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How does studying schizotypal personality disorder inform us about the prodrome of schizophrenia?

Department of Psychiatry, 0810, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
Current Psychiatry Reports (Impact Factor: 3.05). 04/2005; 7(1):41-50. DOI: 10.1007/s11920-005-0024-5
Source: PubMed

ABSTRACT An increasing emphasis in the schizophrenia literature has been on the prodromal phase of the illness. The study of schizophrenia spectrum illness, including schizotypal personality disorder, has added important insight into the etiology, neuropathology, and treatment of schizophrenia, which can facilitate early identification, intervention, and perhaps prevention of the illness. The heterogeneity of the schizophrenia spectrum makes its definition elusive at best. The primary aim of the Cognitive Assessment and Risk Evaluation Program at the authors' institution is to combine the current knowledge of clinical and demographic risk factors for schizophrenia with the rapidly emerging data on vulnerability markers, or endophenotypes, that are associated with schizophrenia. The use of brain-based vulnerability markers may help to identify neurobiologically and clinically meaningful subgroups within this heterogeneous population of individuals in the early stages of schizophrenia. Another important aim of the Cognitive Assessment and Risk Evaluation program is to thoroughly assess those individuals who have not converted to psychosis to understand potential protective factors, reduce the rate of false positives, and decrease disability. The current review details a strategy for researching the schizophrenia prodrome by using information gained from research in schizotypal personality disorder.

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    • "The current research also has implications for the role of disturbances of self-relevant information processing in psychotic-like experiences. Recently, self-disturbances have received attention in the schizophrenia literature, particularly with respect to the prodrome (Lysaker & Lysaker, 2010), which is similar to schizotypal personality disorder (Seeber & Cadenhead, 2005). However, much of this research has been phenomenological or qualitative (e.g., Davidsen, 2009; Moller & Husby, 2000). "
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    ABSTRACT: Most theories of psychotic-like experiences posit the involvement of cognitive mechanisms. The current research examined the relations between psychotic-like experiences and two cognitive mechanisms, high aberrant salience and low self-concept clarity. In particular, we examined whether aberrant salience, or the incorrect assignment of importance to neutral stimuli, and low self-concept clarity interacted to predict psychotic-like experiences. The current research included three large samples (n = 667, 724, 744) of participants and oversampled for increased schizotypal personality traits. In all three studies, an interaction between aberrant salience and self-concept clarity was found such that participants with high aberrant salience and low self-concept clarity had the highest levels of psychotic-like experiences. In addition, aberrant salience and self-concept clarity interacted to predict a supplemental measure of delusions in Study 2. In Study 3, in contrast to low self-concept clarity, neuroticism did not interact with aberrant salience to predict psychotic-like experiences, suggesting that the relation between low self-concept clarity and psychosis may not be a result of neuroticism. Additionally, aberrant salience and self-concept clarity did not interact to predict two other SPD criteria, social anhedonia or trait paranoia, which suggests the interaction is specific to psychotic-like experiences. Overall, our results are consistent with several cognitive models of psychosis suggesting that aberrant salience and self-concept clarity might be important mechanisms in the occurrence of psychotic-like symptoms. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
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    • "EP subjects had developed psychosis per the SCID/KSADS within the last 2 years. AR subjects were assessed with the Structured Interview for Prodromal Syndromes (SIPS) (Miller et al., 2003; Cadenhead et al., 2005; Seeber and Cadenhead, 2005) that characterizes the prodromal syndrome as a recent onset of subsyndromal psychotic symptoms and/or a recent decline in functioning in individuals with a 1 st degree relative with psychosis. CS did not meet criteria for DSM-IV Axis I or II disorders (First et al., 1996a; First et al., 1996b), prodromal symptoms or have a family history of psychosis. "
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    ABSTRACT: The use of biomarkers in the study of the prodrome and first episode of psychosis provides a means of not only identifying individuals at greatest risk for psychosis but also understanding neurodevelopmental abnormalities early in the course of illness. Prepulse inhibition (PPI), a marker that is deficient in schizophrenia and after developmental manipulations in animal models, was assessed in 75 early psychosis (EP), 89 at risk (AR) for psychosis and 85 comparison subjects (CS) at baseline and 6 months. Consistent with findings in chronic schizophrenia, PPI was stable with repeated assessment and EP subjects had reduced PPI but this was most evident in tobacco smokers. A significant positive PPI and age association in AR and EP samples, but not CS, demonstrated potential neurodevelopmental differences in early psychosis. Unexpected findings included the fact that medication naive EP subjects, as well as AR subjects who later developed psychosis, had greater PPI, introducing the possibility of early compensatory changes that diverge from findings in chronic patients. In addition, subjects with a history of cannabis use had greater startle reactivity while EP and AR subjects who used cannabis and were also taking an antipsychotic had greater PPI, again highlighting the potentially important cannabis/psychosis association.
    Psychiatry Research 07/2011; 188(2):208-16. DOI:10.1016/j.psychres.2011.04.011 · 2.68 Impact Factor
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    • "Our samples consisted of 48 subjects at risk for psychosis (AR), 20 first-episode schizophrenia patients (FE) and 29 normal comparison subjects (NC), who were compared at baseline and 6-month follow-up on a battery of neurocognitive tests. The majority of the AR subjects (70.9%) met criteria for at least one of the two most common prodromal syndromes (Miller et al., 2003; Seeber & Cadenhead, 2005; Yung et al., 2005): " Attenuated Positive Symptom " (new onset of subsyndromal psychotic symptoms) and/or " Genetic Risk and Deterioration " (family history of schizophrenia in a first-degree relative or a diagnosis of schizotypal personality disorder that is associated with a recent decline in global functioning) per the Structured Interview for Prodromal Syndromes (SIPS; Miller et al., 2003) and established CARE (Cognitive Assessment and Risk Evaluation) criteria (Ballon et al., 2007). The Attenuated Positive Symptom (APS) category accounted for 28.2% of the at-risk sample, while 6.3% met criteria for the Genetic Risk and Deterioration (GRD) syndrome, 35.4% met both APS and GRD criteria, and 29.1% met criteria for the Brief Limited Intermittent Psychotic Symptoms (BLIPS) category. "
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    ABSTRACT: Understanding the trajectory of cognitive changes in the development of schizophrenia may shed light on the neurodevelopmental processes in the beginning stage of illness. Subjects at risk for psychosis (AR, n = 48), patients in their first episode of schizophrenia (FE, n = 20), and normal comparison subjects (n = 29) were assessed on a neurocognitive battery at baseline and at a 6-month follow-up. There were significant group differences across all cognitive domains as well as a significant group by time interaction in the verbal learning domain. After statistically controlling for practice effects and regression to the mean, a high proportion of FE subjects showed an improvement in verbal learning, and a significant number of AR subjects improved in general intelligence. Moreover, a higher than expected percentage of FE subjects, as well as AR subjects who later converted to psychosis, showed a deterioration in working memory and processing speed. These inconsistent trajectories suggest that some domains may improve with stabilization in the early stages of psychosis, whereas others may decline with progression of the illness, indicating possible targets for cognitive remediation strategies and candidate vulnerability markers for future psychosis.
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