Schizotypal Research Articles

Clinical and epidemiological aspects of schizotypal disorder in children and adolescents according to the Moscow psychiatric service

BACKGROUND: Given the significant increase in the number of children and adolescents diagnosed with schizotypal disorder and the simultaneous decrease in the incidence of schizophrenia in recent years, studying possible causes of the tendency and provision of psychiatric care to these patients is necessary. AIMS: To analyze the frequency of schizotypal disorder (F21) in children and adolescents and study the correspondence of diagnosis with the ICD-10 criteria and changes in accordance with disease dynamics to improve the continuity of psychiatric care. MATERIALS AND METHODS: This retrospective observational study analyzed data of patients who underwent examination and treatment at Sukhareva Scientific and Practical Center for Child and Adolescent Mental Health between 1999 and 2019, and the inpatient and outpatient records of the center and outpatient records of psychoneurological clinics at the place of patients residence were analyzed. RESULTS: The number of patients diagnosed with F21 schizotypal disorder increased along with the general increase in the number of patients (2812 people in 1999 and 5675 in 2019). They account for nearly half (48.3%) of the patients with diagnoses related to the schizophrenia spectrum (F2 schizophrenia and schizotypal and delusional disorders). Moreover, 71.2% of patients with F21 were diagnosed with F21.8 (schizotypal personality disorder). The number of patients diagnosed with schizophrenia decreased threefold, and the number of patients diagnosed with schizotypal disorder increased six-fold. Among those discharged with F21.8 diagnosis excluding rehospitalizations, 527 patients were selected for the clinical and follow-up study. After the exclusion of patients for various reasons, the patient cohort consisted of 139 patients who had been regularly followed up at psychoneurological clinics. The diagnoses with F2 code remained in 96% of 139 patients included in the cohort for the follow-up study, and only five patients had other disease codes. The diagnosis of schizotypal disorder (F21) persisted in 89 patients (64%). CONCLUSION: The decrease in schizophrenia diagnoses and the increase in the diagnosis of schizotypal disorders in children and adolescents, as revealed in the clinical and epidemiological study of ICD-10 use in 20 years, require further in-depth studies of the possible causes of this transformation. In light of the forthcoming adaptation of ICD-11, unified and clear criteria must be developed for schizotypal disorders, and a common understanding of their nosological affiliation is needed to develop more advanced approaches to diagnosis. The organization of psychiatric care provision must be improved to ensure the continuity of inpatient and outpatient care, including non-state institutions.

The complex sexuality of “Italian” Hikikomori and the need for better nosographic framing of psychopathological evidence

Objective: The definition of “hikikomori” evokes dysfunctional personality pictures already known in the literature and medical practice. The aim is to refute the hypothesis of the need to identify this clinical condition in a new descriptive framework. Materials and methods: Pubmed checklist, clinical interview, and psychometric tests. Results: In the entirety of the selected population, it emerges that the primary disorder is schizoid personality disorder; this is followed by depressive disorder, narcissistic covert disorder, bipolar disorder with depressive prevalence, obsessive disorder, avoidant disorder, and somatic disorder as secondary dysfunctional personality traits. Childhood and/or family trauma, capable of impacting the sexual and affective sphere, is present in almost the entire population. Conclusion: The syndrome should be framed as a specific phenomenon and not as a new psychopathological disorder, as the symptomatological descriptions are similar to the already known schizoid personality disorder; the symptomatological differences among patients should be framed according to a logic of correctives determined by the presence of one or more secondary psychopathological traits that draw a more complex personality picture than the simple nosographic diagnosis of the DSM-V.

Schizotypal traits in a large sample of high-school and university students from Tunisia: correlates and measurement invariance of the arabic schizotypal personality questionnaire across age and sex

BackgroundThe main goal of the present study was to examine the characteristics of schizotypal traits and their correlations with genetic (i.e., family history of mental illness), demographic (i.e., age, sex), environmental (e.g., income, urbanicity, tobacco/alcohol/cannabis use), and psychological (i.e., personal history of mental illness other than psychosis) factors in Tunisian high-school and university students. Our secondary goal was to contribute the literature by examining the factor structure and factorial invariance of the Arabic Schizotypal Personality Questionnaire (SPQ) across sex and age (adolescents [12–18 years] vs. young adults [18–35 years]) groups.MethodThis was a cross-sectional study involving 3166 students: 1160 (36.6%) high-school students (53.0% females, aged 14.9 ± 1.8); and 2006 (63.4%) university students (63.9% females, aged 21.8 ± 2.3). All students were asked to complete a paper-and-pencil self-administered questionnaire containing sociodemographic characteristics as well as the Arabic version of the SPQ.ResultsThe total sample yielded total SPQ scores of 24.1 ± 16.6 out of 74. The SPQ yielded good composite reliability as attested by McDonald's omega values ranging from .68 to .80 for all nine subscales. Confirmatory Factor Analysis indicated that fit of the 9-factor model of SPQ scores was acceptable. This model is invariant (at the configural, metric and structural levels) across sex and age. Except for “Odd or eccentric behavior”, all schizotypy features were significantly higher among female students compared to males. Multivariable analyses showed that female sex, being a university student, lowest family incomes, tobacco use, and having a personal history of psychiatric illness were significantly associated with higher positive, negative and disorganized schizotypy subscales scores.ConclusionFuture research still needs to confirm our findings and investigate the contribution of the identified factors in the development of clinical psychosis. We can also conclude that the Arabic SPQ is appropriate for measuring and comparing schizotypy across age and sex in clinical and research settings. These findings are highly relevant and essential for ensuring the clinical utility and applicability of the SPQ in cross-cultural research.

Neural bases of reward anticipation in healthy individuals with low, mid, and high levels of schizotypy

A growing body of research has placed the ventral striatum at the center of a network of cerebral regions involved in anticipating rewards in healthy controls. However, little is known about the functional connectivity of the ventral striatum associated with reward anticipation in healthy controls. In addition, few studies have investigated reward anticipation in healthy humans with different levels of schizotypy. Here, we investigated reward anticipation in eighty-four healthy individuals (44 females) recruited based on their schizotypy scores. Participants performed a variant of the Monetary Incentive Delay Task while undergoing event-related fMRI.Participants showed the expected decrease in response times for highly rewarded trials compared to non-rewarded trials. Whole-brain activation analyses replicated previous results, including activity in the ventral and dorsal striatum. Whole-brain psycho-physiological interaction analyses of the left and right ventral striatum revealed increased connectivity during reward anticipation with widespread regions in frontal, parietal and occipital cortex as well as the cerebellum and midbrain. Finally, we found no association between schizotypal personality severity and neural activity and cortico-striatal functional connectivity. In line with the motivational, attentional, and motor functions of rewards, our data reveal multifaceted cortico-striatal networks taking part in reward anticipation in healthy individuals. The ventral striatum is connected to regions of the salience, attentional, motor and visual networks during reward anticipation and thereby in a position to orchestrate optimal goal-directed behavior.

Insights and risk factors of involuntary hospitalizations through a retrospective analysis of police records: differences between involuntarily and non-hospitalized patients

Involuntary psychiatric admission poses a challenge in terms of providing the most effective yet least restrictive care in accordance with each country's regulations. Effective communication and coordination between the justice, police, and healthcare systems are essential for the successful implementation of this process. This study examines the sociodemographic, clinical, and parametric factors involved in the status of involuntary admission. A retrospective analysis of 292 cases grounded in the Hellenic Police records was conducted to indicate differences between involuntarily and non-hospitalized patients as well as risk and protective factors for the status of compulsory admission in psychiatric units located in Athens, Greece. Out of a total of 292 cases, 240 (77.4%) concerned involuntarily hospitalized patients, compared to 52 (16.8%) non-hospitalized. The most prevalent diagnosis among involuntarily hospitalized patients was schizophrenia, schizotypal, and delusional disorders (53.5%), in contrast to non-hospitalized patients, for whom it was affective disorders (33.3%). Affective disorders, along with neurotic, stress-related, and somatoform disorders, were found to offer a protective factor against involuntary hospitalizations. Our findings indicate that involuntary hospitalizations are associated with procedural downsides, detrimentally affecting mental health treatment recipients. Therefore, community-based compulsory therapeutic interventions should be incorporated into the mental health agenda of Greece.

Prolactin Level Changes according to Atypical Antipsychotics Use: A Study Based on Clinical Data Warehouse.

: Antipsychotic drugs are known as the major cause of non-neoplastic hyperprolactinemia. This study aimed to investigate the levels of serum prolactin depending on the use of antipsychotic drugs in patients through the Clinical Data Warehouse (CDW). : We conducted a cohort search in the CDW application and got 260 patients' medical records diagnosed with schizophrenia, schizotypal and delusional disorders, manic episodes, and bipolar affective disorders who were taking one of risperidone, blonanserin, amisulpride, and olanzapine. After that, we reviewed the medical data and used the ANCOVA analysis and the post hoc test to compare serum prolactin levels among four antipsychotic drug groups. : Among the 117 subjects included in the analysis, the mean serum prolactin level was 64.6 ± 54.6 ng/ml. Serum prolactin levels were significantly higher in subjects taking risperidone or amisulpride compared to blonanserin and olanzapine. The female subjects who took blonanserin, olanzapine, and risperidone had significantly higher prolactin levels, but there was no difference in serum prolactin levels between sex in the subjects who took amisulpride. : This study suggests the need for regular monitoring of serum prolactin levels in patients who are taking antipsychotics, especially in female patients. And we showed that there is a possibility to conduct more effective and simpler big data research using the CDW. Further studies on the subjects with controlled confounding variables and larger sample groups are needed.

Schizophrenia spectrum disorders in Denmark between 2000 and 2018: Incidence and early diagnostic transition.

Schizophrenia spectrum disorders (SSD) comprise a group of related mental disorders, which share clinical features and common genetic disposition, but it is unknown if there is a diagnostic transition between these disorders over time. We aimed to study the incidence at the first SSD diagnosis between 2000 and 2018, defined as schizophrenia, schizotypal or schizoaffective disorder, and the early diagnostic transition between these disorders. Using Danish nationwide healthcare registers, we identified all individuals aged 15-64 years during the period from 2000 to 2018 in Denmark and calculated the yearly incidence rates for the specific SSDs. We studied the diagnostic pathways from the first ever diagnosis of an SSD across the subsequent two treatment courses with an SSD diagnosis to evaluate early diagnostic stability, and explore potential changes over time. Among 21,538 patients, yearly incidence rates per 10,000 individuals were similar during the observation period for schizophrenia (2000: 1.8; 2018: 1.6), lower for schizoaffective disorder (2000: 0.3; 2018: 0.1) and increasing for schizotypal disorder (2000: 0.7; 2018: 1.3). Among the subgroup of 13,417 individuals with three separate treatment courses, early diagnostic stability was present among 89.9% which differed between the disorders (schizophrenia: 95.4%; schizotypal disorder: 78.0%; schizoaffective disorder: 80.5%). Among 1352 (10.1%) experiencing an early diagnostic transition, 398 (3.0%) were diagnosed with schizotypal disorder after a schizophrenia or schizoaffective disorder diagnosis. This study provides comprehensive incidence rates for SSDs. The majority of patients experienced early diagnostic stability, but sizable proportions of people with initial schizophrenia or schizoaffective disorder are subsequently diagnosed with schizotypal disorder.

Correlates of Homelessness Among Adults with Personality Disorder.

Although personality disorders (PDs) are more common among persons experiencing homelessness than the general population, few studies have investigated the risk of experiencing homelessness among persons with PDs. This study seeks to identify the demographic, socioeconomic, and behavioral health correlates of past-year homelessness among persons with antisocial, borderline, and schizotypal PDs. Nationally representative data of the civilian, noninstitutionalized population of the United States was used to identify correlates of homelessness. Descriptive statistics and bivariate associations between variables and homeless status were summarized prior to conducting several multivariate logistic regression models to identify correlates of homelessness. Main findings revealed positive associations between poverty, relationship dysfunction, and lifetime suicide attempt with homelessness. In the antisocial PD (ASPD) and borderline PD (BPD) models, comorbid BPD and ASPD, respectively, were associated with higher odds of past-year homelessness. Findings underscore the importance of poverty, interpersonal difficulties, and behavioral health comorbidities on homelessness among persons with ASPD, BPD, and schizotypal PD. Strategies to promote economic security, stable relationships, and interpersonal functioning may buffer against the effects of economic volatility and other systemic factors that could contribute to homelessness and persons with PD.

Auditory P300 in individuals with high schizotypy: associations of schizotypal traits with amplitude and latency under different oddball conditions.

The aim of this study was to compare the characteristics of auditory P300 between non-clinical individuals with high and low schizotypal traits, and investigate the relationship between schizotypy and P300 under various oddball conditions. An extreme-group design was adopted. After screening 1,519 young adults using the Schizotypal Personality Questionnaire (SPQ), sixty-three participants were chosen and divided into two groups (schizotypy group: 31 participants; control group: 32 participants). Basic demographic information was assessed and matched between groups. Depression and anxiety indexes were evaluated and controlled. The P300 component was evoked by an auditory oddball paradigm with different frequencies and durations. (1) The duration P300 amplitude at PZ site was significantly weaker in the schizotypy group than in the control group [F(1,54) = 7.455, p = 0.009, ηp2 = 0.121]. (2) In the schizotypy group, the latency of frequency P300 at PZ site under large-variant oddball condition was significantly correlated with total SPQ scores (rp = 0.451, p = 0.018) and disorganized dimension scores (rp = 0.381, p = 0.050). (3) In the control group, significantly negative correlations was found between the negative dimension score of SPQ and the frequency P300 amplitudes under small variant condition (PZ: rp = -0.393, p = 0.043; CPZ: rp = -0.406, p = 0.035). In addition, a significant negative relationship was found between disorganized dimension scores and the duration P300 latency at CPZ site under large-variant oddball condition (rp = -0.518, p = 0.006). Moreover, a significant negative association was found between the duration P300 amplitude at CPZ site under small-variant oddball condition and negative factor scores (rp = -0.410, p = 0.034). Individuals with high schizotypal traits were likely to have deficient attention and hypoactive working memory for processing auditory information, especially the duration of sounds. P300 effects were correlated with negative and disorganized schizotypy, rather than positive schizotypy. There were diverse patterns of relationship between schizotypal traits and P300 under different oddball conditions, suggesting that characteristics and parameters of target stimuli should be considered cautiously when implementing an auditory oddball paradigm for individuals with schizophrenia spectrum.

Cluster B Personality Disorder, Treatment, Comorbidity and Stigma

Schizoid, paranoid, and schizotypal personality disorders are examples of unusual or eccentrictraits shared by Cluster A. Antisocial, borderline, histrionic, and narcissistic personality disorders all fall under the category of cluster B personality disorders. Cluster B personality disorders, such as antisocial personality disorder, borderline personality disorder, narcissistic personality disorder, and performance personality disorder, will be the focus of this paper. The problems encountered in treating the disorders are investigated by comparing the similarities and co-morbidity of Cluster B personality disorders in parallel. Highlighted how people with personality disorders can be stigmatized in their lives and therapy. Elaborated on the negative impact of stigma on treating Cluster B personality disorder and how to counteract stigma. Through discussing this kind of personality disorders, we can put forward a scientific basis for how to prevent personality disorders in the future.

Neuroendocrine response to a psychosocial stress test is not related to schizotypy but cortisol elevation predicts inflexibility of semantic memory retrieval

An altered stress response can contribute to the transition from preclinical psychotic symptoms to the clinical manifestation of schizophrenia and other psychotic disorders. The present study was aimed at testing the hypotheses that (i) the autonomic and neuroendocrine responses under psychosocial stress are dysregulated in individuals with high psychosis proneness (schizotypy); (ii) the magnitude of post-stress autonomic activation and cortisol release predicts alterations in semantic memory retrieval. The study was performed in 73 healthy individuals of both sexes with either high or low schizotypal traits preselected out of 609 individuals using the Schizotypal Personality Questionnaire. A psychosocial stress procedure based on public speech was used as a stress model. We found that individuals with high schizotypy engaged in less adaptive emotional stress-coping strategies than low schizotypy individuals. Yet, the neuroendocrine, immune, and sympathetic activation in response to the stress test was not different between the groups. Irrespective of the exposure to the stressor, individuals with high schizotypy were less fluent when retrieving associations from semantic memory. In addition, we demonstrated that acute psychosocial stress reduced the flexibility of semantic memory retrieval. The post-stress mental inflexibility was reliably predicted by the concomitant elevation of cortisol concentrations in saliva. The present study thus brings novel evidence indicating that the acute psychosocial challenge impairs retrieval flexibility in the semantic domain, which may be due to neuroendocrine activation.

Hoarding: a new diagnosis against the traditional interpretation. Case of Artem L.

The article presents the case of twenty-year-old Artem L., whose clinical picture of the disease was dominated by an overvalued hobby in the form of pathological hoarding. The case was analyzed from the standpoint of highlighting a new diagnosis hording in international psychiatric classifications. Differential diagnosis of hording with schizotypal and obsessive-compulsive disorder, as well as with autism spectrum disorders was carried out. It is concluded that the emergence of a new diagnosis of hoarding requires the formation of new algorithms of diagnostic thinking in psychiatrists and the rejection of interpretations of paradoxical, seemingly pretentious behavior as belonging to the circle of schizophrenic disorders.

Examining Cognitive Biases Uniquely Associated with Schizotypy

Introduction: Individuals with schizotypy can experience a number of cognitive biases that may increase their risk in developing schizophrenia-spectrum psychopathology. However, cognitive biases are also present in mood and anxiety disorders, and it is currently unclear which biases are specific to schizotypy and which may be a result of comorbid depression and/or anxiety. Methods: 462 participants completed measures of depression, anxiety, cognitive biases, cognitive schemas, and schizotypy. Correlation analyses were conducted to examine the relationship between these constructs. Three hierarchical regression analyses were conducted to examine if schizotypy, depression, and anxiety explained a statistically significant amount of variance in cognitive biases after controlling for depression and anxiety, schizotypy and anxiety, and schizotypy and depression, respectively. Moderated regression analyses were also conducted to investigate the moderating role of biological sex and ethnicity in the association between cognitive biases and schizotypy. Results: Self-referential processing, belief inflexibility, and attention for threat were associated with schizotypy. The belief inflexibility bias and social cognition problems were specifically associated with schizotypy after controlling for depression and anxiety and were not directly associated with either depression or anxiety. These associations were not moderated by biological sex or ethnicity. Conclusion: The belief inflexibility bias may be an important cognitive bias underlying schizotypal personality, and further research will be important to determine whether this bias is also associated with an increased likelihood of transitioning to psychosis.

Antivax attitude in the general population along the autism-schizophrenia continuum and the impact of socio-demographic factors.

One of the most important inventions in human history is vaccines. However, to date a consistent amount of people exhibit a hesitant approach toward them and mixed results have emerged in the attempt to characterize which factors may play a role in predicting such negative attitude. Here, we aimed at investigating how the individual scoring along the autism-schizophrenic continuum component and socio-cultural factors contribute toward vaccination attitudes in the general population. To test whether individual position along the autism-schizophrenic continuum could predict vaccine attitude, we used principal component analysis (PCA) to extract the component showing diametric loading between the Schizotypal Personality Questionnaire (SPQ) and Autistic Quotient (AQ) subscales. Then, we performed a series of multiple linear regression analyses to understand the relation between the ASD-SSD continuum component and Vax scores. We also included socio-demographic factors (i.e., gender, education level, and age) as predictors. Multiple regression analysis revealed that the closer the individual lied on the positive schizotypal pole, the higher was their negative attitude toward vaccines. A diametric, more favorable disposition was found for individuals closer to the autistic end of the continuum. Furthermore, we reported that among the socio-cultural factors, only age can be considered a significant predictor of vaccination attitudes, with younger participants showing a more positive attitudes toward vaccination, while the level of education is an important protective factor in mitigating the negative impact that the proximity to the SSD pole and age play against vaccination disposition. These findings are relevant to improve targeted public health interventions, highlighting the crucial role of demographic, psychological, and social correlates in predicting anti-vax beliefs, which have the devasting potential to increase the spread of infectious disease.

An evolutionarily informed therapy for adolescents with prominent schizotypal traits: a pilot five case series

ABSTRACT Background There is a growing interest in the early assessment and treatment of maladaptive forms of personality traits in adolescents, though little is known about effective interventions. This case series aims to present the adaption of a therapy specifically tailored on schizotypal traits to adolescents. The treatment – Evolutionary Systems Therapy for Schizotypy – integrates evolutionary psychopathology, metacognitively oriented psychotherapy and compassion focused therapy. Methods Five adolescents attended 6-months of individual psychotherapy. All participants were diagnosed with schizotypal personality disorder in accordance with the DSM-5 Alternative Model of Personality Disorders. Primary outcome was remission from diagnosis. Secondary outcomes were a reliable change in personality pathology and distress and the acceptability of the intervention. Results Four out of five patients showed remission from diagnosis. All the participants showed reliable changes in personality pathology and distress whether comparing initial and final assessments or investigating monthly variations. Changes were maintained at 1-month follow-up. No adverse events were reported, and intervention was described as satisfactory and sustainable. Discussion Further research is needed to confirm the feasibility of the proposed treatment. This study suggests the importance of developing effective interventions for adolescents with personality disorder, especially for those at risk for severe manifestations.

Association Study of BDNF, SLC6A4, and FTO Genetic Variants with Schizophrenia Spectrum Disorders.

Schizophrenia spectrum disorders (patients with a diagnosis of schizophrenia, schizotypal, and delusional disorders: F20-F29 according to International Classification of Diseases 10th revision (ICD-10)) are considered highly heritable heterogeneous psychiatric conditions. Their pathophysiology is multifactorial with involved dysregulated serotonergic neurotransmission and synaptic plasticity. The present study aimed to evaluate the association of SLC6A4 (5-HTTLPR), FTO (rs9939609), and BDNF (rs6265, rs962369) polymorphisms with schizophrenia spectrum disorders in Slovak patients. We analyzed the genotypes of 150 patients with schizophrenia, schizotypal, and delusional disorders and compared them with genotypes from 178 healthy volunteers. We have found a marginally protective effect of LS + SS genotypes of 5-HTTLPR variant of the serotonin transporter SLC6A4 gene against the development of schizophrenia spectrum disorders, but the result failed to remain significant after Bonferroni correction. Similarly, we have not proven any significant association between other selected genetic variants and schizophrenia and related disorders. Studies including a higher number of subjects are warranted to reliably confirm the presence or absence of the studied associations.

Epidemiological Analysis of Mental Health Disorders in Patients at Psychiatric Hospitals in the Special Region of Yogyakarta, Indonesia

Background: Mental disorder is a condition of decreasing all psychiatric conditions that result in deviant behavior. WHO estimates that one in eight people in the world lives with a mental disorder in the world. The COVID-19 pandemic that has occurred since 2019 has had an impact and has had a major impact on the mental health of people in the world and in Indonesia. The Special Region of Yogyakarta is the province with the highest cases of mental disorders in Indonesia based on the results of the 2013 and 2018 Basic Health Research (Riskesdas) surveys. The purpose of this study was to determine the epidemiological description of mental disorders per classification in inpatients at Mental Hospitals in the Special Region of Yogyakarta in 2019-2021.Subjects and Method: This study used a quantitative descriptive method, sourced from secondary data from Mental Hospitals in the Special Region of Yogyakarta for the period 2019 - 2021. The population in this study was 4,413, with a total sample of 3,919. The inclusion criteria are data of inpatients with mental disorders recorded in the recapitulation of medical records of inpatients at the Mental Hospital for the period 2019 to 2021. Exclusion criteria are incomplete data. The sampling technique used is total sampling. The person variable consists of a classification of mental disorders, age, gender, education level, occupation, marital status, health insurance, and end of care. The instrument used in this research is a dummy table. Data from this study were analyzed descriptively by looking at the frequency and proportion of each variable studied.Results: The results showed that the highest disease classification was F20-F29 (schizophrenia, schizotypal disorder, and delusional disorder) 76.72%. Most of them were aged 25-44 years (55.60%), male (61.55%), graduated from high school or equivalent (46.54%), did not work (66.90%), and were not married (57.29%). Most of them use national health insurance (62.95%), end of treatment with doctor's approval (97.86%), and length of stay ≤ 42 days (95.1%). Most of the patients came from Sleman Regency (37.25%) and from urban areas (71.37%).Conclusion: Most patients with mental disorders are in productive age. People with mental disorders are an economic burden that must be borne by their families and the government. So there is a need for comprehensive prevention efforts to reduce the incidence of mental disorders in the community.Keywords: mental disorders, epidemiological studies, schizophreniaCorrespondence: Siti Kurnia Widi Hastuti, Faculty of Public Health Universitas Ahmad Dahlan. Jl Prof Dr Soepomo Warungboto Umbulharjo, Special Region of Yogyakarta, Indonesia. Email: kurnia.widihastuti@ikm.uad.ac.id. Mobile: +62813-2843-3256.Indonesian Journal of Medicine (2023), 08(02): 204-218https://doi.org/10.26911/theijmed.2023.08.02.10

The relationship of frustration reactions and gender role behavior in patients with schizophrenia and affective disorders

The study of violations of the adaptive-compensatory mechanisms of patients with mental disorders makes it relevant to study the combined characteristics of gender, psychosexual sphere and response to stress in mental pathology. The aim of the study was to identify the relationship between the types and directions of frustration reactions as unconscious components of coping with gender and gender-role behavior. 183 patients with diagnoses of schizophrenia and schizotypal disorder, recurrent depressive disorder, bipolar affective disorder were examined. In the diagnostic groups, men and women were dominated by persons under the age of 30. The «Method of diagnostics of gender role behavior accentuations» and «Drawing Associations test» were used. The data obtained indicate that among patients with schizophrenia, men with cross-gender role accentuation better assimilate socio-normative patterns of behavior than women with cross-gender role accentuation; in women with schizotypal disorder, the presence of cross-gender accentuation of gender-role behavior is associated with a lower level of social adaptation compared to women without accentuation.Women with schizotypal disorder and more pronounced masculine gender role accentuation have a profile of the direction of emotional reactions in frustrating situations, characteristic of men with schizotypal disorder. In ontogenesis, the interrelationships of stereotypes of emotional response and the level of gender role accentuation change. The revealed sex differences in the profiles of frustration reactions among patients on the schizophrenic spectrum may be partially explained by the gender-role characteristics of patients. In conclusion of the analysis, it can be concluded that the stereotypes of a person’s emotional response and their formation are closely related to gender-role behavior. Knowledge of this kind of interrelationships enables the psychotherapist in the course of treatment to achieve the patient’s understanding of his behavior, including its unconscious aspects.

Cognitive Processes and Resting-State Functional Neuroimaging Findings in High Schizotypal Individuals and Schizotypal Personality Disorder Patients: A Systematic Review.

Ample research findings indicate that there is altered brain functioning in the schizophrenia spectrum. Nevertheless, functional neuroimaging findings remain ambiguous for healthy individuals expressing high schizotypal traits and patients with schizotypal personality disorder (SPD). The purpose of this systematic review was to identify patterns of task-related and resting-state neural abnormalities across these conditions. MEDLINE-PubMed and PsycINFO were systematically searched and forty-eight studies were selected. Forty studies assessed healthy individuals with high schizotypal traits and eight studies examined SPD patients with functional neuroimaging techniques (fNIRS; fMRI; Resting-state fMRI). Functional alterations in striatal, frontal and temporal regions were found in healthy individuals with high schizotypal traits. Schizotypal personality disorder was associated with default mode network abnormalities but further research is required in order to better conceive its neural correlates. There was also evidence for functional compensatory mechanisms associated with both conditions. To conclude, the findings suggest that brain dysfunctions are evident in individuals who lie along the subclinical part of the spectrum, further supporting the continuum model for schizophrenia susceptibility. Additional research is required in order to delineate the counterbalancing processes implicated in the schizophrenia spectrum, as this approach will provide promising insights for both conversion and protection from conversion into schizophrenia.

Les adolescents aux urgences psychiatriques : motifs de consultation, diagnostics psychiatriques et orientation

IntroductionThe CPOA (Centre Psychiatrique d’Orientation et d’Accueil) is the largest psychiatric emergency center in France, with more than 10,000 consultations per year. The aim of our retrospective observational study is to describe the population of patients aged 15 to 18 years (18 years old not included) consulting our center (reasons for consultation, psychiatric diagnoses, referral decision by specifying the structures to which these minors are referred) and to describe a predictive model for the decision to hospitalize. MethodsAll consecutive patients aged over 15 and under 18 consulting in the CPOA between January 1, 2017 and December 31, 2021 were included in the study. The characteristics of our study sample are described in terms of proportions for qualitative variables and with means and standard deviations for quantitative variables. The probability of being hospitalized was modeled on the entire sample using a multivariate Probit model for which the hypotheses of validity were tested. ResultsWe have recorded 2712 visits, corresponding to 1873 patients included in our study (mean age=16.2±0.72, 54% girls), i.e. an average of 5.2% of the total patients. The main reasons for consultation were depressive ideations (22%), anxiety (19%), and suicidal thoughts (18%). The most frequently diagnosed psychiatric disorders according to the 10th revision of the International Classification of Diseases were F30-39 (mood disorders) (34%), F40-48 (neurotic, stress-related and somatoform disorders) (24%) and F60–69 (personality and behavioral disorders) (11%). Among the patients with an indication for hospitalization, i.e. 27%, 85% were admitted in adult units and fewer than 12% in adolescent specific units, while among the patients with an outpatient care, i.e. 65% in total, only 11% were referred to child psychiatry consultations. An older age, a suicide attempt in the week preceding the visit to the psychiatric emergency department, suicidal behaviour and suicidal ideations, hetero-aggressive behaviour, psychomotor agitation or excitement, delusions, wandering, running away or pathological travel, and a diagnosis of type F20–F29 (Schizophrenia, schizotypal disorder and delusional disorders) and F30–F39 were significantly predictive of a decision to hospitalize. ConclusionPsychiatric hospitalization of adolescents consulting due to psychiatric emergencies is a major problem. The predictive factors for hospitalization reflect an absolute need for immediate care. Unfortunately the lack of structures dedicated to adolescents is such that three quarters of adolescents end up hospitalized in adult structures, which is neither appropriate nor acceptable.