Integration and Development in Schizotypy Research: An Introduction to the Special Supplement

In its fifth decade of existence, the construct of schizotypy is recapturing the early scientific interest it attracted when Paul E. Meehl (1920-2003), who coined the term, pioneered the field of schizotypy research. The International Lemanic Workshop on Schizotypy, hosted at the University of Geneva in December 2013, recently offered an opportunity to address some of the fundamental questions in contemporary schizotypy research and situate the construct in the greater scheme of future scientific projects on schizophrenia and psychological health research. What kind of knowledge has schizotypy research provided in furthering our understanding of schizophrenia? What types of questions can schizotypy research tackle, and which are the conceptual and methodological frameworks to address them? How will schizotypy research contribute to future scientific endeavors? The International Lemanic Workshop brought together leading experts in the field around the tasks of articulating the essential findings in schizotypy research, as well as providing some key insights and guidance to face scientific challenges of the future. The current supplement contains 8 position articles, 4 research articles, and 1 invited commentary that outline the state of the art in schizotypy research toda

A Mentalization-Informed Staging Approach to Clinical High Risk for Psychosis

The practice of diagnosis is fundamentally designed to orient treatment. In the case of early diagnosis for schizophrenia spectrum disorders (SSP) risk, the empirical base for such a practice is still young, and many clinical questions arise in the everyday clinical application of risk algorithms and ensuing therapeutic options. One of the key questions that we will focus on is the following: in cases of SSP where symptoms are successfully treated, why does residual social functioning impairment remain the most serious obstacle to remission and reinsertion in society? We will present the evidence suggesting that the roots of residual social functioning impairment may, in many cases, come from thwarted or arrested development in the specialization of social cognition during adolescence and early adulthood. We will review the evidence suggesting that both during the premorbid phase and clinical high-risk phase, attenuated psychotic symptoms may impede the maturation of key social cognitive processes, particularly the suite of reflective thinking processes coming under the term of mentalization. From this evidence base, we will adapt the staging model of SSP progression in function of our mentalization-informed model, tailored to provide a coherent framework of care addressing the key clinical needs at every stage of psychosis progression

Beyond Clinical High-Risk State for Psychosis: The Network Structure of Multidimensional Psychosis Liability in Adolescents

OBJECTIVES: The main goal of the present study was to analyze the network structure of schizotypy dimensions in a representative sample of adolescents from the general population. Moreover, the network structure between schizotypy, mental health difficulties, subjective well-being, bipolar-like experiences, suicide ideation and behavior, psychotic-like experiences, positive and negative affect, prosocial behavior, and IQ was analyzed. METHOD: The study was conducted in a sample of 1,506 students selected by stratified random cluster sampling. The Oviedo Schizotypy Assessment Questionnaire, the Personal Wellbeing Index-School Children, the Paykel Suicide Scale, the Mood Disorder Questionnaire, the Strengths and Difficulties Questionnaire, the Prodromal Questionnaire-Brief, the Positive and Negative Affect Schedule for Children Shortened Version, and the Matrix Reasoning Test were used. RESULTS: The estimated schizotypy network was interconnected. The most central nodes in terms of standardized Expected Influence (EI) were 'unusual perceptual experiences' and 'paranoid ideation'. Predictability ranged from 8.7% ('physical anhedonia') to 52.7% ('unusual perceptual experiences'). The average predictability was 36.27%, implying that substantial variability remained unexplained. For the multidimensional psychosis liability network predictability values ranged from 9% (estimated IQ) to 74.90% ('psychotic-like experiences'). The average predictability was 43.46%. The results of the stability and accuracy analysis indicated that all networks were accurately estimated. CONCLUSIONS: The present paper points to the value of conceptualizing psychosis liability as a dynamic complex system of interacting cognitive, emotional, behavioral, and affective characteristics. In addition, provide new insights into the nature of the relationships between schizotypy, as index of psychosis liability, and the role played by risk and protective factors.Swiss National Science Foundation (100019_159440)Europa FEDER La Rioja 2014-2020 (SRS 6FRSABC026

Adolescent Resting State Networks and Their Associations with Schizotypal Trait Expression

The rising interest in temporally coherent brain networks during baseline adult cerebral activity finds convergent evidence for an identifiable set of resting state networks (RSNs). To date, little is know concerning the earlier developmental stages of functional connectivity in RSNs. This study's main objective is to characterize the RSNs in a sample of adolescents. We further examine our data from a developmental psychopathology perspective of psychosis-proneness, by testing the hypothesis that early schizotypal symptoms are linked to disconnection in RSNs. In this perspective, this study examines the expression of adolescent schizotypal traits and their potential associations to dysfunctional RSNs. Thirty-nine adolescents aged between 12 and 20 years old underwent an 8-min functional magnetic resonance imaging (fMRI) “resting state” session. In order to explore schizotypal trait manifestations, the entire population was assessed by the Schizotypal Personality Questionnaire (SPQ). After conventional processing of the fMRI data, we applied group-level independent component analysis (ICA). Twenty ICA maps and associated time courses were obtained, among which there were RSNs that are consistent with findings in the literature. We applied a regression analysis at group level between the energy of RSN-associated time courses in different temporal frequency bins and the clinical measures (3 in total). Our results highlight the engagement of six relevant RSNs; (1) a default-mode network (DMN); (2) a dorso-lateral attention network; (3) a visual network (VN); (4) an auditory network (AN); (5) a sensory motor network (SMN); (6) a self-referential network (SRN). The regression analysis reveals a statistically significant correlation between the clinical measures and some of the RSNs, specifically the visual and the AN. In particular, a positive correlation is obtained for the VN in the low frequency range (0.05 Hz) with SPQ measures, while the AN correlates negatively in the high frequency range (0.16–0.19 Hz). Trend-like significance for the SRN may hint to its implication in disorganized thoughts and behaviors during adolescence. Unlike DMN activity in schizophrenic patients, adolescent DMN was unrelated to schizotypal trait expression. This suggests that relationships between the DMN and schizotypy may be modified in later developmental stages of both functional connectivity and psychotic expression. These results are discussed in light of RSNs literature involving children, adults, and individuals with schizophrenia

The Effects of Cognitive-Affective Switching With Unpredictable Cues in Adults and Adolescents and Their Relation to “Cool” Executive Functioning and Emotion Regulation

The impact of emotion on executive functioning is gaining interest. It has led to the differentiation of “cool” Executive Functioning (EF) processes, such as cognitive flexibility, and “hot” EF processes, such as affective flexibility. But how does affective flexibility, the ability to switch between cognitive and affective information, vary as a function of age and sex? How does this construct relate to “cool” executive functioning and cognitive-emotion regulation processes? In this study, 266 participants, including 91 adolescents (M = 16.08, SD = 1.42 years old) and 175 adults (M = 25.69, SD = 2.17 years old), completed a cognitive–affective switching task with specific (as opposed to general) unpredictable switches, as well as measures of inhibition, attention, and cognitive-emotion coping strategies. We expected cognitive to affective switching to be more costly than affective to cognitive switching in females versus males, as well as higher switch costs in adolescents. Using linear mixed modelling, we analysed the effect of age, sex, and types of switching on reaction time. Results show that adolescents are slower switchers than adults, and demonstrate that females, although faster switchers than males, are slower when switching from cognitive to affective content than when they are switching from affective to cognitive content. Multiple regression analyses revealed age-specific associations between cognitive-affective switching and inhibition. These results converge with reported developmental and gender specificities in EF and emotion processing, respectively. Additionally, affective flexibility could relate to differences in vigilance and inhibition

Beyond diagnosis : mentalization and mental health from a transdiagnostic point of view in adolescents from non-clinical population

An increasing volume of evidence suggests that mentalization (MZ) can be an important factor in the transition from mental health to mental illness and vice versa. However, most studies are focused on the role of MZ in specific disorders. This study aims to evaluate the relationship between MZ and mental health as a trans-diagnostic process. A sample of 172 adolescents aged 12 to 18 years old (M = 14.6, SD = 1.7; 56.4% of girls) was assessed on measures of MZ, psychopathology and psychological functioning from a multimethod and multi-informant perspective. Contrary to predictions, MZ was not associated with general psychopathology and comorbidity, even when explored from a broad, trans-diagnostic perspective. However, we observed a robust association linking MZ to functioning and well-being across many dimensions, involving social, role and several psychological indicators of adjustment and mental health. These results suggest that MZ may contribute to mental health beyond symptoms, not so much associated with psychopathology, but rather resilience and well-bein

Developing Psychosis and Its Risk States Through the Lens of Schizotypy

Starting from the early descriptions of Kraepelin and Bleuler, the construct of schizotypy was developed from observations of aberrations in nonpsychotic family members of schizophrenia patients. In contemporary diagnostic manuals, the positive symptoms of schizotypal personality disorder were included in the ultra high-risk (UHR) criteria 20 years ago, and nowadays are broadly employed in clinical early detection of psychosis. The schizotypy construct, now dissociated from strict familial risk, also informed research on the liability to develop any psychotic disorder, and in particular schizophrenia-spectrum disorders, even outside clinical settings. Against the historical background of schizotypy it is surprising that evidence from longitudinal studies linking schizotypy, UHR, and conversion to psychosis has only recently emerged; and it still remains unclear how schizotypy may be positioned in high-risk research. Following a comprehensive literature search, we review 18 prospective studies on 15 samples examining the evidence for a link between trait schizotypy and conversion to psychosis in 4 different types of samples: general population, clinical risk samples according to UHR and/or basic symptom criteria, genetic (familial) risk, and clinical samples at-risk for a nonpsychotic schizophrenia-spectrum diagnosis. These prospective studies underline the value of schizotypy in high-risk research, but also point to the lack of evidence needed to better define the position of the construct of schizotypy within a developmental psychopathology perspective of emerging psychosis and schizophrenia-spectrum disorder

Visuospatial encoding deficits and compensatory strategies in schizophrenia revealed by eye movement analysis during a working memory task

Objective: To investigate scanpath abnormalities during the encoding of static stimuli in schizophrenia and their interaction with visuospatial working memory (VSWM) dysfunction. Methods: Outpatients with schizophrenia and control subjects were asked to encode a static pattern for subsequent recognition after a short delay. We measured the number of correct and incorrect choices. We also assessed the number and the distribution of fixations, the scanning time in specific regions of interest (ROIs) and the head movements during the encoding of the stimuli. The distributions of fixations and scanning time in definite ROIs during the discrimination of the correct pattern from the foils were also measured. Results: Patients recognised fewer correct patterns than controls. Correct trials in patients were characterised by a specific exploration of the central part of the stimulus during its presentation, whereas this feature was absent in incorrect trials. However, the scanning time and the numbers of fixations and head movements during encoding were similar in both groups and unrelated to recognition accuracy. In both groups, correct trials were associated with a selective exploration of the correct pattern amongst the six possibilities during recognition. Furthermore, patients gave more attention to incorrect patterns with a leftmost element identical to that of the correct response and also those approximating its global structure. Conclusion: Patients showed a VSWM deficit independent of oculomotor dysfunctions and head movements during encoding. Patients' correct trials were related to specific scanning during encoding and discrimination phases. Analysis of these patterns suggests that patients try to compensate for reduced VSWM ability by using specific encoding strategie