Schizotypal personality disorder

The Translational Future of Stress Neurobiology and Psychosis Vulnerability: A Review of the Evidence

Psychosocial stress is a well-established risk factor for psychosis, yet the neurobiological mechanisms underlying this relationship have yet to be fully elucidated. Much of the research in this field has investigated hypothalamic-pituitary-adrenal (HPA) axis function and immuno-inflammatory processes among individuals with established psychotic disorders. However, as such studies are limited in their ability to provide knowledge that can be used to develop preventative interventions, it is important to shift the focus to individuals with increased vulnerability for psychosis (i.e., high-risk groups). In the present article, we provide an overview of the current methods for identifying individuals at high-risk for psychosis and review the psychosocial stressors that have been most consistently associated with psychosis risk. We then describe a network of interacting physiological systems that are hypothesised to mediate the relationship between psychosocial stress and the manifestation of psychotic illness and critically review evidence that abnormalities within these systems characterise highrisk populations. We found that studies of high-risk groups have yielded highly variable findings, likely due to (i) the heterogeneity both within and across high-risk samples, (ii) the diversity of psychosocial stressors implicated in psychosis, and (iii) that most studies examine single markers of isolated neurobiological systems. We propose that to move the field forward, we require well-designed, largescale translational studies that integrate multi-domain, putative stress-related biomarkers to determine their prognostic value in high-risk samples. We advocate that such investigations are highly warranted, given that psychosocial stress is undoubtedly a relevant risk factor for psychotic disorders.

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.

A pilot randomized controlled trial comparing a novel compassion and metacognition approach for schizotypal personality disorder with a combination of cognitive therapy and psychopharmacological treatment

BACKGROUND

Schizotypal personality disorder is characterized by a pervasive pattern of maladaptive behavior that has been associated with the liability for schizophrenia. Little is known about effective psychosocial interventions. This pilot non-inferiority randomized controlled trial aimed to compare a novel form of psychotherapy tailored for this disorder and a combination of cognitive therapy and psychopharmacological treatment. The former treatment - namely, Evolutionary Systems Therapy for Schizotypy-integrated evolutionary, metacognitively oriented, and compassion focused approaches.

METHODS

Thirty-three participants were assessed for eligibility, twenty-four randomized on a 1:1 ratio, nineteen included in the final analysis. The treatments lasted 6 months (24 sessions). The primary outcome was change across nine measurements in personality pathology, the secondary outcomes were remission from diagnosis and pre-post changes in general symptomatology and metacognition.

RESULTS

Primary outcome suggested a non-inferiority of the experimental treatment in respect to control condition. Secondary outcomes reported mixed results. There was no significant difference in terms of remission, but experimental treatment showed a larger reduction of general symptomatology (η² = 0.558) and a larger increase in metacognition (η² = 0.734).

CONCLUSIONS

This pilot study reported promising results about the effectiveness of the proposed novel approach. A confirmatory trial on large sample size is needed to provide evidence about relative effectiveness of the two treatment conditions.

TRIAL REGISTRATION

ClinicalTrials.gov; NCT04764708; Registration day 21/02/2021.

[Clinical and psychological assessment of the variability of schizotypal personality disorder in children and adolescents]

OBJECTIVE

To analyze the variability of violations of cognitive and emotional-personal parameters in schizotypal disorder (STD) in children and adolescents according to the pathopsychological profile.

MATERIAL AND METHODS

47 patients with STD were examined, 21 of them with psychopathic variant (F21.4), 16 with neurotic (F21.3) and 10 with personality schizotypal disorder (F21.8) aged 9 to 16 years (37 boys and 10 girls). All patients were examined in detail by a psychiatrist and clinical psychologists. The method of integrative assessment of the pathopsychological profile was used, including the assessment of the presence and severity of impairments in cognitive functioning, emotional-personal and motivational-volitional spheres (the assessment was carried out according to detailed psychological reports). Mathematical processing of the obtained data was carried out.

RESULTS

Cluster analysis of clinical and psychological indicators showed that patients differ in the level of intellectual impairment, as well as in the characteristics of motivational-volitional and personal spheres. Three clusters are described, two of which included patients (10 and 31 patients) with individual variants of STD with a greater severity of various cognitive deficits, and parameters of the emotional and personal sphere, the last cluster included 6 patients with personality variants of STD. A separate largest cluster included all three analyzed variants of STD in approximately equal proportions, with a mildly pronounced intellectual decline and more noticeable changes (deficiency) in the emotional and personal sphere.

CONCLUSION

Thus, patients with STD differ in the severity and structure of deficient changes. At the same time, the nature and degree of involvement of a particular area in the overall picture of the pathopsychological profile is of great importance. Patients with STD differ in the severity and structure of deficient changes. The identified clusters differed in age, in the presence of patients of both sexes, and in various indicators of the pathopsychological profile. At the same time, the nature and degree of involvement of a particular area in the overall picture of the pathopsychological profile is important for diagnosis.

[History of the formation of views on schizotypal disorder in childhood]

The article reflects the stages of development of views on schizotypal disorder (STD) in adults and children from the prenosological period to the present. It is shown how, after the recognition by the majority of psychiatrists of the concept of early dementia proposed by E. Kraepelin, there is a gradual recognition of the single essence of schizophrenia for childhood and adulthood, but with different, specific clinical manifestations at different age periods. The study of variants of schizophrenia without a fatal outcome in dementia, which led to the isolation of sluggish schizophrenia, including in childhood, begins with the works of E. Bleuler. The differences in approaches to the study and interpretation of sluggish schizophrenia in Russian, European and American psychiatry, which led to the isolation of STEs in the framework of personality disorders, are described. Three main concepts that exist at the present stage of research are presented, in which STD is considered as an independent disease in the spectrum of schizophrenic disorders, as one of the types of personality deviations with a high degree of vulnerability for the development of schizophrenia, and as one of the forms of the disease.

Differences in Psychiatric Comorbidities and Gender Distribution among Three Clusters of Personality Disorders: A Nationwide Population-Based Study

Personality disorders (PDs) are grouped into clusters A, B, and C. However, whether the three clusters of PDs have differences in comorbid mental disorders or gender distribution is still lacking sufficient evidence. We aim to investigate the distribution pattern across the three clusters of PDs with a population-based cohort study. This study used the Taiwan national database between 1995 and 2013 to examine the data of patients with cluster A PDs, cluster B PDs, or cluster C PDs. We compared the differences of psychiatric comorbidities classified in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition across the three clusters of PDs. Moreover, we formed gender subgroups of the three PDs to observe the discrepancy between male and female. Among the 9845 patients, those with cluster A PDs had the highest proportion of neurodevelopmental disorders, schizophrenia and neurocognitive disorders, those with cluster B PDs demonstrated the largest percentage of bipolar disorders, trauma and stressor disorders, feeding and eating disorders, and substance and addictive disorders, and those with cluster C PDs had the greatest proportion of depressive disorders, anxiety disorders, obsessive–compulsive disorders, somatic symptom disorders, and sleep–wake disorders. The gender subgroups revealed significant male predominance in neurodevelopmental disorders and female predominance in sleep–wake disorders across all three clusters of PDs. Our findings support that some psychiatric comorbidities are more prevalent in specified cluster PDs and that gender differences exist across the three clusters of PDs. These results are an important reference for clinicians who are developing services that target real-world patients with PDs.

Attenuated Resting-State Functional Anticorrelation between Attention and Executive Control Networks in Schizotypal Personality Disorder

Exploring the disruptions to intrinsic resting-state networks (RSNs) in schizophrenia-spectrum disorders yields a better understanding of the disease-specific pathophysiology. However, our knowledge of the neurobiological underpinnings of schizotypal personality disorders mostly relies on research on schizotypy or schizophrenia. This study aimed to investigate the RSN abnormalities of schizotypal personality disorder (SPD) and their clinical implications. Using resting-state data, the intra- and inter-network of the higher-order functional networks (default mode network, DMN; frontoparietal network, FPN; dorsal attention network, DAN; salience network, SN) were explored in 22 medication-free, community-dwelling, non-help seeking individuals diagnosed with SPD and 30 control individuals. Consequently, while there were no group differences in intra-network functional connectivity across DMN, FPN, DAN, and SN, the SPD participants exhibited attenuated anticorrelation between the right frontal eye field region of the DAN and the right posterior parietal cortex region of the FPN. The decreases in anticorrelation were correlated with increased cognitive–perceptual deficits and disorganization factors of the schizotypal personality questionnaire, as well as reduced independence–performance of the social functioning scale for all participants together. This study, which links SPD pathology and social functioning deficits, is the first evidence of impaired large-scale intrinsic brain networks in SPD.

Early childhood social communication deficits in youth at clinical high-risk for psychosis: Associations with functioning and risk

Effective social functioning requires a broad range of social communication skills that are impaired in psychosis populations. However, little is known about early childhood (4- to 5-year period) social communication during the premorbid (pre-illness) stage of psychosis. The present study utilized retrospective parent reports to examine total early childhood social communication deficits, as well as deficits in two distinct domains, reciprocal social interaction (social smiling/eye gaze) and communication (social chat/gesture), in youth at clinical high-risk (CHR) for psychosis (ages 13-21; 37.2% female). Furthermore, associations between early childhood social communication and CHR youth's current functioning (social, academic/work), symptoms (positive/negative), and risk for conversion to psychosis were examined. Compared to healthy controls, CHR individuals had greater deficits in total and communication-specific early childhood social communication. Early childhood total, communication, and reciprocal social interaction deficits were associated with worse current functioning and greater current negative symptom severity (amotivation/anhedonia) in CHR youth. Early childhood total and reciprocal social interaction deficits were also associated with increased risk for conversion. These findings inform the field's understanding of the etiology and pathophysiology of psychosis by extending the current developmental literature on premorbid deficits in psychosis populations to specific domains of social behavior in a critical developmental period.

Cognitive Deficits in Psychotic Disorders: A Lifespan Perspective

Individuals with disorders that include psychotic symptoms (i.e. psychotic disorders) experience broad cognitive impairments in the chronic state, indicating a dimension of abnormality associated with the experience of psychosis. These impairments negatively impact functional outcome, contributing to the disabling nature of schizophrenia, bipolar disorder, and psychotic depression. The robust and reliable nature of cognitive deficits has led researchers to explore the timing and profile of impairments, as this may elucidate different neurodevelopmental patterns in individuals who experience psychosis. Here, we review the literature on cognitive deficits across the life span of individuals with psychotic disorder and psychotic-like experiences, highlighting the dimensional nature of both psychosis and cognitive ability. We identify premorbid generalized cognitive impairment in schizophrenia that worsens throughout development, and stabilizes by the first-episode of psychosis, suggesting a neurodevelopmental course. Research in affective psychosis is less clear, with mixed evidence regarding premorbid deficits, but a fairly reliable generalized deficit at first-episode, which appears to worsen into the chronic state. In general, cognitive impairments are most severe in schizophrenia, intermediate in bipolar disorder, and the least severe in psychotic depression. In all groups, cognitive deficits are associated with poorer functional outcome. Finally, while the generalized deficit is the clearest and most reliable signal, data suggests specific deficits in verbal memory across all groups, specific processing speed impairments in schizophrenia and executive functioning impairments in bipolar disorder. Cognitive deficits are a core feature of psychotic disorders that provide a window into understanding developmental course and risk for psychosis.

Interrogating the Relationship Between Schizotypy, the Catechol-O-Methyltransferase (COMT) Val158Met Polymorphism, and Neuronal Oscillatory Activity

The COMT Val158Met polymorphism affects the availability of synaptic dopamine in the prefrontal cortex and has been widely studied as a genetic risk factor for psychosis. Schizotypy is associated with an increased risk of psychosis, with some studies implicating similar neurobiological mechanisms to schizophrenia. The present study sought to interrogate the link between the COMT Val158Met polymorphism and schizotypy using electroencephalogram (EEG) to identify neurophysiological mechanisms underpinning psychosis risk. Neurotypical (N = 91) adults were genotyped for the COMT Val158Met polymorphism, completed the Schizotypal Personality Questionnaire (SPQ), and had eyes open resting-state EEG recorded for 4 min. SPQ suspiciousness subscale scores were higher for individuals homozygous for Val/Val and Met/Met versus Val/Met genotypes. Delta, theta, alpha-2, beta-1, and beta-2 amplitudes were lower for Val/Val than Met/Met individuals. Lower theta amplitudes were correlated with higher total SPQ scores (P = 0.050), and multiple regression revealed that higher delta, and lower theta and beta-2 amplitudes (but not COMT genotype) best predicted total SPQ scores (P = 0.014). This study demonstrates the importance of COMT genotype in determining trait suspiciousness and EEG oscillatory activity. It also highlights relationships between dopaminergic alterations, EEG and schizotypy that are dissimilar to those observed in schizophrenia.

The Conceptualization and Assessment of Schizotypal Traits: A Comparison of the FFSI and PID-5

The purpose of the present study was to compare the cognitive and perceptual aberration scales from the Five-Factor Schizotypal Inventory (FFSI; Edmundson, Lynam, Miller, Gore, & Widiger, 2011) and the Personality Inventory for DSM-5 (Krueger, Derringer, Markon, Watson, & Skodol,, 2012), as well as to address more generally the validity of the FFSI as a measure of both schizotypal personality traits and the FFM. Two independent samples were obtained, including 259 college students (55 of whom were preselected with elevated scores on a measure of schizotypal personality disorder [STPD]) and 346 adult MTurk participants (43% of whom had been or were currently in mental health treatment). Administered were the FFSI, the PID-5 Psychoticism scales, and alternative measures of general personality, openness, STPD, and schizotypal cognitive-perceptual aberrations. The results of the study are discussed with respect to the validity of the FFSI and PID-5 schizotypal cognitive and perception scales.

EFFECTS OF SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUGS, BIOLOGICAL AGENTS, AND PSYCHOPHARMACOTHERAPY ON THE MENTAL DISORDERS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Mental disorders (MDs) of the anxiety-depressive spectrum (ADS) and cognitive impairment (CI) are characteristic of the majority of patients with rheumatoid arthritis (RA); however, the effects of disease-modifying antirheumatic drugs (DMARDs), biological agents (BAs), and their combinations with psychopharmacological drugs (PPDs) on these abnormalities have been insufficiently studied.

 

Objective: to investigate trends in the incidence of MDs in RA patients receiving different treatment regimens.

Subjects and methods. The investigation included 128 RA patients (13% men and 87% women) who fulfilled the 1987 American College of Rheumatology criteria; their mean age was 47.4±0.9 years; the median duration of RA was 96 [48; 228] months. RA activity was found to be high, moderate, and low in 48, 56, and 24 patients, respectively. DAS28 averaged 5.34±0.17. 80% of the patients received DMARDs. MDs were diagnosed based on ICD-10 coding, by using a semi-structured interview and scales, such as the Hospital Anxiety and Depression Scale, the Hamilton Anxiety Scale, and the Montgomery-Asberg Depression Rating Scale. Clinical and psychological procedures were used to diagnose CI. At the study inclusion stage, ADS disorders were detected in 123 (96.1%) patients; CI was found in 88 (68.7%). Forty-one (32.1%) patients were diagnosed with major depression (an obvious or moderate depressive episode), 53 (41.4%) patients had minor depression (a mild depressive episode and dysthymia), and 29 (22.6%) had anxiety disorders (ADs) (adjustment disorders with anxiety symptoms, as well as generalized anxiety disorder). The dynamics of MDs was estimated in 112 (87.5%) of the 128 patients and in 83 (64.8%) at one- and five-year follow-ups, respectively. The following groups were identified according to the performed therapy: 1) synthetic DMARDs (n = 39); 2) synthetic DMARDs + PPDs (n = 43); 3) BAs + DMARDs (n = 32); 4) BAs + DMARDs + PPDs (n = 9).

Results and discussion. In Group 1, the frequency of major depression increased insignificantly from 25% to 32.2 and 33.3% (p = 0.36) at one- and five-year follow-ups, respectively; that of minor depression decreased from 51% to 48.4 (p = 0.5) and 50% (p = 0.6) respectively; the number of patients with ADs declined significantly from 24% to 3.2 (p = 0.018) and 4.2% (p = 0.021), respectively. The frequency of CI rose from 63.5% to 64.5 and 81.8%, respectively (p = 0.12). In Group 2, the frequency of major depression decreased from 43 to 19% (p = 0.049) at one-year follow-up; and none of the patients was found to have ADS disorders at five-year follow-up (p < 0.001); the frequency of minor depression dropped from 38% to 23.8 and 7.1% at one-year (p = 0.35) and five-year (p = 0.002) follow-ups, respectively; the frequency of ADs fell from 19% to 4.8 (p = 0.044) and 0% (p = 0.012), respectively. The frequency of CI decreased insignificantly from 80.9% to 76.2 (p = 0.39) and 61.5% (p = 0.061), respectively. In Group 3 treated with BAs, the frequency of major depression increased statistically insignificantly from 31.2% to 37.9 (p = 0.39) and 42.8% (p = 0.28) at oneand five-year follow-ups, respectively; the frequency of minor depression rose insignificantly from 37.5% to 48.3 (p = 0.28) and 52.4% (p = 0.21), respectively; and that of ADs dropped from 25 to 0% at one-year (p = 0.003) and five-year (p = 0.011) follow-ups. Moreover, the frequency of CI increased from 75% up to 79.3 (p = 0.46) and 90% (p = 0.16) at one- and five-year follow-ups respectively. In Group 4, the frequency of major depression decreased significantly from 66.7 to 22.2% (p = 0.076) and complete regression (p = 0.004) at one- and five-year follow-ups, respectively; that of minor depression increased slightly from 11.1 to 33.3% (p = 0.28) due to the transformation of major depression into minor one at one- and five-year follow-ups, respectively; the frequency of ADs fell from 22.2% to zero at 5 years; and the incidence of CI declined 66.7 to 57.1% (p = 0.54).

Conclusion. Synthetic DMARDs had no effect on the ADS disorders and CI in patients with RA; BAs promoted the regression of ADs and did not affect the progression of depression and CI. A combination of DMARDs and BAs used at the adequate dose of PPDs for the same period led to the regression of ADS disorders and the reduction in the frequency of CI.

Associations of differential schizotypal dimensions with executive working memory: A moderated-mediation analysis

BACKGROUND

Increased schizotypal traits are observed in a percentage of the general population and in the schizophrenia-spectrum and have been associated with impairments in working memory. In this study we examined the effects of four schizotypal dimensions [Negative (NegS), Paranoid (ParS), Cognitive-Perceptual (CPS), Disorganized (DiS)] on executive working memory (EWM), as mediated by set-shifting, planning and control inhibition. We also examined whether these associations are moderated by family-history of psychosis.

METHODS

Our sample consisted of 110 unaffected first-degree relatives of schizophrenia-spectrum patients and 120 control individuals. Schizotypy was assessed with the Schizotypal Personality Questionnaire. Participants were also tested with the Letter-Number Sequencing, Wisconsin Card Sorting, Stroop Color-Word and Stockings of Cambridge tasks. The effects of set-shifting, control inhibition and planning on the relationship between schizotypy and EWM were examined with mediation analyses. Moderated-mediation analyses examined potential moderating effects of group membership (unaffected relative/community participant).

RESULTS

All mediators were significant in the relationship between NegS and EWM. The effects of ParS were mediated only by set-shifting and planning. Planning and control inhibition were the only significant mediators on the effects of CPS and DiS on EWM, respectively. The moderated-mediation analyses revealed that these findings apply only in the community group.

CONCLUSIONS

We found that the effects of different schizotypal dimensions on EWM are mediated by other cognitive processes in individuals without personal/family history of psychosis. This is probably due to either more severe impairments in the cognitive processes of the relatives or restrictions in our sample and study-design.

Psychosis

PURPOSE OF REVIEW

Psychosis is a common and functionally disruptive symptom of many psychiatric, neurodevelopmental, neurologic, and medical conditions and an important target of evaluation and treatment in neurologic and psychiatric practice. The purpose of this review is to define psychosis, communicate recent changes to the classification of and criteria for primary psychotic disorders described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and summarize current evidence-based approaches to the evaluation and management of primary and secondary psychoses.

RECENT FINDINGS

The DSM-5 classification of and criteria for primary psychotic disorders emphasize that these conditions occur along a spectrum, with schizoid (personality) disorder and schizophrenia defining its mild and severe ends, respectively. Psychosis is also identified as only one of several dimensions of neuropsychiatric disturbance in these disorders, with others encompassing abnormal psychomotor behaviors, negative symptoms, cognitive impairments, and emotional disturbances. This dimensional approach regards hallucinations and delusions as arising from neural systems subserving perception and information processing, thereby aligning the neurobiological framework used to describe and study such symptoms in primary psychotic disorders with those used to study psychosis associated with other neurologic conditions.

SUMMARY

This article provides practicing neurologists with updates on current approaches to the diagnosis, evaluation, and treatment of primary and secondary psychoses.

Regional cortical thinning may be a biological marker for borderline personality disorder

OBJECTIVE

We investigated cerebral cortical thickness and its relation to measurements of difficulties with identifying and describing emotions in patients with borderline personality disorder (BPD).

METHOD

Eighteen SCID-II-diagnosed female patients with BPD and 21 healthy female controls underwent magnetic resonance imaging and completed the Toronto Alexithymia Scale (TAS). First, regional cortical thickness across the cerebral surface was compared between patients and healthy controls. Then, analyses of the association between cortical thickness and TAS subscales were performed in patients.

RESULTS

Compared with controls, patients exhibited clusters of significantly reduced cortical thickness in the left medial and lateral prefrontal cortex, left temporoparietal junction, bilateral temporal poles, and bilateral paracentral lobules. Significant negative associations were observed between cortical thickness and the 'Difficulties Describing Feelings' TAS subscale (DDF) scores in patients. The anatomical distribution of these associations was highly overlapping with the group differences in cortical thickness.

CONCLUSION

The pattern of regions exhibiting cortical thinning in patients resembles a network of cortical structures repeatedly shown to be involved in social cognition. The results of the DDF analyses suggest that the thinning may partly be related to interpersonal dysfunction in patients with BPD. The pattern of thinning may represent a potential biological marker for BPD.