Schizophrenia Spectrum Conditions Research Articles

Can you believe your eyes? Positive schizotypy is associated with increased susceptibility to the Müller-Lyer illusion

Background and hypothesisVisual illusions provide a unique opportunity to understand cognitive and perceptual alterations in schizophrenia-spectrum conditions. Schizophrenia patients often exhibit increased susceptibility to the Müller-Lyer illusion. Here, we investigate susceptibility to the Müller-Lyer visual illusion in the general population with different levels of schizotypy. Study designWe assessed a population-based convenience sample (N = 263) on an online platform. In addition to basic demographics, participants completed the Müller-Lyer illusion, the Cardiff Anomalous Perceptions Scale (CAPS) to measure perceptual anomalies, and the Multidimensional Schizotypy Scale – Brief (MSS-B) for schizotypic traits. To evaluate what predicts susceptibility to the illusion, we fitted a large set of multilevel logistic regression models and performed model averaging over the coefficients. Study resultsWe found support for increased illusion susceptibility among individuals with high positive schizotypy. However, we did not find a comparable effect for anomalous perceptions alone, or for negative or disorganized schizotypy. ConclusionsThe increased Müller-Lyer effect in positive schizotypy might be specific to delusion-like beliefs and magical ideation. Further research is needed to clarify how a hierarchical Bayesian formulation of brain function (e.g. imbalances between bottom-up perceptual processing and substantial reliance on prior expectations) can account for the Müller-Lyer effect in schizophrenia-spectrum conditions.

Investigation of the Relationship Between Orientation Discrimination Thresholds, Autistic, and Schizotypal Personality Traits

Imbalances in cortical excitation and inhibition (E-I) have been implicated in both autism spectrum conditions (ASC) and schizophrenia spectrum conditions (SSC). However, most studies investigate these clinical conditions independently, possibly due to the difficulty of obtaining comorbid clinical populations. As such, the current study investigated the relationship between performance in the orientation discrimination task “ODT” as a potential proxy for E-I balance and the autistic (as assessed by Autism Spectrum Quotient “AQ”) and schizotypal personality traits (as assessed by Schizotypal Personality Questionnaire-Brief “SPQ-BR”) in the general population. 87 healthy adult volunteers participated in the study. We found that high autistic personality traits are associated with enhanced performance in the oblique condition of ODT. In contrast, high schizotypal personality traits are associated with poor performance in the vertical condition of ODT. Such associations support the suggested disruption of cortical E-I balance in ASC and SSC.

Self-Disorder in Schizophrenia: A Revised View (2. Theoretical Revision-Hyperreflexivity).

A growing body of research supports the role of self-disorders as core phenotypic features of schizophrenia-spectrum conditions. Self-disorders comprise various alterations of conscious experience whose theoretical understanding continues to present a challenge. This is the second of two articles that aim to clarify the nature of self-disorders in schizophrenia by considering the currently most influential, phenomenological model of schizophrenia: the basic-self-disturbance or ipseity-disorder model (IDM). The previous paper (article 1) presented a state-of-the-art overview of this model and critically assessed its descriptive adequacy with respect to the clinical heterogeneity and variability of the alterations in self- and world-awareness characteristic of schizophrenia. This paper (article 2) proposes a theoretical revision by considering how hyperreflexivity might form the crucial common thread or generating factor that unifies the heterogeneous, and sometimes even contradictory features of schizophrenic self-disorders. We outline implications of our revised model (IDMrevised) for explanatory research, therapeutic practice, and our general understanding of the abnormalities in question.

Securing direct stakeholder feedback to inform clinical research in serious mental illness: Results of a patient and family perspectives survey

Mental illness research routinely includes unfamiliar or potentially frightening procedures like lumbar puncture (LP), contributing to low enrollment and retention. Previous studies related to LP acceptance have focused on older individuals, and little information on participant preferences for educational materials is available. We developed an online survey assessing existing knowledge, comfort and concerns, and preferences for educational materials in the context of our clinical study on schizophrenia spectrum conditions (SSCs). We found that participants were generally knowledgeable and interested in engaging with clinical SSC research. Frequency of engagement with research publications differed significantly by participant groups and age. Comfort levels were consistently highest for study procedures other than LP, though surprisingly the average number of informational needs per procedure was not significantly different for LP compared to other procedures. Preferences for format and source of educational materials varied across participant groups and age. Our results suggest that younger individuals with an SSC diagnosis are likely to have limited exposure to information, and proactively providing accessible and accurate educational materials may improve positive perceptions of LP. Providing content in a range of formats and sources will ensure that participants and their support networks have access to their preferred resources.

The moderating role of early traumatic experiences on the association of schizotypal traits with visual perception.

The findings on the association of schizotypal traits with the perception of visual illusions are scarce and inconsistent and have not taken into consideration potential effects of childhood traumatic experiences, a risk factor for schizophrenia-spectrum conditions. Thus, the present study addressed the question of potential moderating effects of early traumatic experiences on the association between different aspects of schizotypal traits with the perception of the Müller-Lyer and Navon's Hierarchical Letters (NHL) illusions. The study revealed that (a) increased suspiciousness was associated with increased liability to the Müller-Lyer illusion, when the exposure to traumatic events was high, whereas the opposite pattern was true when the exposure to traumatic events was low; (b) negative schizotypy was associated with more accurate global perception, and high disorganized schizotypy was associated with superior accuracy when target letters were present during the NHL illusion, when early traumatic experiences were at lower levels; and (c) high negative, disorganized, and total schizotypy were associated with lower accuracy when target letters were present in the NHL paradigm, when early traumatic experiences were at higher levels. The findings of the study suggest that early traumatic events differentially moderate the relationship between various aspects of schizotypal traits and visual perceptual processing.

The Relationship Between Affective Visual Mismatch Negativity and Interpersonal Difficulties Across Autism and Schizotypal Traits.

Sensory deficits are a feature of autism and schizophrenia, as well as the upper end of their non-clinical spectra. The mismatch negativity (MMN), an index of pre-attentive auditory processing, is particularly sensitive in detecting such deficits; however, little is known about the relationship between the visual MMN (vMMN) to facial emotions and autism and schizophrenia spectrum symptom domains. We probed the vMMN to happy, sad, and neutral faces in 61 healthy adults (18–40 years, 32 female), and evaluated their degree of autism and schizophrenia spectrum traits using the Autism Spectrum Quotient (AQ) and Schizotypal Personality Questionnaire (SPQ). The vMMN to happy faces was significantly larger than the vMMNs to sad and neutral faces. The vMMN to happy faces was associated with interpersonal difficulties as indexed by AQ Communication and Attention to Detail subscales, and SPQ associated with more interpersonal difficulties. These data suggest that pre-attentive processing of positive affect might be more specific to the interpersonal features associated with autism and schizophrenia. These findings add valuable insights into the growing body of literature investigating symptom-specific neurobiological markers of autism and schizophrenia spectrum conditions.

A pilot choral intervention in individuals with schizophrenia-spectrum conditions; Singing away loneliness.

Social disconnection is associated with poor outcome and long-term disability in individuals with schizophrenia-spectrum conditions (SCZ) but social isolation is not typically a target for treatment. Singing together has long been shown to promote unique group cohesion and improve sense of well-being across the lifespan. Accordingly, we devised a novel choral intervention to examine the potential efficacy of this low-burden social intervention strategy designed to reduce loneliness in SCZ. Seventeen SCZ participated in a weekly, 1-hr choir group for 8 weeks. At pre- and post-intervention, we examined symptoms, loneliness, stress, and face recognition. Choral intervention led to significant reductions in scores for loneliness, the Brief Psychiatric Rating Scale (BPRS) and the Beck Depression Inventory-II (BDI-II). No significant changes were observed in scores for the Scale for the Assessment of Negative Symptoms (SANS), the Scale for the Assessment of Positive Symptoms (SAPS), face recognition, or the Perceived Stress Scale (PSS). Diminished loneliness was inversely correlated with the number of sessions attended. Participants judged the choir intervention to be acceptable and enjoyable. Reduced loneliness and symptom improvement after 8 weeks of intervention in SCZ suggest that choral intervention presents an enjoyable and low-burden opportunity to collaborate in a group setting for isolated individuals and thus may serve as a beneficial adjunct in a multi-arm intervention strategy for alleviating symptom distress and loneliness.

TU29. GENETICS OF AGE-AT-ONSET IN MAJOR DEPRESSION

Recent evidence suggests that comorbidities between neuropsychiatric conditions and metabolic syndrome may precede and even exacerbate long-term side-effects of psychiatric medication, such as a higher risk of type 2 diabetes and cardiovascular disease, which result in increased mortality. In the present study we compare the expression of key metabolic proteins, including the insulin receptor (CD220), glucose transporter 1 (GLUT1) and fatty acid translocase (CD36), on peripheral blood mononuclear cell subtypes from patients across the neuropsychiatric spectrum, including schizophrenia, bipolar disorder, major depression and autism spectrum conditions (n = 25/condition), relative to typical controls (n = 100). This revealed alterations in the expression of these proteins that were specific to schizophrenia. Further characterization of metabolic alterations in an extended cohort of first-onset antipsychotic drug-naïve schizophrenia patients (n = 58) and controls (n = 63) revealed that the relationship between insulin receptor expression in monocytes and physiological insulin sensitivity was disrupted in schizophrenia and that altered expression of the insulin receptor was associated with whole genome polygenic risk scores for schizophrenia. Finally, longitudinal follow-up of the schizophrenia patients over the course of antipsychotic drug treatment revealed that peripheral metabolic markers predicted changes in psychopathology and the principal side effect of weight gain at clinically relevant time points. These findings suggest that peripheral blood cells can provide an accessible surrogate model for metabolic alterations in schizophrenia and have the potential to stratify subgroups of patients with different clinical outcomes or a greater risk of developing metabolic complications following antipsychotic therapy.

Resilience and its inter‐relationship with symptomatology, illness course, psychosocial functioning, and mediational roles in schizophrenia: A systematic review

Schizophrenia is a major psychiatric disorder which poses substantial illness burden on affected individuals. In view of the need to better understand the growing literature on resilience (adaptation in the face of adversity) and its clinical correlates to inform and optimize clinical management in schizophrenia, we sought to summarize the extant literature which examined the inter-relationships between resilience and demographic features, phenomenology, illness course, psychosocial functioning, and its mediational role among relevant factors. A systematic review was conducted on published empirical studies examining the topic of resilience and clinical correlates within schizophrenia spectrum conditions up until December 2020. Higher level of resilience was associated with lower severity of specific symptomatology including positive, negative, depressive symptoms, suicidal ideation, cognitive deficits, and better insight. Moreover, higher resilience was significantly associated with different aspects of illness course (such as shorter duration of untreated psychosis, longer duration of illness, improved symptom remission and recovery), internal factors (such as lower stigma, better self-esteem), and psychosocial functioning (better overall, real-life, social and interpersonal functioning, better quality of life). Resilience also acts as a mediator in pathways leading to depression, functioning, and quality of life within schizophrenia spectrum conditions. Viewed within the context of various resiliency models (compensatory, challenge, protective factor models), suggestions were made to enhance resilience and balance risk versus protective factors in order to improve disease management. Future research should seek to better elucidate associated biomarkers, inter-relationships with carer resilience, and evaluate the efficacy of suitable resilience-targeted interventions in schizophrenia.

Interpersonal Coordination in Schizophrenia: A Scoping Review of the Literature.

Interpersonal coordination forms the natural bridge between the self and others. It arises from the dynamic and complex set of embodied processes that involve nonverbal behaviors, perceptions, movement, and emotions that support adaptive interactions. Disembodiment has been implicated in a myriad of core clinical phenomena that manifest in a "praecox feeling" in persons with schizophrenia during interpersonal interactions. To further understand mechanisms underlying aberrant interpersonal interactions in schizophrenia, recent research has focused on mimicry, imitation, and interactional synchrony. In this study, we conducted a Pubmed, Web of Science, and PsycInfo database review of the literature on interpersonal coordination in schizophrenia to evaluate the body of work in mimicry, imitation, and interactional synchrony in relation to schizophrenia-spectrum conditions. The results of the review suggest that the sensory-motor processes underlying interpersonal coordination may result in impaired abilities to mimic and synchronize nonverbal behavior during interactions. Opportunities for future progress lie in studies of interpersonal coordination at different developmental stages of psychosis, potential use of interpersonal coordination to improve treatment adherence and reduce stigma, as well as interventions to improve social functioning in people with a serious mental illness.

Social Cognition and Friendships in Adolescents With Autistic-Like Experiences and Psychotic-Like Experiences.

Autism spectrum conditions (ASC) and schizophrenia spectrum conditions (SSC) are both characterized by changes in social-cognitive functioning. Less is known about the overlap and the differences in social-cognitive functioning when comparing individuals with subclinical levels of ASC and SSC, while studies in non-clinical samples have the benefit of avoiding confounds that are present in clinical groups. Therefore, we first examined how autistic-like experiences, positive psychotic-like experiences and the co-occurrence of both correlated with the performance on an extensive battery of social cognition tasks in young adolescents. Second, we examined the effect of autistic-like experiences, psychotic-like experiences and their co-occurrence on friendships in daily life. A total of 305 adolescents (Mage = 12.6, sd = 0.4, 147 boys) participated in the current study. A battery of social cognition tasks, comprising the Reading the Mind in the Eyes task, Dot perspective task and trust game were individually administered in a classroom setting, along with a friendship peer nomination questionnaire. Results indicated no evidence for a relationship between the performance on the social cognition battery and subclinical experiences of autism and/or psychosis. However, results did show that the amount of autistic-like experiences of adolescents were associated with being less often selected as a friend by their peers. By contrast, no relationship between self-reported friendships and autistic-like experiences was found. Neither a relationship between friendships and psychotic-like experiences was reported. This study provides initial evidence that information provided by peers may shed light on (altered) social behavior associated with autistic-like experiences that is not apparent on performance measures, as well as elucidate possible differences between autistic- and psychotic-like experiences.

Exploring cellular markers of metabolic syndrome in peripheral blood mononuclear cells across the neuropsychiatric spectrum

Recent evidence suggests that comorbidities between neuropsychiatric conditions and metabolic syndrome may precede and even exacerbate long-term side-effects of psychiatric medication, such as a higher risk of type 2 diabetes and cardiovascular disease, which result in increased mortality. In the present study we compare the expression of key metabolic proteins, including the insulin receptor (CD220), glucose transporter 1 (GLUT1) and fatty acid translocase (CD36), on peripheral blood mononuclear cell subtypes from patients across the neuropsychiatric spectrum, including schizophrenia, bipolar disorder, major depression and autism spectrum conditions (n = 25/condition), relative to typical controls (n = 100). This revealed alterations in the expression of these proteins that were specific to schizophrenia. Further characterization of metabolic alterations in an extended cohort of first-onset antipsychotic drug-naïve schizophrenia patients (n = 58) and controls (n = 63) revealed that the relationship between insulin receptor expression in monocytes and physiological insulin sensitivity was disrupted in schizophrenia and that altered expression of the insulin receptor was associated with whole genome polygenic risk scores for schizophrenia. Finally, longitudinal follow-up of the schizophrenia patients over the course of antipsychotic drug treatment revealed that peripheral metabolic markers predicted changes in psychopathology and the principal side effect of weight gain at clinically relevant time points. These findings suggest that peripheral blood cells can provide an accessible surrogate model for metabolic alterations in schizophrenia and have the potential to stratify subgroups of patients with different clinical outcomes or a greater risk of developing metabolic complications following antipsychotic therapy.

T228. SOCIAL REWARD REACTIVITY AND SENSITIVITY IN SCHIZOPHRENIA SPECTRUM CONDITIONS

BackgroundIndividuals with schizophrenia spectrum disorders often experience less pleasure during social interaction and frequently demonstrate reduced social motivation. This research examines the extent to which these behaviours may be linked to reduced social reward reactivity and sensitivity, and aims to clarify whether schizophrenia spectrum traits are associated with reduced behavioural and neural responsiveness to social rewards. It includes a systematic review and meta-analyses of social reward sensitivity research in schizophrenia, and also provides preliminary data (participant n = 50) on a novel avatar-based social incentive delay task that was created to further investigate the links between schizophrenia spectrum traits and social reward reactivity.MethodsFirst, a systematic review and meta-analyses (literature database search conducted November 2019) found six studies that investigated social reward anticipation and consumption within the schizophrenia continuum (total participant n = 440). Four investigated social reward sensitivity in clinical samples with schizophrenia diagnoses, and two studied the links between social anhedonia traits and social reward responding in normative samples. The novel social incentive delay task presents participants with the opportunity to win animated avatar-based monetary or social rewards by responding to a cued target.ResultsThe narrative review and meta-analyses of behavioural data from clinical and normative samples found that individuals with schizophrenia diagnoses or traits demonstrate significantly reduced behavioural anticipation of social rewards in comparison to healthy controls. Furthermore, this reduced reward reactivity was more pronounced for social rewards than for monetary rewards. This effect was also mirrored at neural levels, with individuals with schizophrenia demonstrating reduced social reward-related activation in areas such as the ventral striatum and anterior cingulate cortex. Preliminary behavioural data from the social incentive delay task suggest that, in normative samples, more pronounced negative schizotypal traits are associated with reduced anticipation and consumption of social rewards. Like in the reviewed studies, this reduced anticipation was more marked for social rewards than for monetary rewards.DiscussionThis research suggests that schizophrenia spectrum traits are associated with reduced reactivity and sensitivity to social rewards. It also highlights that this reduced reactivity is demonstrated at behavioural and neural levels, and is more marked for social rewards than for monetary rewards. We consider the implications of these findings for treatment programmes that target atypical social behaviour within schizophrenia spectrum conditions. A series of methodological recommendations for future work investigating social reward reactivity in schizophrenia are also included.

Is perception the missing link between creativity, curiosity and schizotypy? Evidence from spontaneous eye-movements and responses to auditory oddball stimuli

What is the relationship between creativity, curiosity, and schizotypy? Schizophrenia-spectrum conditions and creativity have been linked to deficits in filtering sensory information, and curiosity is associated with information-seeking. This raises the possibility of a perception-based link between all three concepts. Here, we investigated whether the same individual differences in perceptual encoding explain variance in creativity, curiosity, and schizotypy. We administered an active auditory oddball task and a free viewing eye-tracking paradigm (N = 88). Creativity was measured with the figural portion of the Torrance Tests of Creative Thinking (TTCT) and two self-report scales. Schizotypy and curiosity were measured with self-reports. We found that creativity was associated with increased reaction time to the rare tone in the oddball task and was positively associated with the number and duration of fixations in the free viewing task. Schizotypy, on the other hand, showed a negative trend with the number and duration of fixations. Both creativity and curiosity were positively associated with explorative eye movements (unique number of regions visited) and Shannon entropy, while schizotypy was negatively associated with entropy. We further compared saliency maps finding that individuals high versus low in creativity and curiosity, respectively, exhibit differences in where they look. These findings may suggest a perception-based link between creativity and curiosity, but not schizotypy. Implications and limitations of these findings are discussed.

Social Life in the Schizophrenia Spectrum: A Phenomenological Study of Five Patients

Background: Social difficulties are a hallmark of schizophrenia spectrum conditions, yet their background and exact nature remain contested. Previous pivotal studies on chronically ill patients have suggested that a position of “positive withdrawal” is associated with a decreased tendency to rehospitalization. This concept designates an essentially withdrawn but not negatively experienced position balanced by elements relating the individual to the social world. Objectives: To explore a less ill subgroup of schizophrenia spectrum patients’ ways of navigating the social world and examine potential links to anomalous self-experiences by applying key insights from phenomenology and anthropology. Method: The present study was part of a 5-year follow-up on a group of first-admission schizophrenia spectrum patients. From this sample of 48 patients, 5 were selected for qualitative evaluation following the principles of thematic analysis. Results: A “positively withdrawn” position characterizes a wider group of patients than originally reported. Further, we identified a preference for partaking in social activities in particular circumstances with clearly circumscribed goals or social roles and rules. This alleviated social discomfort and helped patients stay embedded in a social milieu. All patients experienced high levels of self-disorders. Conclusions: We suggest that certain aspects of social impairment may, in fact, reflect meaningful compensatory mechanisms, and argue that this conceptualization of social difficulties is relevant to various psychotherapeutic interventions.

Emotional expression in psychiatric conditions: New technology for clinicians.

Emotional expressions are one of the most widely studied topics in neuroscience, from both clinical and non-clinical perspectives. Atypical emotional expressions are seen in various psychiatric conditions, including schizophrenia, depression, and autism spectrum conditions. Understanding the basics of emotional expressions and recognition can be crucial for diagnostic and therapeutic procedures. Emotions can be expressed in the face, gesture, posture, voice, and behavior and affect physiological parameters, such as the heart rate or body temperature. With modern technology, clinicians can use a variety of tools ranging from sophisticated laboratory equipment to smartphones and web cameras. The aim of this paper is to review the currently used tools using modern technology and discuss their usefulness as well as possible future directions in emotional expression research and treatment strategies. The authors conducted a literature review in the PubMed, EBSCO, and SCOPUS databases, using the following key words: 'emotions,' 'emotional expression,' 'affective computing,' and 'autism.' The most relevant and up-to-date publications were identified and discussed. Search results were supplemented by the authors' own research in the field of emotional expression. We present a critical review of the currently available technical diagnostic and therapeutic methods. The most important studies are summarized in a table. Most of the currently available methods have not been adequately validated in clinical settings. They may be a great help in everyday practice; however, they need further testing. Future directions in this field include more virtual-reality-based and interactive interventions, as well as development and improvement of humanoid robots.

28.2 DISORDERS OF THE EMBODIED SELF IN SCHIZOPHRENIA: AT THE CROSSROAD BETWEEN DEVELOPMENT AND PSYCHOPATHOLOGY

BackgroundBasic disorders of the embodied self (BDES) encompass a cloud of related clinical constructs (e.g. cenesthesias, distortions of somato-psychic unity, anomalous bodily experiences in a broad sense) that are immanently related to a profound transformation of subjectivity and with the developmental modulation of bodily awareness. They have been historically ascribed a potential role in the emergence of schizophrenia spectrum disorders. However, the clinical-phenomenological level of description has been only marginally integrated with novel insights from developmental psychopathology and neurosciences. ​MethodsWe conducted a conceptual literature review based on clinical analysis and heuristic synthesis.ResultsDespite often occurring in prodromal/clinical at-risk states, as well as in full blown schizophrenia spectrum conditions (where BDES play a pivotal psychopathogenetic role in the genesis of productive symptoms), they are relatively neglected both in research and in routine clinical examination. Furthermore, BDES also discriminate non help-seeking genetic high risk subjects from normal controls.DiscussionWithin the superordinate construct of Self-disorders, BDES are a potentially relevant dimensional phenotype for the characterization of broad Schizophrenia Spectrum vulnerability. Their contextualization within a developmental and neurophysiological perspective could further amplify their value for etio-pathogenetic research. ​

Clinical Manifestations of Self-disorders in Schizophrenia Spectrum Conditions

Abstract This article explores the phenomenologically informed, theoretical and empirical research direction on self-disorders in the schizophrenia spectrum conditions. First, we describe the concept of ‘self’ that is operative in the concept of ‘self-disorders’ and we discuss how this self may be disordered or fragile in the schizophrenia spectrum. Second, we offer a detailed psychopathological presentation and discussion of 3 patients with schizophrenia. The vignettes provide paradigmatic examples of self-disorders in schizophrenia. Third, we summarize the main findings in the current empirical research on self-disorders. These findings consistently indicate that self-disorders constitute a crucial, trait phenotype of the schizophrenia spectrum.

Do Family Interventions Improve Outcomes in Early Psychosis? A Systematic Review and Meta-Analysis.

Family interventions for psychosis (FIp) are effective in reducing service user relapse and carer distress in people with schizophrenia-spectrum conditions. Several treatment and best practice guidelines recommend FIp for all people with schizophrenia. However, outcome findings in relation to early psychosis groups have been inconsistent. The current paper reports a systematic review and meta-analyses of articles that evaluated FIp in early psychosis with a clearly defined comparison group. A combination of electronic database searches (using PsychINFO, Medline, and CENTRAL), citation searches and hand searches of key journals and reviews was conducted. Peer-reviewed articles published in English from database inception to June 2016 were included. Methodological quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool (EPHPP). Seventeen papers from 14 studies met inclusion criteria for review, the overall quality of which was moderate. Meta-analytic synthesis showed that FIp improved service user functioning and reduced the likelihood of relapse by the end of treatment. Psychotic symptoms were significantly reduced in the FIp group at follow up, but this was not evident at end of treatment. In terms of FIp target mechanisms, carers receiving FIp were more likely to shift from high to low expressed emotion and less likely to report patient focused criticism or engage in conflict communication than carers randomized to standard care. Carer burden and well-being were improved by the end of treatment but gains were not sustained at follow up. FIp had no impact on carer emotional over-involvement. The findings indicate that FIp is an effective intervention for early psychosis service users and their relatives. However, further research is required to establish which key therapeutic components of FIp are most effective for whom, in addition to understanding the mechanisms by which FIp might affect positive change.

Atmosphere: On the Phenomenology of “Atmospheric” Alterations in Schizophrenia - Overall Sense of Reality, Familiarity, Vitality, Meaning, or Relevance (Ancillary Article to EAWE Domain 5)

“Atmospheric” alterations are key aspects of altered subjectivity in mental disorder. Karl Jaspers famously described the “delusional mood”: a sense of uncanny salience and ominousness that often precedes the onset of schizophrenic psychosis or of delusions. Such experiences, he writes, involve “a transformation in our total awareness of reality” that often verges on ineffability. In psychiatry, these experiential alterations are often referred to in terms of “derealization.” Though derealization most obviously refers to a decline in the sense of objective presence or felt actuality, it can also refer to other unusual experiences in which things seem unlike normal or standard reality, including altered familiarity, vitality, meaning, or relevance. This paper first describes two complementary ways of approaching these phenomena: the notion of an “ontological” dimension (Sass) and that of “existential feeling” (Ratcliffe). It then offers a wider-ranging synopsis of work in phenomenological psychopathology that has sought to address atmospheric alterations believed to be especially characteristic of schizophrenia spectrum conditions, focusing on the themes of a diminished sense of reality, altered sense of meaning, disrupted feeling of familiarity, and diminished vitality and relevance.