Schizotypal traits and psychotic-like experiences during adolescence: An update

BACKGROUND: The psychosis phenotype is distributed along a severity continuum that ranges from psychological well-being to full-blown psychosis. Schizotypal traits and psychotic-like experiences are considered as one of the possible phenotypic indicators of the latent liability for psychosis (named schizotypy). This selective review offers a general overview and update of trait schizotypy and psychotic like experiences during adolescence. METHOD: The previous literature on schizotypal traits  and psychotic like experiences is selectively reviewed. RESULTS: We begin with a brief introduction of psychosis syndrome from an extended psychosis phenotype framework as well as a brief definition of trait schizotypy and psychotic-like experiences. We introduce the study of these traits and experiences from a developmental perspective, where the psychosis proneness-persistence-impairment model is highlighted. We provide a selective review of the tools available for assessment these constructs from the psychometric high-risk paradigm. We then discuss the factorial validity of the studies conducted in adolescents. In addition, the links between this set of subclinical traits and experiences and other variables gathered from a translational approach are discussed, with the aim to establish a nomological network. CONCLUSIONS: We conclude by considering remaining questions and future directions for the understanding of trait schizotypy and psychotic-like experiences during adolescence

New approaches on the study of the psychometric properties of the STAI

The main purpose of this study was to analyze the psychometric properties of the State-Trait Anxiety Inventory (STAI1). Previous studies have indicated different factor solutions. Nevertheless, there is still a lack of consensus about the best dimensional model of STAI scores.The sample consisted of 417 participants, composed of 387 (29.71% male) healthy participants (comparison group: M=35.5 years; SD=8.40), and 30 (36.66% male) patient (clinical group M=35.8 years; SD=12.94).The internal consistency evaluated through Ordinal Alpha was good, 0.98 and 0.94 in the non-clinical and the clinical samples, respectively. Test-retest reliability (two weeks) for Total Score was 0.81 for the non-clinical subsample, and 0.93 for the clinical subsample. Confirmatory factor analyses supported both a four factor model and bifactor model. Also, STAI scores showed statistically significant correlations with Burns Anxiety Inventory (Burns-A) scores. Furthermore, results showed statistically significant differences in the mean scores of the STAI between the clinical and the non-clinical subsamples.The psychometric properties of the STAI were adequate. The present study contributes to better understand the STAI structure through the comparison of new approaches in the study of the STAI internal structure. The results found may contribute in the efforts to improve the evaluation and identification of anxiety symptoms and disorders

Schizotypy: The Way Ahead

Background: Empirical evidence suggests that schizotypy is a useful construct for analyzing and understanding psychotic disorders. However, several issues remain to be resolved. Method: This selective, critical review, addresses some questions and limitations, and discusses future directions of work. Results: First, we present a conceptual outline and discuss the evidence from translational and interdisciplinary studies on schizotypy. Next, we examine and discuss newer analytical and methodological approaches, including network and machine learning approaches. We also discuss newer psychometric identification approaches, such as those using biobehavioral and ambulatory assessment. Next, we review recent cross-cultural studies in schizotypy research. Finally, we identify new challenges and directions and draw conclusions. Conclusions: This selective, critical review suggests that new methods can contribute to the construction of a solid scientific model of schizotypy as a risk construct. // Esquizotipia: el Camino a Seguir. Antecedentes: la evidencia empírica ha demostrado que la esquizotipia es un constructo útil para analizar y comprender los trastornos psicóticos. Sin embargo, todavía quedan por resolver varias cuestiones. Método: en esta revisión selectiva y crítica se abordan algunas limitaciones, se discuten interrogantes y se comentan direcciones futuras de trabajo. Resultados: en primer lugar, se presenta una delimitación conceptual y se comenta la evidencia acumulada en diferentes estudios y niveles de análisis en el campo de la esquizotipia. A continuación, se examinan nuevos modelos psicopatológicos, como el modelo de red, y se presentan las diferentes herramientas desarrolladas y validadas para su evaluación. Seguidamente, se abordan algunas inquietudes metodológicas de fondo y se presentan nuevas técnicas y procedimientos psicométricos, como la evaluación ambulatoria y bioconductual. También se analizan algunos de los problemas inherentes en la investigación entre países y culturas. Finalmente, se establecen las conclusiones y se abordan nuevos desafíos y direcciones futuras de investigación. Conclusiones: esta revisión selectiva y crítica plantea que es necesario continuar trabajando en la construcción de un modelo científico sólido y refutable e incorporar nuevas pruebas científicas en el campo de la esquizotipia

Youth screening depression: Validation of the Patient Health Questionnaire-9 (PHQ-9) in a representative sample of adolescents

BACKGROUND: Depression symptoms and mood disorders constitute one of the major public health challenges among youths. Thus, early prevention and intervention for depression should be a priority. The main goal of the present study was to validate the Patient Health Questionnaire-9 (PHQ-9) scores in a school-based sample of non-clinical adolescents. METHOD: Stratified random sampling was conducted. Participants were 2235 students (M = 14.49, SD =1.76, range= 12–18 years), 52.9 % were female, from 34 secondary schools in Spain. Several previously validated self-reported questionnaires of mental health and psychopathology were administrated. RESULTS: The unidimensional factorial model of the PHQ-9 items showed adequate goodness of fit indices. Strong measurement invariance across gender was found. Omega for the PHQ-9 total score was 0.87. The PHQ-9 total score was positively associated with anxiety symptoms and emotional and behavioral problems, and negatively associated with prosocial behavior and quality of life. CONCLUSIONS: The PHQ-9 is a brief, easy, and reliable tool for assessing self-reported depressive symptoms in both clinical and school settings. PHQ-9 may be used as a screening tool for universal early detection and monitorization of depression symptoms during adolescence

Are genetic risk factors for psychosis also associated with dimension-specific psychotic experiences in adolescence?

Psychosis has been hypothesised to be a continuously distributed quantitative phenotype and disorders such as schizophrenia and bipolar disorder represent its extreme manifestations. Evidence suggests that common genetic variants play an important role in liability to both schizophrenia and bipolar disorder. Here we tested the hypothesis that these common variants would also influence psychotic experiences measured dimensionally in adolescents in the general population. Our aim was to test whether schizophrenia and bipolar disorder polygenic risk scores (PRS), as well as specific single nucleotide polymorphisms (SNPs) previously identified as risk variants for schizophrenia, were associated with adolescent dimension-specific psychotic experiences. Self-reported Paranoia, Hallucinations, Cognitive Disorganisation, Grandiosity, Anhedonia, and Parent-rated Negative Symptoms, as measured by the Specific Psychotic Experiences Questionnaire (SPEQ), were assessed in a community sample of 2,152 16-year-olds. Polygenic risk scores were calculated using estimates of the log of odds ratios from the Psychiatric Genomics Consortium GWAS stage-1 mega-analysis of schizophrenia and bipolar disorder. The polygenic risk analyses yielded no significant associations between schizophrenia and bipolar disorder PRS and the SPEQ measures. The analyses on the 28 individual SNPs previously associated with schizophrenia found that two SNPs in TCF4 returned a significant association with the SPEQ Paranoia dimension, rs17512836 (p-value=2.57x10-4) and rs9960767 (p-value=6.23x10-4). Replication in an independent sample of 16-year-olds (N=3,427) assessed using the Psychotic-Like Symptoms Questionnaire (PLIKS-Q), a composite measure of multiple positive psychotic experiences, failed to yield significant results. Future research with PRS derived from larger samples, as well as larger adolescent validation samples, would improve the predictive power to test these hypotheses further. The challenges of relating adult clinical diagnostic constructs such as schizophrenia to adolescent psychotic experiences at a genetic level are discussed

Screening of cannabis-related problems among youth: the CPQ-A-S and CAST questionnaires

<p>Abstract</p> <p>Background</p> <p>Cannabis use among young people is a significant problem, making particularly necessary validated screening instruments that permit secondary prevention. The purpose of this study was to analyze and compare the psychometric properties of the CAST and CPQ-A-S questionnaires, two screening instruments specifically addressing the youth population.</p> <p>Methods</p> <p>Information was obtained on sociodemographics, frequency of substance use, psychopathological symptoms and cannabis-use problems, and the CPQ-A-S and CAST were applied, as well as an infrequency scale for discarding responses made randomly. The sample was made up of 144 young people aged 16 to 20 that had used cannabis in the last month, of which 71.5% were boys. Mean age of the sample was 17.38 years (SD = 1.16).</p> <p>Results</p> <p>The results show that from the psychometric point of view both the CAST and the CPQ-A-S are good screening instruments.</p> <p>Conclusions</p> <p>The CAST is shorter and presents slightly better internal consistency than the CPQ-A-S. Both instruments show high sensitivity and specificity in the detection of young people dependent on cannabis according to the DSM IV-TR criteria. The CPQ-A-S appears to show greater capacity for detecting psychopathological distress associated with use. Both questionnaires yield significant odds ratios as predictors of frequent cannabis use and of the DSM IV-TR abuse and dependence criteria. In general, the CPQ-A-S emerges as a better predictor than the CAST.</p

Using participatory design methodologies to co-design and culturally adapt the Spanish version of the Mental Health eClinic: Qualitative study

Background: The Mental Health eClinic (MHeC) aims to deliver best-practice clinical services to young people experiencing mental health problems by making clinical care accessible, affordable, and available to young people whenever and wherever they need it most. The original MHeC consists of home page with a visible triage system for those requiring urgent help; a online physical and mental health self-report assessment; a results dashboard; a booking and videoconferencing system; and the generation of a personalized well-being plan. Populations who do not speak English and reside in English-speaking countries are less likely to receive mental health care. In Australia, international students have been identified as disadvantaged compared with their peers; have weaker social support networks; and have higher rates of psychological distress. This scenario is acquiring significant relevance as Spanish-speaking migration is rapidly growing in Australia, and the mental health services for culturally and linguistically diverse populations are limited. Having a Spanish version (MHeC-S) of the Mental Health eClinic would greatly benefit these students. Objective: We used participatory design methodologies with users (young people aged 16-30 years, supportive others, and health professionals) to (1) conduct workshops with users to co-design and culturally adapt the MHeC; (2) inform the development of the MHeC-S alpha prototype; (3) test the usability of the MHeC-S alpha prototype; (4) translate, culturally adapt, and face-validate the MHeC-S self-report assessment; and (5) collect information to inform its beta prototype. Methods: A research and development cycle included several participatory design phases: co-design workshops; knowledge translation; language translation and cultural adaptation; and rapid prototyping and user testing of the MHeC-S alpha prototype. Results: We held 2 co-design workshops with 17 users (10 young people, 7 health professionals). A total of 15 participated in the one-on-one user testing sessions (7 young people, 5 health professionals, 3 supportive others). We collected 225 source documents, and thematic analysis resulted in 5 main themes (help-seeking barriers, technology platform, functionality, content, and user interface). A random sample of 106 source documents analyzed by 2 independent raters revealed almost perfect agreement for functionality (kappa=.86; P\u3c.001) and content (kappa=.92; P\u3c.001) and substantial agreement for the user interface (kappa=.785; P\u3c.001). In this random sample, no annotations were coded for help-seeking barriers or the technology platform. Language was identified as the main barrier to getting medical or psychological services, and smartphones were the most-used device to access the internet. Acceptability was adequate for the prototype’s 5 main elements: home page and triage system, self-report assessment, dashboard of results, booking and video visit system, and personalized well-being plan. The data also revealed gaps in the alpha prototype, such as the need for tailored assessment tools and a greater integration with Spanish-speaking services and communities. Spanish-language apps and e-tools, as well as online mental health information, were lacking. Conclusions: Through a research and development process, we co-designed and culturally adapted, developed and user tested, and evaluated the MHeC-S. By translating and culturally adapting the MHeC to Spanish, we aimed to increase accessibility and availability of e-mental health care in the developing world, and assist vulnerable populations that have migrated to English-speaking countries

New evidence of factor structure and measurement invariance of the SDQ across five European nations

The main purpose of the present study was to test the internal structure and to study the measurement invariance of the Strength and Difficulties Questionnaire (SDQ), self-reported version, in five European countries. The sample consisted of 3012 adolescents aged between 12 and 17 years (M = 14.20; SD = 0.83). The five-factor model (with correlated errors added), and the five-factor model (with correlated errors added) with the reverse-worded items allowed to cross-load on the Prosocial subscale, displayed adequate goodness of-fit indices. Multi-group confirmatory factor analysis showed that the five-factor model had partial strong measurement invariance by countries. A total of 11 of the 25 items were non-invariant across samples. The level of internal consistency of the Total difficulties scores was .84, ranging between .69 and .78 for the SDQ subscales. The findings indicate that the SDQ's scales need to be modified in various ways for screening emotional and behavioural problems in the five European countries that were analyzed

A randomised controlled feasibility trial for an educational school-based mental health intervention: study protocol

Background: With the burden of mental illness estimated to be costing the English economy alone around £22.5 billion a year [1], coupled with growing evidence that many mental disorders have their origins in adolescence, there is increasing pressure for schools to address the emotional well-being of their students, alongside the stigma and discrimination of mental illness. A number of prior educational interventions have been developed and evaluated for this purpose, but inconsistency of findings, reporting standards, and methodologies have led the majority of reviewers to conclude that the evidence for the efficacy of these programmes remains inconclusive. Methods/Design: A cluster randomised controlled trial design has been employed to enable a feasibility study of 'SchoolSpace', an intervention in 7 UK secondary schools addressing stigma of mental illness, mental health literacy, and promotion of mental health. A central aspect of the intervention involves students in the experimental condition interacting with a young person with lived experience of mental illness, a stigma reducing technique designed to facilitate students' engagement in the project. The primary outcome is the level of stigma related to mental illness. Secondary outcomes include mental health literacy, resilience to mental illness, and emotional well-being. Outcomes will be measured pre and post intervention, as well as at 6 month follow-up. Discussion: The proposed intervention presents the potential for increased engagement due to its combination of education and contact with a young person with lived experience of mental illness. Contact as a technique to reduce discrimination has been evaluated previously in research with adults, but has been employed in only a minority of research trials investigating the impact on youth. Prior to this study, the effect of contact on mental health literacy, resilience, and emotional well-being has not been evaluated to the authors' knowledge. If efficacious the intervention could provide a reliable and cost-effective method to reduce stigma in young people, whilst increasing mental health literacy, and emotional well-being. Trial registration: ISRCTN: ISRCTN0740602