Montreal Cognitive Assessment (MoCA) as a screening tool for cognitive impairment in early stages of psychosis

Background

Cognitive alterations have been reported in early stages of psychosis including people with First Episode Psychosis (FEP), Clinical High-Risk Mental State (CHR), and Psychotic-Like Experience (PLE). This study aimed to compare the cognitive function in early stages of psychosis using the Montreal Cognitive Assessment (MoCA), a low-cost and brief assessment tool of cognitive functions.

Methods

A total of 154 individuals, including 35 with FEP, 38 CHR, 44 PLE, and 37 healthy controls (HC), were evaluated with the MoCA in Santiago, Chile. We calculated the mean total score of the MoCA and the standard deviation of the mean. Groups were assessed for a trend to lower scores in a pre-determined sequence (HC > PLE > CHR > FEP) using the Jonckheere-Terpstra test (TJT).

Results

The mean total MoCA scores were 24.8 ± 3.3 in FEP, 26.4 ± 2.4 in CHR, 26.4 ± 2.3 in PLE, and 27.2 ± 1.8 in HC. The analyses revealed a significant trend (p < 0.05) toward lower MoCA individual domain scores and MoCA total scores in the following order: HC > PLE > CHR > FEP. The mean total scores of all groups were above the cut-off for cognitive impairment (22 points).

Conclusions

The MoCA describes lower scores in cognition across early stages of psychosis and may be a useful low-cost assessment instrument in early intervention centers of poorly resourced settings.

Children's early signs and developmental trajectories of psychotic-like experiences

INTRODUCTION

Children who experience persistent psychotic-like experiences (PLEs) are at a higher risk of developing psychotic disorder later in life. The developmental trajectories of PLEs are influenced by various factors. Therefore, it is important to identify early characteristics that can distinguish and predict between different developmental trajectories of PLEs.

METHODS

Using PLEs scores from the Adolescent Brain Cognitive Development (ABCD) data across three waves, we categorized participants into five distinct PLEs trajectories groups: persistent group (n = 47), remitting group (n = 185), increasing group (n = 117), remittent group (n = 21), and no PLEs group (n = 4,476). We utilized linear mixed-effect models and generalized linear mixed-effect models to examine the differences in baseline characteristics, including psychological and behavioral problems, suicidality, trauma experiences, developmental milestones, cognitive function, physical health, family income, family history of mental illness, and brain structureamong these PLEs trajectory groups.

RESULTS

We found that psychological and behavioral problems (such as DSM-oriented scales/externalizing/ADHD/social/attention/thought problems) assessed by the Child Behavior Checklist (CBCL) were associated with all PLEs groups. The persistent PLEs group had greater ADHD/social/thought problems and suicidal behavior compared to the remitting PLEs group. Comparing with the no PLEs group, poor cognitive function, abnormal brain structure (such as temporal lobe and supramarginal gyrus), more trauma experiences, and lower family income were found in only one of the PLEs groups, but not all PLEs groups.

CONCLUSION

The development of PLEs is accompanied by changes in many domains, implying a dynamic and complex developmental process. Given that psychological and behavioral problems can predict the emergence of PLEs at any time and can be regarded as risk factors for persistent PLEs, thereby enabling early precisely interventions, it is important to place greater emphasis on assessing psychological and behavioral problems.

The impact of spectral basis set composition on estimated levels of cingulate glutamate and its associations with different personality traits

BACKGROUND

1H-MRS is increasingly used in basic and clinical research to explain brain function and alterations respectively. In psychosis research it is now one of the main tools to investigate imbalances in the glutamatergic system. Interestingly, however, the findings are extremely variable even within patients of similar disease states. One reason may be the variability in analysis strategies, despite suggestions for standardization. Therefore, our study aimed to investigate the extent to which the basis set configuration- which metabolites are included in the basis set used for analysis- would affect the spectral fit and estimated glutamate (Glu) concentrations in the anterior cingulate cortex (ACC), and whether any changes in levels of glutamate would be associated with psychotic-like experiences and autistic traits.

METHODS

To ensure comparability, we utilized five different exemplar basis sets, used in research, and two different analysis tools, r-based spant applying the ABfit method and Osprey using the LCModel.

RESULTS

Our findings revealed that the types of metabolites included in the basis set significantly affected the glutamate concentration. We observed that three basis sets led to more consistent results across different concentration types (i.e., absolute Glu in mol/kg, Glx (glutamate + glutamine), Glu/tCr), spectral fit and quality measurements. Interestingly, all three basis sets included phosphocreatine. Importantly, our findings also revealed that glutamate levels were differently associated with both schizotypal and autistic traits depending on basis set configuration and analysis tool, with the same three basis sets showing more consistent results.

CONCLUSIONS

Our study highlights that scientific results may be significantly altered depending on the choices of metabolites included in the basis set, and with that emphasizes the importance of carefully selecting the configuration of the basis set to ensure accurate and consistent results, when using MR spectroscopy. Overall, our study points out the need for standardized analysis pipelines and reporting.

Moderating and mediating effects of resilience between childhood trauma and psychotic-like experiences among college students

BACKGROUND

Extensive literature revealed that childhood trauma serves as a significant risk factor for developing psychotic-like experiences (PLEs) among the general population. Resilience has been regarded as a protective factor against PLEs. However, it remains unclear what role resilience plays in the relationship between childhood trauma and PLEs.

METHODS

A total of 4302 college students completed the web-based survey in January 2021. Participants completed self-report measures of sample characteristics variables, childhood trauma, and PLEs. Moderation and mediation analyses were adopted to examine the associations linking childhood trauma, resilience, and PLEs.

RESULTS

PLEs were positively associated with childhood trauma while negatively associated with resilience. Resilience played a partially mediating role in the relationship between childhood trauma and PLEs. Additionally, resilience moderated the association of childhood trauma with PLEs.

CONCLUSIONS

These findings indicated that resilience plays a crucial role in mediating the relationship between childhood trauma and PLEs, suggesting the potential clinical implication of enhancing resilience for the prevention and intervention of PLEs among college students.

Do anxiety symptoms and coping motives serially mediate the association between psychotic-like experiences and cannabis-related problems in undergraduate recent cannabis users?

Many Canadian emerging adults (ages 18-25 years) use cannabis, with 60 % of past-three-month users experiencing one or more cannabis-related problems (i.e., adverse consequences of use). While psychotic-like experiences (PLEs) and cannabis problems overlap, little is known about the mechanisms explaining this link. One hypothesis is that PLEs are distressing and give rise to anxiety, with which emerging adults attempt to cope through increased cannabis use, in turn increasing their risk for cannabis-related problems. We tested a chained-mediational model to determine if anxiety and coping-with-anxiety motives for cannabis use sequentially mediated the link between PLEs and cannabis problems in emerging adult undergraduates; a conditional process model tested for moderation by sex. Emerging adult cannabis users (N = 413; mean [SD] age = 19.1 [1.5] years; 71.9 % female) from five Canadian universities provided cross-sectional, self-report survey data in fall 2021. Validated measures of PLEs, anxiety, cannabis coping-with-anxiety motives, and cannabis-related problems were administered. Path analyses supported the hypothesized chained mediational indirect effect (b = 0.027, 95 % bootstrap CI [0.012, 0.050]). No direct effect was found (p =.698), suggesting that the PLEs-to-cannabis problems association is fully explained by anxiety and cannabis coping-with-anxiety motives. Inconsistent with hypotheses, mediation did not depend on sex (95 % CIs crossed zero); therefore, anxiety and cannabis coping-with-anxiety motives explain the link between PLEs and cannabis problems in emerging adults regardless of their sex. Results highlight anxiety and cannabis coping-with-anxiety motives as potentially important intervention targets in cannabis-using emerging adults with PLEs, possibly preventing the development/worsening of cannabis-related problems.

Resilience buffers the association between psychotic-like experiences and suicide risk: a prospective study from a non-clinical sample

BACKGROUND

Several studies have reported that psychotic-like experiences are associated with low levels of resilience and increased suicide risk. However, it remains unknown as to whether resilience mediates or moderates the association between psychotic-like experiences and suicide risk. Therefore, in this study, we aimed to explore the moderating and mediating effect of resilience in the association between psychotic-like experiences and suicide risk.

METHODS

A total of 1100 non-clinical, young adults (aged 18 - 35 years) with a negative history of psychiatric treatment were enrolled. Participants were recruited by the snowball sampling methodology through advertisements posted in the online platform. They were followed-up for about 7 months. Variables of interest were recorded using self-reports. Psychopathological assessment was conducted using the Prodromal Questionnaire-16, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Traumatic Experience Checklist, the Childhood Experience of Care and Abuse Questionnaire, the Cannabis Problems Questionnaire, the Connor-Davidson Resilience Scale-10, and the Mini-International Neuropsychiatric Interview. The STROBE statement guidelines were followed.

RESULTS

The moderation analysis revealed that higher levels of psychotic-like experiences and related distress at baseline were associated with significantly higher suicide risk at the follow-up after adjustment for baseline sociodemographic characteristics, depressive and anxiety symptoms, a history of childhood trauma, and problematic cannabis use. The interaction between follow-up resilience and distress related to baseline psychotic-like experiences was significantly and negatively associated with suicide risk at the follow-up. Specifically, the correlation between the level of distress related to psychotic-like experiences and suicide risk was significant and positive only in participants with lower levels of resilience. This interaction did not reach statistical significance for the baseline level of psychotic-like experiences. No significant mediating effect of the follow-up resilience level in the association between baseline psychotic-like experiences and the follow-up suicide risk was found.

CONCLUSIONS

Findings from the present study indicate that resilience might protect against suicide risk in people with psychotic-like experiences. These findings could be applied in the formulation of early intervention strategies aimed at mitigating the risk of suicide. Future studies need to explore the effects of interventions targeting resilience for individuals with psychotic-like experiences.

Endorsement of psychotic-like experiences and problematic cannabis use associated with worse executive functioning performance in undergraduates

BACKGROUND

Emerging adults who endorse more positive psychotic-like experiences (PLEs; bizarre experiences, delusional ideations) may experience greater cannabis-related impairments in executive function. Negative and depressive PLEs are also associated with cannabis use, however, less is known about their relation to executive functioning. Here, we hypothesize that high positive PLEs and cannabis use are associated with worse performance on computerized versions of the Iowa Gambling Task (IGT) and the Card Sorting Task (CST); exploratory analyses are conducted with negative and depressive PLEs.

METHODS

We recruited university students (N = 543) who completed an online study consisting of self-report measures of problematic cannabis use (Cannabis Use Disorder Identification Test; CUDIT-R) and PLEs (Community Assessment of Psychotic Experiences; CAPE). Of these, n=270 completed the CST and n=251 completed the IGT.

RESULTS

Problematic cannabis use and high endorsement of positive PLEs related to significantly worse performance on the IGT and greater perseverative errors on the CST. In addition, people who endorsed high levels of positive PLEs were also significantly more likely to complete the IGT with less money relative to those who endorsed fewer PLEs, regardless of cannabis use. Further analyses based on negative PLEs revealed a similar pattern for perseverative errors on the CST; depressive PLEs were not related to task performance.

CONCLUSION

Findings highlight that problematic cannabis use and more frequent and distressing positive PLEs are associated with poorer executive functioning. Thus, executive functioning may have implications for intervention among those high on both attributes, who are at high risk of onset of psychosis.

Associations between digital media use and psychotic experiences in young adults of Quebec, Canada: a longitudinal study

PURPOSE

Digital media use has been associated with psychotic experiences in youth from the community, but the direction of association remains unclear. We aimed to examine between- and within-person associations of digital media use and psychotic experiences in youth.

METHODS

The sample included 425 participants aged 18-25 years (82.5% female) from the community, followed between May 2021 and January 2022 over 3 time points-of which 263 participants (61.9%) completed at least 2. Digital media use was self-reported as time spent daily on TV and streaming platforms, social media, and video games over the past 3 months. Psychotic experiences in the past 3 months were measured with the 15-item Community Assessment of Psychic Experiences. Associations between digital media use and psychotic experiences were estimated using a random-intercept cross-lagged panel model.

RESULTS

On average, individuals who reported greater digital media use also reported higher levels of psychotic experiences (r = 0.34, 95% CI 0.15, 0.53). However, a person's variation in digital media use, relative to their personal average, was not significantly associated with subsequent variations in their levels of psychotic experiences, or vice-versa. Results were similar across TV/streaming, social media and video game use, and after adjusting for age, sex, education, sleep, physical activity, and cannabis use.

CONCLUSION

Individuals with a tendency for higher levels of digital media use also had a tendency for higher levels of psychotic experiences. Understanding this association may help personalize mental health interventions for people with psychotic experiences, which may be offered digitally to promote their accessibility.

Schizophrenia polygenic risk score in psychosis proneness

Schizophrenia (SZ) is a complex disorder with a highly polygenic inheritance. It can be conceived as the extreme expression of a continuum of traits that are present in the general population often broadly referred to as schizotypy. However, it is still poorly understood how these traits overlap genetically with the disorder. We investigated whether polygenic risk for SZ is associated with these disorder-related phenotypes (schizotypy, psychotic-like experiences, and subclinical psychopathology) in a sample of 253 non-clinically identified participants. Polygenic risk scores (PRSs) were constructed based on the latest SZ genome-wide association study using the PRS-CS method. Their association with self-report and interview measures of SZ-related traits was tested. No association with either schizotypy or psychotic-like experiences was found. However, we identified a significant association with the Motor Change subscale of the Comprehensive Assessment of At-Risk Mental States (CAARMS) interview. Our results indicate that the genetic overlap of SZ with schizotypy and psychotic-like experiences is less robust than previously hypothesized. The relationship between high PRS for SZ and motor abnormalities could reflect neurodevelopmental processes associated with psychosis proneness and SZ.

The dimensionality of perceptual anomalies and their relationships with bullying victimization among Chinese adolescents: From a network perspective

Anomalous perceptual experiences in adolescents are common and may predict future psychotic disorders and other psychopathologies. However, the underlying structure and their specific relationships with bullying victimizations, a typical stressor for adolescents, remain unclear. Therefore, the current study aimed to clarify the structure of perceptual anomalies as assessed by the Cardiff Anomalous Perceptions Scale (CAPS) using exploratory graph analysis (EGA), a new factor retention method based on network psychometrics. The second aim was to explore whether specific dimensions of perceptual anomalies are particularly associated with certain forms of bullying victimization. Data from a validated sample of 1199 Chinese adolescents (56.0 % females, age range: 14-20) on perceptual anomalies and bullying victimizations were analyzed using network approaches, including EGA and mixed graphical modeling (mgm). Results showed that each anomalous perception was experienced by 13.8-50.3 % of the participants. EGA identified four dimensions: aberrant bodily perceptions, altered daily experiences, chemosensation (i.e., abnormal gustatory and olfactory experiences), and clinical psychosis (i.e., visual and auditory hallucinatory experiences). Among them, the altered daily experiences dimension possessed the highest centrality. Physical bullying and cyberbullying were directly and positively linked to two of the aberrant bodily experiences. Bootstrap analyses suggest that the results are reliable. The current findings support the existence of multiple contributive factors to perceptual anomalies and underscore the importance of bullying prevention in reducing mental health risks for adolescents, particularly the risk of psychosis.

Examining delusional ideation: Relationships with race and socioeconomic status

Race and socioeconomic status (SES) are commonly cited as risk factors for psychosis and psychotic-like experiences (PLEs). However, few studies have investigated the relationships between race and SES with specific domains of PLEs. Specifically, little work has examined the relationships between race and SES with delusional ideation, severity (preoccupation, conviction, distress), and delusional themes. Using cross-sectional, general population data (N = 727) from the Nathan Kline Institute-Rockland (NKI-Rockland) database, we investigated racial differences in delusional ideation and severity between Black and White participants, including differences in delusional themes. Then, we investigated SES's relationship with delusional thinking and the interaction between race and SES on delusional thinking. Black American participants endorsed higher delusional ideation with stronger severity than White Americans. A significant interaction between race and delusional theme revealed that Black Americans endorse significantly more delusional ideation in themes of grandiosity, religiosity, and referential-guilt. Black Americans endorse greater delusional severity in grandiose and religious ideations. Black Americans endorse stronger preoccupation and conviction - but not distress-in their referential-guilt ideation. SES was not significantly associated with delusional thinking, nor did SES moderate the significant relationships between race and delusional ideation. These results illuminate the clear racial disparity that exist in delusional ideation within a general population, which did not extend to SES in this dataset. Future work should investigate deeper into the contributory factors to these racial disparities, particularly whether they are based in psychological and/or cultural differences or are the result of assessment/measurement bias.

Psychosis Symptom Trajectories Across Childhood and Adolescence in Three Longitudinal Studies: An Integrative Data Analysis with Mixture Modeling

Psychotic-like experiences (PLEs) are common throughout childhood, and the presence of these experiences is a significant risk factor for poor mental health later in development. Given the association of PLEs with a broad number of mental health diagnoses, these experiences serve as an important malleable target for early preventive interventions. However, little is known about these experiences across childhood. While these experiences may be common, longitudinal measurement in non-clinical settings is not. Therefore, in order to explore longitudinal trajectories of PLEs in childhood, we harmonized three school-based randomized control trials with longitudinal follow-up to identify heterogeneity in trajectories of these experiences. In an integrative data analysis (IDA) using growth mixture modeling, we identified three latent trajectory classes. One trajectory class was characterized by persistent PLEs, one was characterized by high initial probabilities but improving across the analytic period, and one was characterized by no reports of PLEs. Compared to the class without PLEs, those in the improving class were more likely to be male and have higher levels of aggressive and disruptive behavior at baseline. In addition to the substantive impact this work has on PLE research, we also discuss the methodological innovation as it relates to IDA. This IDA demonstrates the complexity of pooling data across multiple studies to estimate longitudinal mixture models.

The influence of psychotic-like experiences on intent to seek treatment: Findings from a multi-site community survey of mental health experiences

Psychotic-like experiences (PLEs) may reflect elevated risk for serious mental illness, including psychosis. Although some studies report an association between PLEs and increased service utilization, there is evidence of unmet need among individuals with PLEs, with few studies exploring the relation between PLEs and intent to seek treatment. Characterizing factors that underlie intent to seek treatment in individuals not otherwise engaged in treatment may assist in determining the role of PLEs and future intentions, and help prioritize symptoms of greatest significance. Non-help-seeking participants ages 16-30 years (nanalysis = 2529) in a multi-site study completed online questionnaires of PLEs (PRIME with distress), depression (CESD), anxiety (STAI), and intention to seek mental health treatment. Associations between PLEs and intent to seek treatment were analyzed through multiple linear regressions. PRIME scores predicted intent to seek treatment, and item-level analyses suggested that this association was driven by items 12 ("going crazy"), 7 (wondering if people may hurt me), 5 (confused if things are real or imagination/dreams), and 1 (odd/unusual things going on). When accounting for the effects of anxiety and depression, PLE sum scores as well as individual experiences remained statistically significant, although effect sizes were negligible. Findings suggest that PLEs can play a role in identifying individuals who intend to seek mental health services and warrant further research in independent samples.

Resting-State Functional Connectivity Explained Psychotic-like Experiences in the General Population and Partially Generalized to Patients and Relatives

Background

Psychotic-like experiences (PLEs) are considered the subclinical portion of the psychosis continuum. Research suggests that there are resting-state functional connectivity (rsFC) substrates of PLEs, yet it is unclear if the same substrates underlie more severe psychosis. Here, to our knowledge, we report the first study to build a cross-validated rsFC model of PLEs in a large community sample and directly test its ability to explain psychosis in an independent sample of patients with psychosis and their relatives.

Methods

Resting-state FC of 855 healthy young adults from the WU-Minn Human Connectome Project (HCP) was used to predict PLEs with elastic net. An rsFC composite score based on the resulting model was correlated with psychotic traits and symptoms in 118 patients with psychosis, 71 nonpsychotic first-degree relatives, and 45 healthy control subjects from the psychosis HCP.

Results

In the HCP, the cross-validated model explained 3.3% of variance in PLEs. Predictive connections spread primarily across the default, frontoparietal, cingulo-opercular, and dorsal attention networks. The model partially generalized to a younger, but not older, subsample in the psychosis HCP, explaining two measures of positive/disorganized psychotic traits (the Structured Interview for Schizotypy: β = 0.25, pone-tailed = .027; the Schizotypy Personality Questionnaire positive factor: β = 0.14, pone-tailed = .041). However, it did not differentiate patients from relatives and control subjects or explain psychotic symptoms in patients.

Conclusions

Some rsFC substrates of PLEs are shared across the psychosis continuum. However, explanatory power was modest, and generalization was partial. It is equally important to understand shared versus distinct rsFC variances across the psychosis continuum.

Evaluation of reliability and validity of the Persian version of Peters et al. delusions inventory (PDI-40) in iranian non-clinical and clinical samples

BACKGROUND

Some individuals may manifest psychotic symptoms that do not fulfill the requisite clinical criteria for a formal diagnosis of psychosis. The assessment of susceptibility to delusions, encompassing both clinical and non-clinical cohorts, frequently makes use of the Peters et al. Delusions Inventory (PDI-40). This study aimed to evaluate the reliability and validity of the Persian version of Peters et al. Delusions Inventory (PDI-40) in Iranian non-clinical and clinical samples.

METHODS

The present study employed a cross-sectional, correlational design in 2020. A total of 1402 Iranian participants were recruited for the study, which consisted of three distinct stages. The first stage involved an Exploratory Factor Analysis (EFA) conducted on a non-clinical sample of 512 participants. The second stage comprising different non-clinical sample 764 participants to perform a Confirmatory Factor Analysis (CFA). In the third stage, a clinical sample of 126 psychotic patients was compared to a non-clinical sample. All participants completed the PDI-40, the Community Assessment of Psychotic Experiences (CAPE-42), and the Depression, Anxiety, and Stress Scale (DASS-21). The internal structure of PDI-40 was examined through the analysis of its factor structure using LISREL 8.8.

RESULTS

The EFA analysis unveiled nine components within Persian version of PDI-40. The CFA analysis demonstrated an excellent fit of the nine-factor structure of Persian PDI-40 to the data. The total score exhibited high internal reliability, as indicated by Cronbach's alpha coefficient of 0.92. Moreover, Persian PDI-40 exhibited satisfactory evidence of convergent validity, as significant correlations were observed between dimensions of PDI-40 and subscales of CAPE-42 and DASS-21. Lastly, findings indicated that psychotic participants scored higher than non-clinical participants in all components of the PDI-40(p < 0.05).

CONCLUSION

Persian version of the PDI-40 demonstrates strong reliability and validity for assessing delusion proneness in both non-clinical and clinical samples in Iran. The observed distinctions between psychotic and non-clinical participants underscore its potential as a valuable tool for discerning delusion proneness in diverse contexts.

Psychiatric and affective predictors of negative racial attitudes

Negative Racial Attitudes (NRA) have been identified as major contributors to discrimination and inequalities. Previous studies of predictors of NRA have focused largely on socioeconomic, socialization, social attitudes, and personality characteristics. Yet, the potential links of psychiatric and affective indicators to NRA have received little scientific inquiry. Three-hundred-and-two participants completed measures of explicit, covert, and implicit NRA, along with indices of psychotic-like experiences (PLEs), mood symptoms, affective processing, social attitudes, and personality characteristics. Explicit and covert NRA were significantly correlated with difficulty identifying and describing feelings, use of suppression to regulate emotion, and the PLEs domains of perceptual abnormalities, bizarre experiences, and persecutory ideation, along with social attitudes and personality characteristics. Implicit NRA was not associated with any indicators. Next, employing hierarchical multiple linear regression analyses, the affective and psychiatric indicators accounted 5.2% and 10.4% of the explicit and covert NRA variance, respectively, controlling for previously identified predictors including demographics, social attitudes, and personality characteristics. Our results point to newly identified predictors of NRA including difficulties identifying and describing emotions, use of suppression to regulate emotions, as well as PLEs, specifically perceptual abnormalities. We discuss the implications of the findings to the development and adaptation of anti-racism interventions.

Associations between social engagement, internalizing symptoms, and delusional ideation in the general population

BACKGROUND

Delusions are a hallmark feature of psychotic disorders and lead to significant clinical and functional impairment. Internalizing symptoms-such as symptoms of depression, anxiety, and trauma exposure-are commonly cited to be related to delusions and delusional ideation and are often associated with deficits in social functioning. While emerging studies are investigating the impact of low social engagement on psychotic-like experiences, little work has examined the relationship between social engagement, internalizing symptoms, and delusional ideation, specifically.

METHODS

Using general population data from the Nathan Kline Institute-Rockland (NKI-Rockland) database (N = 526), we examined the relationships between self-reported delusional ideation, internalizing symptoms, and social engagement and tested four indirect effect models to understand how these factors interrelate.

RESULTS

Delusional ideation was significantly associated with both increased internalizing symptoms (r = 0.41, p < 0.001) and lower social engagement (r = - 0.14, p = 0.001). Within aspects of social engagement, perceived emotional support showed the strongest relationship with delusional ideation (r = - 0.17, p < 0.001). Lower social engagement was also significantly associated with increased internalizing symptoms (r = - 0.29, p < 0.001). Cross-sectional models suggest that internalizing symptoms have a significant indirect effect on the association between delusional ideation and social engagement.

CONCLUSIONS

These findings reveal that elevated delusional ideation in the general population is associated with lower social engagement. Elevated internalizing symptoms appear to play a critical role in reducing engagement, possibly exacerbating delusional thinking. Future work should examine the causal and temporal relationships between these factors.

Attachment and resilience as mediators or moderators in the relationship between trauma and psychotic-like experiences

BACKGROUND

A large body of evidence has established a tight relation between traumatic experiences (TEs) and psychotic-like experiences (PLEs). Nevertheless, more comprehensive models involving multiple interactions of serial or parallel mediations and moderations still need to be elucidated. Among the many potential mediators or moderators, insecure attachment and resilience play a key role in the association of stress with PLEs. Hence, we aim to explore the complex pathways that lead from different types of TEs to PLEs, involving attachment and resilience modeled as mediators or moderators.

METHODS

One thousand ten high school students completed the International Trauma Exposure Measure (ITEM), the 11-item Resilience Scale for Adults (RSA-11), the 16-item Prodromal Questionnaire (iPQ-16), and the Relationship Questionnaire (RQ). A path analysis was conducted to assess mediation and moderation.

RESULTS

The final model showed that the impact of childhood TEs on PLEs was mediated by a pathway through anxious-insecure attachment styles (i.e., fearful and preoccupied, respectively, 8.75 % and 8.53 % of the total effect) and personal resilience resources. Conversely, the avoidant-insecure attachment was associated with lower interpersonal resilience (b = 0.14 [0.08, 0.20]), which in turn moderated the impact of recent TEs on PLEs (interaction term b = 0.34 [0.21, 0.47]).

CONCLUSIONS

Our model examines a complex model that includes factors buffering the effect of traumatic experiences on PLEs. Our results highlight the importance of insecure-anxious attachment to personal resilience resources and of insecure-avoidant attachment to interpersonal resilience as potential targets for clinical practice.

The predictive role of psychotic-like experiences in suicidal ideation among technical secondary school and college students during the COVID-19 pandemic

BACKGROUND

Previous research has shown the strong association between psychotic-like experiences (PLEs) and suicide. However, the predictive role of PLEs in suicidal ideation (SI) during the COVID-19 pandemic remains unclear.

AIMS

This study aimed to explore the association between PLEs before the pandemic and SI during the pandemic among late adolescents.

METHODS

A total of 938 technical secondary school and college students completed both waves of the online survey before and during the pandemic. PLEs were assessed through the 15-item Positive Subscale of the Community Assessment of Psychic Experiences. SI was evaluated by the frequency of SI during the pandemic.

RESULTS

In early stage of the pandemic, most students had low frequent SI, and only 3.3% students showed high frequent SI. Compared to the low frequent group, the high frequent group exhibited significantly higher levels of PLEs (p < 0.001) and scored lower in resilience (p = .001) and perceived social support (p = .008) across the two timepoints. PLEs were significantly associated with higher risk of high frequent SI (OR = 2.56, 95%: 1.07-6.13), while better resilience (OR: 0.93, 95% CI: 0.88-0.99) and stronger perceived social support (OR: 0.96, 95% CI: 0.93-0.99) appeared to be protective factors. No interactions were found among PLEs and other psychosocial and psychological factors.

CONCLUSIONS

PLEs may increase the risk of SI in early stage of the pandemic, while good resilience and adequate social support can help weaken the risk.

Psychotic experiences, suicidality and non-suicidal self-injury in adolescents: Independent findings from two cohorts

BACKGROUND

Prior studies have shown that psychotic experiences are prospectively associated with an increased risk of suicidality. However, it is unclear whether this association is causal or arises from shared risk factors. Furthermore, little is known about the association between psychotic experiences and non-suicidal self-injury (NSSI).

METHODS

We used data from two independent samples of young adolescents, which we analyzed separately. In a population-based cohort, data on hallucinatory experiences and suicidality were collected at ages 10 and 14 years (N = 3435). In a cross-sectional study of a population oversampled for elevated psychopathology levels, psychotic experiences, suicidality, and NSSI were assessed at age 15 years (N = 910). Analyses were adjusted for sociodemographic covariates, maternal psychopathology, intelligence, childhood adversity, and mental health problems.

RESULTS

Psychotic experiences were prospectively associated with an increased risk of suicidality, even when considering self-harm ideation at baseline. Furthermore, persistent and incident, but not remittent, patterns of psychotic experiences were related to an increased burden of suicidality. Self-harm ideation was also prospectively associated with the risk for psychotic experiences, although of smaller magnitude and only by self-report. Among at-risk adolescents, psychotic experiences were cross-sectionally associated with a greater burden of suicidality and a higher frequency of NSSI events, with more extensive tissue damage.

CONCLUSION

Psychotic experiences are longitudinally associated with suicidality beyond the effects of shared risk factors. We also found modest support for reverse temporality, which warrants further investigation. Overall, our findings highlight the importance of assessing psychotic experiences as an index of risk for suicidality and NSSI.

Psychotic-like experiences in non-clinical subgroups with and without specific beliefs

BACKGROUND

Assuming a transdiagnostic and extended psychosis phenotype, psychotic-like experiences (PLEs) and psychotic symptoms are on a phenomenological and temporal continuum between clinical and non-clinical populations. Recent research points towards differences in PLE proneness in different subgroups and clinical impact of different PLE subtypes. This study examines the prevalence of PLEs in three groups of individuals with and without specific sets of beliefs aiming to elucidate the question whether proneness to PLEs varies according to traditional versus less traditional supernatural beliefs.

METHODS

The anonymized 16-item version of the Prodromal Questionnaire (PQ-16) was used to assess PLEs in three groups including individuals with religious beliefs (RB), belief in esoterism and paranormal phenomena (EB), and those embedded in scientific evidence approach and scepticism towards para-scientific theories (non-believers, NB). Male and female participants between 18 and 90 years were eligible for participation.

RESULTS

The sample comprised 159 individuals including 41 RB individuals, 43 EB individuals, and 75 NB individuals. The mean PQ-16 score of the EB individuals (6.86 ± 4.13) was significantly higher compared to NB individuals (3.43 ± 2.99) and to RB individuals (3.38 ± 3.23) with almost twice the score (both p-values < 0.001). There was no significant difference between the PQ-16 scores of the NB group and the RB group (p = 0.935). No significant impact of age (p = 0.330) and gender (p = 0.061) was found on the PQ16-Score. Group affiliation to esoterism was associated with a higher PQ-16 score compared to group affiliation to religious beliefs (p < 0.001) and group affiliation to scepticism (p = 0.011), while the latter two did not differ significantly (p = 0.735). No significant difference was found between the three groups in the degree of distress related to the affirmatively answered PQ-16 items (p = 0.74).

CONCLUSION

Under the assumption of a transdiagnostic psychosis phenotype, our findings provide more insight which subgroups within non-clinical samples have a higher likelihood of reporting PLEs.

Visual illusions in young people reporting psychotic-like experiences

BACKGROUND AND OBJECTIVES

A disruption in the co-ordination of bottom-up and top-down processing is thought to underlie anomalous perceptual experiences in psychosis. Visual illusions represent a valuable methodology in exploring this disruption. Here, we examined visual illusions in a group of young people having psychotic-like experiences. We also examined the relationship between illusion susceptibility and appraisal of psychotic-like experiences as well as depression, anxiety and stress levels.

METHOD

25 young people reporting psychotic-like experiences and 53 healthy participants performed an adjustment task that measured susceptibility to a battery of 13 visual illusions. Levels of depression, anxiety and stress were quantified in both groups. The clinical group also completed measures examining frequency, appraisals and emotional responses to psychotic-like experiences.

RESULTS

A general increase of illusion susceptibility was found in the clinical group compared to the control group. However, when depression, anxiety and stress levels were controlled for, this difference disappeared. Stress turned out to be the best predictor of illusion susceptibility in the clinical group, whereas anomalous experiences, depression and anxiety were unrelated to overall illusion strength.

LIMITATIONS

This study is limited to young participants reporting significant mental health difficulties and psychotic-like experiences. Findings should be replicated in an Ultra High Risk (prodromal) group.

CONCLUSIONS

Increased levels of stress explained the enhanced vulnerability to illusions in the clinical group. This increased susceptibility suggests a perceptual style that relies too heavily on prior expectations at the expense of the true sensory evidence, potentially leading to an altered perceptual experience of the world.

Mediation effect of insomnia symptoms between positive psychotic like experiences and suicidal ideation among Lebanese young adults

BACKGROUND

Psychotic symptoms reported by healthy individuals in the general population are referred to as psychotic-like experiences (PLEs) and have been proven to increase the risk of suicidal ideation (SI) in these individuals. As it is well established that PLEs and insomnia share a bidirectional association and also that insomnia is linked to SI, we hypothesized that insomnia may represent a mediator underlying the relationship between PLEs and SI. Our aim was to validate this hypothesis among Lebanese young adults.

METHODS

A total of 3103 young adults (mean age 21.73 ± 3.80 years; 63.6% females) recruited from all Lebanese governorates completed a self-administered online questionnaire. PLEs were assessed using the CAPE-42 scale, SI using the Columbia Suicide Rating Scale, and insomnia using the Insomnia Severity Index). We conducted a mediation analysis using SPSS PROCESS v3.4 model 4 with three pathways. Variables that showed a p < 0.25 in the bivariate analysis were entered in the path analysis.

RESULTS

A total of 1378 participants (44.4%) had insomnia; 18.8% had SI; 42.5% reported at least one positive PE 'nearly always', and 30.5% reported at least one negative PE with this frequency. The results of the mediation analysis showed that insomnia severity partially mediated the association between positive dimension and SI; higher positive dimension was significantly associated with more insomnia severity, which was, in turn, significantly associated with more SI. Finally, more positive dimension was significantly and directly associated with more SI.

CONCLUSION

These preliminary findings might encourage the implementation of new preventive measures to reduce SI among PLEs patients. Treating symptoms of insomnia might help reduce the risk of suicide.

Potential mechanisms between psychotic-like experiences and suicidal ideation in the context of COVID-19: A longitudinal study

OBJECTIVE

Although many studies have found an association between psychotic-like experiences (PLEs) and suicidal ideation (SI), the underlying psychological mechanisms have not been well established. Therefore, we conducted a longitudinal study in technical secondary school and college students to explore the role of fear-response to the COVID-19 and depression in the association between PLEs and SI in the context of the COVID-19 pandemic.

METHODS

PLEs were assessed using the 15-item Positive Subscale of the Community Assessment of Psychic Experiences (CAPE-P15). Depression, fear, and SI were assessed using the Psychological Questionnaire for Public Health Emergency (PQPHE). PLEs were evaluated before the pandemic (T1), and fear, depression, and SI were measured during the pandemic (T2).

RESULT

A total of 938 students completed both waves of the survey through electronic questionnaires. PLEs, fear, depression, and SI were all correlated with each other (all p < 0.01). T2 depression partly (58.2 %) mediated the relationship between T1 PLEs and T2 SI (b = 0.15, 95%CI = 0.10, 0.22). T2 Fear moderated the relationship between T1 PLEs and T2 depression (b = 0.05, 95%CI = 0.01, 0.09) and the relationship between T1 PLEs and T2 SI (b = 0.11, 95%CI = 0.06, 0.16).

CONCLUSION

PLEs are both directly and indirectly related to SI. Depression can result from PLEs and lead to the subsequent SI. Additionally, high levels of fear during the COVID-19 pandemic can aggravate the adverse impact of PLEs on mental health problems. These findings provide potential targets for future suicide prevention.

A comparative study of mental health status among left-behind, migrant, and local adolescents in China

OBJECTIVE

Influence of migration on mental impairments among adolescents has been well assessed. However, there lack empirical data on multiple mental health problems and comparisons of children who suffer from different parental migration. This study aims to compare the mental health status among left-behind adolescents (LBA), migrant adolescents (MA), and local adolescents (LA).

METHODS

A total of 67,532 adolescents were investigated on depression, anxiety, sleep disturbance, and psychotic-like experiences (PLEs). The LBA were registered in Shenzhen's hukou (household register system) and are living in Shenzhen while their parent(s) has/have migrated to work elsewhere for over 6 months. MA, defined as adolescents who immigrated with parents from other places, are living but not registered in Shenzhen hukou. LA referred to adolescents who were registered in Shenzhen hukou and are living with their parents. Social-demographics, family function, and school climate were also evaluated as influential factors.

RESULTS

The prevalence of overall mental health problems was 37.4 % for LBA, which was higher than that of MA (27.9 %) and LA (27.1 %). Females, adolescents with chronic physical illness, and with family history of mental disorders are all contributed to the increased occurrence of mental health issues. Poorer family function and school climate were also negatively associated with mental health among the three types of adolescents.

CONCLUSION

LBA is at a higher risk for poor mental health than other adolescents. Interventions that promoting family function and improving school climate may be helpful, especially for girls with chronic physical illness, or with family history of mental disorders.

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.

Gender divergent effect of COMT gene rs4680 polymorphism on the association between executive dysfunction and psychotic-like experiences

AIM

Premorbid cognitive impairments are observed prior to the onset of schizophrenia. Catechol-O-methyltransferase (COMT) rs4680 is associated with psychosis and plays a crucial role in the development of the executive function. In addition, genetic COMT variations and gender affect its enzymatic activity. Therefore, the aim of this study was to evaluate the impact of COMT rs4680 on the relationship between executive dysfunction and psychotic-like experiences (PLEs) in college students, with the additional investigation of the gender difference.

METHODS

A total of 463 students provided biological samples for DNA analysis and the COMT gene rs4680 polymorphism was discriminated by the improved multiplex ligase detection reaction method. They also completed the Prodromal Questionnaire and the Dysexecutive Questionnaire.

RESULTS

Executive dysfunction significantly predicted positive PLEs in the total, male and female population (β = 0.515, 0.508 and 0.512, p < 0.001). The results of moderated analysis revealed that COMT rs4680 recessive genetic model ('AA genotype' versus 'G carrier') moderated the relationship between executive dysfunction and psychotic-like experience in the total and females (p = 0.002 and p <0.001, respectively), but not in males.

CONCLUSION

These findings revealed a female-specific effect of COMT rs4680 on the relationship between executive dysfunction and PLEs in young adults.

Psychotic-like experiences during COVID-19 lockdown among adolescents: Prevalence, risk and protective factors

OBJECTIVE

Although plenty of evidence has shown the huge negative impact of COVID-19 on individuals' mental health conditions, little is known about its impact on the psychotic-like experiences (PLEs) in the general population. We aim to explore the prevalence of PLEs and relevant influential factors among adolescents during COVID-19 lockdown.

METHODS

A total of 3234 students completed one online survey between April to May 2020. PLEs were assessed using the 15-item Positive Subscale of the Community Assessment of Psychic Experiences (CAPE-P15). Resilience, social support, childhood trauma, and a series of socio-demographic factors were also evaluated.

RESULTS

In this sample, 51.4 % adolescents reported having at least one PLE, while 11.6 % experienced PLEs frequently during COVID-19 lockdown. Senior high school students showed more frequent PLEs than college students (p < 0.001). Female gender (OR = 1.77), history of mental disorders (OR = 3.07) or chronic physical illness (OR = 2.04), having relatives or friends being infected with COVID-19 (OR = 3.12), longer daily exposure to media coverage of the COVID-19 (OR = 1.60), and more childhood trauma (OR = 1.54-3.49) were correlated with more frequent PLEs, while higher resilience (OR = 0.35-0.54) and more perceived social support (OR = 0.63-0.72) were associated with decreased odds for frequent PLEs. Additionally, there were several differences among the influential factors between senior high school and college students.

CONCLUSIONS

PLEs were relatively common among Chinese adolescents, with higher prevalence among senior high school students during COVID-19 lockdown. Adolescents with specific characteristics should receive more attention in the development of intervention measures in mental health during pandemic lockdown.

Self-reported mental health of children known to child protection services: an Australian population-based record linkage study

Maltreated children are vulnerable to adverse mental health outcomes. Information about how children's mental health needs vary according to different levels of child protection contact (potentially culminating in out-of-home care [OOHC]) is valuable for the effective provision of services. This study aimed to examine associations between different levels of contact with child protection services before the age of 10 years and self-reported mental health difficulties at age 11 years. Participants (n = 26,960) were drawn from the New South Wales Child Development Study, a multiagency, multigenerational, longitudinal record linkage study that combines administrative records with cross-sectional survey data. We examined associations between four levels of child protection response (non-threshold reports, unsubstantiated reports, substantiated reports, OOHC; each relative to no report) and six domains of self-reported mental health difficulties (including internalising and externalising symptoms, and psychotic-like experiences). All levels of contact with child protection services were associated with increased odds of mental health difficulties in all domains. Children who had been placed in OOHC and children with substantiated reports had the highest odds of reporting clinical levels of mental health difficulties; 48.1% of children with an OOHC placement and 45.6% of those with substantiated child protection reports showed clinical levels of mental health difficulties in at least one domain. Children with child protection reports that were unsubstantiated, or determined not to meet the threshold for risk-of-significant harm, were also at increased risk of mental health difficulties in middle childhood. These findings underscore the importance of early detection and intervention for all children at risk of maltreatment.

Sleep disturbance is predictive of psychotic-like experiences among adolescents: A two-wave longitudinal survey

PURPOSE

Psychotic-like experiences (PLEs) are prevalent among adolescents and are the most significant predictor of future mental disorders. This study aims to examine the cross-sectional and longitudinal associations between sleep disturbance and PLEs in a large cohort of adolescents.

METHODS

The 17,722 adolescents in our study were assessed from April 21 to May 12, 2021 (Time 1, T1) and again 6 months later from December 17 to 26, 2021 (Time 2, T2). The Youth Self Rating Insomnia Scale and 8-item Positive Subscale of the Community Assessment of Psychic Experiences were used to assess sleep and PLEs, respectively. Sample characteristics and depression were also evaluated at T1, and negative life events were measured at T2. Sleep duration ≤6 h per night was considered as sleep deprivation, and sleep disturbance was defined as having insomnia or poor sleep quality.

RESULTS

The prevalence of sleep disturbance and frequent PLEs at T1 were 14.1% and 14.5%, respectively. Sleep disturbance and sleep deprivation at T1 were significantly associated with increased risk for PLEs at T2 after adjusting for sample characteristics, depression, and negative life events. Furthermore, sleep disturbance and sleep deprivation also predicted the new onset and persistence of PLEs.

CONCLUSION

Sleep disturbance predicts the development and persistence of PLEs. Early assessment and treatment of sleep disturbance may therefore contribute to a comprehensive strategy for the successful prevention and treatment of PLEs in adolescents.

Hallucinations and Brain Morphology Across Early Adolescence: A Longitudinal Neuroimaging Study

BACKGROUND

Psychotic disorders have been widely associated with structural brain abnormalities. However, it is unclear whether brain structure predicts psychotic experiences in youth from the general population, owing to an overall paucity of studies and predominantly cross-sectional designs. Here, the authors investigated longitudinal associations between brain morphology and hallucinations from childhood to early adolescence.

METHODS

This study was embedded in the population-based Generation R Study. Children underwent structural neuroimaging at age 10 years (N = 2042); a subsample received a second scan at age 14 years (n = 964). Hallucinations were assessed at ages 10 and 14 years and studied as a binary variable. Cross-lagged panel models and generalized linear mixed-effects models were fitted to examine longitudinal associations between brain morphology and hallucinations.

RESULTS

Smaller total gray and white matter volumes and total cortical surface area at baseline were associated with a higher occurrence of hallucinations between ages 10 and 14 years. The regions associated with hallucinations were widespread, including the frontal, parietal, temporal, and occipital lobes, as well as the insula and cingulate cortex. Analyses of subcortical structures revealed that smaller baseline hippocampal volumes were longitudinally associated with hallucinations, although this association was no longer significant following adjustment for intracranial volume. No evidence for reverse temporality was observed (i.e., hallucinations predicting brain differences).

CONCLUSIONS

The findings from this longitudinal study suggest that global structural brain differences are associated with the development of hallucinations. These results extend findings from clinical populations and provide evidence for a neurodevelopmental vulnerability across the psychosis continuum.

Self-reported cognitive biases in psychosis: Validation of the Davos Assessment of Cognitive Biases Scale (DACOBS) in a Spanish sample of psychotic patients and healthy controls

Cognitive biases have been demonstrated to be important in developing and maintaining psychosis. However, self-report measures for everyday clinical practice have been developed only recently. We aimed to study one of these instruments for assessing cognitive biases: the Davos Assessment of Cognitive Biases Scale (DACOBS). In a Spanish sample of 84 patients diagnosed with schizophrenia-spectrum disorders and 152 healthy controls, we examined a) the factor structure using Confirmatory Factor Analysis (CFA) to test the original one-, three- and seven-factor solutions, b) the reliability (Cronbach's alpha), c) the discriminative power (Multivariate Analysis of Covariance - MANCOVA) and d) the relationships of cognitive biases with positive psychotic-like experiences (PPLEs) in healthy individuals and with psychotic symptoms in schizophrenia-spectrum patients. The CFA revealed that the seven-factor solution achieved the best fit. The DACOBS overall scale (Cronbach's alpha = .92) and subscales obtained good internal consistencies. MANCOVA, controlling for age and education, demonstrated that all subscales differentiated between healthy controls and psychotic patients (Wilks' Lambda = 0.87; F_{7, 226} = 4.70; p < .000; partial eta squared = 0.13). In addition, the DACOBS showed high correlations with PPLEs (controls) and moderate correlations with positive and general symptoms (patients), demonstrating its predictive validity. Concluding, the DACOBS proved to be a psychometrically suitable instrument for assessing cognitive biases in psychosis and adequately differentiated between patients and healthy individuals within the Spanish population. Norm scores are provided.

Mediating role of impaired wisdom in the relation between childhood trauma and psychotic-like experiences in Chinese college students: a nationwide cross-sectional study

BACKGROUND

The association between childhood trauma (CT) and psychotic-like experiences (PLEs) is well-established. Many previous studies have recognized wisdom as a protective factor for mental health, but its role in the relation between CT and PLEs remains unknown. We aimed to investigate the mediating effect of wisdom in the above association among Chinese college students.

METHODS

We conducted a nationwide survey covering 9 colleges across China and recruited a total of 5873 students using online questionnaires between September 14 and October 18, 2021. Convenience sampling was adopted. We employed the San Diego Wisdom Scale (SD-WISE), the Childhood Trauma Questionnaire (CTQ-28), and the 15-item Positive Subscale of the Community Assessment of Psychic Experiences (CAPE-15) to measure the wisdom, CT and PLEs, respectively. Descriptive, correlation, and mediation analysis were utilized.

RESULTS

The positive correlation between CT and PLEs was well-replicated among college students (Pearson's r = 0.30, p < 0.001). Wisdom was negatively associated with CT (Pearson's r = - 0.46, p < 0.001) and frequency of PLEs (Pearson's r = - 0.25, p < 0.001). Total wisdom scores partially mediated the relationship between cumulative childhood trauma, neglect, abuse and PLEs, separately. The mediated model respectively explained 21.9%, 42.54% and 18.27% of the effect of CT on PLEs. Our model further suggested that childhood trauma could be related to PLEs through decreasing the following wisdom components: decisiveness, emotional regulation and prosocial behavior.

CONCLUSION

For the first time, our results suggested that impaired wisdom played a role in the translation from childhood adversity to subclinical psychotic symptoms, implicating wisdom as a possible target for early intervention for psychosis among young individuals. Longitudinal work is warranted to verify the clinical implications.

Psychotic-like experiences from adolescence to adulthood: A longitudinal study

Psychotic-like experiences (PLEs), such as delusions and hallucinations, are regarded to occur along a spectrum and to be present also in non-help-seeking individuals from the general population. However, it remains unclear whether the occurrence of PLEs is a unique risk factor for future PLEs or a symptom of general psychopathology. In this study, we investigated whether PLEs during adolescence predict future PLEs in adulthood. A community-based cohort of 1146 young adolescents (mean age, 14.38 years) were assessed and then reassessed 6 years later (mean age, 20.15 years). Participants reported PLEs experienced in the past year, as well as symptoms of depression, anxiety, attention-deficit/hyperactivity disorder, and conduct problems. We adjusted the analysis for other forms of psychopathology and sex differences. Participants who reported PLEs in adulthood had higher ratings for all preceding and co-occurring symptoms of psychopathology. In the adjusted logistic regression model, having PLEs and, to a smaller degree, anxiety during adolescence predicted PLEs in early adulthood. The association between baseline and future PLEs did not differ between males and females, although females were more likely to report PLEs during adolescence. Participants with persistent PLEs reported more hallucinations during adolescence than those with transient symptoms. Our findings suggest that the early occurrence of PLEs is an important and independent predictor of future PLEs and should be monitored to identify individuals with a high risk of future psychopathology and to enable early interventions.

Cognitive Dysfunction as a Risk Factor for Psychosis

The current chapter summarizes recent evidence for cognition as a risk factor for the development of psychosis, including the range of cognitive impairments that exist across the spectrum of psychosis risk symptoms. The chapter examines several possible theories linking cognitive deficits with the development of psychotic symptoms, including evidence that cognitive deficits may be an intermediate risk factor linking genetic and/or neural metrics to psychosis spectrum symptoms. Although there is not strong evidence for unique cognitive markers associated specifically with psychosis compared to other forms of psychopathology, psychotic disorders are generally associated with the greatest severity of cognitive deficits. Cognitive deficits precede the development of psychotic symptoms and may be detectable as early as childhood. Across the psychosis spectrum, both the presence and severity of psychotic symptoms are associated with mild to moderate impairments across cognitive domains, perhaps most consistently for language, cognitive control, and working memory domains. Research generally indicates the size of these cognitive impairments worsens as psychosis symptom severity increases. The chapter points out areas of unclarity and unanswered questions in each of these areas, including regarding the mechanisms contributing to the association between cognition and psychosis, the timing of deficits, and whether any cognitive systems can be identified that function as specific predictors of psychosis risk symptoms.

Trajectories of adolescent psychotic-like experiences and early cannabis exposure: Results from a Finnish Birth Cohort Study

BACKGROUND

Longitudinal studies examining the effect of cannabis exposure (CE) on the prognosis of adolescents with psychotic-like experiences (PLEs) are scarce. We examined trajectories of mental health in adolescents with PLEs and cannabis exposure.

METHODS

The Northern Finland Birth Cohort 1986 (n = 6552) with linkage to nationwide register data was used. Information on lifetime cannabis exposure was collected when participants were aged 15/16. Register-based outcome data on diagnoses made in clinical practice were obtained until age 33. Logistic regression was used to study the association of PLE/CE patterns and subsequent psychiatric disorders. The group with neither PLEs nor CE was utilized as the reference group. Parental psychiatric disorders, family structure, sex, frequent alcohol intoxications, daily smoking and illicit substance use other than cannabis were adjusted for.

RESULTS

In all, 6552 subjects (49.2 % males) were included in analysis. PLEs with cannabis exposure were associated with any psychiatric disorder (OR = 2.59; 95 % CI 1.82-3.68), psychotic disorders (OR = 3.86; 95 % CI 1.83-8.11), mood disorders (OR 4.07; 95 % CI 2.74-6.04), depressive disorders (OR = 4.35; 95 % CI 2.93-6.48), anxiety disorders (OR = 2.06; 95 % CI 1.34-3.17) and substance use disorders (OR = 2.26; 95 % CI 1.13-4.50) compared to reference group. Effect sizes were greater for group with both PLEs and cannabis use than for group with PLEs only.

CONCLUSIONS

Early-onset cannabis use is an adverse prognostic marker for adolescents with PLEs after extensive confounder control including other substance use.

Current psychotic-like experiences among adolescents in China: Identifying risk and protective factors

OBJECTIVE

This study aim to explore the prevalence of current PLEs over past month and relevant influential factors among adolescents.

METHODS

A total of 67,538 students completed one online survey between April 21st and May 12th, 2021. Current PLEs were assessed using the 8-item Positive Subscale of the Community Assessment of Psychic Experiences (CAPE-P8). Participants were defined as having frequent PLEs if they selected "often" or "nearly always" on one or more items of CAPE-P8. Family function, school climate and a series of socio-demographic were also evaluated.

RESULTS

In this sample, 49.3% adolescents reported having at least one PLE over the past month, while 15.4% experienced high frequent PLEs. Alcohol intake was positively associated with high frequent PLEs (OR = 2.61, 95% CI = 2.37-2.88). Adolescents with chronic physical illness (OR = 1.94, 95% CI = 1.73-2.18) or family history of psychiatric illness (OR = 2.61, 95% CI = 2.22-2.77) were more likely to suffer from high frequent PLEs. Dysfunction family function (OR _moderate = 1.98, 95% CI = 1.98-2.09; OR _severe = 6.98, 95% CI = 6.48-7.53) or poor school climate (OR = 3.14, 95% CI = 2.93-3.37) was associated with elevated high frequent PLEs.

CONCLUSIONS

Several factors of socio-demographics, unhealthy lifestyle, family and school environments are found to be related to frequent PLEs. These factors should also be taken into consideration for effective psychosocial intervention in adolescents.

Resilience buffers the association between sleep disturbance and psychotic-like experiences in adolescents

BACKGROUND

Sleep disturbance may cause psychotic-like experiences (PLEs). The present study aimed to exam their rate of co-occurrence and investigate whether resilience buffers the association.

METHODS

A total of 50,625 junior high school students were assessed using the self-compiled socio-demographics and sleep questionnaires, 8-item Positive Subscale of the Community Assessment of Psychic Experiences, 10-item Connor-Davidson Resilience Scale, Patient Health Questionnaire and Generalized Anxiety Disorder Questionnaire.

RESULTS

In this sample, 15.8% participants had frequent PLEs in the past month, where 40.1% exhibited comorbid sleep disturbance. Sleep disturbance positively associated with the onset of frequent PLEs, after adjusting for socio-demographics, depression and anxiety. Moderation analysis showed resilience buffers the association between sleep disturbance and PLEs, with a higher level of resilience, the positive effect of sleep disturbance on PLEs would be diminished to a greater extent.

CONCLUSIONS

These findings suggested that early attention should be drawn to adolescents with sleep disturbance. Intervention strategies should be enhancing resilience, increasing sleep duration and improving sleep quality.

'Thinking about Them is only making me feel worse'. The mediating role of metacognitive factors in the relationship between paranoia-like beliefs and psychopathology symptoms in a community sample

INTRODUCTION

Paranoia in community samples is associated with higher levels of depression, anxiety symptoms and suicidality. The metacognitive model assumes the role of metacognitive factors in these associations. Positive and negative metacognitive beliefs (PMB and NMB, respectively) and cognitive-attentional syndrome (CAS) are to mediate between paranoia-like beliefs and psychopathology symptoms. The current study is an attempt to test this prediction.

METHODS

A cross-sectional community study with n = 840 participants. We used R-GPTS's persecutory subscale to measure paranoia-like beliefs, CAS-1 for CAS and metacognitive beliefs and SCL-27-plus for psychopathology symptoms.

RESULTS

Indirect effects of PMB, CAS and NMB accounted for 22% to 56% (CI 95%) of total effects of relationships between paranoia-like beliefs and vegetative symptoms, symptoms of social phobia, agoraphobia, depression and suicidality screening.

CONCLUSIONS

We demonstrated that PMB, CAS and NMB mediate between paranoia-like beliefs and various psychopathological symptoms, as predicted by the metacognitive model of psychopathology. We also uncovered other indirect effects, including negative mediation effect of PMB on the relationship between paranoia-like beliefs and depressive symptoms and suicidality.

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.

Aberrant Salience among Young Healthy Postgraduate University Students: The Role of Cannabis Use, Psychotic-Like Experiences, and Personality

Aberrant salience (AS) is an anomalous world experience which plays a major role in psychotic proneness. In the general population, a deployment of this construct - encompassing personality traits, psychotic-like symptoms, and cannabis use - could prove useful to outline the relative importance of these factors. For this purpose, 106 postgraduate university students filled the AS Inventory (ASI), the Community Assessment of Psychic Experiences (CAPE), the Temperament and Character Inventory (TCI), and the Symptom Checklist 90-Revised (SCL-90-R). Lifetime cannabis users (n = 56) and individuals who did not use cannabis (n = 50) were compared. The role of cannabis use and psychometric indexes on ASI total scores was tested in different subgroups (overall sample, cannabis users, and nonusers). The present study confirmed that cannabis users presented higher ASI scores. The deployment of AS proved to involve positive symptom frequency (assessed through CAPE), character dimensions of self-directedness and self-transcendence (TCI subscales), and cannabis use. Among nonusers, the role of personality traits (assessed through the TCI) was preeminent, whereas positive psychotic-like experiences (measured by means of CAPE) had a major weight among cannabis users. The present study suggests that pre-reflexive anomalous world experiences such as AS are intertwined with reflexive self-consciousness, personality traits, current subclinical psychotic symptoms, and cannabis use. In the present study, subthreshold psychotic experiences proved to play a major role among cannabis users, whereas personality appeared to be more relevant among nonusers.

Psychotic-like Experiences and Polygenic Liability in the Adolescent Brain Cognitive Development Study

BACKGROUND

Childhood psychotic-like experiences (PLEs) often precede the development of later severe psychopathology. This study examined whether childhood PLEs are associated with several psychopathology-related polygenic scores (PGSs) and additionally examined possible neural and behavioral mechanisms.

METHODS

Adolescent Brain Cognitive Development Study baseline data from children with European ancestry (n = 4650, ages 9-10 years, 46.8% female) were used to estimate associations between PLEs (i.e., both total and presence of significantly distressing) and PGSs for psychopathology (i.e., schizophrenia, psychiatric cross-disorder risk, PLEs) and related phenotypes (i.e., educational attainment [EDU], birth weight, inflammation). We also assessed whether variability in brain structure indices (i.e., volume, cortical thickness, surface area) and behaviors proximal to PGSs (e.g., cognition for EDU) indirectly linked PGSs to PLEs using mediational models.

RESULTS

Total and significantly distressing PLEs were associated with EDU and cross-disorder PGSs (all %ΔR2s = 0.202%-0.660%; false discovery rate-corrected ps < .006). Significantly distressing PLEs were also associated with higher schizophrenia and PLE PGSs (both %ΔR2 = 0.120%-0.216%; false discovery rate-corrected ps < .03). There was evidence that global brain volume metrics and cognitive performance indirectly linked EDU PGS to PLEs (estimated proportion mediated = 3.33%-32.22%).

CONCLUSIONS

Total and significantly distressing PLEs were associated with genomic risk indices of broad-spectrum psychopathology risk (i.e., EDU and cross-disorder PGSs). Significantly distressing PLEs were also associated with genomic risk for psychosis (i.e., schizophrenia, PLEs). Global brain volume metrics and PGS-proximal behaviors represent promising putative intermediary phenotypes that may indirectly link genomic risk to psychopathology. Broadly, polygenic scores derived from genome-wide association studies of adult samples generalize to indices of psychopathology risk among children.

Predicting persistence of hallucinations from childhood to adolescence

BACKGROUND

Psychotic experiences predict adverse health outcomes, particularly if they are persistent. However, it is unclear what distinguishes persistent from transient psychotic experiences.

AIMS

In a large population-based cohort, we aimed to (a) describe the course of hallucinatory experiences from childhood to adolescence, (b) compare characteristics of youth with persistent and remittent hallucinatory experiences, and (c) examine prediction models for persistence.

METHOD

Youth were assessed longitudinally for hallucinatory experiences at mean ages of 10 and 14 years (n = 3473). Multi-informant-rated mental health problems, stressful life events, self-esteem, non-verbal IQ and parental psychopathology were examined in relation to absent, persistent, remittent and incident hallucinatory experiences. We evaluated two prediction models for persistence with logistic regression and assessed discrimination using the area under the curve (AUC).

RESULTS

The persistence rate of hallucinatory experiences was 20.5%. Adolescents with persistent hallucinatory experiences had higher baseline levels of hallucinatory experiences, emotional and behavioural problems, as well as lower self-esteem and non-verbal IQ scores than youth with remittent hallucinatory experiences. Although the prediction model for persistence versus absence of hallucinatory experiences demonstrated excellent discriminatory power (AUC-corrected = 0.80), the prediction model for persistence versus remittance demonstrated poor accuracy (AUC-corrected = 0.61).

CONCLUSIONS

This study provides support for the dynamic expression of childhood hallucinatory experiences and suggests increased neurodevelopmental vulnerability in youth with persistent hallucinatory experiences. Despite the inclusion of a wide array of psychosocial parameters, a prediction model discriminated poorly between youth with persistent versus remittent hallucinatory experiences, confirming that persistent hallucinatory experiences are a complex multifactorial trait.

Cannabis-induced dysphoria/paranoia mediates the link between childhood trauma and psychotic-like experiences in young cannabis users

Childhood trauma (abuse and neglect) is a major risk factor for cannabis use disorder and psychotic-spectrum disorders. Psychotic-like experiences (PLEs) in young people who use cannabis may be an early indicator of psychosis risk following cannabis use. We examined whether (i) childhood trauma moderates the association between cannabis use and PLEs, (ii) the association between childhood trauma and cannabis use is mediated by subjective effects of cannabis (euphoria and dysphoria/paranoia), and (iii) the association between childhood trauma and PLEs is also mediated by these subjective effects. Participants were 2630 cannabis users (aged 16-25) recruited online. They were asked to complete a cross-sectional survey measuring cannabis and other substance use, childhood trauma, PLEs, and the subjective effects of cannabis (euphoria and dysphoria/paranoia). A significant interaction indicated that the effect of cannabis on PLE frequency was stronger for individuals with more severe childhood trauma. Childhood trauma was also associated with greater cannabis use and PLE frequency, both of which were mediated by subjective dysphoria/paranoia when using the drug. This suggests childhood trauma is associated with greater PLEs in young people who use cannabis, which may be linked with an increased susceptibility to the dysphoric/paranoid subjective effects when using the drug. Childhood trauma should be addressed early in young people who use cannabis to mitigate the psychosis-associated harms of the drug.

Do you like cliff-hangers? Objective versus subjective need for closure in the schizophrenia spectrum

Need for closure (NFC) is a cognitive bias that has been implicated in the pathogenesis of delusions. A general population sample (N = 1465) was dichotomized into high versus low schizotypal participants and matched based on core social demographic characteristics (each n = 98). For the first time, we aimed at capturing NFC subjectively (with the NFC Scale) and objectively with a new experimental paradigm, the Ambiguous Movie Scene Task. In this task, participants viewed video scenes with either open or closed endings (i.e., high or low ambiguity) and rated their (emotional) reactions to the clips. Open endings were expected to lead to more frustration (i.e., due to increased need for closure) and to induce greater eagerness to learn about the possible resolution among those high on positive schizotypy. High schizotypal individuals displayed higher scores on the NFC Scale than low schizotypal individuals. Contrary to our expectations, high schizotypal participants did not recognize video scenes with open endings as ambiguous and were less eager to learn about a possible resolution than low schizotypal individuals. In the Ambiguous Movie Scene Task, high schizotypal individuals showed evidence of a jumping to conclusions bias rather than frustration over unresolved storylines. We found an overall stronger emotional response in schizotypal participants and overconfidence in their judgments. The NFC Scale and selected scores of the new task correlated moderately. The study corroborates earlier evidence for a dissociation between objective and subjective biases in the psychosis spectrum.

Family functioning as a moderator in the relation between perceived stress and psychotic-like experiences among adolescents during COVID-19

BACKGROUND

The COVID-19 pandemic has increased psychological stress among adolescents, and the relation between perceived stress (PS) and psychotic-like experiences (PLEs) has been well-established. However, little is known about the role of family functioning (FF) in this relation, especially when adolescents experienced the extended lockdown period with family members.

METHODS

A total of 4807 adolescents completed this retrospective paper-and-pencil survey after school reopening between May 14th and June 6th, 2020 in Hunan Province, China. We measured PS with the Perceived stress scale (PSS-10), PLEs with the eight positive items from Community Assessment of Psychic Experiences (CAPE-8), and FF with the Family APGAR scale. We conducted subgroup analysis based on three FF levels (good, moderate, and poor) determined by previous studies. Finally, correlation and moderation analysis were performed to detect the effect of FF in the relation between PS and PLEs after adjusting for demographic variables.

RESULTS

Adolescents with poor FF had higher levels of PS and higher prevalence of PLEs compared to those with good FF (both p < 0.001). FF was negatively associated with both PS (r = -0.34, p < 0.001) and PLEs (r = -0.29, p < 0.001). Higher FF significantly attenuated the effect of PS on PLEs after adjusting for sex and age (effect = -0.011, bootstrap 95% CI -0.018, -0.005).

CONCLUSION

Our findings indicate that well-functioned family could protect against stress-induced PLEs among adolescents during this crisis. Thus family system could be an early interventional target for distressing psychotic-like experiences in youngsters.

The cross-lagged relationship between loneliness, social support, and psychotic-like experiences in young adults

BACKGROUND

Individuals with psychotic disorders often report feelings of loneliness, fewer social contacts and less satisfaction with their social support prior to diagnosis. However, temporal relationships between these variables remain unclear. The primary aim of this study was to examine whether subjective and objective social factors predict, or are predicted by, psychotic-like experiences (PLEs) in healthy young adults.

METHODS

196 undergraduates completed baseline and 3-month follow-up assessments for PLEs, loneliness, social support size, and satisfaction. Cross-lagged panel models were conducted to investigate the temporal relationships between these variables.

RESULTS

Higher loneliness scores, fewer social contacts, and being less satisfied with social support at both time points were significantly associated with higher endorsement of PLEs. Furthermore, after controlling for baseline levels, cross-lagged analyses revealed that individuals who reported feeling more lonely and having less social support at baseline, predicted higher PLEs three months later but not vice versa. No cross-lagged effect was found between the satisfaction of social support and PLEs.

CONCLUSION

The study highlights the significant relationships between loneliness, social support and PLEs. Higher levels of loneliness and smaller social support networks predicted future PLEs. These findings need to be given full consideration in future clinical practice and intervention for young adults with PLEs.

Exploring multimodal hallucinations and disturbances in the basic and bodily self: A cross-sectional study in a non-clinical sample

The bodily self is key to emotional embodiment, which is important for social functioning and emotion regulation. There is a paucity of research systematically assessing how basic and bodily self-disturbances relate to multimodal hallucinations. This study hypothesised that participants with greater hallucination-proneness would report greater degrees of basic and bodily self-disturbance and would demonstrate more ambiguous and less discrete mapping of emotional embodiment. Stage one screened non-clinical participants' degree of hallucination-proneness. Stage two participants completed seven further questionnaires. Hierarchical linear regression modelled the influence of hallucination-proneness and covariates on measures of basic and bodily self-disturbance and sensed presence. Stage two participants also completed a computerised body mapping task (EmBODY) which assessed emotional embodiment. Topographical maps were generated to compare patterns of embodiment between high and low hallucination-proneness groups. 55 respondents participated in stage two, with 18 participants from the high or low hallucination-proneness groups completing EmBODY. In the hierarchical regression analyses, the addition of a measure of hallucination proneness in the final step only increased predictive power where the dependent variable assessed sensed presence (p = 0.035 and p = 0.009, respectively). The EmBODY data revealed that participants with low hallucination-proneness consistently reported more bodily activation across 14 emotional states, whereas the high hallucination-proneness group reported more deactivation. In conclusion, hallucination-proneness was most strongly associated with sensed presence experiences. Patterns of embodiment appeared similar between the two groups, despite consistent differences in activation and deactivation. These findings are exploratory and need to be confirmed in a larger sample.

Changes of psychotic-like experiences and their association with anxiety/depression among young adolescents before COVID-19 and after the lockdown in China

OBJECTIVE

Lockdown policies during COVID-19 pandemic have potential adverse psychological impacts on youth. However, little is known about their influence on the changes of psychotic-like experiences (PLEs) among adolescents, nor about the possible association between changes in PLEs and changes in anxiety/depression symptoms. We investigated these two questions through a longitudinal comparative study.

METHODS

In total, 1825 adolescents were surveyed before COVID-19 and after the lockdown in China (T0, October 20th, 2019 and T1, May 18th, 2020). PLEs, anxiety, and depression were measured with paranoia, anxiety and depression subscales of the Mental Health Inventory of Middle school students (MMHI-60). Within-subjects Wilcoxon test, Spearman correlation test, and Kruskal-Wallis test were adopted.

RESULTS

Significant increase in adolescent PLEs scores was observed after the lockdown (Wilcoxon's w = 9.302, p < 0.001). We also found positive correlation between changes of PLEs and changes of anxiety/depression (Spearman's rho = 0.59/0.53, both p < 0.001). Furthermore, four PLEs trajectories were identified based on the report of PLEs at two timepoints: 60.4% with no PLEs, 9.3% remitted PLEs, 16.7% new PLEs, and 13.6% persistent PLEs. Significant difference was found in changes of anxiety/depression among four groups (p < 0.001); notably, the group with new-onset PLEs had the greatest exacerbation in anxiety/depression symptoms (both p Bonferroni <0.001).

CONCLUSIONS

This work is the first to identify increases in adolescent PLEs across the COVID-19 pandemic and suggested a close longitudinal association between PLEs and anxiety/depression. Our findings have implications for adolescent mental health crisis interventions during the pandemic.

Examining self-reported social functioning, sleep quality, and psychotic-like experiences in college students

Impairments in social and role functioning have been associated with the prodromal phase of psychosis. Additionally, sleep disturbances impacting daily functioning have been detected across the schizophrenia spectrum. Relationships between social functioning, sleep quality, and psychotic-like experiences (PLEs) in undergraduate-level student populations are less understood. The current project aimed to investigate whether self-reported measures of sleep quality would moderate the relationship between social functioning and PLE endorsement in a community sample of 3042 undergraduate student participants between the ages of 18-35. Participants completed the Social Functioning Scale, the Pittsburgh Sleep Quality Index, and the Prodromal Questionnaire, which indexed PLEs. Bivariate correlations revealed significant associations between social functioning, sleep, and PLEs. As expected, poor sleep and poor social functioning were associated with increased endorsement of PLEs. Contrary to expectation, poor sleep quality was associated with better social functioning. In hierarchical multiple regression models, the interaction between social functioning and sleep was not associated with PLE endorsement. Results indicated that both poor sleep and poor social functioning were significantly associated with PLEs when included in the same model. These findings suggest that poor social functioning and disrupted sleep may act additively to influence PLEs, and that they are both important contributors to psychotic symptoms. Due to deleterious effects of poor sleep on physical and emotional health, these findings provide impetus to further investigate relationships between sleep quality, social functioning, and PLEs using such high-resolution methods as actigraphy, mobile sensing, ecological momentary assessment, and neuroimaging.