The Role of Schizotypy in the Study of the Etiology of Schizophrenia Spectrum Disorders

Alres ajuts: Fundació La Marató de TV3 (091110)Schizotypy provides a useful construct for understanding the development of schizophrenia spectrum disorders. As research on the epidemiology of psychotic symptoms and clinical risk for psychosis has expanded, conceptual challenges have emerged to comprehend the nature and borders of the space comprised between personality variation and psychosis. Schizotypy is considered in light of these more recent constructs. It is suggested that rather than being superseded by them due to their higher specificity and predictive power for transition to psychosis, schizotypy integrates them as it constitutes a dynamic continuum ranging from personality to psychosis. The advantages of schizotypy for studying schizophrenia etiology are discussed (eg, it facilitates a developmental approach and the identification of causal, resilience, and compensating factors and offers a multidimensional structure that captures etiological heterogeneity). An overview of putative genetic, biological, and psychosocial risk factors is presented, focusing on communalities and differences between schizotypy and schizophrenia spectrum disorders. The found notable overlap supports etiological continuity, and, simultaneously, differential findings appear that are critical to understanding resilience to schizophrenia. For example, discrepant findings in genetic studies might be interpreted as suggestive of sets of independent genetic factors playing a differential role in schizotypy and schizophrenia: some would influence variation specifically on schizotypy dimensions (ie, high vs low schizotypy, thereby increasing proneness to psychosis), some would confer unspecific liability to disease by impacting neural properties and susceptibility to environmental factors (ie, high vs low resilience to disorder) and some might contribute to disease-specific characteristics. Finally, schizotypy's promise for studying gene-environment interactions is considered

Deconstructing the relationships between self-esteem and paranoia in early psychosis : an experience sampling study

No studies have examined the association between self-esteem and paranoia developmentally across the critical stages of psychosis emergence. The present study fills this gap and extends previous research by examining how different dimensions, measures, and types of self-esteem relate to daily-life paranoia across at-risk mental states for psychosis (ARMS) and first episode of psychosis (FEP) stages. Furthermore, the moderation effects of momentary anxiety and momentary perceived social support on the association between momentary self-esteem and paranoia were examined. This study used a multilevel, cross-sectional design. One-hundred and thirteen participants (74 ARMS and 39 FEP) were assessed repeatedly over seven consecutive days on levels of momentary paranoia, self-esteem, anxiety and perceived social support using experience sampling methodology. Measures of trait and implicit self-esteem were also collected. Global momentary and trait self-esteem, and their positive and negative dimensions, were related to daily-life paranoia in both ARMS and FEP groups. Conversely, implicit self-esteem was not associated with daily-life paranoia in either group. Anxiety negatively moderated the association between positive self-esteem and lower paranoia, whereas both feeling close to others and feeling cared for by others strengthened this association. However, only feeling cared for by others moderated the association between negative self-esteem and higher paranoia. Different types, measures and dimensions of self-esteem are differentially related to paranoia in early psychosis and are influenced by contextual factors in daily-life. This yields a more complex picture of these associations and offers insights that might aid psychological interventions

A psychosocial pathway to paranoia : The interplay between social connectedness and self-esteem

Altres ajuts: acords transformatius de la UABThe quantity and quality of social contacts have been related to self-esteem, and both social relationships and self-esteem have been implicated in the pathways to paranoia. However, how social relationships interplay with self-esteem to trigger paranoia is not well understood. This study aims to investigate whether different measures of social connectedness (social support, loneliness, and desired friendship), as well as the frequency of social contact, impact paranoia and other positive and negative psychotic-like experiences (PLE) through the indirect effect of self-esteem. Data from a sample of 169 nonclinically ascertained participants oversampled for schizotypy scores were analyzed using two different approaches: retrospective trait-like and ecological momentary measures of social connectedness. Results showed that self-esteem mediates the pathways from poor social support and social longing, but not from loneliness, to paranoia and other cognitive PLE. In contrast, pathways from social connectedness toperceptual PLE and negative PLE were not mediated by self-esteem. Results were consistent across trait-like and momentary measures. Finally, self-esteem was not implicated in the pathways from the frequency of social contact and paranoia or other forms of PLE. These results provide a comprehensive picture of how social connectedness drives specific symptoms of psychosis through self-esteem. Findings underscore the need to explore separately the quality and quantity of social relationships and suggest that the subjective experience of meaningful social bonds is key social determinants of mental health. Therefore, addressing inadequacies of social connectedness could substantially improve symptomatic and functional outcomes of psychosis

Psychological Pathways to Paranoia and Psychotic-Like Experiences in Daily-Life : The Mediating Role of Distinct Affective Disturbances

Influential models of psychosis indicate that the impact of putative causal factors on positive symptoms might be explained partly through affective disturbances. We aimed to investigate whether pathways from stress and self-esteem to positive symptoms, as well as reversal pathways from symptoms to stress and self-esteem, were mediated through specific affective disturbances across the extended psychosis phenotype. Using experience sampling methodology, 178 participants (65 high-schizotypy, 74 at-risk mental state, and 39 first-episode psychosis) were assessed on levels of momentary stress, self-esteem, anxiety, sadness, psychotic-like experiences (PLE), and paranoia. Multilevel mediation models were fit to examine indirect effects of each of these pathways. Considering evidence of mediation, each indirect pathway will be combined in a single model to explore their relative contributions. Anxiety, sadness, and self-esteem mediated the pathways from stress to PLE and paranoia in daily-life. In the pathway to paranoia, sadness, and self-esteem showed larger contributions than anxiety. Pathways from self-esteem to PLE and paranoia were mediated by anxiety and sadness, the later showing a larger contribution. Pathways from symptoms to stress, but not from symptoms to self-esteem, were differently explained by emotional states; sadness lost its mediating effect and anxiety was the most important mediator. Few differences across groups were found. This study lends support to psychological models of psychosis that highlight the relevance of affective disturbances in the risk and expression of psychosis. Furthermore, specific influences of different negative emotional states were identified, which could enhance psychological treatments

Ecological validity of expressed emotion in early psychosis

Expressed emotion (EE) is an aspect of the family environment that influences the course of multiple forms of psychopathology. However, there is limited research about how EE dimensions [i.e., criticism and emotional over-involvement (EOI)] are expressed in real-world settings. The present study used experience sampling methodology to investigate: 1) the criterion and construct validity of daily-life, momentary measures of criticism and EOI, and 2) the construct and ecological validity of psychometric EE-dimensions as assessed with the self-report Family Questionnaire (FQ). A total sample of 55 relatives (34 relatives of at-risk mental state patients and 21 of first-episode psychosis patients) were prompted randomly six times daily for 1-week to assess their current emotional experiences and cognitive appraisals. Relatives also completed the FQ. Momentary criticism and EOI were significantly associated with the two FQ-EE dimensions respectively, supporting the criterion validity of real-world assessed EE dimensions. As hypothesized, momentary and FQ-EE dimensions were associated with decreased positive affect, as well as with appraisals of less effective coping in daily life. Only momentary EE dimensions were associated with increased momentary negative affect. Partly in contrast with our hypotheses, momentary criticism and FQ-criticism were more consistently related to situational stress and burden than momentary EOI and FQ-EOI. Finally, neither momentary nor FQ-EE dimensions showed distinct patterns of associations with illness attributions. Findings partly support the construct validity of momentary criticism and EOI as well as the construct and ecological validity of the FQ as a sensitive measure of EE dimensions

A brief questionnaire measure of multidimensional schizotypy predicts interview-rated symptoms and impairment

The present study employed structured diagnostic interviews to assess the construct validity of the brief version of the Multidimensional Schizotypy Scale (MSS-B), which was developed to assess positive, negative, and disorganized dimensions of schizotypy. It was hypothesized that the MSS-B subscales would be associated with differential patterns of symptoms and impairment, comparable to findings for the full-length MSS. A total of 177 young adults completed structured diagnostic interviews assessing symptoms and impairment. As hypothesized, MSS-B positive schizotypy was significantly associated with interview ratings of positive (psychotic-like) symptoms, as well as schizotypal and paranoid personality disorder traits. MSS-B negative schizotypy was associated with interview ratings of negative symptoms, as well as schizoid, paranoid, and schizotypal traits. Furthermore, negative schizotypy predicted Cluster A personality disorder diagnoses. MSS-B disorganized schizotypy was associated with interview ratings of disorganized symptoms. All three schizotypy dimensions were associated with impaired functioning. This was the first study to evaluate the validity of the MSS-B using interview measures, and the pattern of findings for each MSS-B subscale was closely comparable to the findings for the full-length MSS. Contrary to our hypothesis, cannabis use was largely unassociated with psychotic-like symptoms and did not moderate the expression of the schizotypy dimensions. The MSS-B has good psychometric properties, high concordance with the full-length MSS, and good construct validity. Thus, it appears to be a promising brief alternative to traditional schizotypy measures

The impact of family environment on self-esteem and symptoms in early psychosis

Expressed emotion (EE) and self-esteem (SE) have been implicated in the onset and development of paranoia and positive symptoms of psychosis. However, the impact of EE on patients' SE and ultimately on symptoms in the early stages of psychosis is still not fully understood. The main objectives of this study were to examine whether: (1) patients' SE mediated the effect of relatives' EE on patients' positive symptoms and paranoia; (2) patients' perceived EE mediated the effect of relatives' EE on patients' SE; (3) patients' SE mediated between patients' perceived EE and patients' symptomatology; and (4) patients' perceived EE and patients' SE serially mediated the effect of relatives' EE on patients' positive symptoms and paranoia. Incipient psychosis patients (at-risk mental states and first-episode of psychosis) and their respective relatives completed measures of EE, SE, and symptoms. Findings indicated that: (1) patients' perceived EE mediated the link between relatives' EE and patients' negative, but not positive, SE; (2) patients' negative SE mediated the effect of patients' perceived EE on positive symptoms and paranoia; (3) the association of relatives' EE with positive symptoms and paranoia was serially mediated by an increased level of patients' perceived EE leading to increases in negative SE; (4) high levels of patients' distress moderated the effect of relatives' EE on symptoms through patients' perceived EE and negative SE. Findings emphasize that patients' SE is relevant for understanding how microsocial environmental factors impact formation and expression of positive symptoms and paranoia in early psychosis. They suggest that broader interventions for patients and their relatives aiming at improving family dynamics might also improve patients' negative SE and symptoms

Comparison of Self-reported Attachment in Young Adults from Spain and the United States

Background: Previous studies have provided mixed evidence in support of the structure of Bartholomew’s attachment framework. The current study examined the comparability of the correlations among the attachment prototypes as well as the underlying factor structure of the Relationship Questionnaire in independent samples of Spanish and American young adults. Method: Participants were 547 students from the Universitat Autònoma de Barcelona and 1425 from the University of North Carolina at Greensboro who completed the Relationship Questionnaire. Results: Secure attachment was negatively correlated with fearful attachment, as was preoccupied attachment with dismissing attachment. The secure-fearful association in the American sample represented a medium effect size, whereas the remaining correlations represented small effect sizes. Except for the secure-fearful association, the correlations among prototypes were comparable in magnitude across samples. A principal components analysis yielded two factors that explained similar amounts of variance in the two samples. The pattern of loadings was relatively comparable in both samples; however, it was not entirely consistent with the theoretical model. Conclusions: The findings provided only partial support to the structure of the theoretical framework invoked. We discuss an alternative interpretation of the two factors, as well as further measurement considerations and directions for future research

Dissociation and insecure attachment as mediators of the relation between childhood emotional abuse and nonclinical paranoid traits

Background: Research suggests dissociation and insecure attachment serve as explanatory mechanisms in the pathway from childhood trauma to paranoia. However, past work has not examined these mechanisms concurrently in nonclinical populations. Objective: The current study sought to examine dissociation and insecure attachment as parallel mediators of the association between childhood emotional abuse and paranoid traits. Furthermore, a serial mediation model with insecure attachment preceding dissociation in the explanatory pathway was explored. Methods: Eighty-nine nonclinically ascertained young adults were assessed for childhood emotional abuse, dissociation, attachment styles, and paranoid traits. Parallel and serial mediation models were tested. Results: The association of childhood emotional abuse with both interview-based and self-reported paranoid traits was significantly mediated by dissociation and preoccupied attachment. Fearful attachment was a significant mediator in the model for self-reported paranoid traits. No evidence for a serial mediation effect was found. Conclusions: The present findings extend support for dissociation and attachment insecurity as mechanisms underlying the link between childhood emotional maltreatment and paranoid traits. Longitudinal research is needed to inform whether insecure attachment contributes to dissociation along the pathways to paranoid traits

Emerging adulthood and prospective depression: A simultaneous test of cumulative risk theories

Past research indicates that a history of depression and exposure to abuse and neglect represent some of the most robust predictors of depression in emerging adults. However, studies rarely test the additive or interactive risk associated with these distinct risk factors. In response, the present study explored how these three risk factors (prior depression, abuse, and neglect) synergistically predicted prospective depressive symptoms in a sample of 214 emerging adults (Mage?=?21.4 years; SDage?=?2.4; 78% females). Subtypes of maltreatment and lifetime history of depression were assessed through semi-structured interviews, and depressive symptoms were assessed annually for three years via self-report measures. The results indicated that for both males and females, a lifetime history of depression, abuse, and neglect-exposure uniquely conferred risk for elevated depressive symptoms. Furthermore, the interaction between neglect and prior depression forecasted increasing depressive symptoms, and a history of abuse also predicted increasing depressive symptoms, but only in females. These findings are contextualized within extant developmental psychopathology theories, and translational implications for trauma-informed depression prevention efforts are discussed