The Melbourne assessment of Schizotypy in kids: a useful measure of childhood schizotypal personality disorder

Structural Relationships Among Mental Boundaries, Childhood Imaginary Companions, Creative Experiences, and Entity Encounters

This study investigated relationships between thin mental boundary functioning, creativity, imaginary companions (ICs), and anomalous '(entity) encounter experiences.' A convenience sample of 389 respondents completed the Revised Transliminality Scale, Oxford-Liverpool Inventory of Feelings and Experiences, Creative Experiences Questionnaire, Survey of Strange Events, and a measure of Childhood Imaginary Companions. Competing testing with path analysis found that the best-fitting model was consistent with the causal chain of 'Thin Boundaries (transliminality and schizotypy) → Creative Experiences → ICs → (Entity) Encounter Experiences.' These results suggest that deep-types of ICs (i.e., showing apparent independent agency) are perhaps most accurately characterized as syncretic cognitions versus hallucination-like experiences. The authors examine these findings relative to study limitations, as well as discussing the need for future research that approaches ICs as a special mental state that can facilitate allied altered-anomalous experiences. In this context, this study furthered understanding of relationships between conscious states related to mental boundaries, childhood imaginary companions, creative experiences, and entity encounters.

[Controversial issues of diagnosis and theoretical concepts of schizophrenia in childhood]

The article presents modern approaches to classification, presents debatable diagnostic issues, including the differences between domestic approaches to the diagnosis of schizophrenia in childhood from foreign taxonomies. The modern hypothesis of the etiological continuum of schizophrenic and autistic spectrum disorders is discussed, as well as clinical models of manifest stages of schizophrenia in childhood, with an emphasis on the influence of the age factor on the clinic, dynamics and prognosis of diseases.

A new scale for the screening of childhood early psychotic symptoms

This study aimed to develop a new scale, the Early Psychotic Symptoms screening scale (EPSy), to assess the prodromes of psychotic symptoms in children aged 4 to 13 years. Two versions were proposed: one to assess the child's current behavior and one to assess the child's behavior when he/she was 2 years old. The second aim of this study was to investigate the presence of these symptoms at the age of 2 years and their evolution up to the child's current age. The analysis of EPSy identified three main factors, namely mistrust/paranoia, perceptual aberrations/hallucinations and disorganized symptoms. It has good psychometric properties. Data also shows that, independently of the participant's age, the total score on the 2-years-old version predicts the total score on the current-age version, and this is also the case for each individual factor. Finally, it is of clinical interest since it makes it possible to describe symptomatology both at age 2 and at the child's present age depending on the group to which the children are assigned (control children, psychotic children, non-psychotic children).

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.

[Teraligen in the complex treatment of anxiety-phobic, behavioral and depressive syndromes in children and adolescents with schizotypal disorder]

ABSTRUCT

OBJECTIVE

To determine the frequency of prescribing and the main therapeutic targets of Teraligen in the treatment of Schizotypal disorder (STD) in childhood and adolescence.

MATERIAL AND METHODS

The sample consisted of 151 patients aged 7 to 16 years with a diagnosis of STD (F 21), of which 31.1% (n=47) of female patients and 68.9% (n=104) of male patients who received inpatient or outpatient treatment at the FSBI NCPZ from 2008 to 2020. The study was conducted by clinical-psychopathological, clinical-catamnestic, and statistical methods.

RESULTS

Teraligen was prescribed by psychiatrists to patients with STD in 74.2% of cases, of which in 46.4% of cases patients received Teraligen even before the diagnosis of STD in connection with complaints of neurotic disorders (anxiety, fears and sleep disorders) (n=30), as well as in connection with autistic-like behavior (n=22). At the time of follow-up, 55% (n=83) of patients received Teraligen, of which 63.9% (n=53) of patients were prescribed it for the first time. The applied schemes of prescribing Teraligen for the treatment of anxiety-phobic, depressive and behavioral syndromes within the framework of the STD in a relatively age-related aspect are presented.

CONCLUSION

The high frequency of prescribing Teraligen by psychiatrists and neurologists to children and adolescents with STD at different stages of observation is shown, which reflects the confidence of specialists in this drug. Teraligen has demonstrated a multidimensional pharmacological effect, including a mild antipsychotic effect, providing reduction of a wide range of psychopathological symptoms, with good tolerability and drug interaction. The study of the possibilities of Teraligen, both for monotherapy and for augmentation of the treatment of mental pathology in childhood, remains relevant.

[Assessment of the initial period of schizotypal disorder in childhood]

OBJECTIVE

To identify developmental features, the presence of hereditary burden, social adaptation, the structure of early psychopathological disorders in pediatric patients with schizotypal disorder (STD) and their relationship with the age of manifestation and the clinical structure of the disease.

MATERIAL AND METHODS

The study included 150 patients aged 7 to 16 years with a diagnosis of SD, of which 48 were female and 102 were male. Based on the age of onset of the first stable psychopathological disorders, at the stage preceding the diagnosis of SD, 5 groups of patients were identified: up to 3 years (n=38), from 4 to 6 years (n=36), from 7 to 10 years (n=15), 11-13 (n=41), 14-16 years old (n=20). The study used clinical-psychopathological, clinical-catamnestic, with a retrospective analysis, neurological, pathopsychological, psychometric and statistical research methods.

RESULTS

A high frequency of deviations from normative parameters in early psychomotor development was found in 99 (65%) patients with STD. Mental retardation was observed in 23 (15%) patients, dissociation in mental development was detected in a significant number of patients - 62 (41%). At the same time, the most significantly more frequent and pronounced were violations in the two youngest groups with the onset of psychopathological disorders up to 6 years. In these groups, there was also more often a deficit in three areas at once - emotional, motivational and volitional (38%) compared with the 4th group (13%). In groups 1 and 2, a deficit in intellectual development was also characteristic, which was reflected in academic indicators. High performance in the primary grades was observed in 16% of patients in the 1st group versus 60% in the 5th, and poor performance was found in 37% in the 1st group and only 5% in the 5th. The relationship of clinical variants of STD with the selected groups was revealed. The diagnosis of schizotypal personality disorder was significantly more often (66%) diagnosed in patients from group 1 compared with groups 3 and 5. In group 2, this diagnosis was established in a third of cases. The diagnosis of the psychopathic variant of STD was predominant in patients with the onset of the disorder between 7 and 13 years of age. The neurosis-like variant had a clear tendency to become more frequent with older age, reaching statistically significant differences in group 5 compared to group 1.

CONCLUSION

The age of onset and duration of persistence of psychopathological disorders determines the level of negative changes that have formed at the stage of the disease preceding the onset of distinct clinical symptoms of STD. Age at onset determines the predominant positive disorder.

Early life factors of schizotypal personality disorder in adolescents: A systematic review

WHAT IS KNOWN ON THE SUBJECT?: The complexity and high prevalence of schizotypal personality disorders (SPD) pose serious challenges for mental health practice in its management, and also bring severe consequences for the patients. The identification of the specific early life factors (ELFs) that confer risk to SPD has become a major focus of clinical research on schizophrenia-spectrum disorders which aligns well with the mental health nursing's responsibility in health promotion, prevention and treatment. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Adolescents may experience certain ELFs, which contribute to the occurrence of SPD, but no systematic review has been conducted to identify ELF among them. And nursing literature addressing modifiable ELF is very limited. Two clusters of ELF and SPD in adolescents were identified: prenatal and early postnatal factors; childhood trauma and parental factors. The findings also show that more research is needed to determine the specificity and cumulative effects of ELF on the development of SPD by using rigorous and comprehensive measurements and a longitudinal design. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses, especially nurses in the primary care, should be aware of potentially modifiable ELFs and incorporate more comprehensive and valid instrument for assessing cumulative ELF and SPD. These findings may serve to inform possible future interventions for SPD, such as parent education and support to mitigate these risk factors.

ABSTRACT

INTRODUCTION: Schizotypal personality disorder (SPD) affects 4% of the general population in the United States. The identification of early life factors (ELFs) that confer risk to SPD in adolescents (ages 10-24 years old) has become a major focus of clinical research on schizophrenia-spectrum disorders.

AIM

This systematic review aims to determine what ELFs contribute to the onset of SPD in the adolescent population.

METHODS

A systematic search of PubMed, PsycINFO, Psychiatry online, Scopus, Web of Science, EMBASE and CINAHL databases was conducted using relevant keywords. Data were extracted using a standardized form following PRISMA guidelines.

RESULTS

Twenty-four studies met the criteria for inclusion. ELFs in the development of SPD were grouped into two important clusters: (a) prenatal and early postnatal factors; (b) childhood trauma and parental factors.

CONCLUSION

Mental health nurses, especially nurses in primary care, should be aware of potentially modifiable ELF. Longitudinal research is needed to determine the causative roles of these ELF play in the occurrence of SPD by using rigorous measurements.

IMPLICATIONS FOR PRACTICE

These findings call for awareness of the modifiable ELF for SPD and also inform possible future interventions to reduce these risks, such as parent-training or environmental enrichment programmes.

[History of the formation of views on schizotypal disorder in childhood]

The article reflects the stages of development of views on schizotypal disorder (STD) in adults and children from the prenosological period to the present. It is shown how, after the recognition by the majority of psychiatrists of the concept of early dementia proposed by E. Kraepelin, there is a gradual recognition of the single essence of schizophrenia for childhood and adulthood, but with different, specific clinical manifestations at different age periods. The study of variants of schizophrenia without a fatal outcome in dementia, which led to the isolation of sluggish schizophrenia, including in childhood, begins with the works of E. Bleuler. The differences in approaches to the study and interpretation of sluggish schizophrenia in Russian, European and American psychiatry, which led to the isolation of STEs in the framework of personality disorders, are described. Three main concepts that exist at the present stage of research are presented, in which STD is considered as an independent disease in the spectrum of schizophrenic disorders, as one of the types of personality deviations with a high degree of vulnerability for the development of schizophrenia, and as one of the forms of the disease.

Co-occurrence of autistic and psychotic traits: implications for depression, self-harm and suicidality

BACKGROUND

There is increasing interest in the clinical and aetiological overlap between autism spectrum disorders and schizophrenia spectrum disorders, reported to co-occur at both diagnostic and trait levels. Individually, sub-clinical autistic and psychotic traits are associated with poor clinical outcomes, including increased depressive symptomatology, self-harming behaviour and suicidality. However, the implications when both traits co-occur remain poorly understood. The study aimed to (1) examine the relationship between autistic and psychotic traits and (2) determine if their co-occurrence increases depressive symptomatology, self-harm and suicidality.

METHODS

Cross-sectional data from a self-selecting (online and poster advertising) sample of the adult UK population (n = 653) were collected using an online survey. Validated self-report measures were used to assess sub-clinical autistic and psychotic traits, depressive symptomatology, self-harming behaviour and suicidality. Correlation and regression analyses were performed.

RESULTS

A positive correlation between sub-clinical autistic and positive psychotic traits was confirmed (r_s = 0.509, p < 0.001). Overall, autistic traits and psychotic traits were, independently, significant predictors of depression, self-harm and suicidality. Intriguingly, however, depression was associated with a negative interaction between the autistic domain attention to detail and psychotic traits.

CONCLUSIONS

This study supports previous findings that sub-clinical autistic and psychotic traits are largely independently associated with depression, self-harm and suicidality, and is novel in finding that their combined presence has no additional effect on depression, self-harm or suicidality. These findings highlight the importance of considering both autistic and psychotic traits and their symptom domains in research and when developing population-based depression prevention and intervention strategies.

Developmental Course of Personality Disorder Traits in Childhood and Adolescence

Developmental patterns of personality pathology traits are not well delineated from childhood through late adolescence. In the present study, participants (N = 675, 56% female) were recruited to create three cohorts of third (n = 205), sixth (n = 248), and ninth (n = 222) graders to form an accelerated longitudinal cohort design. We assessed six PD (avoidant, dependent, histrionic, narcissistic, borderline, schizotypal) traits based on DSM-IV trait diagnostic conceptualizations via parent report at baseline, 18 months, and 36 months. According to parent report, mean levels of avoidant, dependent, histrionic, narcissistic, borderline, and schizotypal traits all declined for both boys and girls. The changes in dependent and histrionic traits were of medium effect size, and the changes in avoidant, narcissistic, borderline, and schizotypal traits were of small effect size. Over the 3 years of the study, the traits of each PD also demonstrated moderate to high rank-order stability.

Structural and functional brain abnormalities in children with schizotypal disorder: a pilot study

Schizotypal disorder lies in the schizophrenia spectrum and is widely studied in adult populations. Schizotypal disorder in children (SDc) is less well described. This study examined brain morphological and functional connectivity abnormalities in SDc (12 SDc and 9 typically developing children), focusing on the default mode and executive control brain networks. Results indicated that SDc is associated with reduced grey matter volume (GMV) in superior and medial frontal gyri, and increased resting-state functional connectivity between the superior frontal gyrus and inferior parietal lobule, compared to typically developing children (cluster-level FWE-corrected p < 0.05). The brain structure abnormality (GMV in left superior frontal gyrus) was correlated with clinical symptoms in SDc (r = −0.66, p = 0.026) and functional connectivity abnormality was correlated with extra-dimensional shifting impairments in all participants (r = 0.62, p = 0.011), suggesting their contribution to the underlying mechanisms of clinical presentation. These preliminary results motivate further work to characterize the neural basis of SDc and its significance as a risk factor for later psychosis.

Attentional set-shifting and social abilities in children with schizotypal and comorbid autism spectrum disorders

OBJECTIVE

While diagnostically independent, autism and schizotypal disorders can co-occur. Their concurrent impact on outcomes and phenotypes has not been investigated. We investigated the impact of comorbid autism and schizotypal disorders in children on executive functioning and socio-pragmatic skills - core features of both disorders.

METHOD

Executive functioning (assessed with the Cambridge Neuropsychological Test Automated Battery) and socio-pragmatic skills (assessed using the Melbourne Assessment of Schizotypy in Kids) were investigated in a total of 67 (6-12 year old) children with autism ( n = 15; M/F = 10/5), schizotypal disorder ( n = 8; M/F = 5/3) and comorbid autism and schizotypal disorder ( n = 12; M/F = 5/7) and typically developing children ( n = 32; M/F = 17/15).

RESULTS

Both the autism and schizotypal disorder groups performed more poorly than the typically developing group on socio-pragmatic skills and overall performance (i.e. number of stages completed) of the intra-/extra-dimensional set-shifting task (all ps < 0.001). Clear distinctions between the autism and schizotypal groups were present in the intra-/extra-dimensional task relative to the typically developing group - the autism group had difficulties with extra-dimensional shifts ( p < 0.001), and the schizotypal disorder group with intra-dimensional shifts ( p = 0.08). Interestingly, the overall performance of the comorbid group on the intra-/extra-dimensional task was not significantly different from the typically developing group, and they were superior to both the autism ( p = 0.019) and schizotypal disorder ( p = 0.042) groups on socio-pragmatic skills.

CONCLUSION

The phenotypical overlap between autism and schizotypal disorders may be precipitated by different cognitive styles and/or mechanisms associated with attention and information processing. We propose that sustaining and switching attention represent two poles of irregularities across the autism and schizotypal spectra, which appear to converge in a compensatory manner in the comorbid group. Our findings highlight the importance of investigating children with a dual diagnosis of autism and schizotypal disorders, and raise intriguing questions about possible mechanisms to explain the attenuated impairment observed in the group of children with comorbid autism and schizotpyal disorders.

Understanding adolescent personality pathology from growth trajectories of childhood oddity

Research on developmental trajectories of early maladaptive features for understanding later personality disorders (PDs) is increasingly recognized as an important study area. The course of early odd features is highly relevant in this regard, as only a few researchers have addressed childhood oddity in the context of emerging PDs. Using latent growth modeling, the current study explores growth parameters of odd features in a mixed sample of Flemish community and referred children (N = 485) across three measurement waves with 1-year time intervals. Personality pathology was assessed at a fourth assessment point in adolescence. Beyond a general declining trend in oddity characteristics, the results demonstrated that both an early onset and an increasing trend of oddity-related characteristics over time are independent predictors of adolescent PDs. Childhood oddity tends to be the most manifest precursor for PDs with a core oddity feature (i.e., the schizotypal and borderline PD), but also appears to predict most of the other DSM-5 PDs. Results are discussed from an overarching developmental framework on PDs (Cicchetti, 2014), specifically focusing on the principle of multifinality. From a clinical perspective, the significance of increasing or steady-high childhood oddity trajectories for adolescent PDs highlights the relevance of systematic screening processes across time.