Levels Of Psychotic-like Experiences Research Articles

Exploring the associations between momentary cortisol levels and psychotic-like experiences in young adults: Results from a temporal network analysis of daily-life data.

Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been implicated in the development of psychosis and subthreshold psychotic symptoms commonly referred to as psychotic-like experiences (PLEs). The exact mechanisms linking the HPA axis responses with the emergence of PLEs remain unknown. The present study aimed to explore real-life associations between stress, negative affect, salivary cortisol levels (a proxy of the HPA axis activity) as well as PLEs together with their underlying cognitive biases (i.e., threat anticipation and aberrant salience). The study was based on the experience sampling method scheduled over 7 consecutive days in the sample of 77 drug-naïve, young adults (18-35 years). The saliva samples were collected with each prompt to measure cortisol levels. A temporal network analysis was used to explore the directed associations of tested variables. Altogether, 3234 data entries were analyzed. Data analysis revealed that salivary cortisol levels did not directly predict next-moment fluctuations of PLEs. However, higher salivary cortisol levels were associated with higher next-moment levels of PLEs through the effects on threat anticipation and negative affect. In turn, PLEs appeared to predict cortisol levels through the effects on negative affect and event-related stress. Negative affect and threat anticipation were the most central nodes in the network. There might be bidirectional associations between the HPA axis responses and PLEs. Threat anticipation and negative affect might be the most important mediators of these associations. Interventions targeting these mediators might hold promise for disrupting the connection between the HPA axis dysregulation and PLEs.

Cognitive Biases and Socio-Occupational Functioning Mediate the Relationship between Executive Functions and the Severity of Psychopathology among Young Adults with Psychotic-like Experiences: 1-Year Follow-Up Study.

The aim of this study was to investigate whether Trail Making Test (TMT) performance is associated with the severity of psychopathological symptoms related to psychosis among young adults with elevated level of psychotic-like experiences (PLEs), and whether this relationship is mediated by cognitive biases and socio-occupational functioning. A total of 187 subjects from a larger population of 6722 young adults participated in this 1-year follow-up study. The inclusion criteria were an elevated level of PLEs (the highest score of the Prodromal Questionnaire) and a lack of schizophrenia diagnosis. Eventually, 134 subjects (71.6%) completed the TMT, as well as the DACOBS scale (cognitive biases), at baseline and were examined twice using the CAARMS (psychopathology) and SOFAS (socio-occupational functioning) scales. In the first (I) and second (II) measurements, the calculated effects indicate indirect-only mediations, which explained 35 and 38% of the variance of the CAARMS. The TMT B execution time was positively associated with the DACOBS scale (β = 0.19, p = 0.028), which was negatively related to the SOFAS I (β = -0.37, p < 0.001) and SOFAS II (β = -0.20, p = 0.016) measurements. A lower score on the SOFAS I predicted a higher score on the CAARMS I (β = -0.50, p < 0.001), and a lower SOFAS II predicted a higher score on the CAARMS II (β = -0.61, p < 0.001). Subtle EF dysfunctions may, over time, translate into a greater severity of symptoms related to psychosis in people with elevated PLEs, and this is mediated by a deterioration of their metacognition and socio-occupational functioning.

Psychotic-like experiences predict the perceived intent to seek treatment: A network perspective

We aimed to investigate as to whether psychotic-like experiences (PLEs) predict the perceived intent to seek treatment. Our secondary aim was to explore which PLEs predict the perceived need to seek treatment using a network analysis. The study was based on a community sample of individuals with a negative history of psychiatric treatment. At baseline, they completed questionnaires recording the presence of PLEs, depressive, and anxiety symptoms. After 6–7 months, they were reassessed with respect to the perceived intent to seek treatment. A total of 1100 individuals were assessed at baseline (aged 27.1 ± 5.1 years, 48.6 % males). The follow-up assessment was completed by 581 individuals (52.8 %). Higher baseline levels of PLEs were associated with a greater intent to seek treatment at the follow-up before (Beta = 0.289, p < 0.001) and after adjustment for sociodemographic characteristics, depressive and anxiety symptoms (Beta = 0.128, p = 0.004). A network analysis demonstrated that the intent to seek treatment was connected to five nodes of PLEs including “déjà vu experiences” (weight = 0.046), “problems in differentiating reality and imagination” (weight = 0.103), “a lack of control over own ideas or thoughts” (weight = 0.077), “being distracted by distant sounds” (weight = 0.105), and “paranoid thoughts” (weight = 0.145). Findings from the present study indicate that PLEs might contribute to help-seeking behaviors regardless of co-occurring depressive and anxiety symptoms. However, specific PLEs may differ with respect to their effects on the perceived intent to seek treatment.

Are psychotic-like experiences associated with aberrant prosocial decision-making behavior?

Deficits in social functioning and decision-making are well-documented in schizophrenia, but their relationship with positive symptoms and social conflicts is poorly understood. We created a new paradigm based on the Dictator Game (DG) to explore differences in social decision-making between individuals experiencing high levels of psychotic-like experiences (PLEs), particularly hallucinations and delusions, and controls with less PLEs. A large community sample (N = 1,161) completed a DG in an online study whereby extreme groups were built based on the positive subscale of the CAPE. Overall, participants experiencing PLEs did not act less prosocial than controls but showed a somewhat aberrant decision-making behavior, particularly a pattern of behaving more prosocial in fair situations and generally favoring punishment over compensation relative to controls. Mediation analyses suggest that measures of empathy and Machiavellism have predictive power for prosocial behavior beyond group status. The present study raises the possibility that individuals with high levels of PLEs may be less able to adapt their behavior to the situation at hand than controls. These irregularities might be due to deficits in social cognition which may elicit conflict, thus compromising social functioning and possibly contributing to the formation of positive symptoms.

Effects of the interaction between PTSD and ADHD symptoms on the level of reporting psychotic-like experiences: findings from a non-clinical population.

Psychotic-like experiences (PLEs) are increasingly being recognized as subclinical phenomena that might predict the development of various mental disorders that are not limited to the psychosis spectrum. Accumulating evidence suggests that attention-deficit/hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD) are highly comorbid mental disorders. However, their interactive effect on the occurrence of PLEs has not been investigated so far. Therefore, in the present study we aimed to investigate the effect of interaction between ADHD and PTSD symptoms on the level of psychotic-like experiences (PLEs) in the non-clinical sample. The study included 3,000 individuals aged 18-35 years with a negative history of psychiatric treatment. The symptoms of ADHD and PTSD were assessed using self-reports. There was a significant association of the interaction between ADHD and PTSD with the level of reporting PLEs. This association remained significant after adjustment for age, gender, the level of education, the current vocational situation, lifetime history of problematic substance use, and depressive symptoms. Post-hoc tests demonstrated significantly higher levels of reporting PLEs in participants with positive screening for both ADHD and PTSD compared to other subgroups of participants. Also, individuals with positive screening for one vulnerability (either ADHD or PTSD) reported significantly higher levels of reporting PLEs compared to those with a negative screening for ADHD and PTSD. In turn, no significant differences between individuals reporting one vulnerability, i.e., between those with positive screening for ADHD and those with positive screening for PTSD, were observed. Findings from the present study imply that both PTSD and ADHD symptoms the interaction effect on the level of reporting PLEs that might be of importance for early intervention strategies. However, observed associations require replication in clinical samples.

The predictive role of psychotic-like experiences in suicidal ideation among technical secondary school and college students during the COVID-19 pandemic

BackgroundPrevious research has shown the strong association between psychotic-like experiences (PLEs) and suicide. However, the predictive role of PLEs in suicidal ideation (SI) during the COVID-19 pandemic remains unclear.AimsThis study aimed to explore the association between PLEs before the pandemic and SI during the pandemic among late adolescents.MethodsA total of 938 technical secondary school and college students completed both waves of the online survey before and during the pandemic. PLEs were assessed through the 15-item Positive Subscale of the Community Assessment of Psychic Experiences. SI was evaluated by the frequency of SI during the pandemic.ResultsIn early stage of the pandemic, most students had low frequent SI, and only 3.3% students showed high frequent SI. Compared to the low frequent group, the high frequent group exhibited significantly higher levels of PLEs (p < 0.001) and scored lower in resilience (p = .001) and perceived social support (p = .008) across the two timepoints. PLEs were significantly associated with higher risk of high frequent SI (OR = 2.56, 95%: 1.07–6.13), while better resilience (OR: 0.93, 95% CI: 0.88–0.99) and stronger perceived social support (OR: 0.96, 95% CI: 0.93–0.99) appeared to be protective factors. No interactions were found among PLEs and other psychosocial and psychological factors.ConclusionsPLEs may increase the risk of SI in early stage of the pandemic, while good resilience and adequate social support can help weaken the risk.

Associations of neurodevelopmental risk factors with psychosis proneness: Findings from a non-clinical sample of young adults

Psychotic disorders often develop as the continuum of subclinical symptoms that include hallucination-like and delusion-like experiences, and are commonly referred to as psychotic-like experiences (PLEs). To date, a number of neurodevelopmental risk factors of psychosis have been detected, yet their mutual interplay remains unknown. Therefore, we aimed to investigate the additive association of childhood trauma history, reading disabilities and symptoms of attention-deficit/hyperactivity disorder (ADHD) with psychosis proneness. A total of 3000 young adults (58.3% females, aged 18–35 years) with a negative history of psychiatric treatment were recruited to the cross-sectional study through computer-assisted web interview. Self-reports were administered to measure childhood trauma history, ADHD symptoms and reading disabilities. Linear regression analyses revealed significant main associations of childhood trauma history and reading disabilities with higher levels of PLEs. There were no significant main associations of ADHD with the level of PLEs. However, the associations of all possible interactions between neurodevelopmental risk factors with the level of PLEs were significant. Our findings suggest that childhood trauma history and reading disabilities may additively increase a risk of psychosis. The present findings bring new implications for early intervention strategies in psychosis and posit the rationale of recording the accumulation of neurodevelopmental vulnerabilities in clinical practice.

Understanding Associations Between Race/Ethnicity, Experiences of Discrimination, and Psychotic-like Experiences in Middle Childhood.

The present study aimed to examine factors that may account for race/ethnicity differences in psychotic-like experiences (PLEs) in a middle childhood sample, including evidence for experiences of discrimination as a psychosocial mediator of these differences. In a sample of 9- to 10-year-olds (N= 10,839) from the Adolescent Brain Cognitive Development Study, we compared PLEs across racial/ethnic groups. We also examined whether experiences of discrimination indirectly linked racial/ethnic identity and PLEs and whether social support moderated this indirect association. Differences between racial/ethnic groups were found in the endorsement of PLEs, such that Black and Hispanic participants endorsed higher levels of PLEs compared with Asian, multiracial/multiethnic, and White participants. These differences were accounted for in part by experiences of discrimination, an indirect effect that was in turn attenuated by increased social support. This is the first study to suggest that the experience of discrimination may indirectly link the association between racial/ethnic differences and endorsement of PLEs using the Prodromal Questionnaire-Brief Child Version and additionally that social support may act as a moderator of this mediation. Results provide evidence that social inequities such as racial discrimination may contribute to increases in PLEs. These findings shed further light on the links between structural racism and mental health inequities for people in minoritized groups.

The Impact of the FKBP5 Gene Polymorphisms on the Relationship between Traumatic Life Events and Psychotic-Like Experiences in Non-Clinical Adults

Common variations of the FKBP5 gene are implicated in psychotic disorders, by modulating the hypothalamic–pituitary–adrenal axis reactivity to stress. It has been demonstrated that some of them might moderate the effects of childhood trauma on psychosis proneness. However, these associations have not been investigated with respect to traumatic life events (TLEs). Therefore, we aimed to explore whether the FKBP5 polymorphisms moderate the effects of TLEs on the level of psychotic-like experiences (PLEs). A total of 535 non-clinical adults were approached for participation, and genotyping of six FKBP5 polymorphisms (rs3800373, rs9470080, rs4713902, rs737054, rs1360780 and rs9296158) was performed. The Prodromal Questionnaire-16 (PQ-16) and the Traumatic Events Checklist (TEC) were administered to assess PLEs and TLEs, respectively. Among the rs1360780 CC homozygotes, a history of physical abuse was associated with significantly higher PQ-16 scores. This difference was not significant in the rs1360780 T allele carriers. Similarly, a history of physical abuse was associated with significantly higher PQ-16 scores in the rs9296158 GG homozygotes but not in the rs9296158 A allele carriers. Finally, emotional neglect was related to significantly higher PQ-16 scores in the rs737054 T allele carriers but not in the rs737054 CC homozygotes. The present study indicates that variation in the FKBP5 gene might moderate the effects of lifetime traumatic events on psychosis proneness.

Effects of interactions between variation in dopaminergic genes, traumatic life events, and anomalous self-experiences on psychosis proneness: Results from a cross-sectional study in a nonclinical sample.

There is a growing number of studies showing interactions between genetic polymorphisms associated with dopaminergic neurotransmission and traumatic life events (TLEs) on a risk of psychotic-like experiences (PLEs). Anomalous self-experiences (ASEs) have been associated both with TLEs as well as with PLEs. However, it remains unknown what is the role of ASEs in the complexity of gene-environment interactions on the emergence of PLEs. We included 445 young adults-university students from three big cities in Poland. We used the Traumatic Events Checklist to assess TLEs, the Inventory of Psychotic-Like anomalous self-experiences in order to measure ASEs, and the Prodromal Questionnaire (PQ16) to record the level of PLEs. The following gene polymorphisms, related to dopaminergic neurotransmission, were determined: the catechol-O-methyltransferase (COMT) rs4680 polymorphism, the dopamine D2 receptor (DRD2) rs6277 polymorphism, and the dopamine transporter 1 (DAT1) rs28363170 polymorphism. There was a significant effect of the interaction between the DAT1 polymorphism, a severity of ASEs, and a history of TLEs on the level of PLEs. Among the DAT1 10R/10R homozygotes with low level of ASEs, a severity of PLEs was significantly higher in individuals with a history of any TLEs. Higher scores of the PQ16 were associated with a greater severity of ASEs both in the DAT1 9R allele carriers and the DAT1 10R/10R homozygotes. Our findings imply that genetic liability related to aberrant dopamine transport might impact the association between TLEs and PLEs in subjects with high levels of ASEs.

Schizotypy, social stress and the emergence of psychotic-like states - A case for benign schizotypy?

Schizotypy is a personality-organisation related to schizophrenia-liability as well as the emergence of psychotic symptoms and psychotic-like experiences (PLEs) in non-schizophrenic individuals. It has been suggested that some non-schizophrenic individuals may exhibit PLEs frequently, but in a fashion that is not distressing but life-enhancing (“benign schizotypy”). In schizophrenia and at-risk individuals, however, psychotic symptoms are not only distressing, but also triggered stress.To further investigate questions of causality and examine how PLEs may present as distressing symptoms in some individuals and as benign experiences in others, we explored how schizotypy-facets moderated PLEs-variability under experimentally induced social stress.We performed a standardised social stress-paradigm in 107 healthy adults (77 female, 30 male; average age 22,5 years), measuring changes in psychometrically assessed PLEs and the moderation of changes under stress through positive, negative and disorganised schizotypy.Results suggest two discrete effects: On the one hand, individuals high in disorganised and negative schizotypy showed stress-dependent increases in PLEs; without added effects of positive schizotypy. On the other, individuals low in negative and disorganised schizotypy showed higher levels of PLEs solely as a function of positive schizotypy but not stress.We discuss these findings in light of the fully-dimensional model of schizotypy and hypothesize that PLEs in individuals high in schizotypy-facets suggested to convey risk-for-schizophrenia (negative and disorganised) may reflect qualitatively different entities than PLEs in individuals with low values in these facets, but high expressions of positive schizotypy (“happy schizotypes”). Additionally, we emphasize the importance of not overlooking the disorganised schizotypy-facet in related research.

A combination of self-disturbances and psychotic-like experiences. A cluster analysis study on a non-clinical sample in Poland

We aimed to perform a cluster analysis to investigate the group structure of a combination of psychotic-like experiences (PLEs) and self-disturbances in a non-clinical sample. Non-clinical adults (n = 677) were assessed with the Community Assessment of Psychic Experiences (CAPE), the Davos Assessment of Cognitive Biases Scale (DACOBS) and the Inventory of Psychotic-Like Anomalous Self-Experiences (IPASE). Cluster analysis was conducted based on the positive and negative dimension of CAPE and a total score of IPASE. Four distinct groups were revealed by the cluster analysis. The High Profile group had the highest means, and the Low Profile had the lowest scores of positive and negative subscales of the CAPE and IPASE. The Positive Profile group had a significantly higher level of self-disturbances (in ‘Cognition’, ‘Consciousnesses and ‘Somatization’ dimensions) from participants with the ‘Negative Profile’. The High Profile group had more cognitive biases (i.e., inadequate cognitive inference about internal and external events) related to psychosis as assessed with DACOBS, had the highest means on each IPASE subscale and had a higher level of emotional distress. A combination of high level of PLEs and self-disturbances may capture the highest risk of psychosis in the general population associated with cognitive biases characteristic for psychosis.

The role of ethnic identity, self-concept, and aberrant salience in psychotic-like experiences.

Social-cognitive models of psychosis suggest that aberrant salience and self-concept clarity are related to the development and maintenance of psychoticlike experiences (PLEs). People with high aberrant salience but low self-concept clarity tend to have the highest levels of PLEs. Ethnic identity may also be related to PLEs. The current research aimed to (a) replicate the interaction between aberrant salience and self-concept clarity in their association with PLEs in an ethnically diverse sample, (b) examine whether ethnic identity and aberrant salience interact in their association with PLEs, and (c) determine if self-concept clarity and ethnic identity independently interact with aberrant salience in their association with PLEs. An ethnically diverse group of undergraduates (n = 663) completed self-report measures of aberrant salience, self-concept clarity, ethnic identity, and PLEs. There was an interaction between aberrant salience and self-concept clarity such that people with high levels of aberrant salience and low levels of self-concept clarity had the highest levels of PLEs. Similarly, there was an interaction between aberrant salience and ethnic identity such that people with high aberrant salience but low ethnic identity had the highest PLEs. These interactions independently contributed to explaining variance in PLEs. This interaction was present for the Exploration but not Commitment subscales of ethnic identity. These results suggest that, in addition to low self-concept clarity, low ethnic identity may be a risk factor for the development of psychosis. (PsycINFO Database Record

A randomised controlled trial of cognitive behaviour therapy versus non-directive reflective listening for young people at ultra high risk of developing psychosis: The detection and evaluation of psychological therapy (DEPTh) trial

BackgroundIntervention trials for young people at ultra high risk (UHR) for psychosis have shown cognitive behaviour therapy (CBT) to have promising effects on treating psychotic symptoms but have not focused on functional outcomes. We hypothesized that compared to an active control, CBT would: (i) reduce the likelihood of, and/or delay, transition to psychosis; (ii) reduce symptom severity while improving social functioning and quality of life, whether or not transition occurred. MethodThis was a single-blind randomised controlled trial for young people at UHR for psychosis comparing CBT to an active control condition, Non Directive Reflective Listening (NDRL), both in addition to standard care, with a 6month treatment phase and 12months of follow-up. Statistical analysis is based on intention-to-treat and used random effect models to estimate treatment effects common to all time-points. ResultsFifty-seven young people (mean age=16.5years) were randomised to CBT (n=30) or NDRL (n=27). Rate of transition to psychosis was 5%; the 3 transitions occurred in the CBT condition (baseline, 2months, 5months respectively). The NDRL condition resulted in a significantly greater reduction in distress associated with psychotic symptoms compared to CBT (treatment effect=36.71, standard error=16.84, p=0.029). There were no significant treatment effects on frequency and intensity of psychotic symptoms, global, social or role functioning. ConclusionOur sample was higher functioning, younger and experiencing lower levels of psychotic like experiences than other trials. The significantly better treatment effect of NDRL on distress associated with psychotic symptoms supports the recommendations for a stepped-care model of service delivery. This treatment approach would accommodate the younger UHR population and facilitate timely intervention.Trial registration: ANZCTR 12606000101583

White Matter Abnormalities Associated With Subsyndromal Psychotic-Like Symptoms Predict Later Social Competence in Children and Adolescents.

Recent data suggest that healthy children and adolescents who report psychotic-like experiences (PLEs) evidence abnormalities in white matter (WM). To date, no study has examined whether WM abnormalities associated with PLEs are predictive of outcome at a later time-point. The present study examined whether abnormalities in WM associated with PLEs in children and adolescents at a baseline assessment were predictive of social functioning at a 12-month follow-up. Healthy children and adolescents aged 8-18 years (N = 56) were recruited from the community and received a diffusion tensor imaging exam and a clinical exam at baseline. Voxel-wise statistical analysis of fractional anisotropy (FA), using Tract-Based Spatial Statistics, and probabilistic tractography were used to identify WM abnormalities associated with PLEs at baseline. These abnormalities were then examined for association to social problems and social competence in 28 participants at 12-month follow-up. Lower FA in regions proximal to the superior longitudinal fasciculus (SLF) and corticospinal tract bilaterally as well as in the left inferior fronto-occipital fasciculus and inferior longitudinal fasciculus were associated with higher levels of PLEs at baseline. Moreover, baseline FA in the SLF, but not baseline severity of PLEs, was significantly predictive of social competence at a 12-month follow-up. In contrast, baseline severity of PLEs, but not baseline FA in the SLF, predicted social problems at 12-month follow-up. These findings suggest that alterations in WM, which are associated with symptoms of psychosis well below the threshold of clinical significance, may have significant ramifications for later social development.

Psychotic-like experiences and their relationship to suicidal ideation in adolescents

Studies have suggested that psychotic-like experiences (PLEs) are associated with behavioral problems in adolescents. The aim of this study was to investigate relationships between domains of PLEs, suicidal ideation, and depression in a large community sample of adolescents. The sample consisted of 8096 Korean subjects (3184 boys and 4912 girls) aged 14 to 19 years. The level of PLEs, depression, and suicidal ideation were assessed by the Eppendorf schizophrenia inventory (ESI), Beck's depression inventory, and Beck's scale for suicidal ideation, respectively. Both the level of depression and suicidal ideation were significantly associated with PLEs. Among the four domains of the ESI, the deviant perception, ideas of reference, and auditory uncertainty were associated with the suicidal ideation. Additionally, subjects with more PLEs had significantly more suicidal ideation and depressive symptoms. PLEs in adolescents are associated with potential risk of suicide and depressive symptoms significantly mediated the association between suicidal ideation and PLEs. The presence of perceptual disturbances, ideas of reference, and depression may be regarded as warning signs for suicide-related behaviors.

Psychotic-Like Experiences, Appraisals, and Trauma

This study examined some of the predictions made by cognitive models of psychosis, specifically the potential contribution of appraisals and trauma to the development of "need for care." Two groups reporting psychotic-like experiences with and without a "need for care" were compared on types of experiences, appraisals of these experiences, distress, and trauma. Both groups reported similar overall levels of psychotic-like experiences, but were characterized by distinct types of experiences. The clinical group was more distressed, endorsed more externalizing and personalizing appraisals, and fewer psychological/normalizing apraisals of their experiences than the nonclinical group. Both groups showed high rates of trauma, and interpersonal trauma was associated with more personalizing and fewer psychological/normalizing appraisals. These results suggest that "need for care" is characterized by distress and personalizing appraisals, but not by a higher incidence of trauma. The role of interpersonal trauma, specifically, may be to predispose to a "paranoid" world view.