Interpersonal problems in the prodromal state of schizophrenia: An exploratory study

Employing Contemporary Integrative Interpersonal Theory to Understand Dysfunction in Those at Clinical High Risk for Psychosis

Poor social functioning is related to the development of psychosis; however, our current understanding of social functioning in those at-risk for psychosis is limited by (a) poor conceptual models of interpersonal behavior and (b) a reliance on comparisons to healthy controls (e.g., vs. clinical controls). In this study, we introduce Contemporary Integrated Interpersonal Theory (CIIT) and use its Interpersonal Circumplex (IPC) model to compare interpersonal behavior traits in those at clinical high-risk (CHR) for psychosis, clinical controls, and healthy controls. A community sample (N = 3460) was used to derive estimates of IPC dimensions (i.e., affiliation and dominance), which were then compared among a large subsample that completed diagnostic interviews (N = 337), which included a CHR group, as well as several control groups ranging on degree of psychosis vulnerability and internalizing disorders. CHR individuals were distinguished from healthy controls by low affiliation (d = -1.31), and from internalizing disorder groups by higher dominance (d = 0.64). Negative symptoms were consistently associated with low affiliation and low dominance, whereas positive symptoms were related primarily to coldness. These results connect social functioning in psychosis risk to a rich theoretical framework and suggest a potentially distinct interpersonal signature for CHR individuals. More broadly, this study suggests that CIIT and the IPC may have utility for informing diagnostics and treatment development in psychosis risk research.

Between a rock and a hard place: Associations between Mentzos' "dilemma", self-reported interpersonal problems, and psychosocial functioning in individuals with non-affective psychoses

Primary aim of this study was to determine the extent and type of self-reported interpersonal problems in patients with non-affective psychoses and their impact on psychosocial functioning. Furthermore, we aimed to explore potential links with the psychodynamic construct of Stavros Mentzos' "psychotic dilemma", which describes an insufferable inner tension caused by an individual's struggle of being torn between "self-oriented" and "object-oriented" tendencies. In a cross-sectional study among 129 patients with non-affective psychoses, measures of cognition, symptom load and social functioning as well as a tentative, psychodynamic assessment of Mentzos' "dilemma" were obtained during a clinical research visit. Self-report data on interpersonal problems were gathered using the Inventory of Interpersonal Problems (IIP-64D) and compared with a German representative standard sample. Second, IIP-64D scores were compared between groups with or without Mentzos' "dilemma". Hierarchical regression analyses were performed to test for the impact of interpersonal problems on psychosocial functioning, while controlling for cognitive deficits and psychopathology. Results showed that IIP-64D scores differed significantly from healthy controls, except for "self-centred" and "intrusive" interpersonal styles. Participants with a potential "psychotic dilemma" scored significantly higher on the subscales: "domineering", "self-centred", "cold", and "socially avoidant" than the group without a "psychotic dilemma". The total amount of interpersonal problems, and particularly high scores on the IIP-64D "socially avoidant" subscale, predicted psychosocial dysfunction, whereas a "cold" interpersonal style had an opposite effect. In conclusion, specific interpersonal problems may predict psychotherapeutic outcome measures like psychosocial functioning and are partly compatible with the psychodynamic construct of Stavros Mentzos' "psychotic dilemma".

An Overview of the Evidence for Psychological Interventions for Psychosis: Results From Meta-Analyses

There are numerous psychological approaches to psychosis that differ in focus, specificity and formats. These include psychodynamic, humanistic, cognitive-behavioural and third-wave-approaches, psychoeducation, various types of training-based approaches and family interventions.

We briefly describe the main aims and focus of each of these approaches, followed by a review of their evidence-base in regard to improvement in symptoms, relapse and functioning. We conducted a systematic search for meta-analyses dating to 2017 for each of the approaches reviewed. Where numerous meta-analyses for an approach were available, we selected the most recent, comprehensive and methodologically sound ones.

We found convincing short- and long-term evidence for cognitive behavioural approaches if the main aim is to reduce symptom distress. Evidence is also strong for psychoeducative family interventions that include skills training if the main aim is to reduce relapse and rehospitalisation. Acceptance and commitment therapy, mindfulness-based approaches, meta-cognitive and social skills training, as well as systemic family interventions, were also found to be efficacious, depending on the outcome of interest, but meta-analyses for these approaches were based on a comparatively lower number of outcome studies and a narrower selection of outcome measures. We found no convincing evidence for psychodynamic approaches, humanistic approaches or patient-directed psychoeducation (without including the family).

An array of evidence-based psychological therapies is available for psychotic disorders from which clinicians and patients can choose, guided by the strength of the evidence and depending on the outcome area focused on. Increased effort is needed in terms of dissemination and implementation of these therapies into clinical practice.

Meta-analyses show convincing evidence for CBT if the main target is psychotic symptoms.

Meta-analyses show convincing evidence for family interventions if the main target is relapse.

Effects are promising for ACT, mindfulness-based and systemic approaches, but more research is needed.

The array of effective approaches allows clinicians and patients to select the most appropriate one.