Neurodevelopmental Antecedents and Sensory Phenomena in Obsessive Compulsive Disorder: A Systematic Review Supporting a Phenomenological-Developmental Model.

BACKGROUND: The majority of models on obsessive compulsive disorder (OCD) endorse a top-down perspective on the cognitive mechanisms underlying OCD functioning and maintenance, whereas a bottom-up perspective is rarely pursued. OBJECTIVES: The aim of the study was to review the empirical literature on sensory phenomena (SP) and neurodevelopmental antecedents of OCD, which could support the conceptualization of an alternative, bottom-up perspective integrating neurodevelopmental and phenomenological levels of analysis on OCD. METHODS: A systematic review according to PRISMA guidelines was performed in PubMed/MEDLINE, PsycInfo, the Cochrane Library, and Excerpta Medica Database (EMBASE) and focused on SP and "neurodevelopmental antecedents" (operationalized in early risk factors, neuroimaging signs, neurological soft signs, and sensory responsivity). The time interval was from inception up to March 31, 2022. RESULTS: From the search in electronic databases, 48 studies were retained and reviewed. SP are highly prevalent in OCD patients and overrepresented in comparison with healthy controls. Similarly, OCD patients also present a higher prevalence of early environmental adversities and sensorimotor alterations in terms of neurological soft signs and sensory over-responsivity in the tactile and acoustic domains; additional findings included hypogyrification signs at neuroimaging. Both sensorimotor alterations and SP are associated with tic-related manifestations and poorer insight in OCD patients. CONCLUSIONS: On the ground of established common subjective experience of SP and premorbid neurodevelopmental features, we hypothesized an explanatory model for OCD, which considers the possible pathophysiological role for altered corollary discharge and enhanced error detection in the neurodevelopment of SP and obsessions. SP may represent the subjective experiential resonance of an individual history of persistently inaccurate sensory predictions, whereas accompanying manifestations, such as the obsessive need for order and symmetry, may represent a compensatory attempt to mitigate SP. This neurodevelopmental-phenomenological bottom-up model, describing a dimensional gradient of sensorimotor alterations and related subjective experiences, may contribute to explain the dimensional affinity between OCD and schizophrenia spectrum disorders. Furthermore, this model could be useful for the early detection of subjects at higher risk of OCD.

Along the fringes of Agency: neurodevelopmental account of the obsessive mind.

The experiential core of the obsessive mind rests on subtle, primary mental phenomena (such as obsessions and so called "sensory phenomena") which precede and trigger behavioral compulsions. Converging evidence supports a possible pathophysiological role for altered corollary discharge (phenotypically expressed in sensorimotor symptoms and contributing to a reduced Sense of Agency [SoA]), in the neurodevelopment of obsessions and "sensory phenomena." In phenomenological terms, "sensory phenomena" may represent the subjective experiential resonance of an individual history of persistent inaccurate sensory predictions, whereas accompanying manifestations, such as the obsessive need for order and symmetry, may represent a compensatory attempt to mitigate "sensory phenomena" (eg, by increasing the sensory predictability of the surrounding world). Since disturbances of both SoA and Sense of Ownership have been thematized as potential pathogenetic factors in the neurodevelopment of the psychotic mind, a dimensional account of altered sensorimotor prediction may partly explain the affinities (and high comorbidity) between obsessive-compulsive disorder and schizophrenia spectrum disorders.

Developmental dynamic interplay between executive functions and psychotic risk.

According to the neurodevelopmental hypothesis of schizophrenia, the premorbid stages of nonaffective psychosis are characterized by early phenotypic manifestations of neurobiological vulnerability, whose developmental trends are accurately characterized for IQ, language, and motor abilities. More elusive is the developmental relationship between psychotic risk and executive functions. Few longitudinal studies are available on this relationship, suggesting a developmental lag for executive functions in subjects that will develop psychosis in young adulthood. In this brief commentary we underline specific developmental characteristics of psychotic manifestations that should be considered by further studies, which are aimed at grasping the developmental relationship between psychotic risk and neurocognitive features. Psychosis is an end-stage phenomenon that represents the long-term outcome of a prolonged psychopathological construction. By designing studies addressing developmentally-sensitive risk phenotypes for psychosis, it will be possible to understand how executive functions (among other neurocognitive features) might impact the risk of developing psychosis.

Looking at Intergenerational Risk Factors in Schizophrenia Spectrum Disorders: New Frontiers for Early Vulnerability Identification?

Offspring of individuals with serious mental illness (SMI) constitute a special population with a higher risk of developing psychiatric disorders, which is also highly prevalent among referrals to child and adolescent mental health services (CAMHS). They often exhibit more or less subclinical conditions of vulnerability, fueled by mutually potentiating combinations of risk factors, such as presumed genetic risk, poor or inadequate affective and cognitive parenting, and low socio-economic status. Despite this evidence, neither specific preventive programs for offspring of parents with SMI are usually implemented in CAMHS, nor dedicated supportive programs for parenting are generally available in adult mental health services (AMHS). Needless to say, while both service systems tend to focus on individual recovery and clinical management (rather than on the whole family system), these blind spots add up to frequent gaps in communication and continuity of care between CAMHS and AMHS. This is particularly problematic in an age-range in which an offspring's vulnerabilities encounter the highest epidemiological peak of incident risk of SMI. This paper offers a clinical-conceptual perspective aimed to disentangle the complex intertwine of intergenerational risk factors that contribute to the risk of developing SMI in offspring, taking schizophrenia spectrum disorders as a paradigmatic example.

Anhedonia in adolescents at ultra-high risk (UHR) of psychosis: findings from a 1-year longitudinal study.

Previous findings suggested deficits in pleasure experience in schizophrenia, but little is known in psychosis risk prodrome, especially in adolescence. Aim of this study was (1) to assess anhedonia in distinct help-seeking subgroups of adolescents identified through the ultra-high risk (UHR) criteria, (2) to explore any association of anhedonia with other psychopathological aspects in the UHR group, and (3) to monitor longitudinally the stability of anhedonia in UHR individuals across 1-year follow-up period. 123 participants (13-18 years) completed the Comprehensive Assessment of At-Risk Mental States (CAARMS), the Beck Depression Inventory-II, the Schizotypal Personality Questionnaire-Brief version, the Brief-O-LIFE questionnaire (BOL), and the Brief version of the World Health Organization Quality of Life scale (WHOQOL-BREF). Two different indexes of anhedonia were used: CAARMS "Anhedonia" item 4.3 and BOL "Introvertive Anhedonia" subscale scores. No difference in anhedonia levels between UHR and First Episode Psychosis (FEP) groups was found. UHR adolescents showed higher CAARMS and BOL anhedonia scores than non-UHR/FEP. After 1-year follow-up period, UHR adolescents had a significant decrease in severity only in CAARMS anhedonia subscores. In UHR subgroup, CAARMS anhedonia measures showed significant correlations with impaired role functioning and negative symptoms, while BOL anhedonia was significantly correlated with specific schizotypal personality traits concerning interpersonal deficits. Anhedonia is prominent in the psychosis prodrome, also in adolescence. Its severity is not statistically different from that of FEP adolescents and is related to more severe functioning impairment and a worse quality of life.

Motor Impairment and Developmental Psychotic Risk: Connecting the Dots and Narrowing the Pathophysiological Gap.

The motor system in its manifold articulations is receiving increasing clinical and research attention. This is because motor impairments constitute a central, expressive component of the mental state examination and a key transdiagnostic feature indexing disease severity. Furthermore, within the schizophrenia spectrum, the integration of neurophysiological, developmental, and phenomenological perspectives suggests that motor impairment is not simply a generic, extrinsic proxy of an altered neurodevelopment, but might be more intimately related to psychotic risk. Therefore, an increased understanding, conceptualization, and knowledge of such motor system and its anomalies could empower contemporary risk prediction and diagnostic procedures.

Clinical high risk for psychosis in childhood and adolescence: findings from the 2-year follow-up of the ReARMS project.

The clinical significance and the prognostic value of clinical high risk (CHR) for psychosis, while substantially corroborated in adults, remains less firmly established in children and early adolescents. This follow-up study, developed within the Reggio Emilia At Risk Mental States project, is meant to contribute to the reduction of such lacuna, and has two main aims: (1) to characterize the clinical profile of help seekers [stratified in non-CHR, CHR and first episode psychosis (FEP)] referred to child-adolescent mental health services; and (2) to monitor the cumulative transition rate from CHR to FEP in adolescents at the follow-up of 12 and 24 months. 112 adolescents (aged 13-18 years) were assessed with the Comprehensive Assessment of At-Risk Mental States and the Schizophrenia Proneness Instrument, Child and Youth version. 51 subjects met CHR criteria (45.5% of the sample) and 33 subjects met FEP criteria (29.5%) at baseline. The criterial transition rate from CHR to FEP was 7% over 12 months and 13% over 24 months; higher rates of cumulative transition were detected when also functional transition (indexed by the consensual introduction of antipsychotic medication by the treating clinical staff) was considered. The identification of CHR for psychosis in help-seeking adolescents is feasible and clinically relevant. Studies conducted in real world, publicly funded components of the national health system, should take into consideration not only criterial, psychometric transition, but also functional equivalents of transition.

The Italian version of the 92-item Prodromal Questionnaire: Concurrent validity with the SIPS and factor analysis in a sample of 258 outpatients aged 11-36years.

BACKGROUND: Current early screeners for psychosis-risk states have still to prove ability in identifying at-risk individuals. Among screeners, the 92-item Prodromal Questionnaire (PQ-92) is often used. We aimed to assess the validity of its Italian translation in a large Italian adolescent and young adult help-seeking sample. METHODS: We included all individuals aged 12-36years seeking help at psychiatric mental health services in a large semirural Roman area (534,600 population) who accepted to participate. Participants completed the Italian version of the PQ-92 and were subsequently assessed with the Structured Interview of Prodromal/Psychosis-Risk Syndromes (SIPS). We examined diagnostic accuracy (sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios) and content, concurrent, and convergent validity between PQ-92 and SIPS using Cronbach's alpha, Cohen's kappa, and Spearman's rho, respectively. We tested the validity of adopted cut-offs through Receiver Operating Characteristic (ROC) curves plotted against SIPS diagnoses and the instrument's factor-structure through Principal Component Analysis. RESULTS: PQ-92 showed high internal consistency, acceptable diagnostic accuracy and concurrent validity, and excellent convergent validity. ROC analyses pointed to scores of 18 on the Positive subscale and 36 on the total PQ-92 as best cut-offs. The Scree-test identified a four-factor solution as fitting best. CONCLUSIONS: Psychometric properties of Italian PQ-92 were satisfactory. Optimal cut-offs were confirmed at ≥18 on the positive subscale, but at ≥36 on the total scale was able to identify more SIPS-positive cases.

Developmental Coordination Disorder Plus Oculomotor and Visuospatial Impairment as Neurodevelopmental Heralds of Psychosis Proneness.

Aiming at preventing transitions to more severe psychopathology and boosted by the availability of operational criteria to identify help-seeking subjects at increased risk for psychosis, research into the early prodromal phases of psychosis is attracting a growing clinical interest. Furthermore, the focus of early detection is gradually shifting from prodromal syndromes to the premorbid period. Although mainly driven by clinical-pragatic aims, such a shift is coherent with the neurodevelopmental hypothesis of schizophrenia that might offer a unifying, developmentally informed conceptual framework for early detection. Psychotic experiences, indeed, while overtly manifested in adolescence/early-adulthood, are often antedated by subtle expressions of biological vulnerability already presenting in the early years of life and indexing a putatively altered neurodevelopmental process. Concretely, unspecific premorbid symptoms that may be present since infancy and childhood may lead to early clinical consultancy in child-adolescent mental health services, which could be considered the primary clinical setting to implement early detection. We herewith present a clinical vignette of a child with severe Developmental Coordination Disorder presenting an Attenuated Psychosis Syndrome. The vignette illustrates the intertwining between possible early neurodevelopmental disorders and clinical psychosis proneness in childhood.

Attenuated psychotic and basic symptom characteristics in adolescents with ultra-high risk criteria for psychosis, other non-psychotic psychiatric disorders and early-onset psychosis.

While attenuated psychotic symptoms (APS) and basic symptoms (BS) are the main current predictors of psychosis in adults, studies in adolescents are scarce. Thus, we (1) described the prevalence and severity of positive, negative, disorganization, general, and basic symptoms in adolescent patients at ultra-high risk for psychosis (UHR), with other non-psychotic psychiatric disorders (PC) and with early-onset psychosis (EOP); and (2) investigated BS criteria in relation to UHR criteria. Sixty-nine 12-18-year-old adolescents (15.3 ± 1.7 years, female = 58.0 %, UHR = 22, PC = 27, EOP = 20) were assessed with the structured interview for prodromal syndromes (SIPS) and the schizophrenia proneness instrument-child and youth version (SPI-CY). Despite similar current and past 12-month global functioning, both UHR and EOP had significantly higher SIPS total and subscale scores compared to PC, with moderate-large effect sizes. Expectedly, UHR had significantly lower SIPS positive symptom scores than EOP, but similar SIPS negative, disorganized, and general symptom scores. Compared to PC, both EOP and UHR had more severe basic thought and perception disturbances, and significantly more often met cognitive disturbances criteria (EOP = 50.0 %, UHR = 40.9 %, PC = 14.8 %). Compared to UHR, both EOP and PC significantly less often met cognitive-perceptive BS criteria (EOP = 35.0 %, UHR = 68.2 %, PC = 25.9 %). BS were significantly more prevalent in both EOP and UHR than PC, and UHR were similar to EOP in symptom domains. Given the uncertain outcome of adolescents at clinical high-risk of psychosis, future research is needed to determine whether the combined assessment of early subjective disturbances with observable APS can improve the accuracy of psychosis prediction.

Self-Disorders and Clinical High Risk for Psychosis: An Empirical Study in Help-Seeking Youth Attending Community Mental Health Facilities.

Anomalous subjective experiences involving an alteration of the basic sense of self (ie, Self-disorder [SD]) are emerging as a core marker of schizophrenia spectrum disorders with potential impact on current early detection strategies as well. In this study, we wished to field-test the prevalence of SD in a clinical sample of adolescent/young adult help-seekers at putative risk for psychosis attending standard community mental health facilities in Italy. Participants (n = 47), aged between 14 and 25, underwent extensive psychopathological evaluations with current semi-structured tools to assess Clinical High Risk (CHR) state (ie, Structured Interview for Prodromal Syndromes/Scale of Prodromal Symptoms [SIPS/SOPS], Schizophrenia Proneness Instrument-Adult/Child and Youth [SPI-A/CY]). SD aggregated in CHR subjects as compared to the non-CHR and revealed substantial association with sub-psychotic symptoms (SIPS), subjective experience of cognitive and cognitive-perceptual vulnerability (basic symptoms) and functional level (Global Assessment of functioning). Moreover, a combination of the 2 approaches (ie, CHR plus SD) enabled further "closing-in" on a subgroup of CHR with lower global functioning. The results confirm SD's relevance for the early profiling of youths at potential high risk for psychosis.

Self-reported attenuated psychotic-like experiences in help-seeking adolescents and their association with age, functioning and psychopathology.

OBJECTIVE: Self-rated attenuated psychotic-like experiences (APLEs) are increasingly used to screen for ultra-high-risk (UHR) across all ages. However, self-rated psychotic-like experiences (PLEs), in particular perception-related ones, were more frequent in children and adolescents, in which they possessed less clinical significance. We therefore explored the prevalence of different factors of APLEs in help-seeking adolescents, and their relationship with age, functioning and psychopathology. METHOD: As a part of the "Liberiamo il Futuro" project, help-seeking adolescents (N=171; 11-18 years, 53% male) were screened with the 92-item Prodromal Questionnaire (PQ-92). A factor analysis was performed on the PQ-92 positive items (i.e., APLEs) to identify different APLE-factors. These were assessed for their association with age, functioning and psychopathology using regression analyses. RESULTS: APLEs were very common in help-seeking adolescents, and formed four factors: "Conceptual Disorganization and Suspiciousness", "Perceptual Abnormalities", "Bizarre Experiences", and "Magical Ideation". Associations with age and functioning but not psychopathology were found for "Perceptual Abnormalities" that was significantly more severe in 11-12-year-olds, while "Conceptual Disorganization and Suspiciousness" was significantly related to psychopathology. CONCLUSION: In line with findings on PLEs, prevalence and clinical significance of APLEs, especially perception-related ones, might depend on age and thus neurodevelopmental stage, and may fall within the normal spectrum of experience during childhood. This should be considered when screening for UHR status in younger age groups.

[Challenges in the early detection of psychosis in children and adolescents]. / Le sfide per una corretta individuazione precoce delle psicosi nei bambini e negli adolescenti.

The early detection and treatment of persons at-risk for psychosis is currently regarded a promising strategy in fighting the devastating consequences of psychotic disorders. The two current at-risk approaches, i.e., the "ultra high risk" and the "basic symptom" criteria, were mainly developed on adult samples. Initial evidence suggests, however, that they cannot simply be applied to children and adolescents. For ultra high risk criteria, there is indication of some attenuated psychotic symptoms being potentially non-specific in adolescents and of brief limited intermittent symptoms being difficult to clinically classify in children when observable behavioral correlates are missing. For basic symptoms, too, only preliminary indication of their usefulness in children and adolescents exists. Since developmental peculiarities in the assessment of basic symptoms should be considered, a child and youth version of the Schizophrenia Proneness Instrument (SPI-CY) was developed. In conclusion, research on the clinical-prognostic validity of the at-risk criteria and their potential adoption to the special needs of children and adolescents is needed. If a Prodromal Risk Syndrome for Psychosis or Attenuated Psychotic Symptoms Syndrome will be included into DSM-V, it has to be highlighted that its suitability for children and adolescents is only insufficiently known.

[Psychiatric aspects in workers subject to mobbing]. / Aspetti psichiatrici del lavoratore oggetto di mobbing.

BACKGROUND: Mobbing in the language of ethologists means a particular behaviour of a group of animals consisting of several members forming an alliance against a single animal, in order to eliminate this animal away from the group. This term has been adopted in current usage to mean a kind of relationship at the workplace that, by aggressive and underhand means, aims at influencing or expelling the person. The term "bossing" is used to indicate a negative action, under the meaning described above, made by one or more senior persons, or possibly by the employer. In the Italian Parliament, under the current legislature, several bills are pending regarding this problem. Besides the aspects of topical interest in the problem, there are first and foremost the different kinds of reaction-adaptation to mobbing, according to the type of individual internal working models in action, that can be anxious/avoiding, anxious/resistant or disorganised. OBJECTIVES: The purpose of our study was a clinical evaluation of the different ways of adaptation-reaction to a mobbing-type relationship at the workplace, and of the type of internal working models found among the examined patients. METHODS: A clinical interview was carried out with 40 patients who, over a period of 12 months of observation, came to request a clinical assessment, for medical-legal reasons, of their psycho-pathological state and ways to react to adverse situations at the workplace, such as a mobbing or bossing. RESULTS: Besides the psychological and relational effects of mobbing, the reactions of the examined subjects to mobbing are also described, considering also the different cognitive self-organization possibilities, according to the individual internal working model, regarding patterns of attachment in adult age. The most frequent internal working model seems to be the one related to resistant attachment, followed by the avoidance and lastly--rarely--the disorganized model. Furthermore we observed among these subjects a certain deficit in meta-cognitive capacity of self reflection and decentralization. CONCLUSIONS: Cognitive therapy is proposed as the most effective of therapeutic approaches, associated with symptomatic psycho-pharmacological therapy as needed. Initial clinical results on cognitive therapy of these patients are reported. The individual type of internal working model seems to be the critical element in mobbing reaction and, besides specific intervention plans regarding relationship in the workplace, individual psychotherapy appears to be the best instrument of treatment and prevention of the psychopathologic effects caused by mobbing.