Neural Correlates of Variation in Personal Space and Social Functioning in Schizophrenia and Healthy Individuals

BackgroundChanges in the regulation of interpersonal distance, or “personal space” (PS), have been repeatedly observed in schizophrenia and, in some studies, linked to negative symptoms. However, the neurobiological basis of these impairments is poorly understood.MethodsPersonal space measurements, functional connectivity of a brain network sensitive to intrusions into PS, and symptoms of social withdrawal and anhedonia were assessed, and associations among these outcomes measured, in 33 individuals with a psychotic disorder (primarily schizophrenia [SCZ]) and 36 control subjects (CON).ResultsPersonal space size was significantly higher (P = .002) and PS permeability (reflecting the capacity to tolerate intrusions into PS) was significantly lower (P = .021) in the SCZ relative to the CON group, and both measures were significantly correlated with social anhedonia and withdrawal in the full sample (all P < .007). Moreover, functional connectivity between the PS and default mode (DM) networks was significantly correlated with the permeability, but not the size, of PS in the full sample and in the SCZ and CON groups separately, and with social withdrawal in the SCZ group. Lastly, the association between PS-DM network connectivity and social withdrawal in the SCZ group was fully mediated by PS permeability.DiscussionNeural and behavioral aspects of PS regulation are linked to social motivation in both healthy individuals and those with psychotic disorders, suggesting that measurements of PS could serve as transdiagnostic markers of social functioning.     

Risk Factors for Psychosis: Impaired Social and Role Functioning

Objectives: Risk for psychosis is currently defined primarily on the basis of attenuated positive symptoms (APS), with no inclusion of the functional deficits characteristic of schizophrenia. Impaired social and role functioning have been of interest for reflecting poor outcome but far less is known about the developmental impact of these deficits as vulnerability or risk factors. Methods: Age-appropriate social and role functioning were prospectively assessed in 100 individuals at clinical high risk (CHR) for psychosis included in the 8-site North American Prodromal Longitudinal Study database. A nested case-control design was used to compare changes in social and role functioning in 26 individuals converting to psychosis shortly after baseline assessment and 24 converting over a year later. Individuals in each converter subgroup were directly matched to a non-converter at the same site, controlling for time to conversion, age, gender, and severity of baseline symptoms. Results: At baseline, CHR subjects who later became psychotic were significantly more likely to be impaired socially than matched non-converters. Onset of psychosis did not further disrupt social difficulties. Role functioning showed some of the same trends, but the overall pattern was not as consistent as for the social domain. Controlling for neurocognition did not change the pattern of group differences. Conclusions: Early impaired social functioning appears to be a risk factor for psychosis and, added to APS, could potentially contribute to accurate identification of CHR individuals and provide a new direction for early intervention to reduce long-term disability.     

Searching for bridges between psychopathology and real-world functioning in first-episode psychosis: A network analysis from the OPTiMiSE trial

BackgroundNetwork analysis has been used to explore the interplay between psychopathology and functioning in psychosis, but no study has used dedicated statistical techniques to focus on the bridge symptoms connecting these domains. The current study aims to estimate the network of depressive, negative, and positive symptoms, general psychopathology, and real-world functioning in people with first-episode schizophrenia or schizophreniform disorder, focusing on bridge nodes.MethodsBaseline data from the OPTiMiSE trial were analyzed. The sample included 446 participants (age 40.0 ± 10.9 years, 70% males). The network was estimated with a Gaussian graphical model, using scores on individual items of the positive and negative syndrome scale (PANSS), the Calgary depression scale for schizophrenia, and the personal and social performance scale. Stability, strength centrality, expected influence (EI), predictability, and bridge centrality statistics were computed. The top 20% scoring nodes on bridge strength were selected as bridge nodes.ResultsNodes from different rating scales assessing similar psychopathological and functioning constructs tended to cluster together in the estimated network. The most central nodes (EI) were Delusions, Emotional Withdrawal, Depression, and Depressed Mood. Bridge nodes included Depression, Conceptual Disorganization, Active Social Avoidance, Delusions, Stereotyped Thinking, Poor Impulse Control, Guilty Feelings, Unusual Thought Content, and Hostility. Most of the bridge nodes belonged to the general psychopathology subscale of the PANSS. Depression (G6) was the bridge node with the highest value.ConclusionsThe current study provides novel insights for understanding the complex phenotype of psychotic disorders and the mechanisms underlying the development and maintenance of comorbidity and functional impairment after psychosis onset.     

Duration of attenuated positive and negative symptoms in individuals at clinical high risk: Associations with risk of conversion to psychosis and functional outcome

Research in individuals at clinical high-risk (CHR) for psychosis has focused on subjects with no more than 12 months of present or worsened attenuated positive symptoms. However, the impact of long duration attenuated positive and/or negative prodromal symptoms on outcomes is unclear. Seventy-six CHR subjects with attenuated positive symptoms and at least moderate severity level negative symptoms rated on the Scale of Prodromal Symptoms (SOPS) were prospectively followed for a mean of 3.0 ± 1.6 years. Social and Role functioning was assessed with the Global Functioning: Social and Role scales. Correlations between attenuated positive and negative symptom duration and severity and conversion to psychosis and functional outcomes were analyzed. The average onset of SOPS rated negative symptoms (M = 53.24 months, SD = 48.90, median = 37.27) was approximately twelve months prior to the emergence of attenuated positive symptom (M = 40.15 months, SD = 40.33, median = 24.77, P < 0.05). More severe positive symptoms (P = 0.004), but not longer duration of positive (P = 0.412) or negative (P = 0.754) symptoms, predicted conversion to psychosis. Neither positive symptom duration (P = 0.181) nor severity (P = 0.469) predicted role or social functioning at study endpoint. Conversely, longer negative symptom duration predicted poor social functioning (P = 0.004). Overall, our findings suggest that the severity of attenuated positive symptoms at baseline may be more important than symptom duration for determining individuals at increased risk of developing psychosis. In contrast, long-standing negative symptoms may be associated with persistent social difficulties and therefore have an important position in the treatment of disability.     

Network Analysis of Symptom Comorbidity in Schizophrenia: Relationship to Illness Course and Brain White Matter Microstructure

IntroductionRecent network-based analyses suggest that schizophrenia symptoms are intricately connected and interdependent, such that central symptoms can activate adjacent symptoms and increase global symptom burden. Here, we sought to identify key clinical and neurobiological factors that relate to symptom organization in established schizophrenia. MethodsA symptom comorbidity network was mapped for a broad constellation of symptoms measured in 642 individuals with a schizophrenia-spectrum disorder. Centrality analyses were used to identify hub symptoms. The extent to which each patient’s symptoms formed clusters in the comorbidity network was quantified with cluster analysis and used to predict (1) clinical features, including illness duration and psychosis (positive symptom) severity and (2) brain white matter microstructure, indexed by the fractional anisotropy (FA), in a subset (n = 296) of individuals with diffusion-weighted imaging (DWI) data. ResultsGlobal functioning, substance use, and blunted affect were the most central symptoms within the symptom comorbidity network. Symptom profiles for some patients formed highly interconnected clusters, whereas other patients displayed unrelated and disconnected symptoms. Stronger clustering among an individual’s symptoms was significantly associated with shorter illness duration (t = 2.7; P = .0074), greater psychosis severity (ie, positive symptoms expression) (t = −5.5; P < 0.0001) and lower fractional anisotropy in fibers traversing the cortico-cerebellar-thalamic-cortical circuit (r = .59, P < 0.05). ConclusionSymptom network structure varies over the course of schizophrenia: symptom interactions weaken with increasing illness duration and strengthen during periods of high positive symptom expression. Reduced white matter coherence relates to stronger symptom clustering, and thus, may underlie symptom cascades and global symptomatic burden in individuals with schizophrenia.     

Associations between number of different type of care meetings with social network and improvement in mental well-being in adolescents at risk of first-episode psychosis

Aim: As research in the care of people at risk of developing first‐episode psychosis has mostly focused on cognitive behavioural therapy and antipsychotic medication, little is known about associations between changes in mental well‐being and effect of people participating in the care. Methods: Multiprofessional early intervention team met with adolescents who are at risk of psychosis, including coworkers and their families. Correlations were calculated between change scores in prepsychotic, functioning ability, quality of life (QoL), depression and anxiety scales, and number of family, coworker and adolescent‐participating social network meetings, and total number of social network meetings during the care. Results: Larger change scores in functioning ability were positively associated with the number of social network meetings with participating coworker (P = 0.041), but not with other types of participant meetings. Larger change scores in prepsychotic symptoms were positively associated with the number of meetings where the adolescent was participating (P = 0.001), the number of network meetings where the coworker was participating (P = 0.007) and the number of all meetings (P = 0.001). The number of any other type of meetings did not associate with change scores in QoL, depression and anxiety. Conclusion: According to the present results, adolescents at risk of psychosis seem to benefit from the inclusion of coworkers from the adolescents' natural surroundings in care; this could help to increase functioning ability. Different combinations of meetings, such as larger number of total meetings, larger number of meetings with the adolescent and larger number of meetings with coworkers from the adolescents' natural surroundings, seem to associate with stronger decrease in pre‐psychotic symptoms.     

首发精神分裂症未经治疗时间与临床疗效间关系:4年随访研究（英文）

背景:精神疾病未经治疗的时间和长期临床结局之间关系仍然存在争议。目标:前瞻性评估浦东精神卫生中心2007年1月至2008年12月收治的首发精神分裂症患者未经治疗的时间与临床结果之间的关系。方法:采用简明精神病评定量表(BPRS)、不良反应量表(TESS)、康复状态量表(MRSS)、以及社会功能缺陷筛选量表(SDSS)分别于基线、2010年6月和2012年6月收集一般健康状况,精神症状和社会功能相关信息。结果:共43例首发精神分裂症患者参与研究,将其分为精神疾病未治疗(DUP)短期(≤24周)和精神疾病未治疗(DUP)长期(24周)两组。短期DUP组的平均随访时间为1197(SD=401)天,长期DUP组平均随访时间为1412(SD=306)天(t=9.98,p=0.055)。尽管初诊时长期DUP组患者的精神病性症状较短期DUP组不明显(BPRS平均分,42.5[8.4]v.50.0[10.6],t=2.42,p=0.0210),并且两组临床复发次数类似(基于BPRS阳性症状量表评估),长期DUP组患者更可能在初诊时需要住院治疗(52%[11/21]v.9%[2/22],χ2=9.55,p=0.002),并且在治疗的头两年更有可能再次住院(67%[14/21]v.32%[7/22],χ2=5.22,p=0.022)。另外,经过四年的常规治疗后,虽然两组患者的阳性症状严重程度类似,但是治疗前具有较长DUP的患者比DUP较短的患者社会功能减退更明显。(SDSS平均,7.0[5.2]v.3.4[4.9],t=2.20,p=0.035)。结论:这些结果表明,与治疗前DUP较短的精神分裂症患者相比,尽管DUP较长的患者精神病性症状的严重程度类似(由BPRS测量),但长期社会功能较差。这证实了对慢性精神障碍患者早期识别和及时治疗的临床重要性。     

Association between financial strain,social network and five-year recovery from first episode psychosis

Despite much effort to positively affect long-term outcome in psychosis and schizophrenia many patients are still facing a poor outcome with persistent psychotic symptoms and decline in social functioning. The aim of this study was to examine the relationship between financial strain and social network and five-year outcome of first episode psychosis (FEP). FEP patients were divided into recovered (n = 52) and non-recovered (n = 19). Each person was matched according to age and gender with four persons (n = 284) from a longitudinal population-based study. All persons had answered an extensive questionnaire including social network, quantitative and qualitative, financial strain and mental health. Linear regression analysis showed that both financial strain and social network were associated, and had a unique contribution, to outcome. The results indicate that FEP patients might benefit from interventions that reduce financial strain thus facilitating daily life and cultural and social activities.     

Sex differences in the effect of childhood trauma on the clinical expression of early psychosis

Childhood trauma, a risk factor of psychosis, is associated the clinical expression of the illness (greater severity of psychotic symptoms; poorer cognitive performance). We aimed to explore whether there are sex differences in this relationship. We studied 79 individuals with a psychotic disorder (PD) with < 3 years of illness and 59 healthy subjects (HS). All participants were administered the MATRICS Cognitive Consensus Cognitive Battery (MCCB) to assess cognition. Depressive, positive and negative psychotic symptoms, and global functioning were also assessed. History of childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ). Patients reported a greater history of childhood trauma on all CTQ domains (emotional, physical and sexual abuse, and physical and emotional neglect). A poorer cognitive performance was also observed in PD when compared to HS. No sex differences were found in the CTQ scores. In the relationship between childhood trauma and psychopathological symptoms, significant correlations were found between CTQ scores and positive and negative psychotic symptoms, depressive symptoms and poorer functionality, but only in women. Childhood trauma was associated with poorer social cognition in both men and women. Of all CTQ dimensions, emotional neglect and physical neglect were more clearly associated with a more severe psychopathological and cognitive profile. Our results suggest that childhood trauma, particularly emotional and physical neglect, is associated with the clinical expression of psychosis and that there are sex differences in this relationship.     

Declining social support in adolescents prior to first episode psychosis: Associations with negative and affective symptoms

Social support for individuals with psychosis is associated with decreased symptom severity, improved outcomes, and recovery. In adolescents, declining social support prior to the first hospitalization has been shown to predict time to relapse, which may have implications for early intervention. Data were collected on adolescents (n=84) following a first hospitalization for a psychotic episode in order to examine how change in social support relates to the duration and type of untreated symptoms. Most adolescents experienced a decline in social support (n=46) prior to index hospitalization. Chi-square analyses showed that declining social support was related to negative symptoms and longer duration of untreated psychosis, whereas stable social support was associated with manic symptoms and diagnosis of Bipolar disorder. When entered together into a logistic regression model, the decline in social support was primarily explained by the type of symptoms, rather than by the duration of untreated symptoms. These findings are relevant for targeting psychosocial treatments toward adolescents who may have particular deficits in social support during the prodromal phase and first episode of psychosis.     

Dynamic Association Between Interpersonal Functioning and Positive Symptom Dimensions of Psychosis Over Time: A Longitudinal Study of Healthy Adolescents

Background: Cross-sectional studies have indicated that alterations in social functioning, particularly interpersonal functioning, are associated with the occurrence of psychotic symptoms and experiences at different levels of the extended psychosis phenotype (ranging from population psychometric expression of liability to overt psychotic disorder). However, more research is needed on the development of this association over time. Methods: Cross-lagged path modeling was used to analyze bidirectional, longitudinal associations between 4 dimensions of subclinical psychotic experiences (persecutory ideation, bizarre experiences, perceptual abnormalities, and magical thinking) and interpersonal functioning in an adolescent general population sample (N = 881 at T1, N = 652 at T2, and N = 512 at T3) assessed 3 times in 3 years. Results: All symptom dimensions showed some association with interpersonal functioning over time, but only bizarre experiences and persecutory ideation were consistently and longitudinally associated with interpersonal functioning. Poorer interpersonal functioning predicted higher levels of bizarre experiences and persecutory ideation at later measurement points (both T1 to T2 and T2 to T3). Conclusions: Poor interpersonal functioning in adolescence may reflect the earliest expression of neurodevelopmental alterations preceding expression of psychotic experiences in a symptom-specific fashion.     

Intervention to improve level of overall functioning and mental condition of adolescents at high risk of developing first-episode psychosis in Finland

Aim: Being at high risk of developing psychosis has been suggested to be a result of a combination of acute life stressors and trait‐like vulnerability to psychosis. Reducing levels of stress could support overall functioning and mental condition in those at risk. Methods: The Jorvi Early Psychosis Recognition and Intervention (JERI) project at Helsinki University Central Hospital, Jorvi Hospital, Finland, is an early intervention team for adolescents at risk of developing first‐episode psychosis. The project is based on the idea of multiprofessional, community, home, family and network‐oriented, stress‐reducing, overall functioning‐supporting, low‐threshold care. The JERI team meets multiprofessionally with adolescents in their natural surroundings, for example, at school or at home, together with their parents, network and community co‐worker, who has originally contacted the JERI team because of unclear mental health problems. Subjects were assessed with the PROD‐prodromal screen to identify those at risk of developing first‐episode psychosis. Results: Statistically significant difference between baseline and follow‐up measures was found in at risk subjects (n = 28) in scales of overall functioning (P = 0.000), depression (P = 0.001), anxiety (P = 0.001), quality of life (QOL) and pre‐psychotic symptoms. Conclusions: JERI‐type intervention may improve level of overall functioning and support mental condition in adolescents at risk of developing first‐episode psychosis, even though further study with larger numbers of subjects, with a control group and with a longer follow‐up time, is needed.     

Neural and Behavioral Correlates of Aberrant Salience in Individuals at Risk for Psychosis

The “aberrant salience” model proposes that psychotic symptoms first emerge when chaotic brain dopamine transmission leads to the attribution of significance to stimuli that would normally be considered irrelevant. This is thought to occur during the prodromal phase of psychotic disorders, but this prediction has not been tested previously. In the present study, we tested this model in 18 healthy volunteers and 18 unmedicated individuals at ultra-high risk of psychosis. Subjects performed the Salience Attribution Test, which provides behavioral measures of adaptive and aberrant motivational salience, during functional magnetic resonance imaging to assess neural responses to relevant and irrelevant stimulus features. On a separate occasion, the same subjects were also studied with [¹⁸F]fluorodopa positron emission tomography to measure dopamine synthesis capacity. Individuals at ultra-high risk of psychosis were more likely to attribute motivational salience to irrelevant stimulus features (t(26.7) = 2.8, P = .008), and this bias was related to the severity of their delusion-like symptoms (r = .62, P = .008). Ventral striatal responses to irrelevant stimulus features were also correlated with delusion-like symptoms in the ultra-high risk group (r = .59, P = .017). Striatal dopamine synthesis capacity correlated negatively with hippocampal responses to irrelevant stimulus features in ultra-high risk individuals, but this relationship was positive in controls. These data are consistent with the hypothesis that aberrant salience processing underlies psychotic symptoms and involves functional alterations in the striatum, hippocampus, and the subcortical dopamine system.Key words: psychosis, aberrant salience, salience attribution test, functional magnetic resonance imaging, positron emission tomography, dopamine     

Social network among young adults with first-episode schizophrenia spectrum disorders

Background Social network has considerable impact on physical and mental health. Patients experiencing first-episode psychosis early in adult life may experience severe problems concerning development and maintenance of their social network. Methods A total of 547 first-episode psychotic patients (18–45) were randomised to standard or integrated treatment, (ACT, social skills training and family intervention), and followed up at 2 years. Results Service use or psychotic symptom score did not influence the social network size, measured after the first 2 years of treatment. Small network size was associated with long duration of untreated psychosis (DUP), poor premorbid adjustment, male gender and severe negative symptoms. The number of friends at 2-year follow-up was predicted by age, A-level status, negative symptoms and number of friends at entry, while the determinants for number of family contacts were age, gender, disorganised dimension and family contacts at entry. Conclusions Premorbid functioning, network size at entry and DUP is closely related to small social network size. The integrated psychosocial treatment programme was not sufficient to address this problem.     

Mianserin treatment of patients with psychosis induced by antiparkinsonian drugs

We evaluated the effects of mianserin, a relatively selective 5-HT₂ receptor antagonist, on symptoms related to drug-induced psychosis in patients with Parkinson's disease (PD). A total of 12 patients with PD who had developed drug-induced psychosis showed delirium (DSM-III-R criteria;n=10) and pure visual hallucinations (n=2). The antiparkinsonian drugs involved in the drug-induced psychosis werel-DOPA/carbidopa, bromocriptine, trihexyphenidyl, and amantadine. They received mainserin (mean 36.7 mg, range 20–60 mg) given orally for 8 weeks. Complete relief or marked improvement in psychotic symptoms was noted in 8 patients, moderate improvement in 2 patients, and no effect in 2 patients. The parkinsonian disability also decreased slightly in 8 patients. These results suggest that serotonin antagonism at 5-HT₂ receptors may not only play an important role in the treatment of drug-induced psychosis in PD, but may also ameliorate the symptoms of parkinsonism.     

Psychosis in Parkinson's disease without dementia: Common and comorbid with other non‐motor symptoms

Psychosis in Parkinson's disease (PD) is common and associated with a range of negative outcomes. Dementia and psychosis are highly correlated in PD, but the frequency and correlates of psychosis in patients without cognitive impairment are not well understood. One hundred and ninety‐one non‐demented PD patients at two movement disorders centers participated in a study of neuropsychiatric complications in PD and completed a detailed neurological and neuropsychiatric assessment, including the rater‐administered Parkinson Psychosis Rating Scale for hallucinations, delusions, and minor symptoms of psychosis (illusions and misidentification of persons). Psychotic symptoms were present in 21.5% of the sample. Visual hallucinations were most common (13.6%), followed by auditory hallucinations (6.8%), illusions or misidentification of people (7.3%), and paranoid ideation (4.7%). Visual hallucinations and illusions or misidentification of people were the most common comorbid symptoms (3.1%). Depression (P = 0.01) and rapid eye movement behavior disorder symptoms (P = 0.03) were associated with psychosis in a multivariable model. The odds of experiencing psychotic symptoms were approximately five times higher in patients with comorbid disorders of depression and sleep‐wakefulness. Even in patients without global cognitive impairment, psychosis in PD is common and most highly correlated with other non‐motor symptoms. Screening for psychosis should occur at all stages of PD as part of a broad non‐motor assessment. In addition, these findings suggest a common neural substrate for disturbances of perception, mood, sleep‐wakefulness, and incipient cognitive decline in PD. © 2012 Movement Disorder Society     

Prodromes and coping types in bipolar patients with nonpsychotic or psychotic mania

BackgroundBipolar disorder is a recurrent and cyclical illness frequently accompanied by psychotic symptoms. Detecting prodromes and enhancing coping skills for prodromal symptoms in bipolar patients are very important for relapse prevention. Psychotic features in bipolar patients are related to poor prognosis. We aimed to investigate the differences in prodromal symptoms and coping styles in psychotic and nonpsychotic bipolar patients.MethodsEighty-three euthymic bipolar patients with or without a history of manic psychosis were interviewed about their demographic, diagnostic, and clinical information and completed a 40-item checklist for prodromal symptoms. After the interview, they completed the Coping Inventory for Prodromes of Mania.ResultsThe differences between the psychotic patients and the nonpsychotic patients were found in the prodromal durations, and a few prodromal symptoms such as afraid of going crazy (P = .03), energetic-very active (P = .01), and hearing hallucination (P = .02). The psychotic patients showed a higher score of denial or blame than the nonpsychotic ones (1.92 ± 0.73 in nonpsychosis, 2.32 ± 0.84 in psychosis; P = .03). Logistic regression revealed that the duration of prodromes (P = .02) and hearing hallucination (P = .01) were related to the presence of psychotic features.ConclusionPsychotic patients had a tendency to use denial or blame coping strategy and to experience attenuated psychotic symptoms a little more during the prodromal period. Timely psychosocial approaches for detecting signs and enhancing coping strategies would improve the outcomes.     

Bullying in clinical high risk for psychosis participants from the NAPLS-3 cohort

Purpose

Bullying is associated with a heightened risk for poor outcomes, including psychosis. This study aimed to replicate previous findings on bullying prevalence in clinical high-risk (CHR) individuals, to assess the longitudinal course of clinical and functional variables between bullied and non-bullied CHR and the association of bullying with premorbid functioning, clinical outcome, transition to psychosis and risk of violence.

Methods

The sample consisted of 691 CHR participants and 96 healthy controls. Participants reported whether they had experienced bullying and how long it had lasted. Assessments included DSM-5 diagnoses, attenuated psychotic symptoms, negative symptoms, social and role functioning, depression, stress, premorbid functioning, and risk of violence. The bullied and non-bullied CHR groups were compared at baseline and further longitudinally on clinical and functioning variables and transition to psychosis.

Results

Bullying was more prevalent among CHR individuals than healthy controls. Bullied CHR had a higher prevalence of PTSD and more severe depression and stress at baseline than non-bullied CHR. There was no impact of bullying on clinical and functional variables over time. Bullying was not related to final clinical status or transition to psychosis. However, bullied participants had poorer premorbid functioning and a greater risk of violence.

Conclusion

While bullying may not impact the likelihood of CHR individuals to transition to psychosis, it may be a risk factor for development of the at-risk state and may be related to a greater risk of violence. Future studies should consider bullying perpetration among CHR individuals.

     

Interplay Between Childhood Physical Abuse and Familial Risk in the Onset of Psychotic Disorders

Background: Childhood abuse is considered one of the main environmental risk factors for the development of psychotic symptoms and disorders. However, this association could be due to genetic factors influencing exposure to such risky environments or increasing sensitivity to the detrimental impact of abuse. Therefore, using a large epidemiological case-control sample, we explored the interplay between a specific form of childhood abuse and family psychiatric history (a proxy for genetic risk) in the onset of psychosis. Methods: Data were available on 172 first presentation psychosis cases and 246 geographically matched controls from the Aetiology and Ethnicity of Schizophrenia and Other Psychoses study. Information on childhood abuse was obtained retrospectively using the Childhood Experience of Care and Abuse Questionnaire and occurrence of psychotic and affective disorders in first degree relatives with the Family Interview for Genetic Studies. Results: Parental psychosis was more common among psychosis cases than unaffected controls (adjusted OR = 5.96, 95% CI: 2.09–17.01, P = .001). Parental psychosis was also associated with physical abuse from mothers in both cases (OR = 3.64, 95% CI: 1.06–12.51, P = .040) and controls (OR = 10.93, 95% CI: 1.03–115.90, P = .047), indicative of a gene-environment correlation. Nevertheless, adjusting for parental psychosis did not measurably impact on the abuse-psychosis association (adjusted OR = 3.31, 95% CI: 1.22–8.95, P = .018). No interactions were found between familial liability and maternal physical abuse in determining psychosis caseness. Conclusions: This study found no evidence that familial risk accounts for associations between childhood physical abuse and psychotic disorder nor that it substantially increases the odds of psychosis among individuals reporting abuse.Key words: family history, gene-environment correlation, gene-environment interaction, liability, schizophrenia, trauma     

Severe social anxiety in early psychosis is associated with poor premorbid functioning, depression, and reduced quality of life

ObjectiveThe main aim of the present study was to examine whether patients with first-episode psychosis (FEP) with severe social anxiety show poorer premorbid and current functioning, higher level of current clinical symptoms, and better “insight into illness.” Furthermore, we wanted to explore whether social anxiety is associated with reduced quality of life (QoL).MethodA sample of 144 individuals with an FEP was divided into 3 groups depending on current level of social anxiety symptoms measured by the Liebowitz Social Anxiety Scale. Analysis of variance was performed including measures of demographic and clinical characteristics. A hierarchical regression analysis was performed to explore possible predictors of QoL.ResultsThe most severe social anxiety group revealed poorer premorbid adjustment, lower social functioning, and higher levels of depression. Furthermore, this group revealed a higher awareness of illness and experienced reduced QoL. Overall, social anxiety was associated with reduced QoL even after adjusting for psychotic symptoms and depression.ConclusionSevere social anxiety in FEP is associated with poor premorbid functioning and distinct clinical characteristics, besides being a possible predictor of QoL.