Co-occurrence of borderline and schizotypal personality disorders: a scoping review

BACKGROUND

The historical concept of borderline conditions refers to the pathology on the border between neurosis and psychosis. In DSM-III the conditions were divided into specific but also somewhat overlapping diagnostic criteria for Borderline Personality Disorder (BPD) and Schizotypal Personality Disorder (SPD). This phenomenological overlap, which results in co-occurrence of the two diagnoses, remains a clinical challenge to this day.

METHODS

To address this issue we examined the co-occurrence of SPD and BPD according to the established DSM-IV/-5 diagnostic criteria. A literature search was conducted including studies that employed a structured interview with defined BPD and SPD criteria.

RESULTS

Studies from 20 samples were included (i.e. 15 patients, 3 community and 2 forensic samples). For patients diagnosed primarily with BPD, 1-27% also met the criteria for SPD and for patients diagnosed primarily with SPD, 5 - 33% showed co-occurrence with BPD. In the forensic samples, co-occurrence for primary BPD was 10% and 67 - 82% for primary SPD. In the community samples, co-occurrence for primary BPD was 29% and 50% for primary SPD. The pattern of co-occurrence across community samples was particularly heterogeneous.

CONCLUSION

The identified co-occurrences for BPD and SPD were considerably sample-dependent, and samples and measurements were generally too heterogeneous for a precise meta-analysis. Forensic and community samples generally showed higher co-occurrences, but these findings were characterized by potential methodological limitations.

Parental mental disorders and offspring schizotypy in middle childhood: an intergenerational record linkage study

PURPOSE

To investigate relationships between distinct schizotypy risk profiles in childhood and the full spectrum of parental mental disorders.

METHODS

Participants were 22,137 children drawn from the New South Wales Child Development Study, for whom profiles of risk for schizophrenia-spectrum disorders in middle childhood (age ~ 11 years) were derived in a previous study. A series of multinomial logistic regression analyses examined the likelihood of child membership in one of three schizotypy profiles (true schizotypy, introverted schizotypy, and affective schizotypy) relative to the children showing no risk, according to maternal and paternal diagnoses of seven types of mental disorders.

RESULTS

All types of parental mental disorders were associated with membership in all childhood schizotypy profiles. Children in the true schizotypy group were more than twice as likely as children in the no risk group to have a parent with any type of mental disorder (unadjusted odds ratio [OR] = 2.27, 95% confidence intervals [CI] = 2.01-2.56); those in the affective (OR = 1.54, 95% CI = 1.42-1.67) and introverted schizotypy profiles (OR = 1.39, 95% CI = 1.29-1.51) were also more likely to have been exposed to any parental mental disorder, relative to children showing no risk.

CONCLUSION

Childhood schizotypy risk profiles appear not to be related specifically to familial liability for schizophrenia-spectrum disorders; this is consistent with a model where liability for psychopathology is largely general rather than specific to particular diagnostic categories.

Handedness and anxiety: a review

Handedness is a core phenotype in clinical laterality research and several different disorders such as schizophrenia and autism spectrum disorders have been linked to a higher prevalence of non-right-handedness. Moreover, subclinical personality traits like schizotypy have been linked to a higher prevalence of non-right-handedness. The association with handedness is poorly understood for generalized anxiety disorder and specific phobias, as well as for state and trait anxiety and fear of specific stimuli in nonclinical samples. Therefore, we performed a narrative review of studies investigating handedness in anxiety disorders patients and studies that compared anxiety scores between different handedness groups. Unlike schizophrenia and autism spectrum disorders, there seems to be no strong association between anxiety disorders and handedness in adult patients, except for specific phobias. Studies often had small sample sizes and therefore a high risk to report spurious findings. Similar findings were reported in most non-clinical studies. Importantly, familial handedness affects phobia risk and antenatal maternal anxiety increased the probability of mixed-handedness. This suggests that a transgenerational, developmental perspective is essential to better understand the complex interrelations between handedness and anxiety. Familial and especially maternal handedness and anxiety disorders should be integrated into future studies on handedness and anxiety whenever possible.

Cumulative Environmental Risk in Early Life: Associations With Schizotypy in Childhood

BACKGROUND AND HYPOTHESIS

Psychotic disorders are associated with a growing number of recognized environmental exposures. Cumulative exposure to multiple environmental risk factors in childhood may contribute to the development of different patterns of schizotypy evident in early life. Hypotheses were that distinct profiles of schizotypy would have differential associations with a cumulative score of environmental risk factors.

STUDY DESIGN

We prospectively examined the relationship between 19 environmental exposures (which had demonstrated replicated associations with psychosis) measured from the prenatal period through to age 11 years, and 3 profiles of schizotypy in children (mean age = 11.9 years, n = 20 599) that have been established in population data from the New South Wales-Child Development Study. Multinomial logistic regression was used to examine associations between membership in each of 3 schizotypy profiles (true schizotypy, introverted schizotypy, and affective schizotypy) and exposure to a range of 19 environmental risk factors for psychosis (both individually and summed as a cumulative environmental risk score [ERS]), relative to children showing no risk.

RESULTS

Almost all environmental factors were associated with at least 1 schizotypy profile. The cumulative ERS was most strongly associated with the true schizotypy profile (OR = 1.61, 95% CI = 1.52-1.70), followed by the affective (OR = 1.33, 95% CI = 1.28-1.38), and introverted (OR = 1.32, 95% CI = 1.28-1.37) schizotypy profiles.

CONCLUSIONS

Consistent with the cumulative risk hypothesis, results indicate that an increased number of risk exposures is associated with an increased likelihood of membership in the 3 schizotypy profiles identified in middle childhood, relative to children with no schizotypy profile.

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

OBJECTIVE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSION

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

The prevalence, incidence, and admission rate of diagnosed schizophrenia spectrum disorders in Korea, 2008-2017: A nationwide population-based study using claims big data analysis

This study estimated the prevalence and incidence rate of schizophrenia, schizotypal, and delusional disorders (SSDD) in Korea from 2008 to 2017 and analyzed the hospital admission rate, re-admission rate, and hospitalization period. It used the Korean nationwide National Health Insurance Service claims database. SSDD patients who had at least one visit to Korea's primary, secondary, or tertiary referral hospitals with a diagnosis of SSDD, according to the International Classification of Diseases, 10th Revision (ICD-10), were identified as SSDD cases if coded as F20-F29. Data were analyzed using frequency statistics. Results showed that the 12-month prevalence rate of SSDD increased steadily from 0.40% in 2008 to 0.45% in 2017. Analysis of the three-year cumulative prevalence rate of SSDD showed an increase from 0.51% in 2011 to 0.54% in 2017. In 2017, the five-year cumulative prevalence rate was 0.61%, and the 10-year cumulative prevalence rate was 0.75%. The hospital admission rate among SSDD patients decreased from 2008 (30.04%) to 2017 (28.53%). The incidence of SSDD was 0.05% and no yearly change was observed. The proportion of SSDD inpatients whose first hospital visit resulted in immediate hospitalization was 22.4% in 2017. Epidemiological indicators such as prevalence, incidence, and hospitalization rate play an important role in planning social and financial resource allocation. Therefore, efforts to produce more accurate epidemiological indicators are very important and this study's findings could have a significant social impact.

Psychotic Experiences and Schizotypy in Early Adolescence Predict Subsequent Suicidal Ideation Trajectories and Suicide Attempt Outcomes From Age 18 to 38 Years

Subclinical risk markers for schizophrenia predict suicidality, but little is known about the nature of the relationship. Suicidal ideation is often considered homogenous, but distinguishing passive from active ideation (ie, thoughts of death vs thoughts of killing oneself) and different temporal patterns may further the understanding of risk factors. We tested whether schizotypy and psychotic experiences (PEs) in early adolescence predict subsequent growth trajectories of suicidal ideation and suicide attempt outcomes. Participants were 1037 members of the population-representative Dunedin Study cohort. PE was measured at 11 years and schizotypy at 13 and 15 years. Outcomes were passive and active suicidal ideation, and suicide attempt, measured at 18, 21, 26, 32, and 38 years. Passive ideation was best represented by 2 trajectories, including persistent and transient ideation classes. Schizotypy predicted membership in the smaller persistent class (odds ratio [OR] = 1.21, P = .041), whereas PE was not associated with class membership. The probability of suicide attempts was 13.8% in the persistent ideation class, compared with 1.8% in the transient class. Active ideation was best represented by a 1-class model, the intercept of which was predicted by schizotypy (OR = 1.23, P = .015). Suicide attempts were predicted by schizotypy (OR = 1.53, P = .040) and PE (OR = 3.42, P = .046), and this was partially mediated by indirect effects via the active ideation trajectory. Findings indicate that adolescent schizotypy and PE are related to subsequent suicidal ideation and attempts. Suicidal ideation is heterogeneous, and schizotypy is specifically related to a persistent passive ideation subgroup.

Validity of the EQ-5D in assessing and valuing health status in patients with schizophrenic, schizotypal or delusional disorders

Purpose

The EQ-5D is a generic questionnaire generating a health profile and a single index score for health-related quality of life. This study aimed to analyse the discriminative ability and validity of the EQ-5D in patients with schizophrenic, schizotypal or delusional disorders.

Subjects and methods

One hundred sixty-six patients with schizophrenic, schizotypal or delusional disorders (ICD-10 F2) completed the EQ-5D. Measures of quality of life (WHOQOL-BREF), utility (TTO), subjective (SCL-90R) and objective (PANSS, CGI-S) psychopathology, and functioning (GAF, GARF, SOFAS, HoNOS) provided comparison. Discriminative ability was analysed by assessing frequency distributions of EQ-5D scores. Validity of the EQ-5D self-classifier was analysed by assessing differences in related other scores grouped by response levels of EQ-5D items. Validity of the visual analogue scale (EQ VAS) and the EQ-5D index (UK social tariff) was analysed by assessing their correlation with all other scores.

Results

Seventy-nine percent of respondents reported problems in at least one of the EQ-5D dimensions (anxiety/depression 57%, usual activities 45%, pain/discomfort 44%, self-care 29%, mobility 22%). The mean EQ VAS score/EQ-5D index was 65.7/0.71. The four most frequently reported EQ-5D health states covered 45% of all respondents. For almost all EQ-5D dimensions, different response levels were associated with significantly different scores of measures used for comparison. Correlation of EQ VAS score and EQ-5D index were largest with scores of subjective measures (SCL-90R: −0.50 and −0.73; WHOQOL mental subscore 0.62 and 0.58; always P < 0.001).

Discussion and conclusion

The EQ-5D showed a moderate ceiling effect and seems to be reasonably valid in this patient group.

"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.

Predictors of falls and fractures leading to hospitalization in people with schizophrenia spectrum disorder: A large representative cohort study

AIM

To investigate predictors of falls/fractures leading to hospitalisation in people with schizophrenia-spectrum disorders.

METHODS

A historical cohort of people with schizophrenia-spectrum disorders (ICD F20-29) from 01/2006-12/2012 was assembled using data from the South London and Maudsley NHS Biomedical Research Centre Case Register. Falls/fractures were ascertained from a linkage to national hospitalisation data. Separate multivariate Cox regression analyses were employed to identify predictors of falls and fractures.

RESULTS

Of 11,567 people with schizophrenia-spectrum disorders (mean age 42.6 years, 43% female), 579 (incidence rate 12.79 per 1000 person-years) and 528 (11.65 per 1000 person-years) had at least one reported hospital admission due to a fall or fracture respectively and 822 patients had at least either a recorded fall or a fracture during this period (i.e. 7.1% of sample). Overall, 6.69 and 10.74 years of inpatient hospital stay per 1000-person years of follow-up occurred due to a fall and fracture respectively. 14(0.12%) and 28(0.24%) died due to a fall and fracture respectively. In Multivariable analysis, increasing age, white ethnicity, analgesics, cardiovascular disease, hypertension, diseases of the genitourinary system, visual disturbance and syncope were significant risk factor for both falls and fractures. A previous fracture (HR 2.05, 95% CI 1.53-2.73) and osteoporosis (HR 6.79, 95% CI 4.71-9.78) were strong risk factors for consequent fractures.

CONCLUSION

Comorbid physical health conditions and analgesic medication prescription were associated with higher risk of falls and fractures. Osteoporosis and previous fracture were strong predictors for subsequent fractures. Interventions targeting bone health and falls/fractures need to be developed and evaluated in these populations.

Distress, Impairment and the Extended Psychosis Phenotype: A Network Analysis of Psychotic Experiences in an US General Population Sample

It has been proposed that subclinical psychotic experiences (PEs) may causally impact on each other over time and engage with one another in patterns of mutual reinforcement and feedback. This subclinical network of experiences in turn may facilitate the onset of psychotic disorder. PEs, however, are not inherently distressing, nor do they inevitably lead to impairment. The question arises therefore, whether nondistressing PEs, distressing PEs, or both, meaningfully inform an extended psychosis phenotype. The current study first aimed to exploit valuable ordinal data that captured the absence, occurrence and associated impairment of PEs in the general population to construct a general population based severity network of PEs. The study then aimed to partition the available ordinal data into 2 sets of binary data to test whether an occurrence network comprised of PE data denoting absence (coded 0) and occurrence/impairment (coded 1) was comparable to an impairment network comprised of binary PE data denoting absence/occurrence (coded 0) and impairment (coded 1). Networks were constructed using state-of-the-art regularized pairwise Markov Random Fields (PMRF). The severity network revealed strong interconnectivity between PEs and nodes denoting paranoia were among the most central in the network. The binary PMRF impairment network structure was similar to the occurrence network, however, the impairment network was characterized by significantly stronger PE interconnectivity. The findings may help researchers and clinicians to consider and determine how, when, and why an individual might transition from experiences that are nondistressing to experiences that are more commonly characteristic of psychosis symptomology in clinical settings.

Relationship between social-cognitive and social-perceptual aspects of theory of mind and neurocognitive deficits, insight level and schizotypal traits in obsessive-compulsive disorder

OBJECTIVE

The primary aim of the current study was to investigate different aspects of theory of mind (ToM), including social-cognitive (ToM-reasoning) and social-perceptual (ToM-decoding) in obsessive-compulsive disorder (OCD). We also aimed to investigate the relationship between ToM, neurocognition and a number of clinical variables including overvalued ideas, schizotypal personality traits, level of insight, and disease severity.

METHOD

Thirty-four patients who have been diagnosed with OCD according to DSM-IV and 30 healthy controls were included in the study. All participants were given a neuropsychological battery including tasks measuring ToM-reasoning, ToM-decoding and other neurocognitive functions. Schizotypal Personality Questionnaire (SPQ), Yale Brown Obsession and Compulsion Scale (YBOC-S) and Overvalued Ideas Scale (OVIS) were also administered to the participants.

RESULTS

Patients with OCD showed significant deficits in both aspects of ToM. ToM performances of patients showed a significant positive correlation with neurocognitive functions. When controlled for general cognition factor, patient-control difference for ToM-reasoning (F = 3,917; p = 0,05), but not ToM-decoding, remained statistically significant. ToM-reasoning impairment of patients was significantly related to the severity of OCD symptoms and poor insight (p = 0,026 and p = 0,045, respectively). On the other hand, general cognitive factor (β = 0,778; t = 3,146; p = 0,04) was found to be the only significant predictor of ToM-reasoning in OCD patients in the multiple linear regression model.

CONCLUSION

OCD is associated with ToM impairment, which is related to schizotypal traits, disease severity and poor insight, yet neurocognitive deficits also significantly contribute to this finding. However, ToM-reasoning impairment could be considered as a relatively distinct feature of OCD, which is partly separate from general cognitive deficits.

Co-occurrence of autistic and schizotypal traits and its association with emotional and psychosocial function in Chinese college students

Empirical findings suggest an overlap between autism spectrum disorders (ASD) and schizophrenia spectrum disorders (SSD). Co-occurring autistic and positive schizotypal traits may have a moderating effect on behaviour and cognition. This study attempted to examine the co-occurrence rate of autistic and schizotypal traits in otherwise healthy college students and to test the moderating effect of co-occurring autistic and schizotypal traits on executive function, emotion processing and social function. Eight hundred and sixty-four participants took part in the present study. The results showed that the co-occurrence rate of autistic and schizotypal trait was 3.4% at baseline and 2.4% at one-year follow-up. The interaction between autistic traits and schizotypal traits was associated with better executive functioning and social functioning but poorer emotional expression.

Examining the continuum of psychosis: Frequency and characteristics of psychotic-like symptoms in relatives and non-relatives of patients with schizophrenia

BACKGROUND

A key finding underlying the continuum of psychosis concept is the presence of psychotic-like experiences (PLEs) in healthy subjects. However, it remains uncertain to what extent these experiences are related to the genetic risk for schizophrenia and how far they actually resemble attenuated forms of psychotic symptoms.

METHODS

Forty-nine adults with no history of mental illness in first-degree relatives and 59 siblings of patients with schizophrenia were rated on the psychosis section of the Computerized Diagnostic Interview Schedule IV (C DIS-IV) and the Rust Inventory of Schizotypal Cognitions (RISC). Those who rated positive on the CDIS-IV were re-interviewed using the lifetime version of the Present State Examination 9th edition (PSE-9) and the Structured interview for Schizotypy (SIS).

RESULTS

Seventeen (34.69%) of the non-relatives and 22 (37.29%) of the relatives responded positively to one or more of the psychosis questions on the DIS. This difference was not significant. RISC scores were also similar between the groups. At follow-up interview with the PSE-9, 13/40 PLEs (32.50%) in the non-relatives were classified as possible or probable psychotic symptoms compared to 11/46 (23.91%) in the relatives. Using liberal symptom thresholds, 5 of those who attended the follow-up interview (2 non-relatives and 3 relatives) met SIS criteria for schizotypal personality disorder.

CONCLUSIONS

Rates of PLEs, however considered, do not differ substantially between relatives and non-relatives of patients with schizophrenia. Only a minority of PLEs picked up by screening interviews resemble attenuated forms of psychotic symptoms.

Variability in clinical diagnoses during the ICD-8 and ICD-10 era

AIMS

To explore whether the diagnostic homogeneity in a daily, routine clinical activity changed visibly over two historical periods (the ICD-8 and the ICD-10 era) across and within five psychiatric in-patient clinics.

METHODS

In this register study, we analyzed the discharge diagnoses from five university-affiliated departments of psychiatry in Denmark in two time periods: 1980-1985 (ICD-8) and 2001-2010 (ICD-10).

RESULTS

The synchronic inter-departmental diagnostic differences did not decrease in the ICD-10 era compared with ICD-8 era. Nor did the diachronic stability within each department become more homogeneous.

CONCLUSION

The diagnostic variability reflected by the diagnostic differences between the departments and by the diagnostic homogeneity within each department remained similar in the two historical periods with no evidence of an increased homogeneity of diagnostic habits after the introduction of the ICD-10.

LIMITATIONS

There is a myriad of variables that affects the diagnostic variability over time that we were not able to control.

Processes of Inference, Schizotypal Thinking, and Obsessive-Compulsive Behaviour in a Normal Sample

Previous research has shown inferential confusion as measured by the Inferential Confusion Questionnaire to be related to obsessive-compulsive symptoms. A total of 108 participants (41 men and 66 women) from a normal population in The Netherlands ( M age = 46 yr., SD = 15.5) completed a package of questionnaires measuring inferential confusion, schizotypal symptoms, and obsessive-compulsive behaviour. As expected, scores for both inferential confusion and schizotypal symptoms were significantly related to those for obsessive-compulsive behaviour. In addition, analysis showed that inferential confusion and schizotypal symptoms shared common variance, but both predicted an independent portion of the variance in obsessive-compulsive behaviour while controlling for neuroticism. The present results call for further inquiry into the role of inferential confusion and schizotypal thinking in obsessive-compulsive behaviour.

Epidemiology of DSM-5 Drug Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions-III

IMPORTANCE

Current information on the prevalence and sociodemographic and clinical profiles of individuals in the general population with DSM-5 drug use disorder (DUD) is limited. Given the present societal and economic context in the United States and the new diagnostic system, up-to-date national information is needed from a single uniform data source.

OBJECTIVE

To present nationally representative findings on the prevalence, correlates, psychiatric comorbidity, disability, and treatment of DSM-5 DUD diagnoses overall and by severity level.

DESIGN, SETTING, AND PARTICIPANTS

In-person interviews were conducted with 36,309 adults in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, a cross-sectional representative survey of the United States. The household response rate was 72%; person-level response rate, 84%; and overall response rate, 60.1%. Data were collected April 2012 through June 2013 and analyzed from February through March 2015.

MAIN OUTCOMES AND MEASURES

Twelve-month and lifetime DUD, based on amphetamine, cannabis, club drug, cocaine, hallucinogen, heroin, nonheroin opioid, sedative/tranquilizer, and/or solvent/inhalant use disorders.

RESULTS

Prevalences of 12-month and lifetime DUD were 3.9% and 9.9%, respectively. Drug use disorder was generally greater among men, white and Native American individuals, younger and previously or never married adults, those with lower education and income, and those residing in the West. Significant associations were found between 12-month and lifetime DUD and other substance use disorders. Significant associations were also found between any 12-month DUD and major depressive disorder (odds ratio [OR], 1.3; 95% CI, 1.09-1.64), dysthymia (OR, 1.5; 95% CI, 1.09-2.02), bipolar I (OR, 1.5; 95% CI, 1.06-2.05), posttraumatic stress disorder (OR, 1.6; 95% CI, 1.27-2.10), and antisocial (OR, 1.4; 95% CI, 1.11-1.75), borderline (OR, 1.8; 95% CI, 1.41-2.24), and schizotypal (OR, 1.5; 95% CI, 1.18-1.87) personality disorders. Similar associations were found for any lifetime DUD with the exception that lifetime DUD was also associated with generalized anxiety disorder (OR, 1.3; 95% CI, 1.06-1.49), panic disorder (OR, 1.3; 95% CI, 1.06-1.59), and social phobia (OR, 1.3; 95% CI, 1.09-1.64). Twelve-month DUD was associated with significant disability, increasing with DUD severity. Among respondents with 12-month and lifetime DUD, only 13.5% and 24.6% received treatment, respectively.

CONCLUSIONS AND RELEVANCE

DSM-5 DUD is a common, highly comorbid, and disabling disorder that largely goes untreated in the United States. These findings indicate the need for additional studies to understand the broad relationships in more detail; estimate present-day economic costs of DUDs; investigate hypotheses regarding etiology, chronicity, and treatment use; and provide information to policy makers about allocation of resources for service delivery and research. Findings also indicate an urgent need to destigmatize DUD and educate the public, clinicians, and policy makers about its treatment to encourage affected individuals to obtain help.

A longitudinal twin study of cluster A personality disorders

BACKGROUND

While cluster A personality disorders (PDs) have been shown to be moderately heritable, we know little about the temporal stability of these genetic risk factors.

METHOD

Paranoid PD (PPD) and schizotypal PD (STPD) were assessed using the Structured Interview for DSM-IV Personality in 2793 young adult twins from the Norwegian Institute of Public Health Twin Panel at wave 1 and 2282 twins on average 10 years later at wave 2. Using the program Mx, we fitted a longitudinal latent factor model using the number of endorsed criteria for PPD and STPD.

RESULTS

The stability over time of the criteria counts for PPD and STPD, estimated as polychoric correlations, were +0.34 and +0.40, respectively. The best-fit longitudinal model included only additive genetic and individual-specific environmental factors with parameter estimates constrained to equality across the two waves. The cross-wave genetic and individual-specific environmental correlations for a latent cluster A factor were estimated to equal +1.00 and +0.13, respectively. The cross-time correlations for genetic and environmental effects specific to the individual PDs were estimated at +1.00 and +0.16-0.20, respectively. We found that 68% and 71% of the temporal stability of PPD and STPD derived, respectively, from the effect of genetic factors.

CONCLUSION

Shared genetic risk factors for two of the cluster A PDs are highly stable in adults over a 10-year period while environmental risk factors are relatively transient. Over two-thirds of the long-term stability of the common cluster A PD liability can be attributed to genetic influences.

Childhood trauma and schizotypy: a systematic literature review

BACKGROUND

Schizotypy is a complex concept, commonly defined as a genetic vulnerability to schizophrenia that falls on a continuum between healthy variation and severe mental illness. There is a growing body of evidence supporting an association between childhood trauma and increased psychotic experiences and disorders. However, the evidence as to whether there is a similar association with schizotypy has yet to be systematically synthesized and assessed.

METHOD

We conducted a systematic search of published articles on the association between childhood trauma and schizotypy in four major databases. The search covered articles from 1806 to 1 March 2013 and resulted in 17,003 articles in total. Twenty-five original research studies met the eligibility criteria and were included in this review.

RESULTS

All 25 studies supported the association between at least one type of trauma and schizotypy, with odds ratios (ORs) ranging between 2.01 and 4.15. There was evidence supporting the association for all types of trauma, with no differential effects. However, there was some variability in the quality of the studies, with most using cross-sectional designs. Individuals who reported adverse experiences in childhood scored significantly higher on positive and negative/disorganized schizotypy compared to those who did not report such experiences.

CONCLUSIONS

All forms of childhood trauma and other stressful events (e.g. bullying) were found to be associated with schizotypy, with especially strong associations with positive schizotypy. However, because of the methodological limitations of several studies and a lack of further exploration of different possible mechanistic pathways underlying this association, more research is required.

Specific learning difficulties: a retrospective study of their co morbidity and continuity as early indicators of mental disorders

BACKGROUND

Specific Learning difficulties constitute a continuity of complex disorders, which unfold across the lifespan and are associated with a wide range of mental disorders. In order to determine the importance of specific learning difficulties as an underlying factor in various mental disorders, we investigated associations between mental disorders and factors related to learning difficulties, poor family and school environment, and social and psycho-emotional disorders.

METHODS

This retrospective study is based on data from 835 case histories of adults who were treated at the Psychiatric Clinic of the University Hospital in Ioannina, Greece, between 1992 and 2008. The examination of the early (co-)occurrence of specific disorders was based on the ICD-10 classification of mental disorders. LogLinear analysis showed that all models retained 2nd or 3rd order effects with p-values >0.8 for all estimated likelihood ratios.

RESULTS

Patients with specific learning difficulties, who grew up in a socially disturbed environment, and manifested behavioral problems (aggression, alcoholism, and isolation or running away from home) were found to be more frequently diagnosed with schizophrenia than with any other mental disorder. In some cases, the profiles of these patients also included family problems such as parental loss or alcoholism.

CONCLUSIONS

Significant association between learning and other disorders in adult psychiatric patients' developmental profile has been indicated. Furthermore, a specific association between specific learning difficulties, environmental problems, and schizophrenia corroborates the continuity and complexity of these disorders at higher developmental stages. The results from this study can be utilized in the study of mental disorder etiology, raising the possibility that the early treatment of the learning or other disorders could reduce children's likelihood of developing mental disorders in adulthood.

[Retrospective analysis of psychopathological presentation of psychotic episodes in adolescent inpatients]

AIM

Analysis of a clinical presentation and course of psychotic episodes in adolescent inpatients.

METHOD

A retrospective analysis of charts of all (n=104) inpatients diagnosed with one of the schizophrenia-spectrum disorders (schizophrenia, schizotypal disorder and acute and transient psychotic disorders: F20, F21 and F23 according to ICD-10) and assessed with the Positive and Negative Syndrome Scale (PANSS) over a 10-year period (1998-2008) in the Child and Adolescent Psychiatry Department. A psychopathological profile of different disorders and correlation between symptoms and demographic and clinical data were analysed.

RESULTS

Severity of symptoms correlated with length of hospitalisation. In schizophrenia higher PANSS total score and more severe some general symptoms then in schizotypal disorders were observed. Also in schizophrenia more negative symptoms then in acute and transient psychotic disorders were detected. In all three disorders, the psychopathological profile included negative symptoms.

CONCLUSION

In schizophrenia psychopathological symptoms were more severe than in other disorders. Presence of negative symptoms may indicate that all schizophrenia spectrum disorders may have a neurodevelopmental component.

Movement disorders are associated with schizotypy in unaffected siblings of patients with non-affective psychosis

BACKGROUND

Movement disorders and schizotypy are both prevalent in unaffected siblings of patients with schizophrenia and both are associated with the risk of developing psychosis or schizophrenia. However, to date there has been no research into the association between these two vulnerability factors in persons with an increased genetic risk profile. We hypothesized that unaffected siblings of patients with non-affective psychosis have more movement disorders and schizotypy than healthy controls and that these co-occur.

METHOD

In a cross-sectional design we assessed the prevalence and inter-relationship of movement disorders and schizotypy in 115 unaffected siblings (mean age 27 years, 44% males) and 100 healthy controls (mean age 26 years, 51% males). Movement disorders were measured with the Abnormal Involuntary Movement Scale (AIMS), the Unified Parkinson Disease Rating Scale (UPDRS), the Barnes Akathisia Rating Scale (BARS), and one separate item for dystonia. Schizotypy was assessed with the Structured Interview for Schizotypy--Revised (SIS-R).

RESULTS

There were significant differences in the prevalence of movement disorders in unaffected siblings versus healthy controls (10% v. 1%, p<0.01) but not in the prevalence of schizotypy. Unaffected siblings with a movement disorder displayed significantly more positive and total schizotypy (p=0.02 and 0.03 respectively) than those without. In addition, dyskinesia correlated with positive schizotypy (r=0.51, p=0.02).

CONCLUSIONS

The association between movement disorders (dyskinesia in particular) with positive and total schizotypy in unaffected siblings suggests that certain vulnerability factors for psychosis or schizophrenia cluster in a subgroup of subjects with an increased genetic risk of developing the disease.

Overlap of autistic and schizotypal traits in adolescents with Autism Spectrum Disorders

This study addresses the unraveling of the relationship between autism spectrum and schizophrenia spectrum traits in a population of adolescents with Autism Spectrum Disorders (ASD). Recent studies comparing isolated symptoms of both spectrum disorders as well as diagnostic criteria for each (DSM-IV-TR) suggest resemblances in the clinical phenotype. A group of 27 adolescents with ASD (11 to 18 years) and 30 typically developing adolescents, matched for age and gender, participated in this study. Within the ASD group 11 adolescents satisfied DSM-IV-TR criteria for schizotypal personality disorders. Autistic and schizotypal traits were identified by means of well validated questionnaires (Autism Questionnaire, AQ and Schizotypal Personality Questionnaire-Revised, SPQ). Significantly more schizotypal traits in adolescents with ASD were found than in typically developing controls. Besides high levels of negative symptoms, adolescents with ASD also displayed high levels of positive and disorganized symptoms. There appeared to be a relationship between the mean level of autistic symptoms and schizotypal traits, as well as specific associations between autistic symptoms and negative, disorganized and positive schizotypal symptoms within individuals. Schizotypal symptomatology in all sub dimensions that are reflected by the SPQ scores, was most prominently associated with attention switching problems of the autism symptoms from the AQ. These findings indicate that patients diagnosed with an ASD show schizophrenia spectrum traits in adolescence. Although other studies have provided empirical support for this overlap in diagnostic criteria between both spectrum disorders, the present findings add to the literature that behavioral overlap is not limited to negative schizotypal symptoms, but extends to disorganized and positive symptoms as well.

Early psychopathological features in Spanish adolescents

Schizotypal experiences and depressive symptoms are quite common among adolescents, and have been considered as risk markers for schizophrenia-spectrum and mood disorders. The main goal of the present study was to analyze the relationship between schizotypal experiences and depressive symptoms in a community sample of non-clinical adolescents. The sample comprised a total of 1653 participants, 794 male (48%), with an average age of 15.94 years (SD = 1.23). Results showed that schizotypal traits and depressive symptoms were closely related at a subclinical level. Canonical correlation analysis indicated that the two sets of variables shared approximately 48% of the variance. The study of the dimensionality underlying the subscales of the self-reports revealed the presence of three components, namely: Depressive, Anhedonia and Reality Distortion. These results are convergent with previous studies conducted in both clinical and non-clinical samples, indicating overlap between schizotypal experiences and depressive symptoms.

Schizotypy and pathological personality profile in siblings of patients with psychosis

Schizotypy has been proposed to be the expression of the genetic vulnerability to schizophrenia. Schizotypal features have been associated with personality dimensions found in patients with psychosis. In this study, we compared the Dimensional Assessment of Personality Pathology - Basic Questionnaire (DAPP-BQ) scores of patients with psychosis, siblings scoring higher on schizotypy (SSHS), and siblings scoring lower (SSLS). The SSHSs displayed a DAPP-BQ profile characterized by high scores in the dimensions of affective lability, anxiousness, submissiveness, social avoidance, identity problems, oppositionality, narcissism, and restricted expression, distinguishing them from the SSLS. Due to these dimensions, SSHSs are more similar to the patients' DAPP-BQ profile. The results suggest that this pathological personality profile might contribute to increase the risk of developing psychosis in siblings who have more schizotypal features.

Genetic Risk and Outcome in Psychosis (GROUP) Investigators. Evidence that familial liability for psychosis is expressed as differential sensitivity to cannabis: an analysis of patient-sibling and sibling-control pairs

CONTEXT

Individual differences in cannabis sensitivity may be associated with genetic risk for psychotic disorder.

OBJECTIVES

To demonstrate and replicate, using 2 conceptually different genetic epidemiological designs, that (familial) liability to psychosis is associated with sensitivity to cannabis.

DESIGN, SETTING, AND PARTICIPANTS

Sibling-control and cross-sibling comparisons using samples of patients with a psychotic disorder (n = 1120), their siblings (n = 1057), and community controls (n = 590) in the Netherlands and Flanders.

MAIN OUTCOME MEASURES

Positive and negative schizotypy using the Structured Interview for Schizotypy-Revised (for siblings and controls) and self-reported positive and negative psychotic experiences using the Community Assessment of Psychic Experiences (for siblings and patients). Cannabis use was assessed as current use (by urinalysis) and lifetime frequency of use (by Composite International Diagnostic Interview).

RESULTS

In the sibling-control comparison, siblings displayed more than 15 times greater sensitivity to positive schizotypy associated with particularly current cannabis use by urinalysis (adjusted B = 0.197, P < .001) than controls (adjusted B = 0.013, P = .86) (P interaction = .04) and a similar difference in sensitivity to its effect on negative schizotypy (siblings: adjusted B = 0.120, P < .001; controls: B = -0.008, P = .87; P interaction = .03). Similarly, siblings exposed to cannabis resembled their patient relative nearly 10 times more closely in the positive psychotic dimension of the Community Assessment of Psychic Experiences (adjusted B = 0.278, P < .001) compared with nonexposed siblings (adjusted B = 0.025, P = .12) (P interaction < .001). No significant effect was apparent for the Community Assessment of Psychic Experiences negative domain, although the association was directionally similar (2 times more resemblance; P interaction = .17). Cross-sibling, cross-trait analyses suggested that the mechanism underlying these findings was moderation (familial risk increasing sensitivity to cannabis) rather than mediation (familial risk increasing use of cannabis).

CONCLUSIONS

Genetic risk for psychotic disorder may be expressed in part as sensitivity to the psychotomimetic effect of cannabis. Cannabis use may synergistically combine with preexisting psychosis liability to cause positive and negative symptoms of psychosis.

Personality and schizophrenia: psychobiological model and its relationship with comorbidity

Personality interacts with psychosocial variables, psychopathology and coping strategies of patients with schizophrenia. Psychobiological model of personality is important for schizophrenia as temperament dimensions, except dimension Persistence, have been associated with different neurotransmitter systems. Comorbidity of psychiatric and somatic disorders and syndromes is generally associated with dimensions high Harm avoidance and low Self-directedness. Variations in other dimensions may also be important. High Harm Avoidance may represent state vulnerability marker for various psychiatric disorders and is associated with appearance of comorbidity in schizophrenia. High Self-directedness may be protective factor for development of various psychiatric as well somatic comorbidity states.

Emotional and behavioural antecedents of young adults who screen positive for non-affective psychosis: a 21-year birth cohort study

BACKGROUND

Birth cohort studies have shown that individuals who develop non-affective psychoses display subtle deviations in behaviour during childhood and adolescence. We had the opportunity to examine the widely used Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR) to explore the antecedents of non-affective psychosis.

METHOD

Based on a birth cohort of 3801 young adults, psychopathology was assessed at years 5 and 14 using the CBCL and/or the YSR. Screen-positive non-affective psychosis (SP-NAP) was assessed at year 21 by using the Composite International Diagnostic Interview (CIDI) or a self-report checklist. The association between childhood symptoms and SP-NAP was examined using logistic regression.

RESULTS

Of the cohort, 60 subjects were classified as SP-NAP. In males, SP-NAP was associated with higher scores: (a) on year 5 CBCL 'Total', 'Aggression' and 'Social, Attention and Thought' scores; (b) on year 14 CBCL 'Social', 'Attention' and 'Delinquency' scores, and (c) YSR 'Total' and many YSR subscores. These associations were less clear for females. Hallucinations at year 14 were associated with SP-NAP for both sexes. Boys with high 'Total' scores at both years 5 and 14 were at greatest risk of SP-NAP (a 5-fold risk), followed by boys and girls whose 'Social, Attention and Thought' scores either increased or remained high from years 5 to 14 (3- to 13-fold risk).

CONCLUSIONS

Individuals who screen positive for non-affective psychosis show increased psychopathology during childhood and adolescence. The psychopathological trajectory of children who go on to develop schizophrenia anticipates the heterogeneity associated with the full clinical syndrome.

Self-reported childhood trauma correlates with schizotypal measures in schizophrenia but not bipolar pedigrees

BACKGROUND

Strong evidence supports the association between childhood trauma and psychotic disorders. In two different high-risk populations, we looked for a correlation between the magnitude of schizotypal dimensions and the importance of self-reported childhood trauma.

METHOD

A sample of 138 unaffected first-degree relatives was recruited (67 relatives of schizophrenic probands and 71 relatives of bipolar probands). The relationship between schizotypal dimensions and childhood trauma scores was analyzed by partial correlations.

RESULTS

A positive correlation was found between childhood trauma scores and total schizotypal scores in first-degree relatives of schizophrenic subjects but not in first-degree relatives of bipolar probands. This correlation was primarily due to a strong association with the positive dimension of schizotypy.

CONCLUSIONS

The significant correlation between childhood trauma and schizotypal dimensions in subjects at high genetic risk for schizophrenia suggests that susceptibility genes for schizophrenia may interact with childhood trauma to induce the emergence of schizotypal dimensions, mainly positive psychotic features.

[Confirmatory factor analysis of schizotypal personality traits in university students]

OBJECTIVE

Investigating the factor structure of schizotypal traits in normal population is important to describe the clinical phenotypes associated with susceptibility to schizophrenia. Schizotypal Personality Questionnaire (SPQ) is a commonly used self-rated measure to assess schizotypal traits. While Raine's three-factorial model is most commonly supported model explaining factor structure of schizotypal traits, there is also evidence supporting alternative models. The aim of this study is compare the goodness-of-fitness of various models about factor structure of the SPQ in a substantial number of university students.

METHOD

1059 university students were participated in the study. Alternative models regarding factor structure of the SPQ were compared with confirmatory factor analysis (CFA). The effect of gender on the factor structure of schizotypal traits is also studied.

RESULTS

The 4 factorial model that included cognitive-perceptual, paranoid, interpersonal and disorganized dimensions fit the data the best. Raine's three factorial model did not fit the data adequately. However, after minor modifications, Raine's model also had a satisfactory goodness-of-fit. Gender had no effect on the factor structure of the SPQ.

CONCLUSION

Results of these study supported 4-factorial model of Stefanis and modified version of Raine's model to explain factor structure of schizotypal traits. The structure of schizotypal traits is in parallel with structure of symptom dimensions in schizophrenia. This outcome is compatible with the views seeing schizotypal traits in general population in continuum with schizophrenia spectrum disorders.

Prospective memory deficits in subjects with schizophrenia spectrum disorders: a comparison study with schizophrenic subjects, psychometrically defined schizotypal subjects, and healthy controls

Memory impairment is one of the core deficits in schizophrenia. This study explored the memory profiles of schizophrenic and psychometrically defined schizotypal subjects. The study participants included 15 patients with schizophrenia, 41 schizotypal subjects, and 20 healthy controls. All of the participants completed verbal and visual memory, working memory, and prospective memory tasks. The results showed that patients with schizophrenia were impaired in all aspects of memory function, whereas the schizotypal subjects tended to show moderate to large impairment effect sizes in prospective memory. It is suggested that prospective memory be considered a potential endophenotype of schizophrenia.

Handedness and schizotypal features in healthy subjects

BACKGROUND

An excess of mixed-handedness has been repeatedly reported in schizophrenia and schizotypy. Handedness is a measure of atypical cerebral lateralization, which is considered as a risk factor for schizophrenia. Several studies have attempted to identify correlations between handedness and dimensions of psychosis but the results obtained so far remain inconclusive.

OBJECTIVE

To explore a possible link between mixed-handedness and the three classical dimensions of psychosis. As speech and language disorders may be associated with cerebral lateralization, we predicted a correlation between mixed-handedness and disorganized dimension.

METHODS

We used the Schizotypal Personality Questionnaire (SPQ) and the Edinburgh Handedness Inventory (EHI) to study the correlation between mixed-handedness scores and positive, negative or disorganized dimensions in a sample of 62 healthy subjects.

RESULTS

We found a negative correlation between mixed-handedness and the disorganized dimension of schizotypy, as individuals with prominent mixed-handedness showed more severe disorganization.

CONCLUSION

We have identified a link between mixed-handedness and the disorganized dimension that may help to identify genetic vulnerability factors involved in psychosis.

Childhood and current autistic features in adolescents with schizotypal personality disorder

The diagnostic boundaries between autistic- and schizophrenia-spectrum disorders have varied over the years, and some overlap in diagnostic criteria persists. The present study examined childhood and current signs of autistic disorder (AD) in adolescents with schizotypal personality disorder (SPD) or other personality disorders, as well as healthy controls. A structured interview was administered to rate participants' current symptoms. Participants' guardians were interviewed with the Autism Diagnostic Inventory-Revised (ADI-R), a clinical assessment of childhood and current autistic signs. Compared to both the other personality-disordered and healthy groups, adolescents with SPD were rated as having significantly more impairment on childhood and current social functioning, and having more unusual interests and behaviors. For the entire sample, impaired childhood social functioning and unusual interests and behaviors were associated with higher negative symptom scores. Current impairments in social functioning, unusual interests and behaviors, and communication were also linked with greater negative symptoms. However, neither childhood nor current autistic features significantly predicted later conversion to an Axis I psychotic disorder over the course of three years of follow-up. The findings indicate that past and current autistic signs are more common in adolescents with SPD, but neither current nor childhood autistic features are linked with conversion to psychosis.

Temperament and character as schizophrenia-related endophenotypes in non-psychotic siblings

BACKGROUND

Quantitative endophenotypes are needed to better understand the pathogenesis of schizophrenia. The psychobiological model of temperament and character suggests that personality traits are heritable and regulated by brain systems influencing schizophrenia susceptibility. Thus, measures of temperament and character may serve as schizophrenia-related endophenotypes in individuals with schizophrenia and their non-psychotic siblings.

METHODS

Individuals with schizophrenia (n=35), their non-psychotic siblings (n=34), controls (n=63), and their siblings (n=56) participated in a study of the clinical, neurocognitive and neuromorphological characteristics of schizophrenia. A mixed-model approach assessed group differences on the Temperament and Character Inventory (TCI). Neurocognitive deficits and psychopathology were correlated with the TCI. Configurations of TCI domains were examined using a generalized linear model.

RESULTS

Individuals with schizophrenia and their non-psychotic siblings had higher harm avoidance than controls and their siblings. Individuals with schizophrenia had lower self-directedness and cooperativeness, and higher self-transcendence than their non-psychotic siblings, controls, and the siblings of controls. Neurocognition was not related to temperament and character in individuals with schizophrenia or either control group. In non-psychotic siblings, self-directedness and cooperativeness were correlated with working memory and crystallized IQ.

CONCLUSION

Evidence supports harm avoidance as a schizophrenia-related endophenotype. An increased risk of schizophrenia may be associated with asociality (configured as high harm avoidance and low reward dependence), schizotypy (configured as low self-directedness, low cooperativeness, and high self-transcendence), and neurocognitive deficits (poor executive functioning, working/episodic memory, attention, and low IQ). The non-psychotic siblings demonstrated features of a mature character profile including strong crystallized IQ, which may confer protection against psychopathology.

Affect processing and positive syndrome schizotypy in cannabis users

While cannabis is associated with positive syndrome schizophrenia (SZ), it is unclear whether cannabinoids are also related to negative symptoms such as affective blunting. We examined whether cannabis use is associated with schizotypy and utilized event-related potentials (ERPs) to assess affect processing. Cannabis users demonstrated increased P300 amplitudes for unpleasant trait words, and demonstrated higher positive syndrome schizotypy which correlated with levels of cannabis use. The cannabis group also exhibited lower negative syndrome schizotypy. The lack of blunted responses during the affect ERP and decreased negative subscale schizotypy scores provide evidence that the endocannabinoid theory of schizophrenia may be primarily relevant in relation to positive syndrome SZ.

Schizotypal personality traits in Gilles de la Tourette syndrome

OBJECTIVES

Gilles de la Tourette syndrome (GTS) is a chronic tic disorder associated with comorbid psychopathology, including obsessionality, affective instability and attention-deficit hyperactivity disorder. Evidence linking GTS with schizophrenia-like symptoms is limited and equivocal, despite a common putative substrate involving dopaminergic dysfunction within frontostriatal circuits. The aim of this study was to quantify the prevalence of schizotypal traits in GTS and to detail the relationship between schizotypy and comorbid psychopathology.

MATERIALS AND METHODS

A total of 102 subjects with GTS were evaluated using the Schizotypal Personality Questionnaire and standardized neurological and psychiatric rating scales. The predictive interrelation between schizotypy, tic-related symptoms and psychiatric comorbidities was investigated using correlation and multiple regression analyses.

RESULTS

In our clinical population, 15% of the subjects were diagnosed with the schizotypal personality disorder according to the DSM-IV criteria. The strongest predictors of schizotypy were obsessionality and anxiety ratings. The presence of multiple psychiatric comorbidities correlated positively with schizotypy scores.

CONCLUSIONS

Schizotypal traits are relatively common in patients with GTS, and reflect the presence of comorbid psychopathology, related to the anxiety spectrum. In particular, our preliminary results are consistent with a shared neurochemical substrate for the mechanisms underpinning tic expression, obsessionality and specific schizotypal traits.

Nicotine consumption and schizotypy in first-degree relatives of individuals with schizophrenia and non-psychiatric controls

Individuals with schizophrenia have very high rates of cigarette smoking, and much has been discovered about the influence of nicotine on brain functioning in schizophrenia. However, less is understood about the relationship between nicotine consumption and milder phenotypes related to schizophrenia, specifically schizotypy. This study examined the relationship between nicotine consumption and schizotypy in two unmedicated samples that included first-degree relatives and non-psychiatric controls. Forty-two first-degree relatives and 50 control participants were administered a self-report questionnaire on schizotypal features as well as a self-report questionnaire on smoking behavior. A positive relationship was found between smoking status and level of schizotypy, and higher levels of schizotypy significantly predicted the odds of being a smoker after controlling for gender and group status. Interestingly, group status was a significant moderator in the relationship between level of schizotypy and smoking status, such that the relationship between these two variables was only significant in the first-degree relatives. This is the first study to investigate the relationship between these variables in a sample of first-degree relatives of individuals with schizophrenia. Those individuals with more schizotypal features are presumably at greater risk for schizophrenia-spectrum disorders and thus may be more likely to smoke cigarettes given the known biochemical effects of nicotine on overt positive and negative symptoms of schizophrenia. Although relatives did not differ from controls in their level of self-reported schizotypy, the significant relationship between smoking status and schizotypy in the former group is likely explained by their genetic vulnerability to schizophrenia-spectrum disorders.

Cognitive dimensions in first-episode schizophrenia spectrum disorders

BACKGROUND

The severity and pattern of cognitive deficits in epidemiological cohorts of patients with first-episode schizophrenia spectrum disorders still remains unclear. We aimed to characterize the basic cognitive functioning of a representative sample of patients with a first-episode schizophrenia spectrum disorders.

METHOD

One hundred thirty-one patients experiencing first-episode psychosis and 28 healthy volunteers were administered a comprehensive neuropsychological evaluation. To reduce the number of cognitive test measures into meaningful cognitive dimensions, before analyzing differences between patient and healthy volunteer samples, exploratory factor analysis was carried out on data collected in patients group. The method of extraction was Principal Components Analysis with oblique rotation.

RESULTS

An eight-factor model including verbal learning/memory, verbal comprehensive abilities, speed of processing/executive functioning, motor dexterity, motor speed, sustained attention, and impulsivity emerged. A significant below average performance in all cognitive dimensions, except impulsivity, was found. Patient's performance in speed of processing/executive functioning, motor dexterity and sustained attention dimensions exceeded one standard deviation below healthy comparison subjects.

CONCLUSIONS

At early stages of the illness, patients display a marked impairment in several functionally relevant cognitive domains.

Exophenotypical profile of adolescents with sustained attention deficit: A 10-year follow-up study

We aimed to explore prospectively the relationship between the presence of sustained attention deficit (SAD) in early adolescence and exophenotypical measures of vulnerability to schizophrenia spectrum disorders (personality and psychosocial measures) in early adulthood. Two cohorts of community adolescents were selected in 1993 according to the presence or absence of a CPT-linked SAD. In 2003, both cohorts (Index: n=42, and

CONTROL

n=38) were administered the O-LIFE, the SCID-II, the DOI battery and the COPE scale, among other tests. T-tests were used to compare both cohorts. Index subjects showed a higher level of negative schizotypy, avoidant, depressive and narcissistic personality traits, as well as more asocial behavior and poorer use of coping resources than CONTROL subjects did. A SAD in early adolescence may be associated with coping and social deficits, negative schizotypy, and personality traits indicative of emotional disturbance in adulthood. Our results suggest that SAD in early adolescence might be an indicator of psychopathology in adulthood and give support to dimensional models of psychopathology.

Schizotypal personality: neurodevelopmental and psychosocial trajectories

Schizotypal personality research holds the promise of critically important insights into the etiology and ultimate prevention of schizophrenia. This article provides a critical overview of diagnostic, developmental, demographic, psychosocial, genetic, neurodevelopmental, psychophysiological, neurochemical, neurocognitive, brain imaging, and prevention-treatment issues pertaining to this personality disorder. It is argued that genetic and early environmental influences act in concert to alter brain structure/function throughout development, resulting in disturbances to basic cognitive and affective processes that give rise to three building blocks of schizotypy-cognitive-perceptual, interpersonal, and disorganized features. Two clinical subtypes are hypothesized: (a) neurodevelopmental schizotypy, which has its roots in genetic, prenatal, and early postnatal factors, is relatively stable, has genetic affinity to schizophrenia, and may benefit preferentially from pharmacological intervention, and (b) pseudoschizotypy, which is unrelated to schizophrenia, has its roots in psychosocial adversity, shows greater symptom fluctuations, and may be more responsive to psychosocial intervention.

The initial prodrome of schizophrenia: different duration, different underlying deficits?

In light of various suggestions concerning underlying deficits and transition patterns, approaching the initial schizophrenic prodrome is a multifaceted enterprise. Recently, the prodromal phase has largely been viewed as a singular concept. However, observations of greatly varying prodromal time courses prompted us to investigate whether these differences suggest the existence of diverse prodrome subtypes. Our sample consisted of 160 patients from the Cologne Early Recognition study. The 79 patients transiting from prodrome to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition schizophrenia were divided into 3 time groups according to the length of the prodromal state and compared for their initial symptomatology. We found differences in the prominent clinical picture not only regarding single symptoms but also in logistic equations calculated for each group including cognitive deficits only. Our results indicate different underlying deficits: disturbances in bottom-up and top-down loop processes associated with a long prodrome and in top-down processes with medium prodrome, and a deficient central integrating system with short prodrome.

Taxonic structure of schizotypal personality in nonclinical subjects: Issues of replicability and age consistency

To assess the replicability and age consistency of the taxonic structure and base-rate of schizotypy, 803 university students (21.9 years) and 929 high school students (16.4 years) were administered three self-report measures of schizotypal personality. The two groups came from the same town and were matched on gender. MAXCOV analyses were consistent with a low base-rate taxon of approximately 10% only in the university student group; in the younger group, the three schizotypal personality measures did not show clear evidence of taxonicity. These findings support the hypothesis of the taxonic structure of schizotypal personality in adult subjects, but they raise questions concerning the identification of schizotypy in younger samples.

Prevalence of large cavum septi pellucidi and its relation to the medial temporal lobe structures in schizophrenia spectrum

Magnetic resonance imaging was used to evaluate the prevalence of the cavum septi pellucidi (CSP) in 154 schizophrenia patients, 47 schizotypal disorder patients, and 163 healthy controls. We also explored the relation of a large CSP (> or =6 mm) with medial temporal lobe structures. No significant difference was found in the prevalence of the CSP (76.0% of the schizophrenia patients, 81.6% of the controls, and 85.1% of the schizotypal patients) or the large CSP (6.5% of the schizophrenia patients, 7.4% of the controls, and 10.6% of the schizotypal patients) among the groups, but patients with a large CSP (10 schizophrenia and 5 schizotypal patients) had smaller volumes of bilateral amygdala and left posterior parahippocampal gyrus than patients without it. In the control subjects, the large CSP did not affect the volumes of the medial temporal lobe structures. These findings might reflect neurodevelopmental abnormalities in midline and associated limbic structures of the brain in schizophrenia spectrum.

Elevated social Internet use and schizotypal personality disorder in adolescents

INTRODUCTION

In the past decade, the use of the Internet as a forum for communication has exponentially increased, and research indicates that excessive use is associated with psychiatric symptoms. The present study examined the rate of Internet use in adolescents with personality disorders, with a focus on schizotypal personality disorder (SPD), which is characterized by marked interpersonal deficits. Because the Internet provides an easily accessible forum for anonymous social interaction and constitutes an environment where communication is less likely to be hampered by interpersonal deficits, it was hypothesized that SPD youth will spend significantly more time engaging in social activities on the Internet than controls.

METHODS

Self-reports of daily Internet use in adolescents with SPD (n=19), a control group with other personality disorders (n=22) and a non-psychiatric control group (n=28) were collected.

RESULTS

Analyses revealed that the SPD participants reported significantly less social interaction with 'real-life' friends, but used the Internet for social interaction significantly more frequently than controls. Chat room participation, cooperative Internet gaming, and to a lesser degree, e-mail use, were positively correlated with ratings of SPD symptom severity and Beck Depression Inventory scores.

DISCUSSION

Findings are discussed in light of the potential benefits and risks associated with Internet use by socially isolated SPD youth.

[Handedness, emotional problems, and schizotypy]

The purpose of this study was to analyse the relationship between emotional or behavioural problems and schizotypy. An assessment of handedness and schizotypal personality traits were also performed by means of the Thinking and Perceptual Style Questionnaire, the Multidimensional Schizotypal Traits Questionnaire, the Edinburgh Handedness Inventory, and the Youth Self-Report. The sample comprised 296 participants with a mean age of 13.8 and a standard deviation of 1.34. Data indicate that adolescents with high scores on psychometric factors of schizotypy displayed higher patterns of problem behaviours as well as a significant difference in all the core factors of the Youth Self-Report, compared to those who scored low on these measures. Discriminant analysis showed that the core factors of the Youth Self-Report correctly classified 84% of the adolescents with high or low scores on psychometric schizotypy. Lastly, no significant association between the factors of schizotypy and left-handedness, right-handedness, or mixed-handedness was found.

Self-report of attenuated psychotic experiences in a college population

This study assessed the rates of self-reported "prodromal" psychotic symptoms and related distress in a college population. 1020 students completed the Prodromal Questionnaire (PQ), a self-report screening measure for psychosis risk. Participants' responses were highly similar to the responses of non-psychotic-spectrum patients in the original PQ validation sample [Loewy, R.L., Bearden, C.E., Johnson, J.K., Raine, A., Cannon, T.D., 2005. The Prodromal Questionnaire (PQ): preliminary validation of a self-report screening measure for prodromal and psychotic syndromes. Schizophr. Res. 79 (1) 117-125], suggesting that the PQ may perform similarly with a variety of populations. Applying the cutoff proposed for screening treatment-seeking patients (8 or more positive symptoms) identified 43% of students, while comparatively fewer participants (25%) endorsed eight or more items at the frequency required for prodromal syndrome diagnosis by interview (i.e., weekly), and only 2% endorsed eight or more items as distressing. Although attenuated psychotic experiences are commonly reported by "normal" young adults, frequent and distressing items identify a proportion of students more consistent with the prevalence of psychotic-spectrum disorders in the general population, which suggests a potential for future screening of unselected samples.

A bias against disconfirmatory evidence is associated with delusion proneness in a nonclinical sample

Previous work has suggested that a bias against disconfirmatory evidence (BADE) may be associated with the schizophrenia spectrum. The current investigation focused on whether a BADE (1) overlaps with traditional measures of memory and executive functions or selectively taps into a unique aspect of cognition and (2) is correlated with delusional ideation but not with other aspects of schizotypy. Sixty-eight undergraduate students were administered the Schizotypal Personality Questionnaire (SPQ), the BADE test, the Rey Auditory Verbal Learning Test (RAVLT), the Wisconsin Card Sorting Test (WCST), the Trail Making Tests A and B (TMT), and tests used to estimate IQ. Factor analysis of all cognition measures resulted in a 6-factor solution, 4 of which reflected the 4 domains of neuropsychological tests (WCST, RAVLT, TMT, and IQ), and 2 of which reflected different aspects of the BADE test: Initial Belief and Integration of Disconfirmatory Evidence. This solution suggests that BADE measures were independent from the other cognitive domains measured. Integration of Disconfirmatory Evidence was the only factor that correlated with delusion-content subscales of the SPQ, providing support for the contribution of a BADE to delusional ideation.

Associations between schizotypal features and indicators of neurological and morphological abnormalities

OBJECTIVE

Limited research suggests that subtle neurological and morphological abnormalities that have been documented in patients with schizophrenia also may be associated with schizotypal traits in non-psychiatric samples. Based on the notion that neurological soft signs (NSS) may mark a genetic diathesis, this study hypothesized that NSS scores would be related to the level of schizotypy in relatives of schizophrenia patients and in controls. Additionally, associations between MPA scores and schizotypy were explored in these two groups.

METHOD

Twenty-six first-degree relatives of schizophrenia patients and 38 controls with no personal or family history of psychosis were assessed for schizotypy using the Structured Clinical Interview for DSM-IV Axis II Disorders schizotypal personality disorder module, as well as the self-administered Schizotypal Personality Questionnaire. The Neurological Evaluation Scale and a structured examination for MPAs also were administered.

RESULTS

Mean schizotypy scores did not differ between relatives and controls. Both NSS and MPAs were associated with the level of interviewer-assessed schizotypal features in controls but not in relatives of patients with schizophrenia. NSS and MPAs were not associated with self-reported schizotypy in either group.

CONCLUSIONS

These findings demonstrate that both NSS and MPAs are associated with interview-based schizotypal traits, at least in non-psychiatric participants. Future research should seek to replicate these results in other samples of relatives and controls.