Personality dimensions of schizophrenia patients compared to control subjects by gender and the relationship with illness severity

The relationship between self-esteem and mental disability in patients with schizophrenia: the mediating role of resilience and the moderating role of gender

This study aims to verify the mediating role of resilience between self-esteem and mental disability and to analyze the moderating role of gender in the relationship between resilience and mental disability in patients with schizophrenia. Patients with schizophrenia have been selected from Harbin Psychiatric (Baiyupao) Hospital and Daqing Third Hospital in Heilongjiang Province from January to December 2021. The study recruited a total of 220 patients with schizophrenia, including 120 males and 100 females to measure their self-esteem, resilience and mental disability. The results were as follows: Self-esteem and resilience are important protective factors that have a buffering effect on mental disability. The mediating effect of resilience on self-esteem and mental disability is stronger in males than in females. The results provide new ideas for delaying mental disability and for formulating intervention programs and applying them to clinical practice. The study indicates that psychiatric medical staff should not only treat the patients with schizophrenia psychotic symptoms but also improve their self-esteem and resilience through effective intervention to reduce the occurrence of mental disability.

Maladaptive personality traits in patients with recent-onset psychosis: A case-control study using the Personality Inventory for the DSM-5 (PID-5)

BACKGROUND

The relationship between maladaptive personality traits and psychotic disorders in the early stages of disease has not been thoroughly investigated, even though it is essential for developing prevention and early intervention strategies.

METHODS

The five domains and the 25 facets of the Personality Inventory for DSM-5 (PID-5) were compared between 102 patients with recent-onset psychosis (ROP) and 116 community subjects (C) with a general linear model including age and sex in the analyses. In addition, multiple linear regression models were used to identify which factors associated with the PID-5 domains in ROP, and correlation analyses were used to explore the relationship between personality traits.

RESULTS

Patients with ROP, compared to C, exhibited higher scores in four out of the five domains with medium effect sizes (Cohen's f² ≥ 0.15) in two of them: negative affect (NA, p = 0.013, f² = 0.04), detachment (DET, p < 0.001, f² = 0.15), disinhibition (DIS, p < 0.001, f² = 0.14) and psychoticism (PSY, p < 0.001, f² = 0.16). Significant group differences were observed in 15 of the 25 facets and the largest effects were observed in the facets of withdrawal (p ≤ 0.001, f² = 0.20), irresponsibility (p < 0.001, f² = 0.23) and unusual beliefs (p = 0.001, f² = 0.22). Interestingly, being on antidepressants and high scores on the positive subscale of the Positive and Negative Syndrome Scale (PANSS) were associated with high scores of NA, antagonism (ANT) and PSY.

CONCLUSIONS

Maladaptive personality traits were prominent in persons with ROP. These findings suggest that personality traits might play a role in vulnerability to psychosis and highlight the importance of evaluating personality in the early stages of psychosis.

Personality traits in psychotic illness and their clinical correlates: A systematic review

This systematic review focuses on personality traits according to both the Five Factor Model and Cloninger Psychobiological Model in relation to treatment related outcome variables across all stages of clinical psychotic illness. Search of Pubmed and Psychinfo databases led to final inclusion of 65 studies, which were ranked on quality and analyzed according to the associations between personality and outcome. Main findings are that higher levels of Harm Avoidance and Neuroticism are associated with higher symptom levels, tendency towards passive coping, greater self-stigma, lower quality of life, and Harm Avoidance to higher suicidality. Higher levels of Extraversion and higher levels of Self-Directedness are associated with more preference for active coping, more intrinsic motivation and higher self-esteem. Higher Novelty Seeking is related to more substance use and aggression, in men specifically. On outcome of trauma, care consumption and duration of untreated illness no consistent associations with personality traits were found. Combined evidence from both personality models however reveals a consistent pattern of personality traits related to clinical outcome in psychotic disorder, which is discussed in a dimensional manner.

Disability and premorbid adjustment in schizophrenia: A retrospective analysis

Background

Schizophrenia is highly disabling. Though efforts at genetic mapping to identify those at risk of the illness have been promising but same cannot be said about predicting its associated disability before illness-onset (i.e., during premorbid phase). It is envisaged that Schizophrenia-related disability may be ameliorated if premorbid clinical markers are adequately predictive enough to identify those at risk and worked upon them.

Aim

This study aimed to determine whether there is a relationship between schizophrenia-related disability and premorbid adjustment.

Setting

This cross-sectional study was conducted at the out-patient clinic of the Neuropsychiatric Hospital, Aro, Abeokuta, Ogun State, Nigeria.

Methods

Three hundred patients with the diagnosis of schizophrenia and within the age range of 18-64 years were eligible for the study.

Results

Mean age of the participants was 41.9 ± 10.05 years with a slight female dominance (50.7%). Spearman's correlation revealed a direct correlation between disability and premorbid adjustment, albeit rather weak (r _s = 0.130, p = 0.025).

Conclusion

Pre-diagnostic factors such as premorbid functioning may play a role in the subsequent functioning of an individual post-diagnosis. Other research efforts may focus on yet-to-be identified premorbid factors that may be targets of prevention to reduce disability in schizophrenia.

Contribution

This research serves as a pioneer work on disability and premorbid adjustment and has provided a template for the early identification of those at risk of schizophrenia by providing an intervention opportunity at the premorbid stage.

Integrating trauma, self-disturbances, cognitive biases, and personality into a model for the risk of psychosis: a longitudinal study in a non-clinical sample

The hypothesis of the psychosis continuum enables to study the mechanisms of psychosis risk not only in clinical samples but in non-clinical as well. The aim of this longitudinal study was to investigate self-disturbances (SD), a risk factor that has attracted substantial interest over the last two decades, in combination with trauma, cognitive biases and personality, and to test whether SD are associated with subclinical positive symptoms (PS) over a 12-month follow-up period. Our study was conducted in a non-clinical sample of 139 Polish young adults (81 females, age M = 25.32, SD = 4.51) who were selected for frequent experience of subclinical PS. Participants completed self-report questionnaires for the evaluation of SD (IPASE), trauma (CECA.Q), cognitive biases (DACOBS) and personality (TCI), and were interviewed for subclinical PS (CAARMS). SD and subclinical PS were re-assessed 12 months after baseline measurement. The hypothesized model for psychosis risk was tested using path analysis. The change in SD and subclinical PS over the 12-month period was investigated with non-parametric equivalent of dependent sample t-tests. The models with self-transcendence (ST) and harm avoidance (HA) as personality variables were found to be well-fitted and explained 34% of the variance in subclinical PS at follow-up. Moreover, we found a significant reduction of SD and subclinical PS after 12 months. Our study suggests that combining trauma, cognitive biases, SD and personality traits such as ST and HA into one model can enhance our understanding of appearance as well as maintenance of subclinical PS.

Understanding the Influence of Personality Traits on Risk of Suicidal Behaviour in Schizophrenia Spectrum Disorders: A Systematic Review

Risk of suicidal behaviour (SB) in schizophrenia spectrum disorders (SSD) is a major concern, particularly in early stages of the illness, when suicide accounts for a high number of premature deaths. Although some risk factors for SB in SSD are well understood, the extent to which personality traits may affect this risk remains unclear, which may have implications for prevention. We conducted a systematic review of previous studies indexed in MEDLINE, PsycINFO and Embase examining the relationship between personality traits and SB in samples of patients with SSD. Seven studies fulfilled predetermined selection criteria. Harm avoidance, passive-dependent, schizoid and schizotypal personality traits increased the risk of SB, while self-directedness, cooperativeness, excluding persistence and self-transcendence acted as protective factors. Although only seven studies were retrieved from three major databases after applying predetermined selection criteria, we found some evidence to support that personality issues may contribute to SB in patients with SSD. Personality traits may therefore become part of routine suicide risk assessment and interventions targeting these personality-related factors may contribute to prevention of SB in SSD.

Psychopathy, temperament, and character dimensions of personality as risk determinants of criminal recidivism in schizophrenia patients

There is considerable evidence on the role of personality traits in the risk of criminal recidivism among schizophrenia patients, besides conventional risk factors. We evaluated the effects of psychopathy and biopsychosocial personality model on general criminal recidivism in schizophrenia patients. Ninety-four male DSM-5 diagnosed schizophrenia patients were recruited and classified into three groups according to the number of offenses since diagnosis: reoffenders (n = 32), Initial offenders (n = 31), and nonoffenders (n = 31). All subjects were evaluated by the Turkish versions of Psychopathy Checklist-Revised (PCL-R) and Temperament and Character Inventory-Revised (TCI-R). In Reoffenders, all subscale scores of PCL-R and Novelty seeking were the highest, while Self-directedness and Cooperativeness were the lowest. PCL-R Total, Factor 1 and Factor 2 positively correlated with Novelty Seeking, and negatively correlated with Harm Avoidance, Self-directedness, and Cooperativeness in offender patients. For criminal recidivism in offender patients, high PCL-R Total and Novelty Seeking, low Harm Avoidance, Self-directedness, and Cooperativeness, being unmarried, presence of childhood adversity, and younger age at the first offense were found to be significant predictors in univariate analyses; multivariate regression models revealed PCL-R Total and Persistence as the only significant predictors. These results suggest that certain dimensional personality evaluations combined with potential historical, clinical, and forensic risk factors can be employed in forensic settings to screen offender schizophrenia patients at an increased risk of recidivism and to take necessary precautions against further criminal behavior.

Psychological resilience to suicidal thoughts and behaviours in people with schizophrenia diagnoses : A systematic literature review

PURPOSE

Suicide deaths are a major concern in people with schizophrenia diagnoses. However, many people with such diagnoses do not attempt suicide, nor die by suicide, suggesting that some individuals are resilient to the impact of suicide triggers. This systematic literature review aimed to (1) appraise the evidence for psychological factors which confer resilience to suicidal thoughts and behaviours, and (2) categorize these psychological factors into broader psychological constructs which characterize resilience.

METHODS

The review was conducted in accordance with the PRISMA guidelines for the reporting of systematic reviews. A literature search of four electronic databases (Web of Science, PubMed, PsycINFO, and MEDLINE) was conducted. A quality evaluation of the included studies was carried out by two independent researchers using a quality assessment tool.

RESULTS

Psychological factors from 27 studies were categorized into four constructs: (1) perceived social support, (2) holding religious and spiritual beliefs, (3) identifying reasons for living, and (4) perceived positive personal skills and attributes.

CONCLUSIONS

The limited literature showed that resilience is important in understanding suicidal thoughts and behaviours in people with schizophrenia diagnoses. There is a need for prospective research that investigates moderating effects of psychological resilience in the pathways to suicidal thoughts and behaviours in people with schizophrenia diagnoses.

PRACTITIONER POINTS

Novel evidence for four psychological constructs which may confer resilience to suicidal thoughts and behaviours in people with schizophrenia diagnoses. Strong evidence for the impact of perceived social support and appraisals of personal skills and attributes on the severity of suicidal experiences in people with schizophrenia diagnoses. There was equivocal evidence for the effect of holding religious and spiritual beliefs on suicide attempts. Clinical practice would benefit from assessing perceived personal attributes and levels of social support from significant others and health professionals.

Mediation and moderation analyses: exploring the complex pathways between hope and quality of life among patients with schizophrenia

BACKGROUND

The underlying mechanism between hope and quality of life is as yet unknown. We aim to examine the potential mediating effect of depression and resilience and the moderated effect of sex in this well-established association.

METHODS

Two hundred seven patients diagnosed with schizophrenia were administered a questionnaire battery that measured hope, depression, resilience and QOL. A multiple mediation model was used to examine the mediating effect of resilience and depression on the association between hope and QOL. A subgroup analysis was performed and a moderated mediation model was examined to find and test the moderated effect of sex on the mediation model. We used Mplus to perform moderation and mediation analyses so that the mediators and moderator could function together in the same model.

RESULT

Sex was the moderator on the direct path between hope and QOL. The relationship between hope and QOL was mediated by resilience and depression in both sexes. When compared with female patients, the effect of hope on QOL was completely mediated by resilience and depression in males. In female patients, the model was partially mediated, and the direct effect of hope on QOL was significantly negatively correlated with the level of hope.

CONCLUSION

We present a conceptual model containing the mediated effects of resilience and depression and the moderated effect of sex between hope and QOL, which we believe facilitates the understanding of these associations. This model should be useful in the formulation of strategies to improve QOL.

Personality traits in recent-onset-of-psychosis patients compared to a control sample by gender

Personality traits in recent onset of psychosis (ROP) patients are an under-researched area. Our aim was to examine clinical and clinically significant personality traits in ROP patients compared with a healthy control sample by gender. Data were obtained from 94 ROP patients and a control sample matched in gender and age. The Millon Clinical Multiaxial Inventory and a sociodemographic scale were used. T for independent samples, U-Mann-Whitney and Fisher tests were applied to make comparisons. All personality traits were significantly higher in ROP than control participants in the general sample, except histrionic, narcissistic, and compulsive traits which were higher in controls. Clinically significant schizoid, avoidant, dependent and antisocial personality traits were more common in the ROP than the control participants. However, histrionic clinically significant trait was more common in the control sample. In relation to the males and female samples, more significant differences were found in the male sample in comparison to their control counterparts than in the female sample. These results highlight the importance of the study of clinical personality traits in patients with ROP and the importance of viewing these differences in relation to gender because of the possible therapeutic implications.

The value of novelty in schizophrenia

Influential models of schizophrenia suggest that patients experience incoming stimuli as excessively novel and motivating, with important consequences for hallucinatory experience and delusional belief. However, whether schizophrenia patients exhibit excessive novelty value and whether this interferes with adaptive behaviour has not yet been formally tested. Here, we employed a three-armed bandit task to investigate this hypothesis. Schizophrenia patients and healthy controls were first familiarised with a group of images and then asked to repeatedly choose between familiar and unfamiliar images associated with different monetary reward probabilities. By fitting a reinforcement-learning model we were able to estimate the values attributed to familiar and unfamiliar images when first presented in the context of the decision-making task. In line with our hypothesis, we found increased preference for newly introduced images (irrespective of whether these were familiar or unfamiliar) in patients compared to healthy controls and this to correlate with severity of hallucinatory experience. In addition, we found a correlation between value assigned to novel images and task performance, suggesting that excessive novelty value may interfere with optimal learning in patients, putatively through the disruption of the mechanisms regulating exploration versus exploitation. Our results suggest excessive novelty value in patients, whereby even previously seen stimuli acquire higher value as the result of their exposure in a novel context - a form of 'hyper novelty' which may explain why patients are often attracted by familiar stimuli experienced as new.

The Five-Factor Model personality traits in schizophrenia: A meta-analysis

Personality is one of important factors in the pathogenesis of schizophrenia because it affects patients' symptoms, cognition and social functioning. Several studies have reported specific personality traits in patients with schizophrenia compared with healthy subjects. However, the results were inconsistent among studies. The NEO Five-Factor Inventory (NEO-FFI) measures five personality traits: Neuroticism (N), Extraversion (E), Openness (O), Agreeableness (A) and Conscientiousness (C). Here, we performed a meta-analysis of these personality traits assessed by the NEO-FFI in 460 patients with schizophrenia and 486 healthy subjects from the published literature and investigated possible associations between schizophrenia and these traits. There was no publication bias for any traits. Because we found evidence of significant heterogeneity in all traits among the studies, we applied a random-effect model to perform the meta-analysis. Patients with schizophrenia showed a higher score for N and lower scores for E, O, A and C compared with healthy subjects. The effect sizes of these personality traits ranged from moderate to large. These differences were not affected by possible moderator factors, such as gender distribution and mean age in each study, expect for gender effect for A. These findings suggest that patients with schizophrenia have a different personality profile compared with healthy subjects.

Family caregivers and outcome of people with schizophrenia in rural China: 14-year follow-up study

OBJECTIVE

This study examined the differences in 14-year outcomes of persons with schizophrenia with and without family caregiver(s) in a rural community in China.

METHODS

All participants with schizophrenia (n = 510) aged 15 years and older were identified in a 1994 epidemiological investigation of 123,572 people and followed up in 2004 and 2008 in Xinjin County, Chengdu, China.

RESULTS

Individuals without family caregiver in 1994 had significantly higher rate of homelessness (23.8 %) and lower rate of survival (47.5 %) in 2008 than those with family caregivers (5.1 and 70.9 %). Compared with individuals with family caregivers, those without family caregivers were more likely to be male, live alone, have fewer family members, lower family economic status, lower rates of marriage and complete remission, higher mean scores on PANSS and lower mean score on GAF in 2008. The predictors of participants without family caregiver in 2008 included having a small number of family members at baseline and being male.

CONCLUSIONS

The absence of a family caregiver is a predictive factor of poorer long-term outcome of persons with schizophrenia in the rural community. The critical role of family caregiving should be incorporated in the planning and delivering of mental health policies and community-based mental health services.

Temperament and character dimensions in male patients with substance use disorders: Differences relating to psychiatric comorbidity

Previous research has not considered the influence of the Comorbid Mental Disorder (CMD) among Substance Use Disorders (SUD) patients. We explored the possible differences in personality dimensions among SUD patients taking into account their CMD (Schizophrenia, SZ; Bipolar Disorder, BD; Major Depressive Disorder, MDD); and elucidated clinical factors related to personality dimensions according to the CMD. The Temperament and Character Inventory Revised was used to assess a sample of 102 SUD male patients, considered in three groups according to their CMD: SUD+SZ (N=37), SUD+BD (N=30) and SUD+MDD (N=35). SUD+BD patients had the highest levels of Novelty Seeking and Persistence, SUD+SZ patients showed the highest levels of Harm Avoidance, and SUD+MDD patients reported a lower level of Self-transcendence. Novelty Seeking was positively associated with severity of addiction for SUD+BD; Harm Avoidance was positively associated with psychiatric symptoms for SUD+SZ; and the age of SUD onset was positively linked to Cooperativeness for SUD+BD and to Self-transcendence for SUD+MDD. The different personality characteristics associated to the type of CMD among SUD patients are related to several clinical variables. Interventions in these patients should be tailored according the personality traits that could influence treatment outcomes and patients' prognoses.

Inhibition of parvalbumin-expressing interneurons results in complex behavioral changes

Reduced expression of the Gad1 gene-encoded 67-kDa protein isoform of glutamic acid decarboxylase (GAD67) is a hallmark of schizophrenia. GAD67 downregulation occurs in multiple interneuronal sub-populations, including the parvalbumin-positive (PVALB+) cells. To investigate the role of the PV-positive GABAergic interneurons in behavioral and molecular processes, we knocked down the Gad1 transcript using a microRNA engineered to target specifically Gad1 mRNA under the control of Pvalb bacterial artificial chromosome. Verification of construct expression was performed by immunohistochemistry. Follow-up electrophysiological studies revealed a significant reduction in γ-aminobutyric acid (GABA) release probability without alterations in postsynaptic membrane properties or changes in glutamatergic release probability in the prefrontal cortex pyramidal neurons. Behavioral characterization of our transgenic (Tg) mice uncovered that the Pvalb/Gad1 Tg mice have pronounced sensorimotor gating deficits, increased novelty-seeking and reduced fear extinction. Furthermore, NMDA (N-methyl-d-aspartate) receptor antagonism by ketamine had an opposing dose-dependent effect, suggesting that the differential dosage of ketamine might have divergent effects on behavioral processes. All behavioral studies were validated using a second cohort of animals. Our results suggest that reduction of GABAergic transmission from PVALB+ interneurons primarily impacts behavioral domains related to fear and novelty seeking and that these alterations might be related to the behavioral phenotype observed in schizophrenia.

Dysfunctional meta-cognitive beliefs mediate the relation between temperament traits and hallucination-proneness in non-clinical population

We investigated whether dysfunctional metacognitive beliefs (negative beliefs about uncontrollability and danger of thoughts) mediate the relationship between temperamental characteristics of behavior and hallucinatory-like experiences in healthy subjects (n=137). Our analyses showed that four temperamental traits (emotional reactivity, perseveration, endurance and briskness) were mediated by negative beliefs about uncontrollability and danger of thoughts in relation to hallucination proneness. Our research tentatively suggests that temperament affects hallucination proneness via metacognition.

Sensation/novelty seeking in psychotic disorders: A review of the literature

The evaluation of personality traits is important for the better understanding of the person suffering from psychosis and for treatment individualization. However literature on patients’ personality and character in such disorders is limited. The aim of this review was to summarize the literature on sensation/novelty seeking (SNS), a trait which is biologically based and highly heritable and is associated with dopamine activity, and refers to a person’s tendency to seek varied, novel, complex, and intense sensations and experiences. A total of 38 studies were included in this review, involving 2808 patients and 2039 healthy controls. There is consistent evidence that this trait is independently associated with alcohol and substance abuse in patients with schizophrenia and related disorders. The estimation of SNS would help clinicians to identify patients at risk for abuse. There is also some evidence that higher SNS levels may relate to medication non-adherence and seem to increase the risk of patients’ aggressive and violent behavior, but studies are scarce. SNS was found not to be related to suicidality, whereas in the fields of patients’ quality of life and psychopathology results are contradictory, but most studies show no possible association. Several studies suggest that SNS is lower in psychotic patients compared to controls, whereas most yield no differences. The evidence for this trait as a potential endophenotype of schizophrenia is weak. SNS may be implicated in psychotic disorders’ course and prognosis in several ways and should be always inquired for. This trait can be reliably measured with the use of easily applicable self-rated instruments, and patients’ accounts could inform clinicians when planning management and delivering individualized treatment.