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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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    • "Our preliminary results are consistent with previous data supporting the higher prevalence of schizotypal traits in first-degree relatives of patients with schizophrenia compared to the general population [15,19-21,34]. "
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    ABSTRACT: Schizotypy, or the set of personality traits related to schizophrenia, is considered an endophenotypic manifestation that is more represented in first-degree relatives of patients with schizophrenia than in the general population. The assessment of schizotypy is primarily based on self-reports, and for this reason it presents several limitations. In order to assess schizotypy, this study proposes a diagnostic instrument based on clinical reports. A sample of 66 subjects, composed of 25 outpatients with schizophrenia, 18 siblings of these patients and 23 healthy controls, was subjected to the personality assessment test SWAP-200 by trained clinical interviewers. To test the hypothesis of the difference between the profiles of the Personality Disorders within the schizophrenia spectrum, a Multivariate Analysis of Variance and subsequent planned comparisons were conducted. Patients with schizophrenia scored higher than both their siblings and the controls on all SWAP-200 scales; their siblings, compared to the healthy controls, showed significant statistical differences, with higher mean scores for paranoid (F(1,63) = 7.02; p = 0.01), schizoid (F(1,63) = 6.56; p = 0.013) and schizotypal (F(1,63) = 6.47; p = 0.013) traits (PD T scores of Cluster A and Q-factor scores for the schizoid scale [F(1,63) = 6.47; p = 0.013]). Consistent with previous data, first-degree relatives of patients with schizophrenia scored higher on schizophrenia-related personality traits than a general population comparison sample. SWAP-200, as an alternative diagnostic instrument to self-report measures, is able to reveal the higher prevalence of schizotypal traits in siblings of patients with schizophrenia, suggesting its possible use as a complementary instrument for the assessment of schizophrenia.
    BMC Psychiatry 10/2013; 13(1):245. DOI:10.1186/1471-244X-13-245 · 2.24 Impact Factor
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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).
    Personality Disorders: Theory, Research, and Treatment 03/2012; 4(1). DOI:10.1037/a0027361 · 3.54 Impact Factor
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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.
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