Thought Disorder Research Articles

Comparison of Formal Thought Disorder in the Acute Episode of Schizophrenia and Manic Episode of Bipolar Affective Disorder.

The aim of this study was to compare the formal thought disorder (FTD) in the acute episode of schizophrenia (SCHZ) and bipolar affective disorder (BPAD), and to determine the FTD dimensions associated with BPAD. The study included a total of 34 SCHZ patients not meeting the standardized remission criteria and 20 patients in BPAD manic episode. The patients completed the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression Scale (CGI), the Young Mania Rating Scale (YMRS), the Hamilton Depression Rating Scale (HAM-D) and the Thought and Language Disorder Scale (TALD) in order to assess FTD. The association of FTD with the diagnoses was analyzed by a logistic regression model including the TALD factors and the SCHZ and BPAD groups. Statistically significant differences were not determined between the demographic features, the CGI scores and the TALD objective positive factor scores of the SCHZ and BPAD groups. The objective negative and subjective negative factors (p<0.001 for all) were higher in SCHZ group and the subjective positive factor were significantly higher in BPAD group (p=0.028). In the logistic regression model, the TALD subjective positive factor was associated with BPAD diagnosis, and the objective negative factor was associated with SCHZ diagnosis. In the BPAD group, the TALD total score correlated positively with the manic episode severity, and the scores on the subjective negative and subjective positive factors correlated negatively with disease duration. The study results show that FTD is common to the acute episodes of both SCHZ and BPAD and that assessment of the subjective positive FTD symptoms and objective negative FTD symptoms may be useful to differentiate the acute episode of SCHZ from the BPAD manic episode.

Small Words That Matter: Linguistic Style and Conceptual Disorganization in Untreated First-Episode Schizophrenia.

This study aimed to shed light on the linguistic style affecting the communication discourse in first-episode schizophrenia (FES) by investigating the analytic thinking index in relation to clinical scores of conceptual and thought disorganization (Positive and Negative Syndrome Scale, PANSS-P2 and Thought and Language Index, TLI). Using robust Bayesian modeling, we report three major findings: (1) FES subjects showed reduced analytic thinking, exhibiting a less categorical linguistic style than healthy control (HC) subjects (Bayes factor, BF10 > 1000), despite using the same proportion of function and content words as HCs; (2) the lower the analytic thinking score, the higher the symptoms scores of conceptual disorganization (PANSS-P2, BF = 22.66) and global disorganization of thinking (TLI, BF10 = 112.73); (3) the linguistic style is a better predictor of conceptual disorganization than the cognitive measure of processing speed in schizophrenia (SZ). These findings provide an objectively detectable linguistic style with a focus on Natural Language Processing Analytics of transcribed speech samples of patients with SZ that require no clinical judgment. These findings also offer a crucial insight into the primacy of linguistic structural disruption in clinically ascertained disorganized thinking in SZ. Our work contributes to an emerging body of literature on the psychopathology of SZ using a first-order lexeme-level analysis and a hypothesis-driven approach. At a utilitarian level, this has implications for improving educational and social outcomes in patients with SZ.

Neuroprotective effect of agomelatine in rat model of psychosis: Behavioural and histological evidence

• Ketamine caused hyper-locomotion, increased stereotypy, ataxia, and decreased social withdrawal. • Agomelatine reversed the behavioural effects of ketamine. • Ketamine decreased neuronal count in the hippocampus and increased it in the amygdala. • The ketamine effects on neuronal count were reversed by agomelatine. • Agomelatine has the potential to alleviate negative symptoms of schizophrenia. Schizophrenia is a complex psychiatric disorder associated with positive (delusion, hallucination, and disorganised speech) and negative (affective flatering, avolition and social withdrawal) symptoms. Agomelatine (AGO) has been used as an anti-depressant to improve the negative symptoms in schizophrenia patients with co-morbid major depressive disorder. Therefore, the present study aimed to investigate the anti-psychotic effect of AGO in ketamine (KET)-induced psychosis rat model. Four groups ( n = 12/ group) of wistar rats were administered normal saline, KET (20 m/kg, i.p) and KET + AGO (20 and 40 mg/kg, i.p) for seven days. Behavioural tests were conducted on the seventh day after drug administration. Seven days administration of AGO at two different doses decreased the KET induced stereotypic and ataxic behaviour as compared with KET treated rats. In addition, AGO increased the social interaction time and decreased the horizontal and vertical locomotor behaviour in KET treated rats. Histologically, KET adminstration decreased hippocampal and increased basolateral amygdala (BLA) neuronal counts. AGO administration (at two different doses) significantly reversed the KET induced neuronal loss in the two brain areas. These findings suggest that AGO has a protective effect against KET-induced psychosis in this rat model. This study warrants further research to delineate the possible role of AGO in experimental model of psychosis particularly neurochemical and neuromolecular aspects.

Proportion of Psychiatry Outpatients with Borderline Personality and Associated Clinical Syndromes using the Millon Clinical Multiaxial Inventory-III: A Retrospective Study

Introduction: Personality disorders are a group of behavioural patterns associated with significant personal and socio-occupational disturbances. Numerous studies have demonstrated borderline personality to be one of the most common personality disorders. It’s less often diagnosed with just a clinical assessment. Aim: To examine the proportion of patients with Borderline Personality Disorder (BPD), and its associated personality types and clinical syndromes, using the Millon Clinical Multiaxial Inventory version-III (MCMI-III). Materials and Methods: A retrospective observational study was carried out on 450 adult patients who attended the psychiatry outpatient department of an urban tertiary care hospital. They had been administered the MCMI-III, a self-rating questionnaire commonly used to provide information on personality types and associated clinical syndromes. Statistical Package for the Social Sciences (IBM SPSS, Windows) version 20.0 was used for statistical analyses. Data was expressed in terms of actual number, mean and percentages. Chi-Square or Fisher’s-exact test, as appropriate, was used for categorical data to test for associations. Odds ratio was estimated to measure strength of the association. Results: Borderline was the most common personality type comprising nearly half (46.63%) of the study population. 25.5% had borderline traits while 21.1% had Borderline Personality Disorder (BPD). BPD was significantly higher in females (p&lt;0.001), younger age group below the age of 40 years (p&lt;0.001) and unmarried persons (p&lt;0.001). It was comorbid most with Anxiety (90.91%; OR=4.05; p&lt;0.001), Major Depression (85.23%; OR=18.39; p&lt;0.001), Post Traumatic Stress Disorder (PTSD) (46.59%; OR=6.30; p&lt;0.001) and Thought disorders (56.82%; OR=18.15; p&lt;0.001). Alcohol (22.73%; OR=3.54; p&lt;0.001) and Drug dependence (13.64%; OR=11.52; p&lt;0.001) were also seen significantly higher in patients with BPD. Personality types significantly comorbid with BPD were Sadistic, Depressive, Masochistic, Negativistic, Schizotypal, Avoidant, Dependent, Antisocial and Paranoid types, with odds being most for Sadistic personality (OR=9.44). Conclusion: It is recommended that mental health professionals and clinicians should start to look for underlying symptoms of BPD in patients of anxiety and mood syndromes. If found these patients should be directed for psychotherapy as early as possible. The MCMI psychological test would be an important contribution to this area, given the need for systematic, quick, and objective testing methods that facilitate the diagnosis.

The entropic tongue: Disorganization of natural language under LSD.

Serotonergic psychedelics have been suggested to mirror certain aspects of psychosis, and, more generally, elicit a state of consciousness underpinned by increased entropy of on-going neural activity. We investigated the hypothesis that language produced under the effects of lysergic acid diethylamide (LSD) should exhibit increased entropy and reduced semantic coherence. Computational analysis of interviews conducted at two different time points after 75μg of intravenous LSD verified this prediction. Non-semantic analysis of speech organization revealed increased verbosity and a reduced lexicon, changes that are more similar to those observed during manic psychoses than in schizophrenia, which was confirmed by direct comparison with reference samples. Importantly, features related to language organization allowed machine learning classifiers to identify speech under LSD with accuracy comparable to that obtained by examining semantic content. These results constitute a quantitative and objective characterization of disorganized natural speech as a landmark feature of the psychedelic state.

Les marqueurs linguistiques dans l’amélioration du modèle prédictif de la transition vers la schizophrénie

Over the past twenty years, research in psychiatry has focused primarily on the early detection of schizophrenia. The objective has been to engage the patient with prodromal symptoms in a trajectory of care. It has also been a question of being able to offer treatment as soon as the patient “at risk” of schizophrenia triggered a possible first psychotic episode. Standardized clinical tools were developed and now allow identification of subjects at risk of developing psychotic disorders. However, the reliability of predictions of the psychotic transition, which is between 15 and 25%, remains insufficient. In order to improve care, it is now necessary to highlight markers to refine the prediction of the risk of developing schizophrenia. Some teams are trying to identify linguistic anomalies in UHR subjects (disorganized speech, illogical thoughts, poor speech, altered semantic verbal fluencies…). Some of these abnormalities could be specific to the transition to psychosis. The severity of these markers could be proportional to the progressive stage of the disorder, consistent with the hypothesis of a continuum from normal to pathological in schizophrenia. In addition, automated speech analysis techniques in UHR subjects allow identification of subtle semantic and syntactic anomalies (a decrease in semantic coherence, but also the use of possessive pronouns and a poverty of speech) predictive in 79% of cases of psychotic transition. Some authors demonstrate the value of using linguistic markers and automated speech analysis methods to improve the predictive model of the transition to schizophrenia. However, from reification of language to desubjectification of the individual, this transformation in clinical practice raises ethical and epistemological challenges.

The Socioeconomic Determinants of Crime in Brazil

This paper aims to examine the determinants of crime in the 5,565 municipalities of Brazil, with a special focus on the Bolsa Familía impact. We identified spatial dependence and heterogeneity and adopted spatial models with regimes: North (NO), Northeast (NE), Southeast (SE), South (SO) and Central-West (CW). Among results, population size is an important to explain crime in all regions, while population density is significant only in NE and CW. The Economic-Educational and Social Disorganization Factors, constructed with factorial analysis, are also significant for all regions, except in the NO for the latter. The first factor presented coefficients with different signs and magnitudes depending on the region, while social disorganization are a crime inductor in all localities. Social inequality leads to criminality only in the SO. The Bolsa Família program was significant in the NE, NO and CW. In the latter two, the program inhibits crime while in the Northeast the effect is opposite.

Schizophrenia; Recent Cognitive and Treatment Approaches Using Induced Pluripotent Stem Cells

AbstractOne of the most severe mental disorder which leads to a disturbance in the percipience of reality is named schizophrenia. Schizophrenia is a combination of hallucinations, delusions, and mental disorders, that the severity of them impairs normal thinking and behavior, and in general the inability to perform daily activities. Behavioral, intellectual, and emotional disorders indicate the widespread impact of Schizophrenia on various aspects of mental health. The signs and symptoms of schizophrenia are very varied, although delusions, hallucinations, or disorganized speech are included in common symptoms. Dopamine has been the main subject of much research on schizophrenia for decades. Molecular neuroimaging studies to explore the Dopamine System (DA system) in vivo have revealed that schizophrenia is first associated with a defect in the striatum and then with a defect in extrastriatal regions with centralizing on Cortex and midbrain. Also, the Gamma-Aminobutyric acid (GABA) mRNA dysregulation and Neuroinflammatory mechanisms can be effective in schizophrenia. Various medications such as antipsychotic drugs are used to the aim of treating this disease but they can just decline or improve the positive symptoms. Modeling of neurodevelopment and synaptic connection defects by induced human pluripotent stem cells have made appropriate circumstances to the elimination of schizophrenia treatment barriers. With the development of cell therapies and the usage of induced pluripotent stem cells, there is a hope that the negative symptoms can be improved by this approach.

The effect of psychomotor therapy on mental health in in-patient schizophrenia treatment: A randomized, double-blind intervention study

Background: It has been shown that exercise programmes can influence mental health in patients with mental health disorders. Objective: The aim of this study was to verify the suitability of psychomotor therapy as a supporting method in the treatment of hospitalized patients with schizophrenia. Methods: In this randomized controlled double-blind study 142 in-patients with schizophrenia (age: mean 50.2 years, SD = 6.5, range 21-62) participated. In comparison with a control group (n = 60), the experimental group (n = 82) received an additional psychomotor therapy programme (3 times a week for a period of 14 weeks). The Brief Psychiatric Rating Scale (BPRS) was used to evaluate mental health status. Results: Participants in the psychomotor therapy demonstrated significant improvements for all subscales of the BPRS. Large effect sizes were found for subscales Anxiety/Depression, Energy, Thought Disturbance and Activation, and medium for Hostility. No significant difference between genders was found. Conclusion: The implementation of a psychomotor therapy programme in the treatment of hospitalized patients with schizophrenia has a significant positive effect on their mental health.

Digital Phenotyping Using Multimodal Data

Digital phenotyping involves the quantification of in situ phenotypes using personal digital devices and holds the potential to dramatically reshape how serious mental illnesses (SMI) assessment is conducted. Despite promise, few, if any, digital phenotyping efforts for SMI have garnered the support necessary for clinical implementation. In this paper, we highlight how digital phenotyping efforts can be improved by integrating data from multiple channels (i.e., “multimodal” data integration). We begin by arguing that “multimodal” integration is critical for digital phenotyping of many, possibly most, SMI symptoms. Next, we consider computational approaches that can accommodate multimodal data. We conclude by considering next steps for multimodal data for research and clinical applications. We punctuate this paper with examples of multimodal digital phenotyping using natural language processing (NLP) to measure speech disorganization in psychosis.

Thought Disorder on Object Sorting Test Is Associated with Executive Dysfunction in Schizophrenia.

Background:Thought disorder is considered to be central to the core disturbances in schizophrenia and was described by Goldstein as aberrant “concept formation.” Executive dysfunction is another core deficit in schizophrenia. With a greater emphasis on psychopathology in nosological systems, the classical thought disorder receives less prominence. The present study aimed to understand the association between classical thought disorder (aberrant concept formation and concrete abstraction) and executive dysfunction.Methods:Thirty patients with schizophrenia and thirty healthy subjects, matched on age, gender, education, and socioeconomic status, were screened using MINI 5.0, following which they were assessed on object sorting test (OST) and selected tests for executive functions (EFs).Results:Individuals with schizophrenia were found to have significantly decreased performance on all domains of EFs and OST. Total peculiar scores on OST were significantly associated with mental speed, focused attention, and divided attention. Total impoverished scores on OST was significantly associated with focused attention, sustained attention, planning, set shifting, perseveration, and concept formation.Conclusion:Several correlations, among performance on OST and neuropsychological tests, suggest that patterns of responses on OST can point to underlying executive dysfunction. Both thought disorder and executive dysfunction mirror similar constructs. This similarity represents a conceptual bridge between the classical and contemporary descriptions of the core deficits in schizophrenia.

QT interval prolongation noted in one percent of 2553 Asian patients with schizophrenia: Findings from the REAP-AP survey.

Although the association between antipsychotic use and corrected QT interval (QTc) prolongation has been repeatedly confirmed, the relationship has been rarely studied in a practical setting. Using data from the Research on Asian Psychotropic Prescription Patterns for Antipsychotics (REAP-AP) survey, our study aimed to investigate the prevalence and clinical correlates of QTc prolongation in 2553 Asian patients with schizophrenia. After adjusting for the potential effect of confounding factors, the baseline and clinical characteristics of the schizophrenia patients with and without QTc prolongation were compared using analyses of covariance and binary logistic analyses. In addition, a binary logistic analysis model with a forward selection method was used to identify the distinctive clinical correlates of QTc prolongation. QTc prolongation was noted in 1.1% of Asian patients with schizophrenia. Schizophrenia patients were characterized by lower proportions of disorganized speech and negative symptoms; higher use of amisulpride and clozapine; and higher proportions of rigidity, hypercholesterolemia, and sedation than those without QTc prolongation. Finally, a binary logistic mode showed that amisulpride, clozapine, rigidity, and hypercholesterolemia might be the distinctive clinical correlates of QTc prolongation in Asian patients with schizophrenia. These findings indicate the clinical implications that the uses of amisulpride and clozapine and the occurrences of rigidity and hypercholesterolemia may be potential risk factors for QTc prolongation of schizophrenia patients.

Reliability and validity of the Turkish version of comprehensive assessment of at risk mental states.

To perform the validation of the Comprehensive Assessment at Risk Mental State (CAARMS) in Turkish. Sixty-five volunteers (15-24 years) were enrolled in this study. Concurrent validity was performed with Spearman's Correlation Test using Brief Psychiatric Rating Scale (BPRS). Median scores of the groups were compared using Mann-Whitney U Test. Interrater reliability was assessed by intragroup correlation coefficient method. Internal consistency was studied by the calculation of Cronbach Alfa Coefficient. The correlation of the severity scores of the CAARMS with unusual thought content, suspiciousness, hallucinations and conceptual disorganization items of the BPRS showed that the concurrent validity was good. ROC analysis revealed that CAARMS could discriminate between individuals with UHR and healthy volunteers well. We found a good correlation between the raters. Internal consistency was at very high level. Analyses of concurrent validity, criterion validity, interrater reliability and internal consistency indicate that the Turkish version is valid and reliable.

Hallucinations in posttraumatic stress disorder: Insights from predictive coding.

Although hallucinations are not one of the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) criteria for posttraumatic stress disorder (PTSD), they are increasingly documented in PTSD. They are noted in the absence of clear delusions, formal thought disorganization, disorganized speech, or behavior, ruling out a comorbid psychotic disorder like schizophrenia as a better explanation for these hallucinations. Hallucinations in both PTSD and schizophrenia share phenomenological features. We propose that hallucinations in PTSD, like those in schizophrenia, might be explained in terms of aberrant predictive coding, specifically the misapplication of strong prior beliefs that vitiate perceptual inference. This approach highlights the broader relationship between trauma and psychosis. Under predictive coding, the nervous system organizes past sensory data into an internal model of the world. Under stress, the brain prioritizes speed over accurate encoding. However, memories for traumatic experiences are typically strongly consolidated, to avoid similar experiences in future. In PTSD, this could lead to a world model comprised of inaccurate but overly precise prior beliefs, that can be triggered by stimuli tangentially related to the index trauma, resulting in hallucinations. Crucially, this evidence accumulation depends upon the relative precision of prior beliefs and sensory evidence (supplied in the form of prediction errors). Our basic argument is that stressful situations induce belief updating, in terms of precise prior beliefs, that are difficult to undo. These unduly precise, trauma-related beliefs then constitute perceptual hypotheses, memories, or narratives that bias subsequent experience. This prior bias may be so severe that sensory evidence is effectively ignored; that is, treated as very imprecise, in relation to prior beliefs. Such an account may lead to cognitive therapies for hallucinations aimed at strong prior beliefs, and the exciting prospect of combining such therapies with drugs that modulate neuroplasticity and enhance the adaptive consolidation of more appropriate priors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Supportive Psychotherapy and Psychoeducation as a Media for Changing and Convincing Behavior in Clients with Paranoid Schizophrenia

Schizophrenia is a psychiatric diagnosis that describes mental disorders with character abnormalities in perception or disorders regarding reality. Perception abnormalities can be in the form of disorders in the five senses, usually in the form of auditory hallucinations, paranoia, bizarre delusions, and can also be in the form of speech disorganization and disruption of real social communication. Case. Mr.SA, age 43, came with complaints of rampage to his family and surrounding community for no apparent reason. The patient was treated at Menur General Hospital Surabaya 2 years ago with a similar complaint. Psychiatric status obtained clear awareness, bad insight, blunt affect, auditory hallucinations, visuals, followed by delusions of control, suspicious. Diagnosis of axis I: paranoid schizophrenia, axis II and III: none, axis IV: Primary Support Group (Family) GAF axis scale 20.11 (danger of self-injury / others when entering hospital). Psychopharmaca therapy is chlorpromazine tab 1 x 100 mg, haloperidol tab 3 x 5 mg, and trihexyphenidyl 3 x 2 mg, and psychotherapy that is support. Conclusion The paranoid schizophrenia of this patient is due to work problems

Auditory processing disorder may be present in schizophrenia and it is highly correlated with formal thought disorder

The present study investigates the presence of Auditory Processing Disorder (APD) in schizophrenia and its association with symptomatology, especially Formal Thought Disorder (FTD). 50 patients with schizophrenia and 25 matched healthy controls completed a battery of three auditory processing tests. Positive and Negative Syndrome Scale (PANSS) and Thought, Language and Communication (TLC) scale were used to assess clinical symptoms. The patient group was divided into two subgroups, according to FTD severity. Auditory processing performance of the control group and the patient group was evaluated. Correlations between auditory processing scores and TLC scores, as well as auditory processing scores and PANSS scores were examined. Most of the patients, especially those with FTD, had auditory deficits that can be classified as APD. Patients showed impaired performance compared to controls in all tests. Total severity and specific factors of FTD, as well as other clinical symptoms and symptom categories were correlated with auditory processing performance. We provided evidence that APD may be present in schizophrenia and that FTD, as well as other clinical symptoms are associated with auditory processing deficits. There are important clinical implications for non-pharmacological interventions and early diagnosis of schizophrenia.

Language as a biomarker for psychosis: A natural language processing approach

Human ratings of conceptual disorganization, poverty of content, referential cohesion and illogical thinking have been shown to predict psychosis onset in prospective clinical high risk (CHR) cohort studies. The potential value of linguistic biomarkers has been significantly magnified, however, by recent advances in natural language processing (NLP) and machine learning (ML). Such methodologies allow for the rapid and objective measurement of language features, many of which are not easily recognized by human raters. Here we review the key findings on language production disturbance in psychosis. We also describe recent advances in the computational methods used to analyze language data, including methods for the automatic measurement of discourse coherence, syntactic complexity, poverty of content, referential coherence, and metaphorical language. Linguistic biomarkers of psychosis risk are now undergoing cross-validation, with attention to harmonization of methods. Future directions in extended CHR networks include studies of sources of variance, and combination with other promising biomarkers of psychosis risk, such as cognitive and sensory processing impairments likely to be related to language. Implications for the broader study of social communication, including reciprocal prosody, face expression and gesture, are discussed.

Cognitive behavioural therapy for help-seeking adolescents and young adults with at-risk-mental state: Effects on subclinical positive symptoms.

Cognitive behavioural therapy (CBT) is effective for at-risk-mental state (ARMS) in reducing/delaying transition to psychosis. However, previous systematic reviews pointed out the small number of trials as a limitation and suggested that additional outcomes should be evaluated, not only prevention of first psychosis episode. No study assessed the CBT effects on subclinical psychotic symptoms. The present study investigated the effects of CBT on the transition risk (primary outcome), and on overall remission from ARMS and severity of subclinical symptoms, that is, unusual content of thought, non-bizarre ideas, perceptual abnormalities, disorganized speech (secondary outcome). CBT consisted of 30 individual weekly sessions over 7 months. Fifty-eight participants with ARMS detected by the Comprehensive Assessment of At-Risk-Mental States were randomized to CBT or control condition. Respectively in the CBT and control groups, 1 (3.40%) and 5 (26.31%) participants at post-treatment and 3 (10.30%) and 8 (42.10%) at follow-up made transition with a difference between the two groups, despite at borderline significance. At post-treatment and follow-up, respectively, the number of participants recovered from ARMS was significantly higher in CBT (76.92% and 61.53%) than in control (10.52% and 15.80%). Participants in the control group reported lower reductions on all the subclinical symptoms over time as compared with those in CBT. This is the first study assessing CBT on subclinical positive symptoms in ARMS. CBT seems to be a tailored approach able to produce short- and long-term benefits on this outcome.

Childhood maltreatment in individuals at risk of psychosis: Results from the Brazilian SSAPP cohort.

Childhood maltreatment is a known risk factor for the development of mental disorders, such as psychotic symptoms. An extensive body of literature about childhood maltreatment and mental health has been developed in wealthy countries, but information about this connection is lacking in developing countries. To explore a possible relationship between childhood maltreatment and ultra-high risk of psychosis in a non-help-seeking population in a low- and middle-income country. A household survey was conducted in Sao Paulo, Brazil, involving over 2,500 individuals aged 18-30 years who were randomly selected from the general population. The participants underwent screening with the Prodromal Questionnaire. Ultra-high risk status was assessed using the Structured Interview for Prodromal Syndromes, and childhood maltreatment was assessed using the Childhood Trauma Questionnaire. The final sample comprised 87 ultra-high risk individuals and 115 controls. Childhood maltreatment was significantly more present among ultra-high risk individuals. In ultra-high risk individuals, physical and emotional neglect were inversely related to grandiosity symptoms, physical abuse was related to perceptual abnormalities and physical neglect was related to disorganized speech and thought. This is the first study to investigate the relationship between childhood maltreatment and ultra-high risk status and psychopathological features in a large Latin American sample. Further studies in this field are necessary to better understand the specific influence of various early life adversities on psychosis risk.

Schizophrenia phenomenology revisited: positive and negative symptoms are strongly related reflective manifestations of an underlying single trait indicating overall severity of schizophrenia.

To examine whether negative symptoms, psychosis, hostility, excitation, and mannerism (PHEM symptoms), formal thought disorders (FTD) and psychomotor retardation (PMR) are interrelated phenomena in major neurocognitive psychosis (MNP) or deficit schizophrenia and whether those domains belong to an underlying latent vector reflecting general psychopathology. In this study, we recruited 120 patients with MNP or deficit schizophrenia and 54 healthy subjects and measured the above-mentioned symptom domains. In MNP, there were significant associations between negative and PHEM symptoms, FTD and PMR. A single latent trait, which is essentially unidimensional, underlies these key domains of schizophrenia and MNP and additionally shows excellent internal consistency reliability, convergent validity, and predictive relevance. Confirmatory Tedrad Analysis indicates that this latent vector fits a reflective model. The lack of discriminant validity shows that positive (and PHEM or psychotic) and negative symptoms greatly overlap and probably measure the same latent construct. Soft independent modeling of class analogy (SIMCA) shows that MNP (diagnosis based on negative symptoms) is better modeled using PHEM symptoms, FTD, and PMR than negative symptoms. In stable phase MNP, which is a restricted sample of the schizophrenia population, negative and PHEM symptoms, FTD and PMR belong to one underlying latent vector reflecting overall severity of schizophrenia (OSOS). The bi-dimensional concept of "positive" and "negative" symptoms cannot be validated and, therefore, future research in stable phase schizophrenia should consider that the latent phenomenon OSOS as well as its reflective manifestations are the key factors of schizophrenia phenomenology.