Cognitive correlates of 'Formal Thought Disorder' in a non-clinical sample with elevated schizotypal traits

Different dimensions of formal thought disorder (FTD) are distinguished by different patterns of cognitive dysfunction in patients with schizophrenia; however, inconsistent findings may relate to patient-related confounds. To avoid these confounds, we examined relationships between FTD dimensions and cognitive domains in a non-clinical sample with attenuated schizophrenia-like traits, or schizotypal traits, on the Schizotypal Personality Questionnaire (N = 91). To our knowledge, no study has done this. FTD dimension scores were derived following principal component analysis of the Scale for the Assessment of Thought, Language and Communication (TLC dimensions: Disorganisation, Verbosity, Emptiness) and the Thought and Language Index (TLI dimensions: Negative, Idiosyncratic). The sample completed a comprehensive neuropsychological battery. Findings indicate that higher-order reasoning, executive function (set shift and generative ability) and language/semantic functioning are the primary drivers of FTD in our non-clinical sample with elevated schizotypal traits, in line with schizophrenia research. FTD may have shared aetiology along the schizophrenia spectrum.

Borderline and schizotypal traits in college students: Relationship and personality profiles

The relationships between borderline and schizotypal traits are still debated. Borderline traits, schizotypal traits, and several psychopathological symptoms were assessed among 2,341 college students. A factor analysis was performed on borderline and schizotypal personality measures, leading to 10 factors. Borderline factors were largely intercorrelated, as were schizotypal factors. Moreover, borderline factors were weakly to largely correlated to schizotypal factors. Five factors were very strongly correlated (r > .50). Dissociation was strongly related to Odd Beliefs/Unusual Perceptive Experiences and Anxious-Depressive factors. Social Anxiety was strongly related to Suspiciousness. Based on these 10 factors, a cluster analysis was conducted, and resulted in four clearly distinct groups: a Low Traits cluster, a Narcissistic cluster, a Social Anxiety cluster, and a High Traits cluster. This High Traits cluster had the lowest levels of academic achievement and the highest levels of internalizing behaviors and externalizing behaviors. The clinical implications of the results are discussed.

Clinical presentation and need for treatment of a cohort of subjects accessing to a mental illness prevention service

Outreaching activities decrease prognostic accuracy of at-risk mental state defining tools, over-attracting subjects who are not at increased risk of mental illness. The setting was a mental illness primary indicated prevention outpatients service embedded within the Psychiatry Unit of Padua University Hospital, Italy. Help-seeking patients accessing the service between January 2018 and December 2018 were evaluated with validated tools assessing functioning, at-risk mental state, schizotypal personality features, depressive and anxious symptoms, together with medical and family history collection. The primary outcome was the prevalence of drop in functioning at presentation according to the Social and Occupational Functioning Assessment Scale (SOFAS). Secondary outcomes were diagnoses according to DSM-5 criteria and meeting criteria for at-risk mental state. Fifty-nine patients accessed the service, mean age was 18.8 (2.12) years old, 54.2% were females. Virtually all subjects (97.7%) had a drop in functioning. Baseline primary diagnoses were depressive episode in 33%, anxiety disorder in 21%, personality disorder in 17%, adjustment disorder 9%, conduct disorder 7%, schizophrenia spectrum disorder 5%, bipolar disorder 5%, eating disorder in 1.7%, dissociative disorder 1.7%. Overall, 59.1% met at-risk mental state criteria. Lower functioning was associated with anxious symptoms (p=0.031), a family history of mental illness (p=0.045) and of suicide (p=0.042), and schizotypal personality traits (p=0.036). Subjects accessing a prevention service embedded within the mental health department already present a trans-diagnostic drop in functioning, mainly due to a non-psychotic mental disorder, with at-risk mental state in one patient out of two, and schizophrenia or bipolar disorder already present in only 10% of subjects. Prevention service within mental health facility setting appears to properly detect subjects in need of treatment with a drop in functioning, at risk of developing severe mental illness, without any outreaching activity in the general population.

"Formal Thought Disorder" in a General-Community Sample With Elevated Schizotypal Traits

Different dimensions of formal thought disorder (FTD) are distinguished by different patterns of cognitive dysfunction and cortical variability in patients with schizophrenia; however, inconsistent findings may relate to patient-related confounds. Investigating FTD in nonpatient samples with elevated levels of schizotypal traits avoids these confounds, but its utility to FTD research is unknown. Thus, we performed principal components analysis (PCA) of FTD ratings using the Scale for the Assessment of Thought, Language, and Communication (TLC) and the Thought and Language Index (TLI) in a general-community sample with elevated schizotypal traits. Both scales showed "clinically elevated" FTD, particularly, the TLC. PCA described a three-component TLC solution ("disorganization," "verbosity," "emptiness") and a two-component TLI solution ("negative," "idiosyncratic"), generally consistent with schizophrenia research. TLC "disorganization" and "emptiness" were correlated with psychosis-like experiences. TLI "negative" was associated with lower general cognitive function, consistent with schizophrenia research. FTD may have shared etiology along the schizophrenia spectrum.

Could schizotypy protect against the negative outcomes of borderline traits on alcohol consumption? A cluster analytic study

Schizotypal and borderline personality traits seem to be differently associated to alcohol use in young adult. However, no study has explored co-occurring schizotypal and borderline traits in their link with alcohol consumption. Participants were 1572 students from different French universities who completed self-report questionnaires assessing these three dimensions. A cluster analysis based on the borderline and schizotypal traits scores yielded four distinct groups characterized by low schizotypal and borderline traits (LT), high borderline traits (HB), high schizotypal and borderline traits (HT) and high schizotypal traits (HS). The HS cluster had significantly lower alcohol use than the other three groups. LT and HT clusters did not differ significantly in their alcohol use. Comparison between clusters suggests that schizotypal traits may be protective against the negative impact of borderline traits on alcohol consumption. In the context of a co-occurrence between borderline and schizotypal traits, this study provides important information about their link with alcohol consumption.

Typology of schizotypy in non-clinical young adults: Psychopathological and personality disorder traits correlates

Few typological studies address schizotypy in young adults. Schizotypal traits were assessed on 466 college students using the Schizotypal Personality Questionnaire-Brief (SPQ-B). Other measures evaluated personality traits previously associated with schizotypy (borderline, obsessionnal, and autistic traits), psychopathological symptoms (suicidal ideations, depressive and obsessive-compulsive symptoms) and psychosocial functioning. A factor analysis was first performed on SPQ-B results, leading to four factors: negative schizotypy, positive schizotypy, social anxiety, and reference ideas. Based on these factors, a cluster analysis was conducted, which yielded four clearly distinct groups characterized by "Low" (non schizotypy), "High schizotypy" (mixed positive and negative), "Positive schizotypy", and "Social impairment". Regarding personality disorder traits and psychopathological symptoms, the "High schizotypy" cluster scored higher than the "Positive" and the "Social impairment" groups, which scored higher than the "Low" cluster. The "Positive" group had higher levels of interpersonal relationships than in the "High" and the "Social impairment" clusters, suggesting that positive schizotypy was associated to benefits such as perceived social relationships. Nevertheless the "Positive" cluster was also linked to high levels of personality disorder traits and psychopathological symptoms, and to low academic achievement, at levels similar those observed in the "Social impairment" cluster, confirming an unhealthy side to positive schizotypy.

Association between schizotypal and borderline personality disorder traits, and cannabis use in young adults

The aim of the study was to examine the association of schizotypal and borderline personality traits to cannabis use. Participants were 476 college students (95 males; 381 females; mean age of males=21; mean age of females=20.7) who completed self-report questionnaires assessing cannabis use, schizotypal and borderline personality traits. Problematic cannabis use, depressive symptoms, borderline and schizotypal traits were significantly inter-correlated. A logistic regression analysis showed that only borderline traits contributed significantly to cannabis use in the total sample. A multiple regression analysis showed that only schizotypal traits were positively and uniquely associated to problematic cannabis use symptoms among users. These results may imply that schizotypal traits are not a risk factor for initiating use, but may facilitate the development of problematic use symptoms among users. This study showed the necessity of taking into account schizotypal traits when exploring the relationships between depressive symptoms, borderline traits and cannabis use.

Self-reported symptoms of schizotypal and borderline personality disorder in patients with mood disorders

BACKGROUND

Distinguishing between symptoms of schizotypal (SPD) and borderline personality disorders (BPD) is often difficult due to their partial overlap and frequent co-occurrence. We investigated correlations in self-reported symptoms of SPD and BPD in questionnaires at the levels of both total scores and individual items, examining overlapping dimensions.

METHODS

Two questionnaires, the McLean Screening Instrument (MSI) for BPD and the Schizotypal Personality Questionnaire Brief (SPQ-B) for SPD, were filled in by patients with mood disorders (n=282) from specialized psychiatric care in a study of the Helsinki University Psychiatric Consortium. Correlation coefficients between total scores and individual items of the MSI and SPQ-B were estimated. Multivariate regression analysis (MRA) was conducted to examine the relationships between SPQ-B and MSI.

RESULTS

The Spearman's correlation between total scores of the MSI and SPQ-B was strong (rho=0.616, P<0.005). Items of MSI reflecting disrupted relatedness and affective dysregulation correlated moderately (rφ varied between 0.2 and 0.4, P<0.005) with items of SPQ. Items of MSI reflecting behavioural dysregulation correlated only weakly with items of SPQ. In MRA, depressive symptoms, sex and MSI were significant predictors of SPQ-B score, whereas symptoms of anxiety, age and SPQ-B were significant predictors of MSI score.

CONCLUSIONS

Items reflecting cognitive-perceptual distortions and affective symptoms of BPD appear to overlap with disorganized and cognitive-perceptual symptoms of SPD. Symptoms of depression may aggravate self-reported features of SPQ-B, and symptoms of anxiety features of MSI. Symptoms of behavioural dysregulation of BPD and interpersonal deficits of SPQ appear to be non-overlapping.

Covariance and specificity in adolescent schizotypal and borderline trait expression

AIMS

The first aim of the present study is to assess the overlap between borderline and schizotypal traits during adolescence. The second objective is to examine whether some psychological factors (i.e. cognitive coping mechanisms, impulsivity and encoding style) are differentially related to borderline and schizotypal traits and may therefore improve the efficiency of clinical assessments.

METHODS

One hundred nineteen community adolescents (57 male) aged from 12 to 19 years completed a set of questionnaires evaluating the expression of borderline and schizotypal traits as well as cognitive emotion regulation (CER), impulsivity and encoding style.

RESULTS

Our data first yielded a strong correlation between borderline and schizotypal scores (r = 0.70, P < 0.001). Secondly, linear regression models indicated that the 'catastrophizing' CER strategy and the 'lack of premeditation' impulsivity facet accounted for the level of borderline traits, whereas an internal encoding style predominantly explained schizotypal traits.

CONCLUSIONS

Our results support the abundant literature showing that borderline and schizotypal traits frequently co-occur. Moreover, we provide original data indicating that borderline and schizotypal traits during adolescence are linked to different specific psychological mechanisms. Thus, we underline the importance of considering these mechanisms in clinical assessments, in particular to help disentangle personality disorder traits in youths.