Risk of schizophrenia in character disordered patients

Inpatients from the Chestnut Lodge follow-up study diagnosed with character disorder were studied to predict future schizophrenic decompensation. Individually, three DSM-III criteria for schizotypal personality disorder predicted schizophrenia at long-term follow-up: magical thinking, suspiciousness or paranoid ideation, and social isolation. Additionally, lower IQ, poorer premorbid quality of work, and transient delusional experiences were predictive. No borderline personality disorder criterion was predictive. This suggests that schizotypal but not borderline personality disorder belongs in the schizophrenic spectrum. Within schizotypal personality disorder, criteria from both familial and clinical traditions appear to be dimensions of vulnerability to psychosis.     

Magical ideation associated social cognition in adolescents: signs of a negative facial affect recognition deficit

BackgroundStudies provide evidence for impaired social cognition in schizotypy and its association with negative symptoms. Cognitive features related to magical ideation – a component of the positive dimension of schizotypy – have been less investigated. We aimed to assess social cognitive functioning among adolescents with high magical ideation scores, mainly focusing on face and emotion recognition.Methods22 subjects with magical ideation scale scores above the cut off level and 22 controls with lowest scores from among 250 students screened with this scale were included in the study. A face and emotion recognition n-back test, the empathy quotient, theory of mind tests and the Physical Anhedonia Scale were applied to both magical ideation and control groups.ResultsThe magical ideation group performed significantly worse than controls on both face and emotion recognition tests. Emotion recognition performance was found to be affected by memory load, with sadness, among emotions, revealing a difference between the two groups. Empathy and theory of mind tests did not distinguish the magical ideation group from controls.ConclusionOur findings provide evidence for a deficit in negative emotion recognition affected by memory load associated with magical ideation in adolescents.     

Amygdala reactivity and mood-congruent memory in individuals at risk for depressive relapse.

BACKGROUND: According to cognitive diathesis-stress theories, a latent cognitive vulnerability to depression is activated by negative affect in individuals at risk for depressive relapse. This vulnerability can manifest as mood-congruent memory during sad mood and may involve amygdala response, which is implicated in memory for emotionally arousing stimuli. This study examined whether amygdala modulates memory for negatively valenced words before and after a sad mood induction in healthy individuals with and without a history of recurrent major depression. METHODS: Fourteen unmedicated remitted depressed (RD) and 14 matched never depressed (ND) individuals were scanned using functional magnetic resonance imaging (fMRI) while performing a self-referent encoding/evaluation task (SRET) preceding and following a sad mood challenge. After each SRET, participants' free recall was assessed. RESULTS: Following sad mood induction, bilateral amygdala response during encoding of valenced words predicted increased recall of negative self-referent words for a subset of RD participants. This association was not present before the sad mood induction and was not evident in individuals without a history of depression, regardless of mood state. CONCLUSIONS: These results are consistent with cognitive diathesis-stress theories and suggest a role for the amygdala in modulating mood-congruent memory during transient sad mood in individuals who are vulnerable to depression relapse.     

Schizotypal traits and cognitive function in healthy adults

Growing evidence has shown that psychometrically identified schizotypes among student populations have subtle cognitive impairments in several domains such as attention, working memory and executive function, but the possible association between psychometric schizotypy in adult populations and cognitive function has not been well documented. Here we examined the association between schizotypal traits as assessed by the Schizotypal Personality Questionnaire (SPQ) and cognitive function including memory, attention, executive function, and general intelligence in 124 healthy adults. Cognitive functioning was assessed with the Wechsler Memory Scale-Revised (WMS-R), the Wechsler Adult Intelligence Scale-Revised (WAIS-R), and the Wisconsin Card Sorting Test (WCST). SPQ scores showed a significant inverse correlation with verbal IQ and the information, comprehension and similarities subtests. No correlation was found between SPQ scores and memory, attention, performance IQ, or executive functioning. These results indicate that schizotypal traits in healthy adults are associated with verbal IQ decrements, suggesting that schizotypal traits themselves, even at a non-clinical level, may play unfavorable roles in cognitive functioning, which is in line with the viewpoint that schizotypy is on a continuum with normality, with its extreme form being clinically expressed as schizophrenia.     

Cognitive and prepulse inhibition deficits in psychometrically high schizotypal subjects in the general population: relevance to schizophrenia research

Schizophrenia and schizotypal personality disorder share common clinical profiles, neurobiological and genetic substrates along with Prepulse Inhibition and cognitive deficits; among those, executive, attention, and memory dysfunctions are more consistent. Schizotypy is considered to be a non-specific "psychosis-proneness," and understanding the relationship between schizotypal traits and cognitive function in the general population is a promising approach for endophenotypic research in schizophrenia spectrum disorders. In this review, findings for executive function, attention, memory, and Prepulse Inhibition impairments in psychometrically defined schizotypal subjects have been summarized and compared to schizophrenia patients and their unaffected first-degree relatives. Cognitive flexibility, sustained attention, working memory, and Prepulse Inhibition impairments were consistently reported in high schizotypal subjects in accordance to schizophrenia patients. Genetic studies assessing the effects of various candidate gene polymorphisms in schizotypal traits and cognitive function are promising, further supporting a polygenic mode of inheritance. The implications of the findings, methodological issues, and suggestions for future research are discussed. (JINS, 2012, 18, 1-14).     

Changes in blood glucose and salivary cortisol are not necessary for arousal to enhance memory in young or older adults

Emotional arousal enhances memory, and this memory-enhancing effect may involve neurochemicals released by arousal, such as glucose and cortisol. Physiological consequences of arousal change with age, and these changes may contribute to age-related memory decline. The present study examined whether emotionally arousing pictures would affect glucose and cortisol levels and enhance memory in young and older adults. Blood glucose and salivary cortisol were measured once before and six times after young and old adults viewed either 60 highly arousing or 60 relatively neutral pictures. Recall for the stimuli was measured 75 min later. The results indicated that recall was impaired in older adults. Arousal as measured by self-report enhanced recall in both young and older adults. However, arousal did not affect glucose or cortisol levels in either group. These findings demonstrate that changes in blood glucose or salivary cortisol levels are not necessary for arousal to enhance memory.     

Preventive effect of beta-adrenoceptor blockade on glucocorticoid-induced memory retrieval deficits

OBJECTIVE: Elevated glucocorticoid levels impair retrieval of emotional information, and animal studies indicate that this effect depends on concurrent emotional arousal-induced increases in noradrenergic transmission within the brain. The authors investigated whether the beta-adrenoceptor antagonist propranolol blocks glucocorticoid-induced memory retrieval impairments in human subjects. METHOD: In a double-blind, placebo-controlled study, 42 healthy volunteers were presented a set of words with variable emotionality and asked to learn them for recall. A day later, cortisone (25 mg), propranolol (40 mg), or both drugs were administered orally 1 hour before a free-recall test. RESULTS: Cortisone selectively impaired the recall of emotionally arousing words by 42%. This impairment was blocked by the concurrent administration of propranolol. Propranolol alone did not affect recall of either emotional or neutral words. CONCLUSIONS: A pharmacological blockade of beta-adrenoceptors prevents glucocorticoid-induced memory retrieval deficits in human subjects. This finding may have important implications for the treatment of memory deficits in hypercortisolemic states, such as stress and depression.     

Magical ideation -- defense mechanism or neuropathology? A study with multiple sclerosis patients

BACKGROUND: The major psychological stress factor in multiple sclerosis (MS) is loss of control of life. In MS patients with impaired cognition, magical ideation might be a characteristic way of thinking. Proof for this may be the high frequency of alternative treatments used by individuals with MS. The study investigates whether the level of magical ideation in MS patients is higher compared to healthy control subjects and, in case of positive confirmation, with which somatic and psychological features it is associated. Moreover, it is aimed to discuss the modalities of magical ideation in general. SAMPLING AND METHODS: A German version of the Magical Ideation Scale was validated with a group of 69 healthy subjects. Ninety-four MS patients were additionally assessed with the Dissociative Experience Scale, the Symptom-Check-List-90-Revised and 5 neuropsychological tests. RESULTS: The Magical Ideation Scale did not reveal a significant difference between MS patients and healthy controls (p = 0.968). Among the MS patients, magical ideation shows a correlation neither with age nor with disability, but a positive correlation (p = 0.007; r = 0.329) with the grade of neuropsychological deficiency. Among the psychological parameters, the highest positive correlation with magical ideation was found in dissociation (p = 0.000; r = 0.520). DISCUSSION: Magical ideation, sharing common features with dissociation, can be viewed as an early defense mechanism when perceiving a loss of control of life, particularly in early stages of MS. In late stages, when developing neuropsychological deficits, it may occur as a substitute for cognitive coping. The data may encourage clinicians to identify magical ideation. In young and previously diagnosed patients, it is important to acknowledge helplessness and support a rather rational way of coping. Training cognitive skills could be crucial to prevent older patients from losing touch with reality. More generally, the occurrence of a significant amount of magical ideation is discussed both as a psychological and a neurophysiologic regression of thinking.     

Sleep Spindles Are Related to Schizotypal Personality Traits and Thalamic Glutamine/Glutamate in Healthy Subjects

Background: Schizophrenia is a severe mental disorder affecting approximately 1% of the worldwide population. Yet, schizophrenia-like experiences (schizotypy) are very common in the healthy population, indicating a continuum between normal mental functioning and the psychosis found in schizophrenic patients. A continuum between schizotypy and schizophrenia would be supported if they share the same neurobiological origin. Two such neurobiological markers of schizophrenia are: (1) a reduction of sleep spindles (12–15 Hz oscillations during nonrapid eye movement sleep), likely reflecting deficits in thalamo-cortical circuits and (2) increased glutamine and glutamate (Glx) levels in the thalamus. Thus, this study aimed to investigate whether sleep spindles and Glx levels are related to schizotypal personality traits in healthy subjects. Methods: Twenty young male subjects underwent 2 all-night sleep electroencephalography recordings (128 electrodes). Sleep spindles were detected automatically. After those 2 nights, thalamic Glx levels were measured by magnetic resonance spectroscopy. Subjects completed a magical ideation scale to assess schizotypy. Results: Sleep spindle density was negatively correlated with magical ideation (r = −.64, P < .01) and thalamic Glx levels (r = −.70, P < .005). No correlation was found between Glx levels in the thalamus and magical ideation (r = .12, P > .1). Conclusions: The common relationship of sleep spindle density with schizotypy and thalamic Glx levels indicates a neurobiological overlap between nonclinical schizotypy and schizophrenia. Thus, sleep spindle density and magical ideation may reflect the anatomy and efficiency of the thalamo-cortical system that shows pronounced impairment in patients with schizophrenia.Key words: sleep EEG, magical ideation, magnetic resonance spectroscopy, thalamo-cortical connections, schizophrenia, continuum model     

Factor versus cluster models of schizotypal traits. II: relation to neuropsychological impairment.

Heterogeneity in cognitive performance in schizophrenia and schizotypy may be accounted for, by differences in predominant symptom presentation. However, studies have not demonstrated consistent relations between specific cognitive impairments and specific trait dimensions in either population. Studies of group differences, particularly those using groups defined by cluster analyses are rare, but suggest that the negative trait dimension is more associated with executive function deficits, positive trait dimension with memory and attentional difficulties, and the disorganized trait dimension with attention problems. The present study examined the relation of schizotypal trait dimensions and executive function deficits in schizotypal individuals using two methods. Correlations between schizotypal factor scores and cognitive measures demonstrated that high negative symptoms were associated with poor performance on the WCST, while high scores on other trait dimensions were related to a better WCST performance. High scores in all trait dimensions were related to the na?ve rater's observations of unusual social behavior. A cluster analysis revealed three groups of schizotypals (predominantly negative presentation, predominantly positive symptom presentation, and high on all dimensions). The cluster with predominantly negative symptoms performed worse, than all other schizotypal groups and unselected controls, on the WCST and a higher percentage of them were rated as clinically impaired on the neuropsychological battery. However, schizotypals who were high on all trait dimensions were rated as having the most unusual social behavior by the na?ve raters. Overall, results support the hypothesis of a relation between executive function deficits and negative symptoms in schizotypal individuals.     

Psychometric schizotypy modulates levodopa effects on lateralized lexical decision performance

Emergence of psychotic thought has been related to a breakdown in left-hemisphere language dominance. Dopamine (DA) is implicated in both psychotic pathology and modulation of the semantic system. The present study explored whether controlled DA administration modulates basic language functions: (1) in general and/or (2) as a function of schizophrenia-associated thought. Forty healthy men performed a tachistoscopic lexical decision task. Participants' performance was also analyzed as a function of their positive (magical ideation, MI) and negative (physical anhedonia, PHYSAN) schizotypal features. Half of the subjects received 200 mg levodopa, the other half a placebo. Our findings showed that pharmacological treatment per se did not influence task performance, but influenced laterality patterns as a function of participants' schizotypal features. In the placebo, but not in the levodopa group, right hemisphere language contribution increased as a function of increasing MI scores. In the levodopa, but not in the placebo group, superior left hemisphere lexical decision performance was related to increasing PHYSAN scores. The findings from both substance groups suggest that in the healthy brain, a DA agonist restores left-hemispheric dominance for language by reducing right-hemispheric contribution with respect to a positive schizotypal trait and by increasing left-hemispheric specialization with respect to a negative schizotypal trait. We conjecture that the healthy brain compensates through intact neurochemical mechanisms an increased DA concentration, in particular for persons with elevated positive psychotic-like features.     

Emotional memory deficit and its psychophysiological correlate in family caregivers of patients with dementia

This study examined the cortisol secretion pattern and declarative memory performance of dementia caregivers. An illustrated story paradigm memory task was used to evaluate the effects of emotional arousal on memory and assess the caregivers' cognitive compensation capacity. Younger (n=19) and elderly (n=24) noncaregivers and elderly caregivers (n=14) took part in 2 experiments to elucidate the effects of aging (experiment 1) and chronic stress (experiment 2) on memory performance and cortisol levels. Each group was divided in 2 subgroups: one that was exposed to an emotionally neutral story, and one that was exposed to a similar, but emotionally arousing story. Participants completed a multiple-choice questionnaire in the test session. Salivary cortisol samples were collected at 8:00 AM, 4:00 PM, and 10:00 PM, 1 day after memory testing. Experiment 1 showed that, despite an age-related memory deficit, arousal manipulation produced a similar effect in both age groups. Experiment 2 showed that, in addition to the characteristic memory decline of aging, elderly caregivers did not benefit from emotionally arousing material as their noncaregiver counterparts did. This impairment correlated with elevated nighttime cortisol levels, indicating a potential worsening impact of caregiver burden on age-related cognitive decline.     

Physiological correlates of cognitive functioning in an elderly population

Cognitive decline in old age is not universal or inevitable. Associations have been observed with neuroendocrine function, but the relevance of other physiological processes is unclear. We predicted that impairment of memory in an ageing population would be related to the dysregulation of neuroendocrine and cardiovascular responses. One hundred and thirty-nine participants (65-80 years) were recruited from general practice in London. Two standardised verbal paired-associates recall tasks were administered in order to determine declarative memory performance, and a fluid intelligence task (matrix reasoning) was also performed. Salivary cortisol samples were collected every 10 min, while blood pressure and heart rate were measured before, during and after each task. Illness history and medication use were obtained from medical records. Multiple linear regression analysis, adjusted for age, gender, education, chronic illness, and medication use, revealed that cortisol responses were inversely related to memory performance. Additionally, superior memory was associated with more effective post-task recovery of heart rate (in both men and women) and diastolic blood pressure recovery in men. Cardiovascular recovery effects were independent of covariates, and of levels of heart rate and blood pressure measured during tasks themselves. These associations were also independent of subjective ratings of stress and perceived performance. Neither neuroendocrine nor cardiovascular responses were related to performance of the reasoning task. We conclude that memory in the elderly is associated both with hypothalamic-pituitary-adrenocortical function and cardiovascular regulation. Disturbances of neuroendocrine and hemodynamic function may be related to greater vulnerability to cognitive decline.     

Cortisol has different effects on human memory for emotional and neutral stimuli

Adrenal stress hormones are considered to play a role in memory enhancement of emotionally arousing events. To investigate the effects of cortisol on human emotional memory, subjects were administered hydrocortisone (25 mg) or placebo and presented with either an emotionally arousing or a neutral story. Memory for the story was tested 1 week later. In all memory tests, subjects who viewed the emotional story scored better for the emotionally arousing story parts, indicating that arousal enhances memory. In memory of details, cortisol showed an interaction with story valence but no main effect: cortisol enhanced memory for details of the neutral story version, but impaired memory for details of the emotionally arousing version. We thus confirm a non-linear interaction between cortisol and arousal on memory formation.     

Schizotypal disorder and schizophrenia: a profile analysis of neuropsychological functioning in Japanese patients.

This study compares neuropsychological functioning in a Japanese schizophrenia spectrum disorder group and a group of healthy Japanese volunteers. Participants were 37 patients diagnosed with schizophrenia, 28 schizotypal patients, and 99 psychiatrically-normal volunteers. A wide range of cognitive measures were examined. All participants completed a Japanese version of a neuropsychological battery assessing executive function, working memory, processing speed, language, verbal memory, and spatial organization. Comparisons of neuropsychological function demonstrated similarities and differences between patients diagnosed with schizotypal disorder and those diagnosed with schizophrenia. Impairments in verbal memory, language, and processing speed were common to both patient groups and may represent a vulnerability to schizophrenia. Impairments in aspects of working memory, spatial organization and executive function were preferentially observed in schizophrenia and may be features of the overt manifestation of psychosis. Possible differences in the contributions of prefrontal and temporo-limbic structures provide direction for further studies.     

Facial affect recognition and schizotypal personality characteristics

Aim: Deficits in facial affect recognition are well established in schizophrenia, yet relatively little research has examined facial affect recognition in hypothetically psychosis‐prone or ‘schizotypal’ individuals. Those studies that have examined social cognition in psychosis‐prone individuals have paid little attention to the association between facial emotion recognition and particular schizotypal personality features. The present study therefore sought to investigate relationships between facial emotion recognition and the different aspects of schizotypy. Methods: Facial affect recognition accuracy was examined in 50 psychiatrically healthy individuals assessed for level of schizotypy using the Schizotypal Personality Questionnaire. This instrument provides a multidimensional measure of schizophrenia proneness, encompassing ‘cognitive‐perceptual’, ‘interpersonal’ and ‘disorganized’ features of schizotypy. It was hypothesized that the cognitive‐perceptual and interpersonal aspects of schizotypy would be associated with difficulties identifying facial expressions of emotion during a forced‐choice recognition task using a standardized series of colour photographs. Results: As predicted, interpersonal aspects of schizotypy (particularly social anxiety) were associated with reduced accuracy on the facial affect recognition task, but there was no association between affect recognition accuracy and cognitive‐perceptual features of schizotypy. Conclusions: These results suggest that subtle deficits in facial affect recognition in otherwise psychiatrically healthy individuals may be related to the vulnerability for interpersonal communication difficulties, as seen in schizophrenia.     

Interactive decision-making in people with schizotypal traits: A game theory approach

Studies that have investigated whether deficits in social cognition observed in schizophrenia are also present in schizotypal individuals have largely been inconclusive, and none of these studies have examined social interactive behavior. Here, we investigated interactive decision-making behavior in individuals differing in the amount of schizotypal symptoms using tasks derived from Game Theory. In total 1691 undergraduate students were screened with the Schizotypal Personality Questionnaire-Brief version. We selected 69 people distributed across the full schizotypal continuum to participate in Ultimatum and Dictator Games in which they played against human and non-human, computer partners. The results showed that higher levels of schizotypal symptoms, particularly positive and disorganized schizotypy, were related to proposing higher offers to all partners. Additionally, the amount of interpersonal schizotypal symptoms was associated with an increased acceptance rate of very unfair offers from human partners, possibly reflecting a blunted emotional response to such offers. We conclude that positive and disorganized schizotypal symptoms are associated with less adequate bargaining behavior, similar to what has been recently observed in patients with schizophrenia. The observed similarities on Ultimatum Game behavior between patients with schizophrenia and individuals with more schizotypal symptoms contribute to the growing evidence that social cognitive deficits may represent a marker of vulnerability to schizophrenia.     

Enhanced memory for emotional material following stress-level cortisol treatment in humans

Memory tends to be better for emotionally arousing information than for neutral information. Evidence from animal studies indicates that corticosteroids may be necessary for this memory enhancement to occur. We extend these findings to human memory performance. Following administration of cortisol (20 mg) or placebo, participants were exposed to pictures varying in emotional arousal. Incidental memory for the pictures was assessed one week later. We show that elevated cortisol levels during memory encoding enhances the long-term recall performance of emotionally arousing pictures relative to neutral pictures. These results extend previous work on corticosteroid enhancement of memory and suggest that high cortisol levels during arousing events result in enhanced memory in humans.     

Magical ideation is related to questionnaire but not behavioural measures of handedness

Magical ideation has repeatedly been shown to be related to handedness, with mixed-handers exhibiting higher levels of magical thinking. However, most previous research has assessed hand preference with a questionnaire measure, leaving open the possibility that the correlation reflects some aspect of questionnaire-taking behaviour and not an underlying neuropsychological relationship. The present study addressed this issue by administering the Magical Ideation Scale (Eckblad & Chapman, 1983), the Waterloo Handedness Questionnaire-Revised (Elias, Bryden, & Bulman-Fleming, 1998), and a manual dot-filling task (Tapley & Bryden, 1985) as a behavioural measure of handedness to an undergraduate student sample. The expected relationship between magical ideation and handedness as assessed by the questionnaire was observed. However, magical ideation was not related to the behavioural measure of handedness. Results cast doubt on a neuropsychological interpretation of the relationship between handedness and magical ideation in sub-clinical populations.     

The relationship between fantasy proneness and schizotypy in adolescents

Previous research has found substantial relationships between fantasy proneness and schizotypy in adulthood. The aim of the present study is to examine the connections between these constructs in an adolescent sample. A sample of 511 adolescents filled out a measure of fantasy proneness and a measure of psychotic-like phenomena. The factorial pattern for schizotypal traits in adolescents replicate the earlier documented three-factor structure. Also, the full range of schizotypal features was found to be related to imaginative tendencies tapped by fantasy proneness. Finally, joint analysis of fantasy and schizotypy showed that, in adolescents, fantasy converges with magical ideation and the cognitive-perceptual dimension of schizotypy, but diverges from the interpersonal aspects of schizotypy.