Examining the relationships between cognition and auditory hallucinations: A systematic review

OBJECTIVE

Auditory hallucinations (hearing voices) have been associated with a range of altered cognitive functions, pertaining to signal detection, source-monitoring, memory, inhibition and language processes. Yet, empirical results are inconsistent. Despite this, several theoretical models of auditory hallucinations persist, alongside increasing emphasis on the utility of a multidimensional framework. Thus, clarification of current evidence across the broad scope of proposed mechanisms is warranted.

METHOD

A systematic search of the Web of Science, PubMed and Scopus databases was conducted. Records were screened to confirm the use of an objective behavioural cognitive task, and valid measurement of hallucinations specific to the auditory modality.

RESULTS

Auditory hallucinations were primarily associated with difficulties in perceptual decision-making (i.e. reduced sensitivity/accuracy for signal-noise discrimination; liberal responding to ambiguity), source-monitoring (i.e. self-other and temporal context confusion), working memory and language function (i.e. reduced verbal fluency). Mixed or limited support was observed for perceptual feature discrimination, imagery vividness/illusion susceptibility, source-monitoring for stimulus form and spatial context, recognition and recall memory, executive functions (e.g. attention, inhibition), emotion processing and language comprehension/hemispheric organisation.

CONCLUSIONS

Findings were considered within predictive coding and self-monitoring frameworks. Of concern was the portion of studies which - despite offering auditory-hallucination-specific aims and inferences - employed modality-general measures, and/or diagnostic-based contrasts with psychologically healthy individuals. This review highlights disparities within the literature between theoretical conceptualisations of auditory hallucinations and the body of rigorous empirical evidence supporting such inferences. Future cognitive investigations, beyond the schizophrenia-spectrum, which explicitly define and measure the timeframe and sensory modality of hallucinations, are recommended.

An online survey on clinical and healthy individuals with auditory verbal hallucinations: Abuse did not lead to more negative voice content

Despite the clinical and theoretical importance of the negative content in auditory verbal hallucinations (AVHs), little research has been conducted on the topic. A handful of studies suggest that trauma or adverse life events contribute to negative content. The findings are somewhat inconsistent, however, possibly due to methodological limitations. Moreover, only trauma occurring in childhood has been investigated so far. In the present study, we studied the effect of abuse, experienced in either child- or adulthood, and clinical status on negative content of AVHs in four groups of participants that were assessed as part of a large, previously published online survey: Individuals with a psychotic disorder and AVHs (total n = 33), who had experienced abuse (n = 21) or not (n = 12) as well as a group of healthy individuals with AVHs (total n = 53), who had experienced abuse (n = 31) or not (n = 22). We hypothesized that having experienced abuse was associated with a higher degree of negative content. The clinical group collectively reported significantly higher degrees of negative AVHs content compared to the healthy group, but there was no effect of abuse on the degree of negative AVHs content. The presence of AVHs was more common amongst individuals who reported a history of abuse compared to individuals with no history of abuse, both in clinical and healthy participants with AVHs. This implies that at group level, being subjected to traumatic events increases an individual's vulnerability to experiencing AVHs. However, it does not necessarily account for negative content in AVHs.

On hallucinations and memory: the relationship between hallucinations and autobiographical overgenerality in Alzheimer's Disease

OBJECTIVES

Alzheimer's disease (AD) has been associated with autobiographical overgenerality (i.e. a tendency of patients to retrieve general rather than specific personal memories). AD has also been associated with hallucinations. We investigated the relationship between autobiographical overgenerality and hallucinations in AD.

METHODS

We invited 28 patients with mild AD to retrieve autobiographical memories, and we also evaluated the occurrence of hallucinations in these patients.

RESULTS

Analysis demonstrated significant correlations between hallucinations and autobiographical overgenerality in the patients.

CONCLUSION

AD patients who are distressed by hallucinations may demonstrate autobiographical overgenerality as a strategy to avoid retrieving distressing information that may be related with hallucinations. However, hallucinations as observed in our study can be attributed to other factors such as the general cognitive decline in AD.

A ten-year longitudinal repeated assessment study of cognitive improvement in patients with first-episode schizophrenia and healthy controls: The Oslo Schizophrenia Recovery (OSR) study

The mapping of cognitive trajectories after a first episode of schizophrenia has been the aim in several studies, but the longitudinal course of cognitive impairments remains an important question. Due to methodological limitations, it has been challenging to pinpoint specific periods of improvement or stability in cognitive functioning over time. The objective of this study is to further clarify the longitudinal course of cognitive change after a first episode of schizophrenia through frequent repeated measurement. A total of 56 persons participated in the study (28 first episode patients and 28 healthy pairwise matched controls) with 79 % of patients retained at the 10-year follow-up. The Oslo Schizophrenia Recovery study has a repeated measurement design and includes data from nine cognitive assessments over 10 years. Cognition was assessed with the MATRICS Consensus Cognitive Battery, which is well suited for repeated measurements. Data were analyzed with linear multilevel models. The results challenge some of the views about the course of cognitive impairment in first-episode schizophrenia patients. Using quadratic time effects in our analyses and balancing the patient group with regards to the most relevant confounding demographic variables such as age, gender, and education, we showed that cognitive deficits change and improve more than in healthy individuals until year 6, when both groups stabilize. The patient group improved on some of the most important cognitive domains associated with functional outcome with 63.5 % full recovery at 10-year follow-up.

Anomalous self-experiences and neurocognitive functioning in adolescents at risk for psychosis: Still no significant associations found between these two vulnerability markers

BACKGROUND

Anomalous self-experiences (ASEs) and neurocognitive impairments are considered essential domains of vulnerability for developing psychotic disorders. However, little research exists of possible associations between ASEs and neurocognitive functions in individuals at-risk for psychosis. The interconnections between ASEs and neurocognitive impairments should therefore be clarified as much as possible, especially in young individuals at risk. No previous studies have investigated these two fundamental domains in non-help-seeking adolescents at risk for developing psychosis.

METHODS

This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa). Adolescents (N = 48, 94% females, mean age = 15.3) were invited to participate after completing a 14-year-old survey distributed by MoBA. At-risk adolescents were selected based on the 0.4% highest scores on 19 items assessing both psychotic-like experiences and ASEs. Five specifically selected and formulated items measuring ASEs were computed to an ASEs total score. Neurocognitive functioning was assessed using the MATRICS Consensus Cognitive Battery.

RESULTS

Regression analyses revealed no significant relationships between ASEs and any neurocognitive domain.

CONCLUSIONS

We did not find any significant associations between ASEs and neurocognitive functions in non-help-seeking adolescents at risk for psychotic disorders, which is in line with reports from other types of cohorts. Thus, ASEs and neurocognitive functions may be understood as two relatively separate domains that co-exist in at-risk states. These results underline the need for a wider scope when making predictions about future trajectories, e.g. the development of psychotic disorders. Including both ASEs and neurocognitive functioning in at-risk populations may increase the specificity of vulnerability criteria in this population and enhance our understanding of early psychosis psychopathology.

Using 360-degree immersive videos to assess multiple transdiagnostic symptoms: A study focusing on fear of negative evaluation, paranoid thoughts, negative automatic thoughts, and craving

Over the last 20 years, virtual reality (VR) has gained a great interest for both assessment and treatment of various psychopathologies. However, due to high costs and material specificity, VR remains disadvantageous for clinicians. Adopting a multiple transdiagnostic approach, this study aims at testing the validity of a 360-degree immersive video (360IV) for the assessment of five common psychological symptoms (fear of negative evaluation, paranoid thoughts, negative automatic thoughts, craving for alcohol and for nicotine). A 360IV was constructed in the Darius Café and included actors behaving naturally. One hundred and fifty-eight adults from the general population were assessed in terms of their proneness towards the five symptoms, were then exposed to the 360IV and completed measures for the five state symptoms, four dimensions of presence (place, plausibility, copresence and social presence illusions) and cybersickness. Results revealed that the five symptoms occurred during the immersion and were predicted by the participants' proneness towards these symptoms. The 360IV was also able to elicit various levels of the four dimensions of presence while producing few cybersickness. The present study provides evidence supporting the use of the 360IV as a new accessible, ecological, and standardized tool to assess multiple transdiagnostic symptoms.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10055-023-00779-y.

Eliciting false auditory perceptions using speech frequencies and semantic priming: a signal detection approach

INTRODUCTION

Individuals experiencing auditory hallucinations (AH) tend to perceive voices when exposed to random noise. However, the factors driving this tendency remain unclear. The present study examined the interaction of a top-down (expectations) and bottom-up (type of noise) process to better understand the mechanisms that underlie AH.

METHODS

Fifty-two healthy individuals (29 with high proneness and 23 with low proneness to AH) completed a signal detection task, in which they listened to pre-recorded sentences. The last word was either masked by noise or only noise was presented without the word. Two types of noise existed (speech-related versus speech-unrelated frequencies) and words were characterised by either high or low levels of semantic expectation.

RESULTS

Participants with high proneness to AH showed a more liberal decision bias (i.e., they were more likely to report having heard a word) and poorer discrimination ability as compared to participants with low proneness to AH - but only when the word was masked by speech-related noises and the level of expectation was high. Further, the more liberal decision bias correlated negatively with the tendency to experience AH.

CONCLUSION

This novel paradigm demonstrated an interaction between top-down (level of expectation) and bottom-up (type of noise) processes, supporting current theoretical models of AH.

Translation and Validation of the French Version of the Revised Green et al., Paranoid Thoughts Scale (R-GPTS) in Two Samples: Non-Clinical and Clinical Adults

Paranoia consists of unfounded beliefs that harm will be caused with intent to hurt the subject. Paranoid thoughts exist on a continuum of severity from severe forms in several psychological pathologies to milder forms in a significant minority of individuals of the general population (Freeman, 2007). It can be measured using several types of questionnaires. One recent questionnaire that measures paranoia in both clinical and non-clinical populations is the revised Green et al., Paranoid Thoughts Scale (R-GPTS) (Freeman et al., 2019). This questionnaire is an improved version of the Green et al., Paranoid Thoughts Scale (GPTS) (Green et al., 2008) and has excellent psychometric properties. In the present study, the R-GPTS was translated into French and the psychometric properties of the new French version were evaluated in a sample of the general population (N = 600) and in a clinical sample (N = 22). Confirmatory factor analysis supported the original two-factor structure (social reference and persecution subscales) of the R-GPTS. Evidence of excellent internal consistency of the R-GPTS was found. Furthermore, good convergent and discriminant validity was also found. Test-retest reliability showed significant positive correlations over a 1-month period. The findings discussed above were found in the non-clinical sample. Lastly, the R-GPTS revealed good preliminary criterion validity established from the comparison between the clinical and the non-clinical groups. In conclusion, the French version of the R-GPTS is a valid and reliable tool to measure paranoia in the general population. Due to the small sample size of the clinical sample, further studies are needed in order to confirm good psychometric properties in clinical populations, even though our preliminary findings are promising.

From core schemas about the self and others to voice phenomenology: Anxiety and depression affect voice hearers differently

OBJECTIVES

Auditory verbal hallucinations (AVHs) occur as a symptom in various mental disorders, and show different phenomenological aspects, depending on their underlying psychopathology. Anxiety and depression, which are known to be involved in the development of AVHs, are suggested to amplify a vicious cycle in which negative interpretations of daily experiences feed into the formation of negative core schemas about the self and others. However, the way in which these variables interrelate is still unknown. Therefore, our aim was to determine the specific roles of anxiety and depression in the relationship between core schemas and emotional aspects of AVHs for three groups (non-clinical voice hearers, affective voice hearers and non-affective voice hearers).

METHODS

Positive and negative core schemas of the self and others were tested as predictors of emotional distress due to AVHs, examining anxiety and depression separately as potential mediators.

RESULTS

Results showed full mediating effects of depression in non-affective voice hearers in the relationship between negative core schemas and AVH distress, but not in affective voice hearers. Anxiety was not a mediator in any of the groups.

CONCLUSIONS

These findings suggest different emotional mechanisms depending on the underlying psychopathology.

A systematic review of premorbid cognitive functioning and its timing of onset in schizophrenia spectrum disorders

Cognitive impairments are core features of established schizophrenia spectrum disorders (SSD). However, it remains unclear whether specific cognitive functions are differentially impaired pre-onset and at what age these impairments can be detected. The purpose of this review was to elucidate these issues through a systematic summary of results from longitudinal studies investigating impairment in specific cognitive domains as antecedents of SSD.

Relevant studies were identified by electronic and manual literature searches and included any original study of cognitive domains any time pre-onset of SSDs that included a control group. Effect sizes were calculated by domain for studies comparing high-risk participants who developed SSD with those who did not.

The strongest evidence for impairment pre-onset was for mental processing speed, verbal learning and memory, executive function, and social cognition. Some verbal impairments, like language abilities at age 3 and verbal learning and memory at age 7, may develop as static deficits. Conversely, some non-verbal impairments, like mental processing speed, visuospatial abilities, and visual working memory manifest as developmental lag and become significant later in life. Most effect sizes were small to moderate, except for verbal fluency (d′ = 0,85), implying this impairment as central in high-risk participants who develop SSD.

The present review documents extensive cognitive impairments pre-onset of SSD, and that these impairments start early in life, in line with the neurodevelopmental hypothesis of schizophrenia. Increased knowledge about cognitive impairments preonset can provide a better basis for understanding the complex pathogenesis of SSD as well as informing cognitive remediation programs.

•

Specific cognitive domains evidence differential impairment pre-onset.

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Most effect sizes were small to moderate.

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Some verbal impairments develop as static deficits from early childhood.

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Some non-verbal impairments present as developmental lag and become apparent later.

•

Impairments start early in life, in line with the neurodevelopmental hypothesis.

Cognitive functioning in a group of adolescents at risk for psychosis

Cognitive deficits are a core feature of schizophrenia, and impairments are present in groups at-risk for psychosis. Most at-risk studies include young adults and not younger age-groups, such as adolescents. Participants are usually help-seeking individuals, even though risk factors may also be present in non-help seeking adolescents. We aim to explore cognitive functions in a group of non-help-seeking 15-year-old adolescents at risk for psychosis compared to age- and gender matched controls, including particular focus on specific cognitive domains. Hundred participants (mean age = 15.3) were invited after completing the 14-year-old survey distributed by the Norwegian Mother-, Father- and Child Study. At-risk adolescents were selected based on high scores on 19 items assessing both psychotic experiences and anomalous self-experiences. Matched controls were selected from the same sample. Cognitive functioning was assessed using the MATRICS Consensus Cognitive Battery and IQ using Wechsler's Abbreviated Test of Intelligence. We found that the adolescents at-risk for psychosis had significantly poorer scores than controls on the composite score of the MCCB. IQ scores were also significantly lower in the at-risk group. The results highlight general cognitive deficits as central in a group of non-help-seeking adolescents at-risk for psychosis. Results indicate that the development of cognitive impairments starts early in life in at-risk groups. It is still unclear whether specific cognitive domains, such as verbal learning, are related to psychotic symptoms or may be specifically vulnerable to symptoms of depression and anxiety.

Hallucinations and Covid-19: Increased Occurrence of Hallucinations in Patients with Alzheimer's Disease During Lockdown

We investigated the effects of lockdown, as implemented by retirement homes to cope with the spread of Covid-19, on hallucinatory experiences in patients with Alzheimer's disease (AD). The study included 47 patients with AD living in retirement homes and who were already experiencing hallucinations prior to the lockdown. We invited caregivers to rate hallucinatory experiences in these patients during the lockdown, and compared this rating with that provided by the same caregivers prior to the lockdown. Results demonstrated increased hallucinatory experiences in patients with AD during the lockdown, compared with before the lockdown. The decrease in social and physical activities during the lockdown, and especially, the physical separation of residents from family members, might have led to decreased sensory stimulation and increased loneliness, and consequently, to the hallucinatory experiences in patients with AD living in retirement homes during the lockdown. While the restrictive measures were necessary to cope with the spread of Covid-19, these measures have increased hallucinations in patients with AD living in retirement homes, at least in those who were already experiencing hallucinations prior to the lockdown.

Item-specific overlap between hallucinatory experiences and cognition in the general population: A three-step multivariate analysis of international multi-site data

Hallucinatory experiences (HEs) can be pronounced in psychosis, but similar experiences also occur in nonclinical populations. Cognitive mechanisms hypothesized to underpin HEs include dysfunctional source monitoring, heightened signal detection, and impaired attentional processes. Using data from an international multisite study on non-clinical participants (N = 419), we described the overlap between two sets of variables - one measuring cognition and the other HEs - at the level of individual items. We used a three-step method to extract and examine item-specific signal, which is typically obscured when summary scores are analyzed using traditional methodologies. The three-step method involved: (1) constraining variance in cognition variables to that which is predictable from HE variables, followed by dimension reduction, (2) determining reliable HE items using split-halves and permutation tests, and (3) selecting cognition items for interpretation using a leave-one-out procedure followed by repetition of Steps 1 and 2. The results showed that the overlap between HEs and cognition variables can be conceptualized as bi-dimensional, with two distinct mechanisms emerging as candidates for separate pathways to the development of HEs: HEs involving perceptual distortions on one hand (including voices), underpinned by a low threshold for signal detection in cognition, and HEs involving sensory overload on the other hand, underpinned by reduced laterality in cognition. We propose that these two dimensions of HEs involving distortions/liberal signal detection, and sensation overload/reduced laterality may map onto psychosis-spectrum and dissociation-spectrum anomalous experiences, respectively.

A Group Intervention for Motivational Deficits: Preliminary Investigation of a Blended Care Approach Using Ambulatory Assessment

Motivational deficits are an important predictor of functional outcomes in individuals with a serious mental illness such as schizophrenia and mood spectrum disorders. The aim of the present study was to explore the feasibility, acceptability, and preliminary efficacy of a group version of "Switch," an intervention that targets motivational deficits, enriched with an ecological momentary intervention (EMI) approach (i.e., prompts on the participants' smartphone to encourage the use of trained strategies in their daily life). Eight participants with schizophrenia, schizoaffective, or major depressive disorder entered the study. The intervention took place twice a week for 2 months. Assessment measures included traditional evaluations of motivational negative symptoms, apathy, quality of life and daily functioning, in addition to ambulatory assessment methods strategies, including the experience sampling method (ESM) to assess motivation and related processes, and actigraphy (daily step-count) to assess participants' activity level. Four participants were considered as non-completers (followed less than 2/3 of the program) and four were considered as completers. Only completers presented a decrease in amotivation/apathy and an improvement in functional outcomes after the intervention and at follow-up. Furthermore, mixed-effects ESM models showed significant interaction effects on multiple processes related to motivation, indicating improvements only in completers: heightened motivation, increased engagement in meaningful and effortful activities, better mood, higher levels of confidence, increased frequency of projection into the future (pleasure anticipation), and of positive reminiscence. This preliminary investigation provides evidence that Switch may be an effective intervention, with specific effects on motivation and associated processes.

Using 360° immersive videos to assess paranoia in a non-clinical population

Introduction: For the past two decades, virtual reality (VR) has proven to be an innovative approach for the assessment of state paranoia. However, the use of VR remains costly, and avatars are still far from realistic in terms of facial and bodily expressions. The present study aimed to test the validity of three 360° immersive videos (360IVs) as an accessible and realistic alternative for the assessment of non-clinical state paranoia.Method: Three 360IVs were created (a Lift, a Library and a Bar) and included actors behaving naturally. One hundred and fifty healthy students were assessed in terms of their proneness towards trait paranoia, were then exposed to one of the three 360IVs, and finally completed measures of state paranoia, sense of presence and cybersickness.Results: Results revealed the presence of various interpretations about the actor's attitudes in the three 360IVs. Also, paranoid thoughts were predicted by proneness towards trait paranoia in two out of the three 360IVs. Furthermore, moderate levels of sense of presence and low levels of cybersickness were observed for each 360IV.Conclusion: The present study provides evidence in favour of the use of 360IVs as a new accessible, realistic, and standardised tool to assess state paranoia in non-clinical samples.

In the twilight zone: An epidemiological study of sleep-related hallucinations

BACKGROUND

Few studies have investigated hallucinations that occur at the onset/offset of sleep (called hypnagogic/hypnopompic hallucinations; HHHs), despite the fact that their prevalence in the general population is reported to be higher than the prevalence of daytime hallucinations. We utilized data from an epidemiological study to explore the prevalence of HHHs in various modalities. We also investigated phenomenological differences between sleep-related (HHHs) and daytime hallucinations in the auditory modality. We hypothesized that individuals with only HHHs would not differ from controls on a range of mental health and wellbeing measures, but that if they occur together with daytime hallucinations will pose a greater burden on the individual experiencing them. We also hypothesize that HHHs are qualitatively different (i.e. less severe) from daytime hallucinations.

METHODS

This study utilized data from a cross-sectional epidemiological study on the prevalence of hallucinations in the Norwegian general population. The sample (n = 2533) was divided into a control group without hallucinations (n = 2303), a group only experiencing sleep-related hallucinations (n = 62), a group only experiencing daytime hallucinations (n = 57), and a group experiencing both sleep-related as well as daytime hallucinations (n = 111). Prevalence rates were calculated and groups were compared using analyses of variance and chi-square tests where applicable.

RESULTS

The prevalence for HHHs in the auditory domain was found to be 6.8%, whereas 12.3% reported multimodal HHHs, and 32.2% indicated out-of-body experiences at the onset/offset of sleep. Group comparisons of hallucinations in the auditory modality showed that individuals that experienced only auditory HHHs scored significantly (p < 0.05) lower than those who also experienced daytime auditory hallucinations on a range of variables including mental health, anxiety, childhood happiness, and wellbeing. In addition, individuals with only auditory HHHs reported significantly (p < 0.05) less frequent hallucinations, less disturbing hallucinations, more neutral (in terms of content) hallucinations, hallucinations with less influence over their behavior, and less hallucination-related interference with social life compared to those individuals that experience daytime hallucinations. We also found that purely auditory HHHs had a significantly higher age of first onset of hallucinations than the purely daytime and the combined daytime and auditory HHHs groups (28.2 years>20.9 > 19.1).

CONCLUSIONS

Sleep-related hallucinations are common experiences in the general population, with the auditory modality being the least common. They occur mostly in combination with daytime hallucinations. However, some individuals (2.4%) experience only (auditory) sleep-related hallucinations and this group can be seen as more closely related, on a range of health-related factors, to non-hallucinating individuals than individuals who experience daytime hallucinations. Finally, there is a clear need for more research in this field, and ideas for future studies are presented.

Correlates of Hallucinatory Experiences in the General Population: An International Multisite Replication Study

Hallucinatory experiences can occur in both clinical and nonclinical groups. However, in previous studies of the general population, investigations of the cognitive mechanisms underlying hallucinatory experiences have yielded inconsistent results. We ran a large-scale preregistered multisite study, in which general-population participants (N = 1,394 across 11 data-collection sites and online) completed assessments of hallucinatory experiences, a measure of adverse childhood experiences, and four tasks: source memory, dichotic listening, backward digit span, and auditory signal detection. We found that hallucinatory experiences were associated with a higher false-alarm rate on the signal detection task and a greater number of reported adverse childhood experiences but not with any of the other cognitive measures employed. These findings are an important step in improving reproducibility in hallucinations research and suggest that the replicability of some findings regarding cognition in clinical samples needs to be investigated.

The Impact of Sexualized Video Game Content and Cognitive Load on State Rape Myth Acceptance

The potential negative impact of sexualized video games on attitudes toward women is an important issue. Studies that have examined this issue are rare and contain a number of limitations. Therefore, it largely remains unclear whether sexualized video games can have an impact on attitudes toward women. This study examined the consequences of sexualized video game content and cognitive load (moderator) on rape victim blame and rape perpetrator blame (used as a proxy of rape myth acceptance), and whether the degree of humanness of the victim and of the perpetrator mediated these effects. Participants (N = 142) played a video game using sexualized or non-sexualized female characters. Cognitive load was manipulated by setting the difficulty level of the game to low or high. After gameplay, participants read a rape date story, and were then asked to judge the victim's and the perpetrator's degree of responsibility and humanness. Based on the General Aggression Model (GAM), it was hypothesized that playing the video game with a sexualized content would increase the responsibility assigned to the victim and diminish the responsibility assigned to the perpetrator. Further, degree of humanness of the victim and the perpetrator was expected to mediate this relation. The results were partially consistent with these predictions: Playing a video game containing sexualized female characters increased rape victim blame when cognitive load was high, but did not predict degree of humanness accorded to the victim. Concerning the perpetrator, video game sexualization did not influence responsibility, but partly influenced humanness. This study concludes that video games impact on attitudes toward women and this, in part, due to its interactive nature.

Hallucinations and source monitoring in Alzheimer's disease

INTRODUCTION

the source monitoring account has been widely investigated for hallucinations in schizophrenia. According to this account, hallucinations are inner events that are misattributed to another source. Our paper investigated this account for Alzheimer's disease.

METHOD

we investigated hallucination experiences in participants with Alzheimer's disease and age-matched healthy controls, as well as their source monitoring ability. The assessment of source monitoring included three conditions. In the first condition, participants had to remember whether objects were previously manipulated by themselves or by the experimenter (i.e. reality monitoring). In the second condition, they had to remember whether objects were previously manipulated by a black or white experimenter-gloved hand (i.e. external monitoring). In the third condition, participants had to remember whether they had previously manipulated objects or had imagined having done so (i.e. internal monitoring).

RESULTS

relative to healthy control participants, participants with Alzheimer's disease experienced hallucinations more often and lower hits on source monitoring. Interestingly, significant correlations were only observed between hallucinations and the internal monitoring condition in participants with Alzheimer's disease.

DISCUSSION

hallucinations in Alzheimer's disease seem to be related to the processes of making judgments about the (internal) context in which an event has occurred.

Sensory and Quasi-Sensory Experiences of the Deceased in Bereavement: An Interdisciplinary and Integrative Review

Bereaved people often report having sensory and quasi-sensory experiences of the deceased (SED), and there is an ongoing debate over whether SED are associated with pathology, such as grief complications. Research into these experiences has been conducted in various disciplines, including psychiatry, psychology, and anthropology, without much crossover. This review brings these areas of research together, drawing on the expertise of an interdisciplinary working group formed as part of the International Consortium for Hallucination Research (ICHR). It examines existing evidence on the phenomenology, associated factors, and impact of SED, including the role of culture, and discusses the main theories on SED and how these phenomena compare with unusual experiences in other contexts. The review concludes that the vast majority of these experiences are benign and that they should be considered in light of their biographical, relational, and sociocultural contexts.

Hallucinations in a Patient with Alzheimer's Disease During the COVID-19 Crisis: A Case Study

While social distancing may be deemed necessary in order to avoid COVID-19 infections, the lockdown may impact mental health of patients with Alzheimer’s disease (AD). We present a case study involving hallucinations in a patient with AD who lives in a nursing home during the COVID-19 crisis. We compared this patient’s hallucination scores before and during the lockdown. We observed increased hallucinations during, compared to before, the lockdown. These increased hallucinations can be attributed to a number of elements such as the decreased in daily activities, social distancing, lack of physical contact with family members, and loneliness during the lockdown.

Mapping psychotic-like experiences: Results from an online survey

Suggestions have been made that psychotic-like experiences (PLEs), such as hallucinatory and delusional experiences, exist on a continuum from healthy individuals to patients with a diagnosis of schizophrenia. We used the screening questions of the Questionnaire for Psychotic Experiences (QPE), an interview that captures the presence and phenomenology of various psychotic experiences separately, to assess PLEs in Norway. Based on data from an online survey in a sample of more than 1,400 participants, we demonstrated that the QPE screening questions show satisfactory psychometric properties. Participants with mental disorders reported more frequent lifetime and current hallucinatory experiences than participants without mental disorders. Childhood experiences were rather low and ranged from 0.7% to 5.2%. We further replicated findings that young age, illegal drug use, lower level of education, and having parents with a mental disorder are associated with higher endorsement rates of PLEs. Finally, a binomial regression revealed that the mere presence of PLEs does not discriminate between individuals with and without a mental disorder. Taken together, the findings of the present study support existing models that both hallucinations and delusions exist on a structural and phenomenological continuum. Moreover, we demonstrated that the QPE screening questions can be used by themselves as a complementary tool to the full QPE interview.

Idiographic analyses of motivation and related processes in participants with schizophrenia following a therapeutic intervention for negative symptoms

BACKGROUND

Motivational negative symptoms hinder quality of life and daily functioning of individuals with schizophrenia spectrum disorders. A recently developed intervention, Switch, has shown promising effects on negative symptoms and functional outcomes. Switch targets multiple cognitive, emotional and behavioural processes associated with motivation and goal directed behaviours. We aimed to investigate its effects on motivation and associated processes in a naturalistic setting, and to explore the dynamics between the processes.

METHODS

We used a single case approach (n = 3), with a pre-post and follow-up assessment design, which also included ambulatory assessments (experience sampling method, ESM; and step count). We computed autoregressive lag 1 models to evaluate the effects of the intervention on daily motivation levels and related processes, descriptive pie-charts, and vector autoregressive modelling to reveal the dynamics of the processes over time.

RESULTS

The intervention was beneficial for each participant according to traditional evaluations of motivational negative symptoms, apathy, daily functioning and quality of life. The effects on the ESM variables revealed distinct outcomes for each individual. The dynamics between the various processes differed between participants, and fluctuated within participants (when comparing baseline, intervention phase, and follow-up).

CONCLUSIONS

This study used an innovative approach to look at the effectiveness of an intervention. The intervention seems to lead to meaningful improvements in motivational negative symptoms and functional outcomes. The mechanisms of change need to be further investigated.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov, NCT04325100 . Registered 27 March 27, 2020 -retrospectively registered.

REPORTING

Guidelines from the Transparent Reporting of Evaluations with Non-randomized Designs (TREND) statement were followed.

A Review of Multimodal Hallucinations: Categorization, Assessment, Theoretical Perspectives, and Clinical Recommendations

Hallucinations can occur in different sensory modalities, both simultaneously and serially in time. They have typically been studied in clinical populations as phenomena occurring in a single sensory modality. Hallucinatory experiences occurring in multiple sensory systems-multimodal hallucinations (MMHs)-are more prevalent than previously thought and may have greater adverse impact than unimodal ones, but they remain relatively underresearched. Here, we review and discuss: (1) the definition and categorization of both serial and simultaneous MMHs, (2) available assessment tools and how they can be improved, and (3) the explanatory power that current hallucination theories have for MMHs. Overall, we suggest that current models need to be updated or developed to account for MMHs and to inform research into the underlying processes of such hallucinatory phenomena. We make recommendations for future research and for clinical practice, including the need for service user involvement and for better assessment tools that can reliably measure MMHs and distinguish them from other related phenomena.

Personal resilience factors protect against distressing auditory hallucinations: A study comparing psychotic patients with auditory hallucinations, non-patients with auditory hallucinations, and healthy controls

Although studies have identified several risk factors for the development of psychotic disorders, potential protective factors - such as resilience - have rarely been examined. Studies suggest that the negative beliefs people hold about their Auditory Hallucinations (AH) may be an indicator of a need for care. However, the reason why certain people do not develop negative beliefs is unclear but may be related to resilience. The present study aimed to examine the role of resilience in AH by comparing psychotic patients with AH, non-patients with AH, and healthy controls without AH. Another aim was to explore whether resilience is related to the beliefs people hold about their AH. Results revealed that patients with AH and non-patients with AH had similarly weak interpersonal resilience factors compared to healthy controls without AH. In contrast, patients with AH showed weak personal factors of resilience compared to both non-patients with AH and healthy controls without AH. Patients with AH had more negative and fewer positive beliefs about their AH than non-patients with AH. Finally, the personal factors of resilience were related to the beliefs about AH. These results showed that personal factors of resilience are decisive variables influencing the need for care in people experiencing AH and thus represent an important treatment target.

Hallucinations in Older Adults: A Practical Review

Older adults experience hallucinations in a variety of social, physical, and mental health contexts. Not everyone is open about these experiences, as hallucinations are surrounded with stigma. Hence, hallucinatory experiences in older individuals are often under-recognized. They are also commonly misunderstood by service providers, suggesting that there is significant scope for improvement in the training and practice of professionals working with this age group. The aim of the present article is to increase knowledge about hallucinations in older adults and provide a practical resource for the health and aged-care workforce. Specifically, we provide a concise narrative review and critique of (1) workforce competency and training issues, (2) assessment tools, and (3) current treatments and management guidelines. We conclude with a brief summary including suggestions for service and training providers and future research.

Switch, a new intervention that targets motivational negative symptoms in people with schizophrenia: An uncontrolled pilot study

OBJECTIVE

People diagnosed with schizophrenia experience difficulties in their daily life, which is best explained by motivational negative symptoms. This study explores the feasibility, acceptability, and efficacy of Switch, a new multifactorial intervention that targets motivational deficits.

METHOD

Eight participants with schizophrenia or schizoaffective disorder followed around 30 individual sessions of Switch over 12 months. Participants and their informants were interviewed at baseline (T0), at 6 months (T1), at the end of the intervention (T2), and at 6 months follow-up (T3).

RESULTS

T0-T1 paired sample t tests showed large improvements on motivational deficits, general negative symptoms, and apathy and functional outcomes (both as rated by informants). At T2 and T3, moderate to large improvements were maintained. Switch was well accepted by participants.

CONCLUSIONS

This preliminary investigation provides evidence that Switch may be a feasible, acceptable, and effective intervention specifically designed to target motivational deficits and improve daily functioning.

Further evidence of the multi-dimensionality of hallucinatory predisposition: factor structure of a modified version of the Launay-Slade Hallucinations Scale in a normal sample

Recent years has seen an increasing interest in the hallucinatory experience, including investigations of its phenomenological prevalence and character both in pathological and normal (predisposed) populations. We investigated the multi-dimensionality of hallucinatory experiences in 265 subjects from the normal population, who completed a modified version of the Launay-Slade Hallucinations Scale. Principal components analysis was performed on the data. Four factors were obtained loading on items reflecting (1) sleep-related hallucinatory experiences (2) vivid daydreams (3) intrusive thoughts or realness of thought and (4) auditory hallucinations. The results offer further evidence of the multi-dimensionality of hallucinatory disposition in the normal population. Directions for future research in hallucinatory predisposition are discussed.

Quantifying auditory impressions in dreams in order to assess the relevance of dreaming as a model for psychosis

A long noted hypothesis is that mechanisms of dreaming play a role in psychotic hallucinations. One challenge for this hypothesis is that while psychotic hallucinations primarily are auditory, dreaming most characteristically is visual. At the same time, previous studies have not explicitly examined auditory impressions in dreaming. Here, we mapped the prevalence and characteristics of auditory impressions in 130 dreams reported after spontaneous awakenings from sleep in 13 normal, healthy people. We instructed participants to report any dream they could recall and to pay particular attention to possible auditory impressions. The participants reported auditory impressions in 93.9% of their dreams on average. The most prevalent auditory type was other people speaking (83.9% of participants’ dreams), followed by the dreamer speaking (60.0%), and other types of sounds (e.g. music, 33.1%). Of altogether 407 instances of auditory impressions in the 130 dreams, auditory quality was judged comparable to waking in 46.4%, indeterminate in 50.6%, and absent or only thought-like in 2.9%. The results suggest that also internally generated auditory (verbal) sensations are a central component of dreaming, typically occurring several times every night in normal, healthy people.

Confabulations on Time: Relationship between Confabulations and Timing Deviations in Alzheimer’s Disease

Objectives

We investigated the relationship between confabulations and the ability to process chronological characteristics of memories in Alzheimer’s Disease (AD).

Methods

We evaluated provoked confabulations, spontaneous confabulations, and time perception in 31 AD patients. We evaluated provoked confabulations with questions probing general and personal knowledge. We evaluated spontaneous confabulations with a scale rated by nursing and medical staff. Regarding time perception, we invited the participants to perform a simple ongoing activity (i.e., deciding whether words were abstract or concrete), in order to provide a verbal estimation of the elapsed time intervals.

Results

We observed significant positive correlations between provoked/spontaneous confabulations and deviations in time estimation on the time perception task.

Conclusions

These findings demonstrate a relationship between confabulations in AD and difficulties in processing the chronological characteristics of elapsed events.

Psychometric investigation of the French version of the Aberrant Salience Inventory (ASI): differentiating patients with psychosis, patients with other psychiatric diagnoses and non-clinical participants

During the prodromal phase of psychosis, individuals may experience an aberrant attribution of salience to irrelevant stimuli. The concept of aberrant salience has been hypothesized to be a central mechanism in the emergence and maintenance of psychosis. The 29-item Aberrant Salience Inventory (ASI) was designed to measure five aspects of aberrant salience. The aim of this study was to investigate the psychometric properties of the French version of the ASI comparing patients with psychosis, patients with other diagnosis and healthy, non-clinical participants. The French-language ASI was adapted using the back-translation procedure. Two hundred and eighty-two participants issued from the general population and 150 psychiatric patients were evaluated. Internal validity was assessed using a two-parameter logistic item response model. Reliability was estimated using a test-retest procedure. Convergent validity was estimated using correlations between the ASI scores and several other scales. Sensitivity was evaluated by comparing the scores of participants with a diagnosis of psychosis, patients with other diagnoses and the general population. The best model distinguished three factors: Enhanced Interpretation and Emotionality, Sharpening of Senses and Heightened Cognition. Reliability and convergent validity estimates were good in both groups. The Sharpening of Senses factor was able to discriminate between patients and the general population. Only the Heightened Cognition factor was able to discriminate patients with psychosis from the other psychiatric patients. The ASI is a valid and reliable tool to study not only the aberrant salience phenomenon in patients with psychosis, but also with other diagnoses and within the general population.

Relationships Between Confabulations and Mental Time Travel in Alzheimer's Disease

The authors assessed the relationship between confabulations in Alzheimer's disease and the ability to mentally travel in time to reexperience memories. Twenty-seven patients with Alzheimer's disease were administered evaluations of provoked confabulations, spontaneous confabulations, and mental time travel. Provoked and spontaneous confabulations were evaluated with questions probing personal and general knowledge and with a scale rated by nursing and medical staff. Mental time travel was assessed by asking patients to retrieve personal memories. After each memory, participants had to provide a "remember" response if they were able to retrieve the event with their encoding context or a "know" response if they knew that the event had occurred but were unable to recall any contextual details. Results showed significant negative correlations between confabulations and "remember" responses. These findings reflect a relationship between the occurrence of confabulations in patients with Alzheimer's disease and impairments in their ability to mentally project themselves in time when retrieving the context in which confabulated memories were originally encoded.

A look into hallucinations: the relationship between visual imagery and hallucinations in Alzheimer's disease

Introduction: We investigated the relationship between visual hallucinations and vividness of visual imagery in patients with Alzheimer's disease (AD). Method: We recruited 28 patients with AD and 30 healthy control participants, matched for age and education. We evaluated proneness towards hallucinations with the Launay-Slade Hallucinations Scale, which includes items assessing visual and auditory hallucinations. We also evaluated vividness of visual imagery with the Vividness of Visual Imagery Questionnaire on which participants had to imagine four images (i.e., imagining the face of a friend, the rising sun, a familiar shop-front, and a country scene) and report the vividness of the images they generated. Results: Analysis demonstrated significant positive correlations between visual hallucinations and vividness of visual imagery in AD patients, however, no significant correlations were observed between auditory hallucinations and vividness of visual imagery in these participants. No significant correlations were observed between hallucinations and vividness of visual imagery in healthy control participants, probably due to the lack of hallucinations in these participants. Discussion: These results demonstrate a selective relationship between the occurrence of visual (but not auditory) hallucinations and the ability to generate vivid visual images in AD.

Testing a model of auditory hallucinations: the role of negative emotions and cognitive resources

Introduction: Models of auditory hallucinations (AH) state that AH arise through an interaction between negative emotions and limited available cognitive resources. However, this hypothesis has never been directly tested. Methods: A two-by-two factorial design was used to examine the effect of emotions (neutral VS negative) and available cognitive resources (high VS low) on the elicitation of false alarms in an auditory signal detection paradigm. One hundred and seventy four healthy participants were assigned to one of the four experimental conditions. While participants were listening to white noise, their emotional state was manipulated using affective pictures and the level of available cognitive resources was manipulated using a visual N-back task. Results: Results revealed significant interaction effects between emotions and cognitive resources on the number of false alarms. In particular, participants with fewer available cognitive resources and at the same time who were in a negative emotional state, tended to hear significantly more false alarms. In addition, the degree of certitude was significantly correlated with a higher degree of hallucination proneness. Conclusions: Such results are in agreement with models of AH and they provide new data for the understanding of the emotional and cognitive mechanisms that underpin AH.

A comparison of hallucinatory experiences and their appraisals in those with and without mental illness

Few studies have compared the content and appraisal of hallucinatory experiences (HE) by people with psychosis and those without. This study compared the characteristics of HE, and their appraisals, in individuals with psychotic disorder, non-psychotic mental disorder and no disorder in the general population. Participants (n = 253) aged between 30-33 years who reported HE were recruited from a birth cohort and assessed for lifetime diagnoses of mental disorders. They were allocated to groups based on their diagnosis and their HE were rated to assess their form, content and associated appraisals. Compared to those with no mental disorder, participants with a psychotic disorder had almost twelve times the odds of appraising their HE as distressing and dangerous and nine times the odds of experiencing recurrent HE. Those with a non-psychotic disorder had more than twice the odds of recurrent HE compared to those with no disorder. Overall, HE showed more similarities than differences across the diagnostic groups. Negative appraisals of HE and their recurrence differentiated clinical from non-clinical populations. Screening for HE and assessment of their associated appraisals is essential in those seeking care for mental health difficulties. Interventions aimed at modifying maladaptive appraisals can assist in reducing hallucination related distress.

Effects of sexualized video games on online sexual harassment

Negative consequences of video games have been a concern since their inception. However, one under-researched area is the potential negative effects of sexualized video game content on players. This study analyzed the consequences of sexualized video game content on online sexual harassment against male and female targets. We controlled for a number of variables that might be related to online sexual harassment (i.e., trait aggressiveness, ambivalent sexism, online disinhibition). Participants (N = 211) played a video game with either sexualized or non-sexualized female characters. After gameplay, they had the opportunity to sexually harass a male or a female partner by sending them sexist jokes. Based on the General Aggression Model integrated with the Confluence Model of Sexual Aggression (Anderson & Anderson, ), we predicted that playing the game with sexualized female characters would increase sexual harassment against female targets. Results were consistent with these predictions. Sexual harassment levels toward a female partner were higher for participants who played the game with sexualized female characters than for participants who played the same game with non-sexualized female characters. These findings indicate that sexualization of female characters in a video game can be a sufficient condition to provoke online sexual harassment toward women.

Beyond Trauma: A Multiple Pathways Approach to Auditory Hallucinations in Clinical and Nonclinical Populations

That trauma can play a significant role in the onset and maintenance of voice-hearing is one of the most striking and important developments in the recent study of psychosis. Yet the finding that trauma increases the risk for hallucination and for psychosis is quite different from the claim that trauma is necessary for either to occur. Trauma is often but not always associated with voice-hearing in populations with psychosis; voice-hearing is sometimes associated with willful training and cultivation in nonclinical populations. This article uses ethnographic data among other data to explore the possibility of multiple pathways to voice-hearing for clinical and nonclinical individuals whose voices are not due to known etiological factors such as drugs, sensory deprivation, epilepsy, and so forth. We suggest that trauma sometimes plays a major role in hallucinations, sometimes a minor role, and sometimes no role at all. Our work also finds seemingly distinct phenomenological patterns for voice-hearing, which may reflect the different salience of trauma for those who hear voices.

Potential Applications of Digital Technology in Assessment, Treatment, and Self-help for Hallucinations

The field of digital mental health is rapidly expanding with digital tools being used in assessment, intervention, and supporting self-help. The application of digital mental health to hallucinations is, however, at a very early stage. This report from a working group of the International Consortium on Hallucinations Research considers particular synergies between the phenomenon of hallucinations and digital tools that are being developed. Highlighted uses include monitoring and managing intermittently occurring hallucinations in daily life; therapeutic applications of audio and video media including virtual and augmented reality; targeting verbal aspects of hallucinations; and using avatars to represent hallucinatory voices. Although there is a well-established Internet-based peer support network, digital resources for hallucinations have yet to be implemented in routine practice. Implementation may benefit from identifying how to market resources to the broad range of populations who experience hallucinations and identifying sustainable funding models. It is envisaged that digital tools will contribute to improved self-management and service provision for people experiencing hallucinations.

Measurement invariance of the Spanish Launay-Slade Hallucinations Scale-Extended version between putatively healthy controls and people diagnosed with a mental disorder

OBJECTIVES

The current study aimed at evaluating the reliability, convergent and divergent validity, and factor structure of the Spanish Launay-Slade Hallucinations Scale-Extended version (LSHS-E) in people with mental disorders and healthy controls.

METHODS

Four hundred and twenty-two individuals completed the Spanish LSHS-E and the Spanish Community Assessment of Psychic Experiences. The convergent and divergent validity of the LSHS-E was assessed with the three dimensions of the Community Assessment of Psychic Experiences (positive, negative, and depressive dimensions) in healthy controls and people with a mental disorder. Factor structure of the LSHS-E was assessed using confirmatory factor analysis and measurement invariance.

RESULTS

The LSHS-E had a good reliability in healthy controls and people with a mental disorder (Cronbach's = 0.83 and 0.91, respectively). The LSHS-E was more strongly associated with positive psychotic-like experiences than with depressive and negative symptoms. Four factors were found: (a) "intrusive thoughts"; (b) "vivid daydreams"; (c) "multisensory hallucination-like experiences"; and (d) "auditory-visual hallucination-like experiences" that were invariant between the group of healthy controls and people with a mental disorder.

CONCLUSION

The Spanish version of the LSHS-E possesses adequate psychometric properties, and the confirmatory factor analysis findings provide further support for the multidimensionality of proneness to hallucination in clinical and nonclinical samples.

The ice in voices: Understanding negative content in auditory-verbal hallucinations

Negative voice-content is the best sole predictor of whether the hearer of an auditory-verbal hallucination will experience distress/impairment necessitating contact with mental health services. Yet, what causes negative voice-content and how interventions may reduce it remains poorly understood. This paper offers definitions of negative voice content and considers what may cause negative voice-content. We propose a framework in which adverse life-events may underpin much negative voice-content, a relation which may be mediated by mechanisms including hypervigilance, reduced social rank, shame and self-blame, dissociation, and altered emotional processing. At a neurological level, we note how the involvement of the amygdala and right Broca's area could drive negative voice-content. We observe that negative interactions between hearers and their voices may further drive negative voice-content. Finally, we consider the role of culture in shaping negative voice-content. This framework is intended to deepen and extend cognitive models of voice-hearing and spur further development of psychological interventions for those distressed by such voices. We note that much of the relevant research in this area remains to be performed or replicated. We conclude that more attention needs to be paid to methods for reducing negative voice-content, and urge further research in this important area.

Source flexibility in schizophrenia: specificity and role in auditory hallucinations

INTRODUCTION

One important aspect of human cognition relies on the ability to bias attention towards stimulus-independent and stimulus-oriented thoughts and to switch between these states - or source flexibility. This mechanism has received very little attention in the literature, and in particular in schizophrenia. Moreover, there is good reason to believe that this mechanism could also be implicated in hallucinations, but this hypothesis has never been examined. Thus, the aim of the present study was, for the first time in the literature, to explore source flexibility abilities in schizophrenia and their potential relations with auditory hallucinations.

METHODS

Forty persons diagnosed with schizophrenia and 26 healthy controls were evaluated with tasks assessing source flexibility, cognitive flexibility and processing speed. Patients were also assessed with a measure of hallucinations and delusions.

RESULTS

Results revealed that persons diagnosed with schizophrenia presented a poorer performance than healthy controls for source flexibility. Moreover, results demonstrated that source flexibility performance could not be explained by a more general impairment of processing speed or buy difficulties in cognitive flexibility. Finally, source flexibility was found to be related to hallucinations.

CONCLUSIONS

Source flexibility plays an important role in schizophrenia and in particular is a cognitive mechanism involved in hallucinations.

The Network Structure of Schizotypal Personality Traits

Elucidating schizotypal traits is important if we are to understand the various manifestations of psychosis spectrum liability and to reliably identify individuals at high risk for psychosis. The present study examined the network structures of (1) 9 schizotypal personality domains and (2) 74 individual schizotypal items, and (3) explored whether networks differed across gender and culture (North America vs China). The study was conducted in a sample of 27001 participants from 12 countries and 21 sites (M age = 22.12; SD = 6.28; 37.5% males). The Schizotypal Personality Questionnaire (SPQ) was used to assess 74 self-report items aggregated in 9 domains. We used network models to estimate conditional dependence relations among variables. In the domain-level network, schizotypal traits were strongly interconnected. Predictability (explained variance of each node) ranged from 31% (odd/magical beliefs) to 55% (constricted affect), with a mean of 43.7%. In the item-level network, variables showed relations both within and across domains, although within-domain associations were generally stronger. The average predictability of SPQ items was 27.8%. The network structures of men and women were similar (r = .74), node centrality was similar across networks (r = .90), as was connectivity (195.59 and 199.70, respectively). North American and Chinese participants networks showed lower similarity in terms of structure (r = 0.44), node centrality (r = 0.56), and connectivity (180.35 and 153.97, respectively). In sum, the present article points to the value of conceptualizing schizotypal personality as a complex system of interacting cognitive, emotional, and affective characteristics.

A direct examination of the cognitive underpinnings of multitasking abilities: A first study examining schizophrenia

Many real world activities are complex and require multitasking abilities. However, the nature of these abilities remains poorly understood, and in particular in schizophrenia. The aim of the present study was to provide a better understanding of such abilities with the help of a newly developed computerized tool, the Computerized Meeting Preparation Task (CMPT). Fifty-seven individuals with schizophrenia and 39 healthy controls completed the CMPT and an extensive cognitive battery. Patients were also evaluated with a series of clinical measures. During the CMPT, participants are asked to prepare a room for a meeting while, at the same time, dealing with interruptions, solving problems, and remembering prospective memory instructions. The CMPT was found to significantly differentiate patients and healthy controls for several variables. Results also showed that multitasking abilities were related to a large array of cognitive functions and, in particular, to those associated to executive functioning. These relations were not explained by the presence of a general cognitive impairment. Finally, a double dissociation between multitasking abilities and performance on standard cognitive tests was observed. Altogether, these results underline the importance of evaluating multitasking abilities in schizophrenia as it allows detecting cognitive difficulties that cannot be identified by standard cognitive tests.

Comparisons of schizotypal traits across 12 countries: Results from the International Consortium for Schizotypy Research

BACKGROUND

Schizotypal traits are expressions of underlying vulnerability to psychotic disorders which have a potential impact on mental health status, neurocognition, quality of life, and daily functioning. To date, little research has examined epidemiologic landscape of schizotypal traits at the cross-national level. Our aim was to study the expression of schizotypal traits by sex, age, and country in a combined sample gathered from 12 countries.

METHODS

A total of 27,001 participants completed the Schizotypal Personality Questionnaire (SPQ). The mean age of participants was 22.12 (SD=6.28); 37.5% (n=10,126) were males.

RESULTS

Schizotypal traits varied according to sex, age, and country. Females scored higher than males in the positive dimension, whereas males scored higher in the disorganization dimension. By age, a significant decrease in the positive schizotypal traits was observed. Epidemiological expression of schizotypal traits varied by country. Moreover, several interactions by sex, age, and country were found.

CONCLUSIONS

This pattern is similar to those found in patients with psychosis and psychotic-like experiences. These findings provide new insights and the opportunity to explore the phenotypic expression of schizotypal traits at cross-national level.

No sex difference in an everyday multitasking paradigm

According to popular beliefs and anecdotes, females best males when handling multiple tasks at the same time. However, there is relatively little empirical evidence as to whether there truly is a sex difference in multitasking and the few available studies yield inconsistent findings. We present data from a paradigm that was specifically designed to test multitasking abilities in an everyday scenario, the computerized meeting preparation task (CMPT), which requires participants to prepare a room for a meeting and handling various tasks and distractors in the process. Eighty-two males and 66 females with a wide age range (18–60 years) and a wide educational background completed the CMPT. Results revealed that none of the multitasking measures (accuracy, total time, total distance covered by the avatar, a prospective memory score, and a distractor management score) showed any sex differences. All effect sizes were d ≤ 0.18 and thus not even considered “small” by conventional standards. The findings are in line with other studies that found no or only small gender differences in everyday multitasking abilities. However, there is still too little data available to conclude if, and in which multitasking paradigms, gender differences arise.

Brief assessment of schizotypal traits: A multinational study

The Schizotypal Personality Questionnaire-Brief (SPQ-B) was developed with the aim of examining variations in healthy trait schizotypy, as well as latent vulnerability to psychotic-spectrum disorders. No previous study has studied the cross-cultural validity of the SPQ-B in a large cross-national sample. The main goal of the present study was to analyze the reliability and the internal structure of SPQ-B scores in a multinational sample of 28,426 participants recruited from 14 countries. The mean age was 22.63years (SD=7.08; range 16-68years), 37.7% (n=10,711) were men. The omega coefficients were high, ranging from 0.86 to 0.92 for the total sample. Confirmatory factor analysis revealed that SPQ-B items were grouped either in a theoretical structure of three first-order factors (Cognitive-Perceptual, Interpersonal, and Disorganized) or in a bifactor model (three first-order factors plus a general factor of schizotypal personality). In addition, the results supported configural but not strong measurement invariance of SPQ-B scores across samples. These findings provide new information about the factor structure of schizotypal personality, and support the validity and utility of the SPQ-B, a brief and easy tool for assessing self-reported schizotypal traits, in cross-national research. Theoretical and clinical implications for diagnostic systems, psychosis models, and cross-national mental health strategies are derived from these results.