Subthreshold Psychotic Experiences Research Articles

The relationship between childhood trauma, psychotic symptoms, and cognitive schemas in patients with schizophrenia, their siblings, and healthy controls: results from the EU-GEI study.

The relationship between childhood trauma (CT) and psychotic symptoms in patients with schizophrenia (SCZ), and subthreshold psychotic experiences in non-clinical populations is well-established. However, little is known about the relationship between subtypes of trauma and specific symptoms in patients, their siblings, and controls. It is also not clear which variables mediate the relationship between trauma and psychotic symptoms. Seven hundred and forty-two patients with SCZ, 718 of their unaffected siblings and 1039 controls from three EU-GEI sites were assessed for CT, symptom severity, and cognitive schemas about self/others. CT was assessed with the Childhood Trauma Questionnaire, and cognitive schemas were assessed by The Brief Core Schema Scale. Patients with psychosis were affected by CT more than their siblings and controls in all domains. Childhood emotional abuse and neglect were more common in siblings than controls. CT was related to negative cognitive schemas toward self/others in patients, siblings, and controls. We found that negative schemas about self-mediated the relationship between emotional abuse and thought withdrawal and thought broadcasting. Approximately 33.9% of the variance in these symptoms was explained by the mediator. It also mediated the relationship between sexual abuse and persecutory delusions in SCZ. Our findings suggest that childhood abuse and neglect are more common in patients with schizophrenia than their siblings and healthy controls, and have different impacts on clinical domains which we searched. The relationship between CT and positive symptoms seems to be mediated by negative cognitive schemas about self in schizophrenia.

Longitudinal hippocampal subfield development associated with psychotic experiences in young people

Hippocampal volumetric reductions are observed across the psychosis spectrum, with interest in the localisation of these reductions within the hippocampal subfields increasing. Deficits of the CA1 subfield in particular have been implicated in the neuropathophysiology of psychotic disorders. Investigating the trajectory of these abnormalities in healthy adolescents reporting sub-threshold psychotic experiences (PE) can provide insight into the neural mechanisms underlying psychotic symptoms without the potentially confounding effects of a formal disorder, or antipsychotic medication. In this novel investigation, a sample of 211 young people aged 11-13 participated initially in the Adolescent Brain Development study. PE classification was determined by expert consensus at each timepoint. Participants underwent neuroimaging at 3 timepoints, over 6 years. 78 participants with at least one scan were included in the final sample; 33 who met criteria for a definite PE at least once across all the timepoints (PE group), and 45 controls. Data from bilateral subfields of interest (CA1, CA2/3, CA4/DG, presubiculum and subiculum) were extracted for Linear Mixed Effects analyses. Before correction, subfield volumes were found to increase in the control group and decrease in the PE group for the right CA2 and CA2/3 subfields, with moderate to large effect sizes (d = −0.61, and d = −0.79, respectively). Before correction, right subiculum and left presubiculum volumes were reduced in the PE group compared to controls, regardless of time, with moderate effect sizes (d = −0.52, and d = −0.59, respectively). However, none of these effects survived correction. Severity of symptoms were not associated with any of the noted subfields. These findings provide novel insight to the discussion of the role of hippocampal subfield abnormalities in the pathophysiology underlying psychotic experiences.

Ethno-racial variation in psychotic experiences in the United States: Findings from the National Latino and Asian American Survey and the National Survey of American Life

BackgroundEthno-racial differences in psychosis risk are documented; however, there is less research on whether these differences extend to sub-threshold psychotic experiences, and whether there is significant variation within ethno-racial categories. MethodsWe analyzed data from the National Latino and Asian American Survey (NLAAS) and the National Survey of American Life (NSAL). Using multivariable logistic regression, we examined the association between race/ethnicity and lifetime psychotic experiences among Latino, Asian, and Black adults in the general population, adjusting for gender, age, nativity, education level, income level, employment status, and everyday discrimination. ResultsPuerto Ricans, Cubans, and other Hispanics had greater odds of lifetime psychotic experiences when compared with Mexicans, though differences diminished when adjusting for covariates. Filipino and other Asians had greater odds of lifetime psychotic experiences when compared with Chinese, though again, differences diminished when adjusting for covariates. Among Black Americans, there were no significant ethnic subgroup differences. ConclusionEthno-racial differences extend across the psychosis continuum. There are nuanced health profiles across and within ethno-racial categories. Differences may be attributable to differences in experiences living in the US, underscoring the need for community-specific interventions.

A Pilot Study of Adolescents with Psychotic Experiences: Potential Cerebellar Circuitry Disruption Early Along the Psychosis Spectrum.

A berrant connectivity in the cerebellum has been found in psychotic conditions such as schizophrenia corresponding with cognitive and motor deficits found in these conditions. Diffusion differences in the superior cerebellar peduncles, the white matter connecting the cerebellar circuitry to the rest of the brain, have also been found in schizophrenia and high-risk states. However, white matter diffusivity in the peduncles in individuals with sub-threshold psychotic experiences (PEs) but not reaching the threshold for a definitive diagnosis remains unstudied. This study investigates the cerebellar peduncles in adolescents with PEs but no formal psychiatric diagnosis.Sixteen adolescents with PEs and 17 age-matched controls recruited from schools underwent High-Angular-Resolution-Diffusion neuroimaging. Following constrained spherical deconvolution whole-brain tractography, the superior, inferior and middle peduncles were isolated and virtually dissected out using ExploreDTI. Differences for macroscopic and microscopic tract metrics were calculated using one-way between-group analyses of covariance controlling for age, sex and estimated Total Intracranial Volume (eTIV). Multiple comparisons were corrected using Bonferroni correction.A decrease in fractional anisotropy was identified in the right (p = 0.045) and left (p = 0.058) superior cerebellar peduncle; however, this did not survive strict Bonferroni multiple comparison correction. There were no differences in volumes or other diffusion metrics in either the middle or inferior peduncles.Our trend level changes in the superior cerebellar peduncle in a non-clinical sample exhibiting psychotic experiences complement similar but more profound changes previously found in ultra-high-risk individuals and those with psychotic disorders. This suggests that superior cerebellar peduncle circuitry perturbations may occur early along in the psychosis spectrum.

Longitudinal Gray Matter Development Associated With Psychotic Experiences in Young People

BackgroundGray matter abnormalities are observed across the psychosis spectrum. The trajectory of these abnormalities in healthy adolescents reporting subthreshold psychotic experiences (PEs) may provide insight into the neural mechanisms underlying psychotic symptoms. The risk of psychosis and additional psychopathology is even higher among these individuals who also report childhood adversity/DSM-5 diagnoses. Thus, the aims of this longitudinal study were to investigate PE-related volumetric changes in young people, noting any effects of childhood adversity/DSM-5 diagnosis. MethodsA total of 211 young people 11 to 13 years of age participated in the initial Adolescent Brain Development study. PE classification was determined by expert consensus at each time point. Participants underwent neuroimaging at 3 time points over 6 years. A total of 76 participants with at least one scan were included in the final sample; 34 who met criteria for PEs at least once across all the time points (PE group) and 42 control subjects. Data from 20 bilateral regions of interest were extracted for linear mixed-effects analyses. ResultsRight hippocampal volume increased over time in the control group, with no increase in the PE group (p = .00352). DSM-5 diagnosis and childhood adversity were not significantly associated with right hippocampal volume. There was no significant effect of group or interaction in any other region. ConclusionsThese findings further implicate right hippocampal volumetric abnormalities in the pathophysiology underlying PEs. Furthermore, as suggested by previous studies in those at clinical high risk for psychosis and those with first-episode psychosis, it is possible that these deficits may be a marker for later clinical outcomes.

Economic strain, parental education and psychotic experiences among college students in the United States: Findings from the Healthy Minds Study 2020.

Socioeconomic status (SES) is linked to psychosis, and much can be learned by examining how various indicators of SES-specifically economic strain and intergenerational transfer of resources-are related to sub-threshold psychotic experiences among college students. Using data from the Healthy Minds Survey (September 2020-December 2020), we used multivariable logistic regression models to examine the associations between five SES indicators and 12-month psychotic experiences, adjusting for age, gender and race/ethnicity. We also examined the count of predictors and psychotic experiences. Each indicator of economic strain was associated with greater odds of psychotic experiences. In particular, increasing levels of financial stress (current, childhood and pandemic-related) were associated with greater odds of psychotic experiences in a dose-response fashion. Food insecurity was associated with double the odds of psychotic experiences. In terms of intergenerational transfer of resources, having either one or no parents who attended college was associated with significantly greater odds of having psychotic experiences, when compared with having both parents who attended college. Examining all predictors in the same model, only childhood and current financial stress and food insecurity were significantly associated with psychotic experiences. The count of predictors was significantly associated with greater odds of having psychotic experiences in a dose-dependent fashion. Among college students, economic strain and intergenerational transfer of resources were associated with recent psychotic experiences, highlighting the importance of economic interventions targeting young adults to influence risk for psychosis.

Altered temporal, but intact spatial, features of transient network dynamics in psychosis

Contemporary models of psychosis suggest that a continuum of severity of psychotic symptoms exists, with subthreshold psychotic experiences (PEs) potentially reflecting some genetic and environmental risk factors shared with clinical psychosis. Thus, identifying abnormalities in brain activity that manifest across this continuum can shed new light on the pathophysiology of psychosis. Here, we investigated the moment-to-moment engagement of brain networks (“states”) in individuals with schizophrenia (SCZ) and PEs and identified features of these states that are associated with psychosis-spectrum symptoms. Transient brain states were defined by clustering “single snapshots” of blood oxygen level-dependent images, based on spatial similarity of the images. We found that individuals with SCZ (n = 35) demonstrated reduced recruitment of three brain states compared to demographically matched healthy controls (n = 35). Of these three illness-related states, one specific state, involving primarily the visual and salience networks, also occurred at a lower rate in individuals with persistent PEs (n = 22), compared to demographically matched healthy youth (n = 22). Moreover, the occurrence rate of this marker brain state was negatively correlated with the severity of PEs (r = −0.26, p = 0.003, n = 130). In contrast, the spatial map of this state appeared to be unaffected in the SCZ or PE groups. Thus, reduced engagement of a brain state involving the visual and salience networks was demonstrated across the psychosis continuum, suggesting that early disruptions of perceptual and affective function may underlie some of the core symptoms of the illness.

Multiple Network Dysconnectivity in Adolescents with Psychotic Experiences: A Longitudinal Population-Based Study.

Abnormal functional connectivity (FC, the temporal synchronization of activation across distinct brain regions) of the default mode (DMN), salience (SN), central executive (CEN), and motor (MN) networks is well established in psychosis. However, little is known about FC in individuals, particularly adolescents, reporting subthreshold psychotic experiences (PE) and their trajectory over time. Thus, the aim of this study was to investigate the FC of these networks in adolescents with PE. In this population-based case-control study, 24 adolescents (mean age = 13.58) meeting the criteria for PE were drawn from a sample of 211 young people recruited and scanned for a neuroimaging study, with a follow-up scan 2 years later (n = 18, mean age = 15.78) and compared to matched controls drawn from the same sample. We compared FC of DMN, SN, CEN, and MN regions between PE and controls using whole-brain FC analyses. At both timepoints, the PE group displayed significant hypoconnectivity compared to controls. At baseline, FC in the PE group was decreased between MN and DMN regions. At follow-up, dysconnectivity in the PE group was more widespread. Over time, controls displayed greater FC changes than the PE group, with FC generally increasing between MN, DMN, and SN regions. Adolescents with PE exhibit hypoconnectivity across several functional networks also found to be hypoconnected in established psychosis. Our findings highlight the potential for studies of adolescents reporting PE to reveal early neural correlates of psychosis and support further investigation of the role of the MN in PE and psychotic disorders.

A Population-Based Analysis of Interpersonal Trauma, Psychosis, and Suicide: Evidence, Pathways, and Implications.

Subthreshold psychotic experiences (PEs) are known to confer a risk for suicidality. Yet, despite evidence of a strong etiological trauma-psychosis pathway, the coalesced effect of such concurrences on suicide risk is largely discounted. Our aims were to examine the impact of different manifestations of life span trauma and PEs on the risk of suicidal thoughts and attempts, using an exploratory person-centered approach. Data from the Adult Psychiatric Morbidity Survey (N = 7,403) were analyzed. PEs were assessed using the Psychosis Screening Questionnaire (PSQ) alongside items probing childhood and adult trauma, in addition to 12-month suicide thoughts and attempt. A manual three-step latent class analysis elicited four distinct profiles, namely, a socially disconnected/high PE, a sexual victimization/moderate PE, a life span trauma/low PE, and a baseline class. The socially disconnected class, characterized by a moderate likelihood of social disconnection, a high probability of various PE endorsements, yet a low likelihood of other significant trauma, showed the greatest risk of 12-month suicide ideation (odds ratio [OR] = 13.0, 95% confidence interval [CI] = [8.539, 19.021) and attempt (OR = 24.2, 95% CI = [10.349, 56.860). Neither multiple nor recurrent traumatic experiences invariably result in the emergence of PEs. Instead, a sense of social disconnection may be either resultant of PEs or alone sufficient to cultivate such symptom presentations, even in the absence of prior traumas. Moreover, just as traumatic encounters increase the risk of suicidality, so too might seemingly more innocuous adversities, such as poor-quality social relationships, further elevate the risk, particularly when proximal and coupled with the simultaneity of PEs.

Evidence for interaction between genetic liability and childhood trauma in the development of psychotic symptoms

PurposeWhilst childhood trauma (CT) is a known risk factor across the spectrum of psychosis expression, little is known about possible interplay with genetic liability.MethodsThe TwinssCan Study collected data in general population twins, focussing on expression of psychosis at the level of subthreshold psychotic experiences. A multilevel mixed-effects linear regression analysis was performed including 745 subjects to assess the interaction between genetic liability and CT. The Symptom Checklist-90 (SCL-90-R) score of the co-twin was used as an indirect measure of genetic liability to psychopathology, while the Childhood Trauma Questionnaire Short-Form (CTQ-SF) was used to assess CT in the domains of physical, emotional and sexual abuse, as well as physical and emotional neglect. The Community Assessment of Psychic Experience (CAPE) questionnaire was used to phenotypically characterize psychosis expression.ResultsIn the model using the CAPE total score, the interaction between CT and genetic liability was close to statistical significance (χ2 = 5.6, df = 2, p = 0.06). Analyses of CAPE subscales revealed a significant interaction between CT and genetic liability (χ2 = 8.8, df = 2, p = 0.012) for the CAPE-negative symptoms subscale, but not for the other two subscales (i.e. positive and depressive).ConclusionThe results suggest that the impact of CT on subthreshold expression of psychosis, particularly in the negative subdomain, may be larger in the co-presence of significant genetic liability for psychopathology.

Neuropsychological deficits in participants at clinical high risk for psychosis recruited from the community: relationships to functioning and clinical symptoms.

The current study examined the pattern of neurocognitive impairments in a community-recruited sample of clinical high-risk (CHR) participants and established relationships with psychosocial functioning. CHR-participants (n = 108), participants who did not fulfil CHR-criteria (CHR-negatives) (n = 42) as well as a group of healthy controls (HCs) (n = 55) were recruited. CHR-status was assessed using the Comprehensive Assessment of At-Risk Mental States (CAARMS) and the Schizophrenia Proneness Instrument, Adult Version (SPI-A). The Brief Assessment of Cognition in Schizophrenia Battery (BACS) as well as tests for emotion recognition, working memory and attention were administered. In addition, role and social functioning as well as premorbid adjustment were assessed. CHR-participants were significantly impaired on the Symbol-Coding and Token-Motor task and showed a reduction in total BACS-scores. Moreover, CHR-participants were characterised by prolonged response times (RTs) in emotion recognition as well as by reductions in both social and role functioning, GAF and premorbid adjustments compared with HCs. Neurocognitive impairments in emotion recognition accuracy, emotion recognition RT, processing speed and motor speed were associated with several aspects of functioning explaining between 4% and 12% of the variance. The current data obtained from a community sample of CHR-participants highlight the importance of dysfunctions in motor and processing speed and emotion recognition RT. Moreover, these deficits were found to be related to global, social and role functioning, suggesting that neurocognitive impairments are an important aspect of sub-threshold psychotic experiences and a possible target for therapeutic interventions.

24. FROM DUSK TILL DAWN: LIFELONG TRAJECTORIES OF COGNITIVE FUNCTIONING IN PSYCHOTIC DISORDERS AND THEIR IMPLICATIONS FOR FUNCTIONAL RECOVERY AND TREATMENT DECISION

Overall : This symposium will draw together state of the art findings on the lifelong cognitive trajectories, on key-predictors of cognitive functioning and the functional consequences of cognitive impairments in schizophrenia and related psychotic disorders from developmental epidemiological, prodromal, and clinical research. Four speakers will take the audience through new findings on the cognitive course of the lifespan, ranging from childhood to old age. Specifically, the talks will address four key-questions:1) Which areas of cognitive functioning are impaired and when does this impairment start?2) How well can cognitive functioning predict the development of a psychotic illness, as well as diagnostic and functional outcome?3) Does cognitive functioning remain stable after illness onset or are psychotic disorders characterized by continuing decline? When does decline occur and is it possible to predict it?4) And what is the functional sequelae of specific cognitive impairments in older adults with schizophrenia?Specifically, Dr. Mollon will present new data examining the origin of cognitive impairment across the psychosis spectrum using a population-based cohort followed prospectively from birth. Her findings demonstrate that while individuals with affective psychosis, subthreshold psychotic experiences and even depression experience some degree of cognitive impairment across the first two decades of life, only those who go on to develop non-affective psychosis exhibit large, widespread and increasing deficits.Most studies of neurocognitive functioning in Clinical High Risk (CHR) cohorts have examined group averages, likely concealing heterogeneous subgroups. The study of Dr. Velthorst therefore used two independent methods to identify neurocognitive subgroups in a large population at Clinical High Risk for developing psychosis. Her findings show that neurocognitive profiles vary substantially in their severity and are associated with diagnostic and functional outcome, underscoring neurocognition as a predictor of illness outcomes.Dr. Fett will present recent research on cognitive functioning in a large sample of patients at first hospitalization for a psychotic disorder who have been followed 20-years into the illness. Her findings indicate that cognitive functioning in psychotic disorders continues to decline after illness onset, that this decline is not specific to schizophrenia but present across psychotic disorders, and that, relative to never-psychotic individuals, impairments on some key-cognitive domains worsen with age. Decline could not reliably be predicted by key patient characteristics at baseline.Lastly, Dr. Harvey will share novel data on the course of cognitive functioning in middle aged and older patients with schizophrenia. His findings demonstrate that cognitive impairments are moderated in their impact on everyday outcomes by the presence of severe communication abnormalities. Interestingly, verbal under-productivity and disconnected speech had different functional correlates, with under-productivity impacting clinician rated social outcomes and performance on measures of interpersonal social competence.A lifetime focus on cognition is paramount in order pinpoint critical periods for prevention and intervention. This symposium seeks to present a comprehensive overview of the cognitive landscape of psychotic disorders by integrating findings on predictors and consequences of lifelong cognitive functioning of individuals diagnosed with a psychotic disorder.

S28. THE ROLE OF COPING IN THE ASSOCIATION BETWEEN SUBCLINICAL PSYCHOTIC EXPERIENCES AND DAILY FUNCTIONING: EVIDENCE FROM TWO INDEPENDENT ADOLESCENT SAMPLES FROM THE GENERAL POPULATION

BackgroundSubclinical psychotic experiences (attenuated, brief, or limited psychotic-like experiences) are present in approximately 5% of adults and 7.5% of adolescents from the general population. Whilst the majority of these experiences are transitory, individuals who report subclinical psychotic experiences are at greater risk developing psychotic spectrum disorders, as well as other adverse outcomes. It is now well established that there is an inverse association between psychosocial functioning and (subthreshold) psychotic experiences in both clinical and non-clinical populations, however the mechanisms which drive this association are unclear. Adolescents with subclinical psychotic experiences are more likely to use maladaptive coping strategies and less likely to use adaptive ones. Given that coping styles are potentially modifiable, clarifying how coping may mediate the association between subclinical psychotic experiences and functioning could provide an important avenue for psychosocial intervention. In the current study we aimed to determine whether the association between subclinical psychotic experiences and psychosocial functioning is mediated by coping style. We conducted a within study replication in two large adolescent samples from the general populations of Australia and the United Kingdom.Methods723 adolescents from Melbourne, Australia, and 239 adolescents from Birmingham, UK, took part in the study. Subclinical positive psychotic experiences were measured using the Community Assessment of Psychic Experiences (CAPE). The Coping Inventory for Stressful Situations (CISS) assessed three different coping styles; task oriented (adaptive) styles and emotion and avoidance oriented (maladaptive) styles. Functioning was measured via the Multidimensional Assessment of Functioning Scale (MAFS), which assesses general, family, and peer functioning. Mediation analysis was conducted using the PROCESS macro for SPSS.ResultsSubclinical psychotic experiences were strongly associated with reduced general and family functioning, and to a lesser extent with reduced peer functioning. Higher subclinical psychotic experiences were associated with lower task (adaptive) and avoidance (maladaptive) oriented coping and increased emotion (maladaptive) oriented coping. Task and emotion oriented coping were found to significantly mediate the relationship between subclinical psychotic experiences and all three types of functioning in both the Melbourne and the Birmingham samples. Avoidance oriented coping was found to significantly mediate subclinical psychotic experiences and peer functioning in the Melbourne sample only. Avoidance oriented coping was not found to mediate subclinical psychotic experiences with general or peer functioning in either sample.DiscussionGiven that 17% of children and 7.5% of adolescents experience subclinical psychotic experiences and that these experiences are associated with reduced functioning, high levels of distress, and suicidal ideation, introducing classroom based learning about coping strategies in schools may encourage the adoption of more positive coping strategies earlier. Additionally, the findings of the present study have important clinical treatment implications, as they suggest that techniques which increase levels of adaptive coping and reduce levels of maladaptive coping (in particular emotion-oriented styles) may help to break the cycle between subclinical psychotic experiences, functional decline, and eventual need for care.

O12.8. LOWER FAMILY INCOME PREDICTS PSYCHOTIC EXPERIENCES IN A COMMUNITY SAMPLE OF YOUTHS IN BRAZIL: RESULTS FROM A 3-YEAR FOLLOW-UP STUDY

BackgroundUp to 17% of community youths, from 9 to 12 years old, report subthreshold psychotic experiences (PE). Besides increasing conversion risk to psychotic disorders, PE also predicted suicide attempts and were associated with more severe general psychopathology. Understanding predisposing factors to PE during development can inform on risk to mental disorders, a crucial step to future prevention interventions. Adversity in early life has been associated with psychotic symptoms, and low socioeconomic status (SES) is an established environmental risk factor for several mental disorders. However, few studies investigated the effect of low SES on PE risk in youths, prospectively. This topic is highly relevant in underprivileged countries like Brazil, where large populations are exposed to poverty. We hypothesized that low income at baseline would predict later report of PEs.MethodsWe analyzed data from the Brazilian High Risk Cohort Study for Psychiatric Disorders (HRC), in which 2,512 youths (6–12 years old, mean age at baseline 9.7 years, SD = 1.92; 53,1% male) completed the baseline assessment and 2,012, the 3-year follow-up (T1). PE were assessed at each time-point through two sources of information: parental report, using the Child Behavior Checklist (CBCL), and youth self-report, using the positive dimension of the Community Assessment of Psychic Experiences (CAPE). A single latent variable for each time-point was created to encompass both sources of information using Confirmatory Factor Analysis, yielding good model fit. Total family income (T0) was correlated to the psychotic latent variable (T1), controlling for age, gender and baseline report of PE. Then, we investigated how any mental disorder diagnosis and exposure to trauma, two possible confounding factors, affected the results. The Development and Well-Being Assessment (DAWBA) was used to investigate mental disorders diagnoses. No conversion to psychotic disorder was observed at the follow-up. A latent variable encompassing parental and youths reports, measured by Childhood Trauma Questionnaire (CTQ), was used as trauma exposure.ResultsThe mean family income reported was approximately US$ 394 per month (p25 = US$ 195, p50 = US$ 307, p75 = US$ 516). Income (baseline) and PE (T1) had a negative significant correlation (pcorr = -0.064; df = 2004; p = 0.004). Subjects with any mental disorder reported PE more frequently, either at baseline or at the follow-up. Low income inversely correlated with trauma, whereas trauma was strongly associated with PE and having any mental disorder at both time points. The correlation between income and PE did not remain significant, after controlling for any mental disorder (T1) (pcorr = -0.049; df = 1597; p = 0.050) or trauma exposure (T0) (pcorr = -0.043; df = 2003; p = 0.053).DiscussionOther studies have previously reported a positive correlation between adversity and PE, but few have described a specific association between family income and psychotic experiences. Our additional analyses suggest that this is not specific, considering the influence of non-psychotic mental disorders, and mediated by low-income related exposures, i.e. childhood trauma. Even not surviving multivariate analyses, income could work as a proxy for adversity exposures and may be useful as a tool to define populations at risk for psychotic and non-psychotic mental disorders. We expect that the longer follow-up assessments help us answer the questions raised.

Aberrant salience and alexithymia in subthreshold psychotic experiences among adolescent migrants in Italy: A comparison with native Italian adolescents

IntroductionIn this decade in the Italian context, there has been a significant increase of the immigration phenomenon. Consistent data indicated higher risk of psychotic experiences among migrants. Poor work investigated clinical variables associated with stronger subthreshold psychotic experiences among this population of adolescents. Aberrant salience, the biased assignment of significance to otherwise innocuous stimuli, and alexithymia, the difficulty identifying/describing feelings are believed to have a role in the onset and maintenance of psychotic symptoms. No study evaluated whether they could moderate the relation between migrant status and psychotic experiences among in adolescence.ObjectivesThe current study investigated whether salience and alexithymia predicted more intense subthreshold psychotic experiences and moderated the effect of migrant status among migrant and native Italian adolescents.MethodsSeventy-three adolescents born in other countries than Italy and 75 native Italian adolescents (mean age = 17.57, SD = 2.08, 47.30% females) completed the aberrant salience inventory, the Toronto Alexithymia Scale-20 and the screening for psychotic experiences.ResultsMigrant adolescents had higher levels of subthreshold psychotic experiences (F = 10.65, P < 0.01), alexithymia (F = 8.93, P < 0.01) and salience (F = 4.38, P < 0.05) than native Italian adolescents. A main effect of aberrant salience and alexithymia on subthreshold psychotic experiences emerged. An interaction effect between migrant status and alexithymia was found: migrant adolescents with stronger alexithymia had more intense subthreshold psychotic experiences.ConclusionsPublic health policies should consider migrant adolescents as a group at risk for stronger subthreshold psychotic experiences. Prevention programs could take into account alexithymia as a target of intervention for this population of adolescents.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychotic Experiences in the Context of Police Victimization: Data From the Survey of Police-Public Encounters.

Social defeat has been proposed as the common mechanism underlying several well-replicated risk factors for sub-threshold psychotic experiences (PEs) identified in epidemiological research. Victimization by the police may likewise be socially defeating among vulnerable individuals and, therefore, may be associated with elevated risk for PEs. However, no prior studies have examined the relation between police victimization and PEs. We tested the hypothesis that exposure to police victimization (ie, physical, sexual, psychological, and neglect) would be associated with increased odds for PEs in the Survey of Police-Public Encounters data (N = 1615), a general population sample of adults from 4 US cities. Respondents who reported each type of police victimization were more likely to report PEs in logistic regression analyses (all P < .01), most of which were significant even when adjusting for demographic variables, psychological distress, and self-reported crime involvement (adjusted OR range: 1.30 to 7.16). Furthermore, the prevalence of PEs increased with greater exposure to police victimization in a linear dose-response relation, OR (95% CI) = 1.44 (1.24-1.66). These findings suggest that police victimization is a clinically important and previously unreported risk factor for PEs in the urban US population. These findings support the need for community-based outreach efforts and greater police training to reduce the prevalence of this exposure, particularly in socially disadvantaged urban communities.

Workplace Mobbing as a Psychosocial Stress and Its Relationship to General Psychopathology and Psychotic Experiences Among Working Women in a University Hospital

Mobbing at work has become an alarming phenomenon worldwide. The prevalence of mobbing among women is higher than among men. The aim of this study is to investigate the relationship of mobbing as a psychosocial stress in the workplace with general psychopathology and psychotic experiences among women. 428 women from the Medical Faculty of Dokuz Eylul University were included in the study. Of the 428 women, 139 were doctors, 190 were nurses, and 99 were sub-contracted employees. Stratified and cluster sampling METHODS were used. Sociodemographic data form, mobbing scale and symptom checklist (SCL-90-R) were used in order to collect the data. 304 (71%) of the participants had experienced mobbing at least once. It was determined that nurses had experienced mobbing more frequently than doctors and sub-contracted employee. Total and subscale scores of the mobbing scale were statistically higher in participants who went to psychiatry outpatient clinics and who use psychiatric medication and alcohol. There was a positive statistically significant correlation between SCL-90-R and mobbing scale scores. Correlation coefficients ranged from 0.25 to 0.56. The highest correlation was between the paranoid sub-scale of SCL-90-R and mobbing (r= 0.56) CONCLUSION: Generally, exposure to mobbing seems to be related with higher psychopathology. Also, according to our research results, mobbing is a psychosocial stress source that might be triggering subthreshold psychotic experiences.

Suicide in the Early Stage of Schizophrenia.

Suicide is a relevant leading cause of death among patients affected by schizophrenia. Even if suicidal ideation may be present in different stages of disease, some differences have been described between the risk of suicide in patients experiencing first episode of psychosis and those with long-term schizophrenia. It is particularly higher during the first year of illness and reaches a steady decline over the following years. Suicidal ideation and attempts may also be common among subjects with subthreshold psychotic experiences. Factors associated with the risk of suicide in the early phase of schizophrenia are previous suicidal attempts and social aspects: the lack of social support and stable relationships, social drift after the first episode, and social impairment. Also, several psychotic symptoms (suspiciousness, paranoid delusions, mental disintegration and agitation, negative symptoms, depression and hopelessness, and command hallucinations) and substance abuse are associated with higher risk of suicide. It has been described that perfectionism and good levels of insight among individuals who have recently developed psychotic symptoms are significantly associated with higher numbers of suicidal attempts. Moreover, recent evidences show that prefrontal cortex-based circuit dysfunction may be related to suicide in the early stage of schizophrenia. This narrative review summarizes available evidences on suicide in the early stage of schizophrenia and deals with issues to be further studied and discussed.

Psychosis as a transdiagnostic and extended phenotype in the general population.

A large body of research indicates that weak expressions of positive psychotic symptoms ("psychotic experiences") can be measured in the general population, and likely represent the behavioural manifestation of distributed multifactorial (genetic and non-genetic) risk for psychosis. Psychotic experiences are a transdiagnostic phenomenon: the majority of individuals with these experiences have a diagnosis of non-psychotic disorder, particularly common mental disorder, in which psychotic experiences predict greater illness severity and poorer treatment response. Some of the people with common mental disorder and psychotic experiences will present to mental health services meeting criteria for "clinical high risk". Treatment of the transdiagnostic dimension of psychosis in individuals with common mental disorder who meet "clinical high risk" criteria thus may improve outcome (which cannot be interpreted as prevention of "schizophrenia"). Subthreshold psychotic experiences are transitory in about 80% of individuals, while around 20% go on to develop persistent psychotic experiences and 7% a psychotic disorder, with an annual transition rate of 0.5-1%. Persistence is associated, on the one hand, with environmental exposures, particularly childhood trauma, and, on the other, with network-type dynamic interactions between psychotic experiences themselves (e.g., interactions between hallucinatory experiences and delusional ideation) and between symptom dimensions (e.g., interactions between affective symptoms and psychotic experiences, or interactions between subthreshold negative symptoms and psychotic experiences). The study of psychotic experiences is helping to elucidate the mechanisms by which environmental and genetic influences shape the transdiagnostic expression of psychosis proneness, that is mostly transitory but may first become persistent over time and eventually give rise to transition to a psychotic disorder.

Prevention of psychotic disorders in the general population

Subthreshold psychotic experiences are widely reported within otherwise healthy populations. Their phenomenology is broad and very heterogeneous ranging from meaningful coincidences and precognitive dreams over haunting to out-of-body experiences and visual as well as auditory hallucinations.Although creative aspects of these experiences are implied too, a similarity in form and content to positive symptoms in schizophrenia (e.g., delusion, disordered thought, and hallucinations) or schizotypy (e.g. magical thinking, unusual perceptual experiences, ideas of reference or paranoid ideation) seems to be obvious. However, the borderline between normal and pathological experiences and behaviour is unclear.The so called “continuum approach” assumes that schizophrenia or schizotypy are not discrete or categorical illness entities. It implies a gradient in the severity of the symptoms, ranging from healthy population to full-blown schizophrenia. As such, psychotic signs are no longer restricted to formal diagnoses according to DSM or ICD, but would, instead, complete the spectrum of psychological and biological features that characterize individual variations among human beings.Can subthreshold psychotic experiences be integrated in this continuum? Do individuals indicating such experiences lack some social cognitive abilities and are particularly vulnerable to false inferences in their social world. How are these experiences related to increased neural activity or an abnormal dopaminergic neurotransmission?These and similar questions will be discussed in the presentation.Disclosure of interestThe author has not supplied his declaration of competing interest.