Beyond Clinical High-Risk State for Psychosis: The Network Structure of Multidimensional Psychosis Liability in Adolescents

Suicidal behaviour in adolescents: A network analysis

OBJECTIVE

Suicidal behaviour has not yet been analysed from a network approach in adolescent samples. It is imperative to incorporate new psychological models to understand suicidal behaviour from a different perspective. The main objective of this work was twofold: (a) to examine suicidal behaviour through network analysis and (b) to estimate the psychological network between suicidal behaviour and protective and risk factors in school-age adolescents.

METHOD

Participants were 443 students (M=14.3 years; SD=0.53; 51.2% female) selected incidentally from different schools. Different instruments were administered to assess suicidal behaviour, emotional and behavioural difficulties, prosocial behaviour, subjective well-being, emotional intelligence, self-esteem, depressive symptomatology, empathy, positive and negative affect, and emotional regulation.

RESULTS

The resulting network of suicidal behaviour was strongly interconnected. The most central node in terms of strength and expected influence was "Consider taking your own life". In the estimated psychological network of suicidal behaviour and risk and protective factors, the nodes with the highest strength were depressive symptomatology, positive affect, and empathic concern. The most influential nodes were those related to emotional intelligence abilities. Suicidal behaviour was positively connected to depression symptoms and negative affect, and negatively connected to self-esteem and positive affect. The results of the stability analysis indicated that the networks were accurately estimated.

CONCLUSIONS

Suicidal behaviour can be conceptualized as a dynamic, complex system of cognitive, emotional, and affective characteristics. The new psychopathological and psychometric models allow us to analyse and understand human behaviour and mental health problems from a new perspective, suggesting new forms of conceptualization, evaluation, intervention, and prevention.

Psychotic-like experiences as a co-occurring psychopathological indicator of multi-dimensional affective symptoms: Findings from a cross-sectional survey among college students

BACKGROUND

Although connections between psychotic-like experiences (PLEs) and a series of non-psychotic disorders have been widely explored in previous research, it is unclear whether PLEs could act as a co-occurring psychopathological indicator of multi-dimensional affective symptoms.

METHODS

A total of 4761 students took part in an online survey which assessed the frequency of PLEs and three types of affective symptoms over lifetime. Binary logistic regression models were used to examine associations between PLEs and each type of affective symptom. Network analysis was conducted to explore the relationship among three subtypes of PLEs - persecutory ideation (PI), bizarre experiences (BEs) and perceptual abnormalities (PAs), and different types of affective symptoms.

RESULTS

The results showed that compared with the non-PLEs group, the PLEs group suffered significantly higher risk of experiencing three types of affective symptoms, including manic symptoms [adjusted odds ratio (aOR) 11.50, 95 % confidence interval (CI) (4.59-28.81)], depressive symptoms [aOR 7.28, 95 % CI (4.98-10.66)] and anxiety symptoms [aOR 4.47, 95 % CI (3.10-6.43)]. In the network model, bizarre experiences were the most critical central symptom. Both depressive and anxiety symptoms were most strongly associated with persecutory ideation while manic symptoms were most closely related to bizarre experiences.

LIMITATIONS

Cross-sectional data and self-reported symptoms.

CONCLUSIONS

These findings suggest that PLEs are a vital co-occurring indicator of multi-dimensional affective symptoms and show its enormous potential as a target for a host of mental health problems. Further investigation may shed light on the aetiology of the relationship between different subtypes of PLEs and affective symptoms.

(Attenuated) hallucinations join basic symptoms in a transdiagnostic network cluster analysis

Hallucinations are considered characteristic symptoms of psychosis and part of the 'psychosis superspectrum' of the Hierarchical Taxonomy Of Psychopathology (HiTOP) initiative. To gain insight into their psychopathological relevance, we studied their dimensional placement within a single dense transdiagnostic network constituting of basic symptoms as well as of attenuated and frank psychotic, and related symptoms. Newman's modularity analysis was used to detect symptom clusters in an earlier generated network (Jimeno, N., et al., 2020. Main symptomatic treatment targets in suspected and early psychosis: New insights from network analysis. Schizophr. Bull. 46, 884-895. https://doi.org/10.1093/schbul/sbz140). The constituting 86 symptoms were assessed with the Schizophrenia Proneness Instrument, Adult version (SPI-A), the Structured Interview for Psychosis-Risk Syndromes (SIPS), and the Positive And Negative Syndrome Scale (PANSS) in three adult samples of an early detection service: clinical high-risk (n = 203), first-episode psychosis (n = 153), and major depression (n = 104). Three clusters were detected: "subjective disturbances", "positive symptoms and behaviors", and "negative and anxious-depressive symptoms". The predominately attenuated hallucinations of both SIPS and PANSS joined the basic symptoms in "subjective disturbances", whereas other positive symptoms entered "positive symptoms and behaviors". Our results underline the importance of insight in separating true psychotic hallucinations from other hallucinatory experiences that, albeit phenomenologically similar are still experienced with some insight, i.e., are present in an attenuated form. We conclude that, strictly, hallucinations held with any degree of insight should not be used to diagnose transition to or presence of frank psychoses and, relatedly, to justify antipsychotic medication.

Risk and Protective Factors in Adolescent Suicidal Behaviour: A Network Analysis

Given that death by suicide continues to rank among the top three causes of death during adolescence, new psychological models may contribute critical insight towards understanding the complex interactions between risk and protective factors in suicidal behaviour. The main objective of this study was to analyse the psychological network structure of suicidal behaviour and putative risk and protective factors in school-aged adolescents. Methods: Stratified random cluster sampling was performed. The final sample comprised 1790 students (53.7% female, M = 15.7 years, SD = 1.26). Instruments were administered to assess suicidal behaviour, emotional and behavioural difficulties, prosocial behaviour, subjective well-being, self-esteem, depressive symptomatology, academic performance, socio-economic status, school engagement, bullying, and cyberbullying. Results: In the estimated psychological network, the node with the highest strength was depressive symptomatology, and that with the highest expected influence value was bullying. Suicidal behaviour was positively connected to symptoms of depression and behavioural problems. In addition, suicidal behaviour was negatively connected to self-esteem and personal well-being. The results of the stability analysis indicated that the network was accurately estimated. Conclusions: Suicidal behaviour can be conceptualised as a dynamic, complex system of cognitive, emotional, and affective characteristics. New psychological models allow us to analyse and understand human behaviour from a new perspective, suggesting new forms of conceptualisation, evaluation, intervention, and prevention.

Impact of conspiracist ideation and psychotic-like experiences in patients with schizophrenia during the COVID-19 crisis

Conspiratorial belief is a type of argument that accepts implausible explanations in situations of great uncertainty or mystery. Claiming that the coronavirus is an artificial fabrication of laboratories is an example of conspiracist belief. The aim of this research was to analyze the impact of conspiracist ideation and psychotic-like experiences in patients with schizophrenia, patients with other mental disorders, and participants with no psychiatric history with a 132-day follow-up during the COVID-19 crisis. Analysis of variance (ANOVA) was applied and Bayesian inferences were carried out. The results conclude that conspiracist ideation and psychotic-like experiences increased significantly after 132 days of social-health restrictions in the general population. However, psychotic-like experiences did not increase in patients with schizophrenia. Conspiracist ideation has a quantitative degradation similar to the continuum model of psychosis; it is present both in patients with schizophrenia and in those participants with no clinical history. The psychopathological value of conspiracist ideation within the spectrum of psychosis is discussed.

A Latent Profile Analysis of Psychotic Experiences, Non-psychotic Symptoms, Suicidal Ideation and Underlying Mechanisms in a Sample of Adolescents From the General Population

Psychotic experiences (PEs) are prevalent in the general population, particularly in adolescents. PEs are associated with various negative outcomes such as psychotic, depressive, anxiety and post-traumatic stress disorders and suicidal behavior. Recent studies in the general population have suggested that what makes PEs relevant is not so much the experiences per se, but their association with non-psychotic comorbidity and other transdiagnostic domains. Thus, there is a need for a better understanding of how PEs exist in a larger psychopathological context in adolescents. In the present study we aimed to explore this, using latent profile analysis (LPA) to identify different patterns in which PEs, psychiatric symptoms and psychological processes co-occur. LPA was conducted using data from an adolescent general population subsample (n = 335) with PEs. We conducted LPA, using measures of PEs, psychiatric symptoms and behaviors (depression, anxiety post-traumatic stress disorder and suicidal behavior) and cognitive and affective processes of entrapment/defeat and emotional regulation as manifest variables. We found that the best fit was obtained with a four-class solution that distinguished primarily between different levels of overall severity: "low symptomatology" (19.1%), "mild-moderate symptomatology" (39.4%), "moderate symptomatology" (33.7%); "high symptomatology" (7.8%). Levels of depression, post-traumatic stress symptoms and defeat/entrapment were most differentiated between classes. The high symptomatology group showed the highest scores in all psychiatric symptoms suicidal ideation, and emotional/cognitive domains, except in cognitive reappraisal. This group also showed the highest usage of emotional suppression. Our results suggest that the assessment of mental health risk in adolescents should be aware that PEs exist in a broad context of other domains of psychopathology and transdiagnostic cognitive and affective processes.

Network structure of psychotic-like experiences in adolescents: Links with risk and protective factors

AIM

The main goal was to analyse the network structure of psychotic-like experiences (PLEs) in a large sample of adolescents. In addition, the network structure between PLEs and putative risk (mental health difficulties, suicidal behaviour, depression symptoms) and protective factors (prosocial behaviour, subjective well-being, self-esteem) for psychosis was analysed.

METHODS

The sample compromised a total of 1790 adolescents (M=15.7 years; SD=1.26), 816 men (45.6%), selected by stratified random cluster sampling. Various tools were used to measure PLEs, general psychopathology, suicide ideation and behaviour, depression symptoms, prosocial behaviour, subjective well-being, and self-esteem. The Gaussian graphical model for continuous variables and Ising model for binary variables were used for network estimation.

RESULTS

The PLEs estimated network was strongly interconnected. Unusual perceptual experiences were among the most central nodes. The average predictability of this network was 16.41%. The PLEs and risk and protective factors estimated network showed a high degree of interconnectedness between PLEs and psychopathology domains. PLEs, behavioural problems, and emotional symptoms were among the most central nodes. The mean predictability of this network was 43.46%. The results of the stability and accuracy analysis indicated that networks were accurately estimated.

CONCLUSIONS

At population level, extended psychosis phenotype can be conceptualized as a network of interacting cognitive, emotional, and behavioural features. The network model allows us to understand psychosis risk, at the same time opening new lines of study in the mental health arena.

A Correlative Study Between Personality Traits and the Preference of Site Selection in Cosmetic Treatment

Background: Cosmetic treatment was closely associated with beauty seekers' psychological well-being. Patients who seek cosmetic surgery often show anxiety. Nevertheless, not much is known regarding how personality traits relate to the selection of body parts that receive cosmetic treatment. Aims: This study aims to investigate the correlation between personality traits and various selection sites for cosmetic treatment via Eysenck Personality Questionnaire (EPQ). Methods: A cross-sectional approach was adopted to randomly recruited patients from a general hospital planning to undergo cosmetic treatments. All respondents completed the EPQ and provided their demographic information. The EPQ involves four scales: the extraversion (E), neuroticism (N), psychoticism (P), and lying scales (L). Psychological scales were evaluated to verify that people who selected different body sites for cosmetic intervention possessed different personality portraits. Results: A total of 426 patients with an average age of 32.14 ± 8.06 were enrolled. Among them, 384 were females, accounting for more than 90% of patients. Five treatment sites were analyzed, including the body, eye, face contour, nose, and skin. Comparatively, patients with neuroticism were more likely to undergo and demand rhinoplasty (OR 1.15, 95% CI 1.07-1.24, P < 0.001). Face contour treatment was commonly associated with extraversion (OR 1.05, 95% CI 1.00-1.11, P = 0.044), psychoticism (OR 1.13, CI 1.03-1.25, P = 0.013), and neuroticism (OR 1.05, CI 1.01-1.10, P = 0.019). Conclusions: This novel study attempted to determine the personality profiles of beauty seekers. The corresponding assessments may provide references for clinical treatment options and enhance postoperative satisfaction for both practitioners and patients.

Applying network analysis to investigate the links between dimensional schizotypy and cognitive and affective empathy

BACKGROUND

Although impairment in empathy has been reported in schizophrenia spectrum disorders, little is known about the relationship between empathy and schizotypal traits. This study examines this relationship by applying network analysis to a large sample collected at 18-months follow-up in a longitudinal dataset.

METHODS

One thousand four hundred and eighty-six college students were recruited and completed a set of self-reported questionnaires on empathy, schizotypy, depression, anxiety and stress. Networks were constructed by taking the subscale scores of these measures as nodes and partial correlations between each pair of nodes as edges. Network Comparison Tests were performed to investigate the differences between individuals with high and low schizotypy.

RESULTS

Cognitive and affective empathy were strongly connected with negative schizotypy in the network. Physical and social anhedonia showed high centrality measured by strength, closeness and betweenness while anxiety and stress showed high expected influence. Predictability ranged from 22.4% (personal distress) to 79.9% (anxiety) with an average of 54.4%. Compared with the low schizotypy group, the high schizotypy group showed higher global strength (S = 0.813, p < 0.05) and significant differences in network structure (M = 0.531, p < 0.001) and strength of edges connecting empathy with schizotypy (adjusted ps < 0.05).

LIMITATIONS

Only self-rating scales were used, and disorganized schizotypy was not included.

CONCLUSIONS

Our findings suggest that the cognitive and affective components of empathy and dimensions of schizotypy are closely related in the general population and their network interactions may play an important role in individuals with high schizotypy.