Blunted Affect Research Articles

Analyse de la structure factorielle de la version brève du questionnaire de personnalité schizotypique (SPQ-B) – format Likert – en population générale en France

IntroductionThe main objective of the study was to explore the factorial structure of the French version of the Schizotypal Personality Questionnaire-Brief (SPQ-B) in a Likert format, in a representative sample of the general population. In addition, differences in the dimensional scores of schizotypy according to gender and age were analyzed. As the study in the general population of schizotypal traits and its determinants has been recently proposed as a way toward the understanding of aetiology and pathophysiology of schizophrenia, consistent self-report tools are crucial to measure psychometric schizotypy. A shorter version of the widely used Schizotypal Personality Questionnaire (SPQ-Brief) has been extensively investigated in different countries, particularly in samples of students or clinical adolescents, and more recently, a few studies used a Likert-type scale format which allows partial endorsement of items and reduces the risk of defensive answers. MethodA sample of 233 subjects representative of the adult population from an urban area near Paris (Créteil) was recruited using the “itinerary method”. They completed the French version of the SPQ-B with a 5-point Likert-type response format (1=completely disagree; 5=completely agree). We examined the dimensional structure of the French version of the SPQ-B with a Principal Components Analysis (PCA) followed by a promax rotation. Factor selection was based on Eigenvalues over 1.0 (Kaiser's criterion), Cattell's Scree-plot test, and interpretability of the factors. Items with loadings greater than 0.4 were retained for each dimension. The internal consistency estimate of the dimensions was calculated with Cronbach's α. In order to study the influence of age and gender, we carried out a simple linear regression with the subscales as dependent variables. ResultsOur sample was composed of 131 women (mean age=52.5±18.2 years) and 102 men (mean age=53±18.1 years). SPQ-B Likert total scores ranged from 22 to 84 points (mean=43.6±13). Factor analysis resulted in a 3-factor solution that explained 47.7% of the variance. Factor 1 (disorganized; 10 items) included items related to “odd behavior”, “odd speech”, as well as “social anxiety”, one item of “constricted affect” and one item of “ideas of reference”. Factor 2 (interpersonal; 7 items) included items related to “no close friends”, “constricted affect”, and three of the items of “suspiciousness”. Factor 3 (cognitive-perceptual; 5 items) included items related to “ideas of reference”, “magical thinking”, “unusual perceptual experiences” and one item of “suspiciousness”. Coefficient α for the three subscales and total scale were respectively 0.81, 0.81, 0.77 and 0.88. We found no differences in total schizotypy and the three dimensions scores according to age and sex. ConclusionFactor analysis of the French version of the SPQ-B in a Likert format confirmed the three-factor structure of schizotypy. We found a pure cognitive perceptual dimension including the most representative positive features. As expected, “Suspiciousness” subscale is included in both positive and negative dimensions, but mainly in the negative dimension. Surprisingly, “social anxiety” subscale is included in the disorganized dimension in our analysis. The SPQ-B in a Likert format demonstrated good internal reliability for both total and subscales scores. Unlike previous published results, we did not find any influence of age or gender on schizotypal dimensions.

Towards an exposure-dependent model of post-traumatic stress: longitudinal course of post-traumatic stress symptomatology and functional impairment after the 2011 Oslo bombing.

Our understanding of the dynamics of post-traumatic stress symptomatology and its link to functional impairment over time is limited. Post-traumatic stress symptomatology (Post-traumatic Checklist, PCL) was assessed three times in 1-year increments (T1, T2, T3) following the Oslo bombing of 22 July, 2011, in directly (n = 257) and indirectly exposed (n = 2223) government employees, together with demographics, measures of exposure and work and social adjustment. The dynamics of post-traumatic stress disorder symptom cluster interplay were examined within a structural equation modelling framework using a cross-lagged autoregressive panel model. Intrusions at T1 played a prominent role in predicting all symptom clusters at T2 for the directly exposed group, exhibiting especially strong cross-lagged relationships with avoidance and anxious arousal. For the indirectly exposed group, dysphoric arousal at T1 played the most prominent role in predicting all symptom clusters at T2, exhibiting a strong relationship with emotional numbing. Emotional numbing seemed to be the main driver behind prolonged stress at T3 for both groups. Functional impairment was predominately associated with dysphoric arousal and emotional numbing in both groups. For directly exposed individuals, memories of the traumatic incident and the following intrusions seem to drive their post-traumatic stress symptomatology. However, as these memories lose their potency over time, a sequela of dysphoric arousal and emotional numbing similar to the one reported by the indirectly exposed individuals seems to be the main driver for prolonged post-traumatic stress and functional impairment. Findings are discussed using contemporary models within an exposure-dependent perspective of post-traumatic stress.

Latent typologies of posttraumatic stress disorder in World Trade Center responders

Posttraumatic stress disorder (PTSD) is a debilitating and often chronic psychiatric disorder. Following the 9/11/2001 World Trade Center (WTC) attacks, thousands of individuals were involved in rescue, recovery and clean-up efforts. While a growing body of literature has documented the prevalence and correlates of PTSD in WTC responders, no study has evaluated predominant typologies of PTSD in this population. Participants were 4352 WTC responders with probable WTC-related DSM-IV PTSD. Latent class analyses were conducted to identify predominant typologies of PTSD symptoms and associated correlates. A 3-class solution provided the optimal representation of latent PTSD symptom typologies. The first class, labeled “High-Symptom (n = 1,973, 45.3%),” was characterized by high probabilities of all PTSD symptoms. The second class, “Dysphoric (n = 1,371, 31.5%),” exhibited relatively high probabilities of emotional numbing and dysphoric arousal (e.g., sleep disturbance). The third class, “Threat (n = 1,008, 23.2%),” was characterized by high probabilities of re-experiencing, avoidance and anxious arousal (e.g., hypervigilance). Compared to the Threat class, the Dysphoric class reported a greater number of life stressors after 9/11/2001 (OR = 1.06). The High-Symptom class was more likely than the Threat class to have a positive psychiatric history before 9/11/2001 (OR = 1.7) and reported a greater number of life stressors after 9/11/2001 (OR = 1.1). The High-Symptom class was more likely than the Dysphoric class, which was more likely than the Threat class, to screen positive for depression (83% > 74% > 53%, respectively), and to report greater functional impairment (High-Symptom > Dysphoric [Cohen d = 0.19], Dysphoric > Threat [Cohen d = 0.24]). These results may help inform assessment, risk stratification, and treatment approaches for PTSD in WTC and disaster responders.

Intolerance of uncertainty and post-traumatic stress symptoms: An investigation within a treatment seeking trauma-exposed sample

BackgroundIntolerance of uncertainty (IU) has been associated with post-traumatic stress symptoms (PTSS) in the literature. However, no research to date has investigated the relationship between IU and PTSS within a clinical trauma-exposed sample, which is an important next step in the literature and crucial for the generalizability of these findings. Therefore, the current study hypothesized that IU would be related to increased PTSS within a clinical sample of trauma-exposed individuals. Further, we hypothesized that IU would be related to elevated PTSS after accounting for anxiety sensitivity (AS) and negative affect (NA), two known correlates of PTSS. Finally, we examined the relations between IU and the PTSS clusters (i.e., avoidance, emotional numbing, hyperarousal, and re-experiencing) while covarying for AS and NA. MethodsParticipants included community adults (n=126) presenting at an outpatient clinic. All participants had previously experienced a traumatic event as defined by the DSM-5 PTSD Criterion A. MethodsResults revealed that IU was significantly associated with increased PTSS above and beyond AS and NA. Further, results indicated that IU was significantly related to the avoidance, hyperarousal, and emotional numbing PTSS clusters, even after covarying for AS and NA. IU was not significantly associated with the PTSS re-experiencing cluster once AS and NA were taken into account. ConclusionsOur results expand upon the extant literature by demonstrating that IU is associated with PTSS above and beyond AS and NA within a clinical trauma-exposed sample. These findings are discussed in terms of promising directions for future research and treatment strategies.

Determining the effectiveness of the third person interview in the level of insight psychotic patients.

The goal of this study was to determine the effectiveness of the third person interview in increasing the level of insight and cooperation in psychotic patients. We used a quasi-experimental posttest design with an alternative method group. A number of 40 individuals with a definite diagnosis of psychosis were selected using a simple random sampling, and were put randomly in an experimental group (third person interview) and an alternative control group (clinical interview). The results indicated that using the third person interview, the insight level of the psychotic patients increased in all dimensions of insight, except awareness of flat or blunted affect and awareness of unsociability. The results of the independent t-test samples showed no significant difference in cooperation between the two groups of psychotic patients. It seems that the ability to consider one's mental viewpoint from other's, is dependent on the relative ability of psychotic patients to represent other's mental states (theory of mind). But, psychotic patients have severe impairment in the ability to represent their own mental states, resulting in an impairment in the recognition of their mental disorder, psychotic symptoms, the need for therapy, and social consequences of their mental disorder.

Abnormal auditory pattern perception in schizophrenia

Mismatch negativity (MMN) in response to deviation from physical sound parameters (e.g., pitch, duration) is reduced in individuals with long-term schizophrenia (Sz), suggesting deficits in deviance detection. However, MMN can appear at several time intervals as part of deviance detection. Understanding which part of the processing stream is abnormal in Sz is crucial for understanding MMN pathophysiology. We measured MMN to complex pattern deviants, which have been shown to produce multiple MMNs in healthy controls (HC). Both simple and complex MMNs were recorded from 27 Sz and 27 matched HC. For simple MMN, pitch- and duration-deviants were presented among frequent standard tones. For complex MMN, patterns of five single tones were repeatedly presented, with the occasional deviant group of tones containing an extra sixth tone. Sz showed smaller pitch MMN (p=0.009, ~110ms) and duration MMN (p=0.030, ~170ms) than healthy controls. For complex MMN, there were two deviance-related negativities. The first (~150ms) was not significantly different between HC and SZ. The second was significantly reduced in Sz (p=0.011, ~400ms). The topography of the late complex MMN was consistent with generators in anterior temporal cortex. Worse late MMN in Sz was associated with increased emotional withdrawal, poor attention, lack of spontaneity/conversation, and increased preoccupation. Late MMN blunting in schizophrenia suggests a deficit in later stages of deviance processing. Correlations with negative symptoms measures are preliminary, but suggest that abnormal complex auditory perceptual processes may compound higher-order cognitive and social deficits in the disorder.

Interparental conflict and adolescents' self-representations: The role of emotional insecurity

Adolescents' signs of emotional insecurity in the context of interparental conflict (IC) – emotional reactivity, internal representations (i.e., constructive/destructive; spillover) and behavioral responses (i.e., withdrawal; inhibition; involvement) – were examined as mediators in the relation between IC and adolescents' self-representations. Self-reported measures were filled out by 221 Portuguese adolescents (59.3% girls; Mage = 12.91), attending public elementary and secondary schools. IC predicted less favorable self-representations. Adolescents' emotional reactivity and withdrawal mediated the relation between IC and emotional and physical appearance self-representations, while conflict spillover representations and constructive family representations mediated associations between IC and instrumental self-representations. This study emphasizes the importance of interparental conflict and adolescent emotional insecurity in the construction of their self-representations, having important theoretical and practical implications. It highlights the value of analyzing the specific role of several emotional insecurity dimensions, and informs practitioners' work aimed at promoting constructive conflict and adaptive emotional regulation skills.

Factor structure and external correlates of posttraumatic stress disorder symptoms among African American firefighters.

This study compared the relative goodness of fit of three well-established factorial models of posttraumatic stress disorder (PTSD) symptoms among 477 African American male firefighters in a large city in the US. The compared models were the two four-factor emotional numbing and dysphoria models and a five-factor dysphoric arousal model. The study also examined the convergent and discriminant validity of PTSD symptom clusters in relation to depression and alcohol dependence symptoms. Both the emotional numbing and dysphoric arousal PTSD models provided a superior fit to the data compared to the dysphoria model. Findings also indicated a good fit for factor models that included PTSD, depression, and alcohol dependence latent factors, which provides support for the specificity of PTSD symptom clusters. Depression symptoms were more strongly correlated with PTSD symptom clusters than alcohol dependence. In the dysphoric arousal model, depression and alcohol dependence were equally related to the emotional numbing and dysphoric arousal clusters; however, both depression and alcohol dependence were more highly correlated with dysphoric arousal than with anxious arousal. Even though the emotional numbing and dysphoric arousal models demonstrated a superior fit to the data, the four-factor dysphoria model may provide a more parsimonious representation of PTSD’s latent structure than the five-factor dysphoric arousal model. In conclusion, this study extends support for the well-established PTSD symptom factor models among African Americans, a population with whom these models had not been examined earlier.

Reduced prefrontal MEG alpha-band power in mild traumatic brain injury with associated posttraumatic stress disorder symptoms.

To determine if changes in cortical alpha-band power in patients with mild traumatic brain injury (mTBI) are associated with the severity of their post-traumatic stress disorder (PTSD) symptoms, and if injury severity and level of exposure to psychologically traumatic events are predictors of these electrophysiological changes. Resting-state magnetoencephalographic recordings were analyzed in 32 patients with mTBI. Alpha-band power was estimated for each patient in 68 cortical regions and was compared between groups of patients with low versus high PTSD symptoms severity. Participants with high PTSD symptom severity showed reduced alpha-band power bilaterally in the superior and middle frontal gyri and frontal poles, and in the left inferior frontal gyrus. Alpha-band power in bilateral middle frontal gyri and frontal poles was negatively correlated with scores reflecting symptoms of emotional numbing. Loss of consciousness (LOC) associated with mTBI and level of exposure to psychologically traumatic events were predictors of decreased prefrontal alpha-band power in some of these regions. Altered prefrontal alpha-band activity, shown to be partly explained by mTBI-related LOC, is associated with PTSD symptoms severity. Our findings will guide future studies addressing the electrophysiological mechanisms underlying a higher incidence of PTSD in patients with mTBI.

SU‐F‐SPS‐07: Magnetic Resonance Spectroscopy Findings in Early‐Phase Psychosis

Purpose:Schizophrenia is a psychiatric disorder characterized by disordered thoughts, abnormal social behaviors, flat affect, and auditory or visual hallucinations. The current study aims to investigate alterations in brain metabolism in patients near the onset of psychosis (early‐phase psychosis, EPP), to characterize abnormalities during the early stages of schizophrenia. To this end, we used magnetic resonance imaging (MRI) and spectroscopy (MRS) to measure metabolite levels and subsequently monitor the effect of treatment with N‐acetylcysteine (NAC).Methods:Here we report on the cross‐sectional comparison at the baseline scan between 13 healthy controls (mean age = 21.5 yrs) and 28 EPP patients (mean age = 23.9 yrs), within three years of psychotic illness onset. Metabolite levels of glutamine + glutamate (Glx), N‐acetylaspartate (NAA), creatine (Cre), and myo‐inositol (mI) were measured on a Siemens 3T whole‐body scanner with MRS voxels placed in the frontal lobe (size = 2×2×2 cm3; TE = 30ms; TA = 4min). Metabolite levels were quantified using LCModel V6.2‐0R, scaled to the internal water signal, and reported in institutional units (i.u.). Comparison of NAA, Cre and Glx levels between the two groups was performed using two‐tailed unpaired t‐tests.Results:A significant decrease of Glx concentration in FEP patients was found (patients: 4.1±1.4 i.u.; controls: 5.2 ± 0.2 i.u.; p=0.04). No significant differences were found at baseline in Cre nor NAA concentrations.Conclusion:Significant decreases in Glx were observed in the frontal lobe of the FEP patients. This decrease supports prior research on schizophrenia in similar cortical regions. The alteration in frontal Glx levels may be involved in the behavioral and cognitive abnormalities. Future steps include investigating the effect of NAC vs. placebo treatment on reversing this decrease in Glx in EPP patients over a 12‐month period.This project is supported by the Stanley Medical Research Institute.

Validity of symptom reports of asylum seekers in a psychiatric hospital: A descriptive study

Our study involved three samples (N=85; N=38, and N=27) of asylum seekers in a Dutch psychiatric hospital. We looked at how often they reported severe dissociative episodes (i.e., not recognizing oneself in a mirror; seeing traumatic images in a mirror) and whether these symptoms were related to deviant performance on Symptom Validity Tests (SVTs), notably items from the Structured Inventory of Malingered Symptomatology (SIMS; Widows & Smith, 2005) and a forced-choice task modeled after the Morel Emotional Numbing Test (MENT; Morel, 1998). We also examined whether poor language proficiency and the presence of incentives to exaggerate symptoms might affect scores on SVTs. Dissociative target symptoms were reported by considerable percentages of patients (27–63%). Patients who reported these symptoms had significantly more often deviant scores on SVT items compared with those who did not report such symptoms. With a few exceptions, deviant scores on SVT items were associated with incentives rather than poor language skills. We conclude that the validity of self-reported symptoms in this target group should not be taken for granted and that SVTs may yield important information.

A Two-Factor Model Better Explains Heterogeneity in Negative Symptoms: Evidence from the Positive and Negative Syndrome Scale.

Acknowledging separable factors underlying negative symptoms may lead to better understanding and treatment of negative symptoms in individuals with schizophrenia. The current study aimed to test whether the negative symptoms factor (NSF) of the Positive and Negative Syndrome Scale (PANSS) would be better represented by expressive and experiential deficit factors, rather than by a single factor model, using confirmatory factor analysis (CFA). Two hundred and twenty individuals with schizophrenia spectrum disorders completed the PANSS; subsamples additionally completed the Brief Negative Symptom Scale (BNSS) and the Motivation and Pleasure Scale—Self-Report (MAP-SR). CFA results indicated that the two-factor model fit the data better than the one-factor model; however, latent variables were closely correlated. The two-factor model’s fit was significantly improved by accounting for correlated residuals between N2 (emotional withdrawal) and N6 (lack of spontaneity and flow of conversation), and between N4 (passive social withdrawal) and G16 (active social avoidance), possibly reflecting common method variance. The two NSF factors exhibited differential patterns of correlation with subdomains of the BNSS and MAP-SR. These results suggest that the PANSS NSF would be better represented by a two-factor model than by a single-factor one, and support the two-factor model’s adequate criterion-related validity. Common method variance among several items may be a potential source of measurement error under a two-factor model of the PANSS NSF.

PTSD and Romantic Relationship Satisfaction: Cluster- and Symptom-Level Analyses.

Previous studies have demonstrated bidirectional associations between posttraumatric stress disorder (PTSD) and romantic relationship dissatisfaction. Most of these studies were focused at the level of the disorder, examining the association between relationship dissatisfaction and having a diagnosis of PTSD or the total of PTSD symptoms endorsed. This disorder-level approach is problematic for trauma theorists who posit symptom-level mechanisms for these effects. In the present study, we examined the prospective, bidirectional associations between PTSD symptom clusters (e.g., reexperiencing) and relationship satisfaction using the data from 101 previously studied individuals who had had a recent motor vehicle accident. We also conducted exploratory analyses examining the prospective, bidirectional associations between individual PTSD symptoms and relationship satisfaction. Participants had completed the PTSD Checklist-Civilian Version and the Relationship Assessment Scale at 4, 10, and 16 weeks after the MVA. We performed time-lagged mixed-effects regressions to examine the effect of lagged relationship satisfaction on PTSD clusters and symptoms, and vice versa. No cluster effects were significant after controlling for a false discovery rate. Relationship satisfaction predicted prospective decreases in reliving the trauma (d = 0.42), emotional numbness (d = 0.46), and irritability (d = 0.49). These findings were consistent with the position that relationship satisfaction affects PTSD through symptom-level mechanisms.

Longitudinal Associations Between PTSD Symptoms and Dyadic Conflict Communication Following a Severe Motor Vehicle Accident

There are well-documented associations between posttraumatic stress disorder (PTSD) symptoms and intimate relationship impairments, including dysfunctional communication at times of relationship conflict. To date, the extant research on the associations between PTSD symptom severity and conflict communication has been cross-sectional and focused on military and veteran couples. No published work has evaluated the extent to which PTSD symptom severity and communication at times of relationship conflict influence each other over time or in civilian samples. The current study examined the prospective bidirectional associations between PTSD symptom severity and dyadic conflict communication in a sample of 114 severe motor vehicle accident (MVA) survivors in a committed intimate relationship at the time of the accident. PTSD symptom severity and dyadic conflict communication were assessed at 4 and 16weeks post-MVA, and prospective associations were examined using path analysis. Total PTSD symptom severity at 4weeks prospectively predicted greater dysfunctional communication at 16weeks post-MVA but not vice versa. Examination at the level of PTSD symptom clusters revealed that effortful avoidance at 4weeks prospectively predicted greater dysfunctional communication at 16weeks, whereas dysfunctional communication 4weeks after the MVA predicted more severe emotional numbing at 16weeks. Findings highlight the role of PTSD symptoms in contributing to dysfunctional communication and the importance of considering PTSD symptom clusters separately when investigating the dynamic interplay between PTSD symptoms and relationship functioning over time, particularly during the early posttrauma period. Clinical implications for the prevention of chronic PTSD and associated relationship problems are discussed.

‘It’s silly these doors don’t open’: a six-year-old girl emerges from a chronic state of emotional withdrawal

This clinical paper explores the way in which the first two years of a long-term psychotherapy helped six-year-old Anna to lessen her retreat into a chronic withdrawn emotional state. Over the course of the first year she would occasionally pick up the fridge from the doll’s house and try to open the doors, but because the fridge was actually a block of wood the doors could not open. In treatment, this inquiry came to represent the difficulties of engaging and making contact with a baby who found it very hard to feed. The author describes how, as Anna entered into a therapeutic relationship, it slowly became clear that there was an inner world jam-packed with persecutory anxieties and a family history of unmourned loss and trauma. Through fear Anna slammed the doors to her mind – to knowing herself – and by not feeding, Anna starved herself of opportunities for mental growth. It took some time for her to state, “it’s silly these doors don’t open, they should”. In the discussion of this clinical material the author draws on the work of Francis Tustin, Alessandra Piontelli and Marguerite Reid to consider the link between intergenerational and prenatal trauma and subsequent emotional disturbance in the child.

Editorial: Schizophrenia: Human and Animal Studies.

Schizophrenia is a complex disorder with relatively stable prevalence rates estimated at about 0.5–1% (Saha et al., 2005). Schizophrenia is characterized by the occurrence of various psychopathological symptoms that have been described as positive symptoms (delusions and hallucinations), negative symptoms (apathy, lack of motivation, flat affect, poverty of speech, and social withdrawal), disorganized symptoms (disorganized speech and behavior), and cognitive impairment (Moustafa et al., 2016). Traditionally, cognitive impairment was thought to be evident only in elderly deteriorated patients with schizophrenia; however, over the past 25 years, a body of evidence challenged this view and showed that cognitive dysfunction is a core feature of schizophrenia (O'Carroll, 2000; Weickert et al., 2000; Bora et al., 2010). Cognitive deficits can be moderate to severe across several domains, including attention, working memory, verbal learning and memory, and executive functions (Weickert et al., 2000; Bowie and Harvey, 2006). These deficits pre-date the onset of psychosis and further decline in cognitive functioning is observed in the course of illness in most patients (Trotta et al., 2015). Numerous rehabilitation programs have been developed in order to alleviate the burden associated with cognitive impairment in schizophrenia since cognitive deficits respond poorly to antipsychotic treatment (Tao et al., 2015). Below we describe articles in this research topic (mostly focusing on cognitive studies in schizophrenia), dividing them into human vs. animal studies.

Differences in Clinical Features of Methamphetamine Users with Persistent Psychosis and Patients with Schizophrenia

Background: Methamphetamine exerts neurotoxic effects and elicits psychotic symptoms. This study attempted to compare clinical differences between methamphetamine users with persistent psychosis (MAP) and patients with schizophrenia. In addition, we examined the discrimination validity by using symptom clusters to differentiate between MAP and schizophrenia. Methods: We enrolled 53 MAP patients and 53 patients with schizophrenia. The psychopathology of participants was assessed using the Chinese version of the Diagnostic Interview for Genetic Studies and the 18-item Brief Psychiatric Rating Scale. Logistic regression was used to examine the predicted probability scores of different symptom combinations on discriminating between MAP and schizophrenia. The receiver operating characteristic (ROC) analyses and area under the curve (AUC) were further applied to examine the discrimination validity of the predicted probability scores on differentiating between MAP and schizophrenia. Results: We found that MAP and schizophrenia demonstrated similar patterns of delusions. Compared to patients with schizophrenia, MAP experienced significantly higher proportions of visual hallucinations and of somatic or tactile hallucinations. However, MAP exhibited significantly lower severity in conceptual disorganization, mannerism/posturing, blunted affect, emotional withdrawal, and motor retardation compared to patients with schizophrenia. The ROC analysis showed that a predicted probability score combining the aforementioned 7 items of symptoms could significantly differentiate between MAP and schizophrenia (AUC = 0.77). Conclusion: Findings in the current study suggest that nuanced differences might exist in the clinical presentation of secondary psychosis (MAP) and primary psychosis (schizophrenia). Combining the symptoms as a whole may help with differential diagnosis for MAP and schizophrenia.

Numbing of Positive, Negative, and General Emotions: Associations With Trauma Exposure, Posttraumatic Stress, and Depressive Symptoms Among Justice-Involved Youth.

Increasing attention has been drawn to the symptom of emotional numbing in the phenomenology of posttraumatic stress disorder (PTSD), particularly regarding its implications for maladaptive outcomes in adolescence such as delinquent behavior. One change in the definition of emotional numbing according to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013) was the limitation to the numbing of positive emotions. Previous research with youth, however, has implicated general numbing or numbing of negative emotions in PTSD, whereas numbing of positive emotions may overlap with other disorders, particularly depression. Consequently, the goal of this study was to investigate whether numbing of positive emotions was associated with PTSD symptoms above and beyond numbing of negative emotions, general emotional numbing, or depressive symptoms among at-risk adolescents. In a sample of 221 detained youth (mean age = 15.98 years, SD = 1.25; 50.7% ethnic minority), results of hierarchical multiple regressions indicated that only general emotional numbing and numbing of anger accounted for significant variance in PTSD symptoms (total R(2) = .37). In contrast, numbing of sadness and positive emotions were statistical correlates of depressive symptoms (total R(2) = .24). Further tests using Hayes' Process macro showed that general numbing, 95% CI [.02, .45], and numbing of anger, 95% CI [.01, .42], demonstrated indirect effects on the association between trauma exposure and PTSD symptoms.

Development of a stage-dependent prognostic model to predict psychosis in ultra-high-risk patients seeking treatment for co-morbid psychiatric disorders.

Current ultra-high-risk (UHR) criteria appear insufficient to predict imminent onset of first-episode psychosis, as a meta-analysis showed that about 20% of patients have a psychotic outcome after 2 years. Therefore, we aimed to develop a stage-dependent predictive model in UHR individuals who were seeking help for co-morbid disorders. Baseline data on symptomatology, and environmental and psychological factors of 185 UHR patients (aged 14-35 years) participating in the Dutch Early Detection and Intervention Evaluation study were analysed with Cox proportional hazard analyses. At 18 months, the overall transition rate was 17.3%. The final predictor model included five variables: observed blunted affect [hazard ratio (HR) 3.39, 95% confidence interval (CI) 1.56-7.35, p < 0.001], subjective complaints of impaired motor function (HR 5.88, 95% CI 1.21-6.10, p = 0.02), beliefs about social marginalization (HR 2.76, 95% CI 1.14-6.72, p = 0.03), decline in social functioning (HR 1.10, 95% CI 1.01-1.17, p = 0.03), and distress associated with suspiciousness (HR 1.02, 95% CI 1.00-1.03, p = 0.01). The positive predictive value of the model was 80.0%. The resulting prognostic index stratified the general risk into three risk classes with significantly different survival curves. In the highest risk class, transition to psychosis emerged on average ⩾8 months earlier than in the lowest risk class. Predicting a first-episode psychosis in help-seeking UHR patients was improved using a stage-dependent prognostic model including negative psychotic symptoms (observed flattened affect, subjective impaired motor functioning), impaired social functioning and distress associated with suspiciousness. Treatment intensity may be stratified and personalized using the risk stratification.

Study on relationship between general psychopathology and relapse in opioids dependence under treatment on methadone maintenance therapy, Kerman, Iran, 2014

Introduction Performed studies indicate association between drug abuse and other mental disorders. Mental disorders could be effective in response to treatment and also, accession of recurrence process in addiction treatment course. Methods and materials This research is causal – comparative and of cross-sectional type was performed in 2014 on 200 drug abusers under methadone maintenance treatment (in two groups, with relapse in treatment process and without relapse) in drug rehabilitation centers of Kerman city. Questionnaire which includes demographic features and BPRS test was completed. Data were processed by suitable statistical methods via SPSS20 and SAS9.1 software. Findings Results obtained from the research showed that the acquired scores average from BPRS test is more in relapsing group ( P P =0.030), anxiety ( P P P =0.003), hostility ( P P =0.008), suspiciousness ( P =0.024), hallucination ( P =0.009), blunted affect ( P =0.030), tension ( P =0.012), uncooperativeness ( P =0.011), excitement ( P =0.038) and emotional withdrawal ( P =0.019) in two abuser groups had significant difference (more in relapsing group). No significant difference was observed between subscales of unusual thought content, disorientation, conceptual disorganization, mannerism and posturing and motor retardation in two groups ( P >0.05). In patients with more relapse in treatment process, score of BPRS is higher ( P Conclusion Findings of this study showed that intensity of psychiatric disorders in relapsing drug users is more than non-relapsing users and with growth of disorders intensity, the number of recurrence increases.