Assessment and treatment planning for schizotypal personality disorder: A metacognitively oriented point of view.

OBJECTIVE: The aim of this study was to pilot test a novel assessment and treatment plan for patients with a schizotypal personality disorder by integrating the Diagnostic and Statistical Manual of Mental Disorders (5th ed.) alternative model of personality disorders, metacognitively oriented psychotherapies, and recovery approaches. METHOD: I recruited 12 patients diagnosed with schizotypal personality disorder. I report results from the global assessment including measures on symptoms, maladaptive traits, Big Five personality traits, schizophrenia proneness, and metacognition. I also describe how I planned treatment to promote an individualized understanding of a person's agenda and recovery. The treatment plans were also evaluated through in-depth qualitative interviews at the end of the intervention. Interviews were analyzed through a phenomenological framework and a computer-aided qualitative analysis software. RESULTS: Assessment results and qualitative interviews highlight the importance of a multilevel, progressive treatment plan aimed at considering the personality functioning from a recovery-oriented, nonpathologizing approach. On 1 hand, an assessment that focuses on both healthy and maladaptive traits fosters a progressive redefinition of the therapeutic agenda. On the other hand, a constant and recursive evaluation of metacognition and personality traits offers a treatment strategy that supports my core assumption that recovery from schizotypal personality disorder is possible. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: A twofold focus on personality traits and metacognition seems to represent a viable strategy for treating patients with schizotypal personality disorder. A metacognitively oriented rehabilitation may be a flexible, personalized and effective approach toward recovery. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Biological Rhythms Interview of Assessment in Neuropsychiatry in patients with bipolar disorder: correlation with affective temperaments and schizotypy

Objective: To assess the relationship of biological rhythms, evaluated by the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), with affective temperaments and schizotypy. Methods: The BRIAN assessment, along with the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A) and the Oxford-Liverpool Inventory for Feelings and Experiences (O-LIFE), was administered to 54 patients with remitted bipolar disorder (BD) and 54 healthy control (HC) subjects. Results: The TEMPS-A cyclothymic temperament correlated positively and the hyperthymic temperament correlated negatively with BRIAN scores in both the BD and HC groups, although the correlation was stronger in BD subjects. Depressive temperament was associated with BRIAN scores in BD but not in HC; conversely, the irritable temperament was associated with BRIAN scores in HC, but not in BD. Several positive correlations between BRIAN scores and the schizotypal dimensions of the O-LIFE were observed in both BD and HC subjects, especially with cognitive disorganization and less so with unusual experiences and impulsive nonconformity. A correlation with introversion/anhedonia was found only in BD subjects. Conclusion: Cyclothymic and depressive temperaments predispose to disturbances of biological rhythms in BD, while a hyperthymic temperament can be protective. Similar predispositions were also found for all schizotypal dimensions, mostly for cognitive disorganization.

The Biological Rhythms Interview of Assessment in Neuropsychiatry in patients with bipolar disorder: correlation with affective temperaments and schizotypy.

OBJECTIVE:: To assess the relationship of biological rhythms, evaluated by the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), with affective temperaments and schizotypy. METHODS:: The BRIAN assessment, along with the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A) and the Oxford-Liverpool Inventory for Feelings and Experiences (O-LIFE), was administered to 54 patients with remitted bipolar disorder (BD) and 54 healthy control (HC) subjects. RESULTS:: The TEMPS-A cyclothymic temperament correlated positively and the hyperthymic temperament correlated negatively with BRIAN scores in both the BD and HC groups, although the correlation was stronger in BD subjects. Depressive temperament was associated with BRIAN scores in BD but not in HC; conversely, the irritable temperament was associated with BRIAN scores in HC, but not in BD. Several positive correlations between BRIAN scores and the schizotypal dimensions of the O-LIFE were observed in both BD and HC subjects, especially with cognitive disorganization and less so with unusual experiences and impulsive nonconformity. A correlation with introversion/anhedonia was found only in BD subjects. CONCLUSION:: Cyclothymic and depressive temperaments predispose to disturbances of biological rhythms in BD, while a hyperthymic temperament can be protective. Similar predispositions were also found for all schizotypal dimensions, mostly for cognitive disorganization.

Vocational functioning in schizotypal and paranoid personality disorders.

Impaired vocational functioning is a hallmark of schizophrenia, but limited research has evaluated the relationships between work and schizophrenia-spectrum personality disorders, including schizotypal (SPD) and paranoid personality disorder (PPD). This study compared employment history and job characteristics of 174 individuals drawn from the community or clinic, based on four personality disorder groups: SPD Only, PPD Only, SPD+PPD, and No SPD or PPD. Symptoms and cognitive functioning were also assessed. Both PPD and/or SPD were associated with lower rates of current employment, and a history of having worked at less cognitively complex jobs than people without these disorders. Participants with PPD were less likely to have a history of competitive work for one year, whereas those with SPD tended to have worked at jobs involving lower levels of social contact, compared with those without these disorders. When the effects of symptoms and cognitive functioning were statistically controlled, PPD remained a significant predictor of work history, and SPD remained a significant predictor of social contact on the job. The findings suggest that impaired vocational functioning is an important characteristic of SPD and PPD.

[Early stages of schizophrenia, challenges and prospects]. / Schizophrénie débutante, enjeux et perspectives.

Despite a relatively extensive treatment armamentarium, the evolution of schizophrenic patients overall remains unfavourable. Early treatment is essential and influences the prognosis. Facilitating access to care through the creation of specialised assessment centres to complement the current system of care is one of the possible avenues for improvement.

The Social Cognition and Interaction Training (SCIT): an extension to individuals with schizotypal personality features.

The current study aimed to extend the clinical utility of the Social Cognition and Interaction Training (SCIT) to individuals with schizotypal personality features. It provided preliminary findings on the suitability and efficacy of the SCIT for these individuals in mainland China.

The role of leisure in the lives of psychotic patients: a qualitative study.

Quality of life is defined by indicators that measure the life patterns of a person or community in relation to an ideal model. Leisure is an important component of quality of life and a tool for rehabilitation for patients with chronic psychosis. This qualitative study evaluated the role of leisure in the life of patients living with psychosis. Interviews with patients and relatives indicate that sociability is an important value for both groups. Deeper analysis, however, indicates that sociability is a culturally learned concept for patients and does not relate to their real needs. Improvement of symptoms and respect of individuality are more central to their well-being.

Family expressed emotion prior to onset of psychosis.

UNLABELLED: This study compared components of expressed emotion (EE; rejection, warmth, protectiveness, and fusion) across three samples: two in which the subjects had an established schizophrenic or mood disorder, and a third in which the subjects were at high risk for an initial psychosis. METHODS: Family members rated themselves on the Social Adjustment Scale-III and, in the prodromal sample, estimated the duration of the prodrome. RESULTS: Scores were all but identical in the two established-disorder samples but were markedly higher than scores in the prodromal sample on all four factors. In mothers, warmth (decreasing), rejection, protectiveness, and fusion (increasing) were significantly correlated with duration of prodrome, whereas for fathers, warmth and protectiveness were similarly correlated. CONCLUSION: These data suggest that expressed emotion is largely reactive to deterioration manifested by the young person developing a psychotic disorder, rather than a trait of family members.

Anomalous subjective experience among first-admitted schizophrenia spectrum patients: empirical investigation.

Our research group has for several years conducted philosophically informed, phenomenological-empirical studies of morbid alterations of conscious experience (subjectivity) in schizophrenia (Sz) and its spectrum of disorders. Some of these experiential alterations constitute, in our view, the vulnerability markers to Sz--indicators that are intrinsic to this disorder and which were historically considered as constituting the phenotypic anchor of the very concept and the diagnostic validity of Sz spectrum disorders. In a more pragmatic clinical context, these indicators, considered here as symptoms, may be potentially effective for early differential diagnosis. In this study, 151 consecutive first-admitted patients (with bipolar, melancholic and organic patients excluded) diagnosed according to the ICD-10, were evaluated on a number of expressive and experiential psychopathological dimensions, with special emphasis on the experiences of perplexity, disorders of self-awareness, perceptual disorders and anomalous bodily experiences. The a priori scales derived from the item pool of a slightly modified OPCRIT and BSABS were used for analyses. Sz and schizotypal disorder scored equally on the subjective dimensions, suggesting a basic phenomenological affinity of these disorders. In contrast, anomalies of subjective experience were clearly more pronounced among the patients within, as compared to those outside the Sz spectrum.

Schizotypal dimensions: continuity between schizophrenia and bipolar disorders.

BACKGROUND: Family studies have suggested that schizophrenia and bipolar disorders share some susceptibility factors. Schizotypal personality disorder (SPD) may be an intermediate phenotype common both to schizophrenia and bipolar disorders. We explored the familiality of schizotypal dimensions by comparing the magnitude of schizotypal dimensions between schizophrenic and bipolar relatives. We also looked for intra-familial resemblance for these dimensions, and for an increased familial risk of schizophrenia and/or bipolar disorders associated with a particular schizotypal dimension. METHODS: We used the Schizotypal Personality Questionnaire (SPQ) to study the three schizotypal dimensions (disorganization, negative and positive) in a sample of unaffected first-degree relatives of schizophrenic (N=85), psychotic bipolar (N=63) and bipolar (N=32) probands. Differences between groups were tested using a two-tailed t-test or ANOVA for continuous variables and a chi-squared test for discrete variables. We used the intraclass correlation method to study the intra-familial correlation. Linear mixed models were used to measure the familial risk. RESULTS: The disorganization dimension appears to be common to relatives of both schizophrenia and psychotic bipolar disorders, but not in the relatives of non-psychotic bipolar probands. This dimension also increases the familial risk of these two disorders. The negative dimension shows intra-familial resemblance (R=0.29), we failed to observe the expected familiality for the disorganized dimension. CONCLUSIONS: The shared nature of the disorganization dimension shown by a similar familial risk for schizophrenia and psychotic bipolar disorders suggests that same genetic background may underlie psychotic disorders. Although, negative dimension is familial, it is not associated for an increased familial risk for both disorders.

[Psychotic disorders and drug abuse in adolescents]. / Psychotische Störungen und Drogenmissbrauch bei Jugendlichen.

OBJECTIVES: The relation between substance abuse and symptoms of psychosis as well as related disorders was evaluated among patients at the Hospital for Child and Adolescent Psychiatry and Psychotherapy of the University of Marburg. METHODS: Using a child and adolescent version of the IRAOS (Instrument of the Retrospective Assessment of the Onset of Schizophrenia, Häfner et al., 1990), all patients with a co-morbid substance abuse were assessed. Patients with a drug-induced psychosis (n = 8) were compared to psychotic patients with co-morbid substance abuse and to patients with other psychiatric disorders and substance abuse (n = 30). RESULTS: These three groups could be significantly distinguished on the basis of pre-morbid symptoms and pre-morbid functioning. CONCLUSIONS: The IRAOS shows some evidence that psychotic patients with co-morbid substance abuse can be distinguished from patients with a drug-induced psychosis according to the course of the initial psychopathology and pre-morbid functioning.

Prodromes of first-episode psychosis: how can we challenge nonspecificity?

Prevention of functional psychosis is a major concern of modern psychiatry. The aim is to avoid biological and psychosocial deterioration at the earliest possible stage of the illness. The term "prodrome" has become crucial for identification of the very early stage. Recent years have yielded intensive research effort in defining prodromal signs and symptoms; however, the conclusion of most researchers is that they are nonspecific. We present the descriptive and phenomenological findings of the prodrome concept. Although prodromes are nonspecific, their discrepancy with persisting social impairment over time is a frequently encountered and highly alarming feature in young at-risk individuals. The inclusion of phenomenological findings may suggest the presence of psychosis-like inner experiences already as early as the prodromal phase, and thus bears in itself the question of the starting point for psychopharmacological and psychosocial treatment. Finally, a decision pathway for clinicians is proposed in their difficult task of identifying young individuals at risk.

Vocational interests and career indecision among psychosis-prone college students.

This study investigated the relationship between scores on scales that purport to measure psychosis-proneness and scores on vocational interests, identity, and differentiation scales in a sample of 233 college students who completed the Perceptual Aberration and Magical Ideation scales, the Strong Campbell Interest Inventory, and the Career Decision Scale. The present findings are consistent with prior work indicating a sex-related association of scores on measures of psychosis-proneness and vocational interests. A positive correlation between scores on vocational indecision and measures of psychosis-proneness was also found, suggesting that both men and women who score high on psychosis-proneness find it difficult to formulate long-term career goals. Finally, there was no significant correlation between scores on measures of psychosis-proneness and Holland's Vocational Differentiation Index. Present results are discussed in light of previously reported sex differences among psychosis-prone adults and diagnosed schizophrenics. The implications of the findings for vocational counselors are also addressed.

Recognition of warning signs: a consideration for cost-effective treatment of severe mental illness.

Warning signs of decompensation, also known as prodromal symptoms, and problems related to poor recognition of warning signs were examined in a sample of 370 adult outpatients with severe mental illness. Clinicians' ratings, client interviews, and eight months of client service records revealed that poor recognition of warning signs was a prevalent problem in this population and was related to poorer treatment outcomes and greater use of the most expensive types of services. Poor recognition was more likely to improve when it was specifically treated than when not treated. Improvement in recognition was related to better outcomes and lower costs. Results suggest the need for patients' recognition of warning signs to receive standardized assessment, treatment, and monitoring.

Premorbid adjustment as predictor of outcome in schizophrenia: results of a prospective study.

The present prospective follow-up study of 163 schizophrenic patients admitted to hospital for the first time examined the relationship between premorbid adjustment and different measures of the 3-year course and outcome. The same instruments had been used in all phases of the study. The Premorbid Adjustment Scale was used to assess premorbid social functioning. Outcome measures were positive symptoms, negative symptoms, social disability and number of rehospitalizations. The results of the multiple regression analyses showed that premorbid adjustment was the strongest overall predictor of outcome. Premorbid adjustment was significantly associated with negative symptoms and social disability over the 3-year course of illness. In a further step, we examined the relationship between good, moderate and poor premorbid adjustment and the course of positive symptoms, negative symptoms and social disability within the first 3 years after index admission. The most important finding was that premorbid functioning showed a stronger correlation with the course of negative symptoms and social disability than with the course of positive symptoms. Poor premorbid social functioning implies a poor social course of the illness. Female subjects showed better premorbid functioning than male subjects. Good premorbid adjustment was strongly associated with an acute onset of the illness, and poor premorbid adjustment with an insidious onset.

Prodromal symptoms of relapse in schizophrenia: a review.

It is often stated that there are identifiable prodromal symptoms of psychosis in patients suffering from schizophrenia. In this article, we review the evidence for the existence of such prodromal symptoms. Computerized and direct searches of the psychiatric literature were conducted to identify relevant reports. The methods and findings of the studies were then examined for their relevance to several issues concerning prodromal symptoms. We found that very few studies have directly assessed the relationship between putative prodromal symptoms and the exacerbation of psychosis. The research that has been reported suggests that prodromal symptoms have only modest power as predictors of relapse. It appears that while some individual schizophrenia patients may show reasonably consistent patterns of prodromal symptoms, such symptoms are probably of limited general value in predicting psychosis. Two particular issues that warrant further investigation are individual differences in patterns of prodromal symptoms and the extent to which such symptoms actually precede changes in level of psychosis.

Buspirone use in an adolescent with social phobia and mixed personality disorder (cluster A type).

The use of buspirone for the treatment of social phobia has been reported in some adult patients; however, to the authors' knowledge, there are no reports of its use in adolescents with this disorder. Use of buspirone in children and adolescents with anxiety disorders is reviewed. An unusual case study is presented of a 16-year-old male patient with social phobia and a mixed personality disorder predominantly with schizotypal features, who responded well to an open trial of buspirone for anxiety and "soft" psychotic symptoms.