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

Eduardo Fonseca-Pedrero,Felix Inchausti,Juan Francisco Rodríguez-Testal,Martin Debbané,Javier Ortuño-Sierra

doi:10.3389/fpsyt.2019.00967

Abstract

ObjectivesThe 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.MethodThe 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.ResultsThe 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.ConclusionsThe 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.

Highlights

The leitmotiv of psychosis high-risk paradigms [i.e., psychometric, genetic and Clinical High Risk (CHR)] is based on the ability to identify those individuals potentially at risk of developing psychosis in order to conduct prevention and prophylactic interventions [1, 2]
Stratified random cluster sampling was conducted at the classroom level, in an approximate population of 15,000 students selected from a region located in northern Spain
Predictability ranged from 8.7% (‘physical anhedonia’) to 52.7% (‘unusual perceptual experiences’)

Summary

Introduction

The leitmotiv of psychosis high-risk paradigms [i.e., psychometric, genetic and Clinical High Risk (CHR)] is based on the ability to identify those individuals potentially at risk of developing psychosis in order to conduct prevention and prophylactic interventions [1, 2]. Psychosis high risk approaches attempt to capturing early clinical (micro) phenotypes at early stages before care is needed and disability ensues. With these objectives in mind, proliferation of programs and centers specialized in early intervention in psychosis have emerged in the last twenty years [3,4,5]. The construct that harbors the latent liability for schizophrenia and related manifestations is called schizotypy [8]. Schizotypy can manifest itself, in a range variety of expressions, such us schizotypal traits, psychotic-like experiences, subclinical psychotic symptoms (i.e., CHR), frank psychotic symptoms, schizotypal personality disorder, or psychosis-spectrum disorders [2, 9]. Schizotypy is a multidimensional construct, composed basically of three factors (Cognitive-Perceptual, Negative, and Disorganization), which is consistent with the factor structure found in patients with psychosis and CHR samples [14,15,16]

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