide novel insight for psychosis prevention efforts and intervention targets for cyber-victimized individuals prone to experience subclinical psychotic symptoms.

Six-year trajectories and associated factors of positive and negative symptoms in schizophrenia patients, siblings, and controls: Genetic Risk and Outcome of Psychosis (GROUP) study

Positive and negative symptoms are prominent but heterogeneous characteristics of schizophrenia spectrum disorder (SSD). Within the framework of the Genetic Risk and Outcome of Psychosis (GROUP) longitudinal cohort study, we aimed to distinguish and identify the genetic and non-genetics predictors of homogenous subgroups of the long-term course of positive and negative symptoms in SSD patients (n = 1119) and their unaffected siblings (n = 1059) in comparison to controls (n = 586). Data were collected at baseline, and after 3- and 6-year follow-ups. Group-based trajectory modeling was applied to identify latent subgroups using positive and negative symptoms or schizotypy scores. A multinomial random-effects logistic regression model was used to identify predictors of latent subgroups. Patients had decreasing, increasing, and relapsing symptoms course. Unaffected siblings and healthy controls had three to four subgroups characterized by stable, decreasing, or increasing schizotypy. PRSSCZ did not predict the latent subgroups. Baseline symptoms severity in patients, premorbid adjustment, depressive symptoms, and quality of life in siblings predicted long-term trajectories while were nonsignificant in controls. In conclusion, up to four homogenous latent subgroups of symptom course can be distinguished within patients, siblings, and controls, while non-genetic factors are the main factors associated with the latent subgroups.

A latent profile analysis of sleep disturbance in relation to mental health among college students in China

Aims

This study aimed to examine the subtype classification characteristics of sleep disturbance (SD) in college students and their associations with sample characteristic factors and mental health outcomes.

Methods

The sample comprised 4,302 college students (Mean age = 19.92 ± 1.42 years, 58.6% females). The Youth Self-Rating Insomnia Scale, Beck Depression Inventory, 8-item Positive Subscale of the Community Assessment of Psychic Experiences, and 10-item Connor-Davidson Resilience Scale were used to assess adolescents' sleep disturbance, depressive symptoms, psychotic-like experiences (PLEs), and resilience. Latent profile analysis, logistic regression, and liner regression analysis were used to analyze the data.

Results

Three subtypes of SD in college students were identified: the high SD profile (10.6%), the mild SD profile (37.5%), and the no SD profile (51.9%). Compared with college students in the "no SD" profile, risk factors for "high SD" include being male and poor parental marital status. Sophomores were found to predict the "high SD" profile or "mild SD" profile relative to the "no SD" profile. College students in the "mild SD" profile or "high SD" profile were more likely to have a higher level of depressive symptoms and PLEs, while a lower level of resilience.

Conclusion

The findings highlighted that target intervention is urgently needed for male college students, sophomores, and those with poor parental marital status in the "mild SD" profile or "high SD" profile.

Exploring psychological and psychosocial correlates of non-suicidal self-injury and suicide in college students using network analysis

BACKGROUND

Non-suicidal self-injury (NSSI) and suicide are a serious health concern in young people. Remarkable progress has been made in understanding the correlates and risk factors for suicidality. However, it remains unclear the complex interplay between different factors and which factors are most saliently associated with NSSI and suicide risk and should be targeted for interventions.

METHODS

This study utilized network analysis to examine the interrelationship between NSSI, suicide and a variety of psychological (e.g., depression, psychotic-like experiences) and psychosocial (e.g., childhood maltreatment, family dysfunction, being bullied and social support) correlates in a sample of Chinese first year college students (n = 2328).

RESULTS

The severity of depressive symptoms was the only factor connected to both NSSI and suicide. Other psychiatric factors like psychotic experiences could only act in an indirect way via the bridging effect of depression. Emotional abuse, compared with other forms of childhood adversities, was found to be the most influential maltreatment form associated with suicidal ideation and attempts. Finally, social support showed the potential to lower the risk of self-injury and suicide in young people.

LIMITATIONS

Only a subset of risk and resilience factors of NSSI and suicide were included. Causal inference was impossible due to the cross-sectional design.

CONCLUSIONS

Our findings highlighted the importance of identifying risk groups with mental illnesses or negative childhood events, and providing additional support during the key time of transitioning into higher education.

Inferential Emotion Tracking reveals impaired context-based emotion processing in individuals with high Autism Quotient scores

Emotion perception is essential for successful social interactions and maintaining long-term relationships with friends and family. Individuals with autism spectrum disorder (ASD) experience social communication deficits and have reported difficulties in facial expression recognition. However, emotion recognition depends on more than just processing face expression; context is critically important to correctly infer the emotions of others. Whether context-based emotion processing is impacted in those with Autism remains unclear. Here, we used a recently developed context-based emotion perception task, called Inferential Emotion Tracking (IET), and investigated whether individuals who scored high on the Autism Spectrum Quotient (AQ) had deficits in context-based emotion perception. Using 34 videos (including Hollywood movies, home videos, and documentaries), we tested 102 participants as they continuously tracked the affect (valence and arousal) of a blurred-out, invisible character. We found that individual differences in Autism Quotient scores were more strongly correlated with IET task accuracy than they are with traditional face emotion perception tasks. This correlation remained significant even when controlling for potential covarying factors, general intelligence, and performance on traditional face perception tasks. These findings suggest that individuals with ASD may have impaired perception of contextual information, it reveals the importance of developing ecologically relevant emotion perception tasks in order to better assess and treat ASD, and it provides a new direction for further research on context-based emotion perception deficits in ASD.

Cognitive Processes and Resting-State Functional Neuroimaging Findings in High Schizotypal Individuals and Schizotypal Personality Disorder Patients: A Systematic Review

Ample research findings indicate that there is altered brain functioning in the schizophrenia spectrum. Nevertheless, functional neuroimaging findings remain ambiguous for healthy individuals expressing high schizotypal traits and patients with schizotypal personality disorder (SPD). The purpose of this systematic review was to identify patterns of task-related and resting-state neural abnormalities across these conditions. MEDLINE-PubMed and PsycINFO were systematically searched and forty-eight studies were selected. Forty studies assessed healthy individuals with high schizotypal traits and eight studies examined SPD patients with functional neuroimaging techniques (fNIRS; fMRI; Resting-state fMRI). Functional alterations in striatal, frontal and temporal regions were found in healthy individuals with high schizotypal traits. Schizotypal personality disorder was associated with default mode network abnormalities but further research is required in order to better conceive its neural correlates. There was also evidence for functional compensatory mechanisms associated with both conditions. To conclude, the findings suggest that brain dysfunctions are evident in individuals who lie along the subclinical part of the spectrum, further supporting the continuum model for schizophrenia susceptibility. Additional research is required in order to delineate the counterbalancing processes implicated in the schizophrenia spectrum, as this approach will provide promising insights for both conversion and protection from conversion into schizophrenia.

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.

Protocol for the development and testing of the schiZotypy Autism Questionnaire (ZAQ) in adults: a new screening tool to discriminate autism spectrum disorder from schizotypal disorder

BACKGROUND

Autism spectrum disorder (ASD) and schizotypal disorder (SD) both have a heterogenous presentation, with significant overlaps in symptoms and behaviour. Due to elevated recognition and knowledge of ASD worldwide, there is a growing rate of referrals from primary health professionals to specialised units. At all levels of assessment, the differential diagnostic considerations between ASD and SD exert major challenges for clinicians. Although several validated screening questionnaires exist for ASD and SD, none have differential diagnostic properties. Accordingly, in this study, we aim to develop a new screening questionnaire, the schiZotypy Autism Questionnaire (ZAQ), which provides a combined screening for both conditions, while also indicating the relative likelihood of each.

METHODS

We aim to test 200 autistic patients and 100 schizotypy patients recruited from specialised psychiatric clinics and 200 controls from the general population (Phase 1). The results from ZAQ will be compared to the clinical diagnoses from interdisciplinary teams at specialised psychiatric clinics. After this initial testing phase, the ZAQ will be validated in an independent sample (Phase 2).

CONCLUSIONS

The aim of the study is to investigate the discriminative properties (ASD vs. SD), diagnostic accuracy, and validity of the schiZotypy Autism Questionnaire (ZAQ).

FUNDING

Funding was provided by Psychiatric Centre Glostrup, Copenhagen Denmark, Sofiefonden (Grant number: FID4107425), Trygfonden (Grant number:153588), Takeda Pharma.

TRIAL REGISTRATION

Clinical Trials, NCT05213286, Registered 28 January 2022, clinicaltrials.gov/ct2/show/NCT05213286?cond = RAADS&draw = 2&rank = 1.

Attachment Style and Self-Experience: The Association Between Attachment Style and Self-Reported Altered Self-Experience in Patients With Psychotic Disorders, Unaffected Siblings, and Healthy Controls

ABSTRACT

The present study aimed to examine the cross-sectional association between attachment style and self-reported disturbed self-awareness (disturbed sense of mineness of experiences) and depersonalization (disturbed sense of first-person perspective) in patients with psychotic disorders, unaffected siblings, and healthy controls. Data pertain to a subsample of the GROUP (Genetic Risk and Outcome of Psychosis) study. We found positive associations between anxious attachment and disturbed self-awareness and depersonalization across participants with different psychosis vulnerability. We also found a positive association between avoidant attachment and depersonalization, although on a trend level. Findings indicate that attachment style is associated with self-reported disturbed self-awareness and depersonalization over and above the influence of psychotic or depressive experiences in people across the vulnerability spectrum of psychosis. This supports the importance of attachment style, self-awareness, and depersonalization as potential targets in prevention and treatment interventions in patients with psychotic disorders or those with increased vulnerability.

Personal recovery suits us all: A study in patients with non-affective psychosis, unaffected siblings and healthy controls

Personal recovery transcends illness and is a unifying human experience. Core elements in personal recovery are hope, meaning, and rebuilding oneself. Here we aim to investigate whether factors associated with personal recovery in patients with non-affective psychosis, unaffected siblings and healthy controls are similar. We investigated the association between personal recovery and resilience, social support, socio-demographic and illness-related variables in 580 patients, 630 siblings, and 351 healthy controls who participated in the Genetic Risk and Outcome of Psychosis (GROUP) study. Bi-variate associations between personal recovery and individual variables were assessed and multiple linear regression analyses were performed to estimate the proportion of variance in personal recovery that could be accounted for by the predictors and to investigate which predictors independently added to the model. Positive self was significantly and independently associated with personal recovery in all three groups. Pro-active action taking also seems to be important. Social functioning significantly contributed to explained variance in patients and siblings. Regarding illness-related factors, depressive symptoms had impact on personal recovery in both patients and siblings, whereas positive symptoms only did in siblings. The findings imply that not only personal recovery itself, but also some associated factors are universally human and suit us all. This means that patients and non-patients share supportive factors of personal recovery which may help to reach mutual understanding. Recovery-oriented practices and mental health services might be more effective when focusing also on improving self-image, functional coping styles and generating social interaction, next to the reduction of affective symptoms.

Psychotic Like Experiences in Healthy Adolescents are Underpinned by Lower Fronto-Temporal Cortical Gyrification: a Study from the IMAGEN Consortium

BACKGROUND AND HYPOTHESIS

Psychotic Like Experiences (PLEs) are widely prevalent in children and adolescents and increase the risk of developing psychosis. Cortical gyrification characterizes brain development from in utero till about the first 2 years of life and can be measured in later years as static gyrification changes demonstrating neurodevelopment and dynamic gyrification changes reflecting brain maturation during adolescence. We hypothesized that PLEs would be associated with static cortical gyrification changes reflecting a neurodevelopmental abnormality.

STUDY DESIGN

We studied 1252 adolescents recruited in the IMAGEN consortium. We used a longitudinal study design, with Magnetic Resonance Imaging measurements at age 14 years and age 19 years; measurement of PLEs using the Community Assessment of Psychic Experiences (CAPE) questionnaire at age 19 years; and clinical diagnoses at age 23 years.

STUDY RESULTS

Our results show static gyrification changes in adolescents with elevated PLEs on 3 items of the CAPE-voice hearing, unusual experiences of receiving messages, and persecutory ideas-with lower cortical gyrification in fronto-temporal regions in the left hemisphere. This group also demonstrated dynamic gyrification changes with higher cortical gyrification in right parietal cortex in late adolescence; a finding that we replicated in an independent sample of patients with first-episode psychosis. Adolescents with high PLEs were also 5.6 times more likely to transition to psychosis in adulthood by age 23 years.

CONCLUSIONS

This is the largest study in adolescents that demonstrates fronto-temporal abnormality of cortical gyrification as a potential biomarker for vulnerability to PLEs and transition to psychosis.