Schizotypal Disorder Resources

MedWire News: Adolescents with mild intellectual impairmentand schizotypal features have medial temporal gray matter lossescomparable to populations at high risk for schizophrenia, UKresearchers have discovered.

Previous studies have shown thatadolescents with mild intellectual impairment have an increased riskfor developing schizophrenia compared with other adolescents. However,it is not clear whether risk markers for later schizophrenia arepresent within these individuals.

To investigate further, ThomasMoorhead and colleagues from the University of Edinburgh measured thedegree of schizotypal features in 98 adolescents with mild intellectualimpairment using the Structured Interview for Schizotypy.

Inaddition, the team performed two structural magnetic resonance imagingscans approximately 16 months apart and used tensor-based morphometryto assess changes over time in gray-matter volumes.

Onwhole-brain analysis, there were no significant differences betweenpatients with and without schizotypal features in terms of gray-matterand white-matter volumes, the team notes in the journal Psychiatry Research: Neuroimaging.

However,assessing small volume-change images for the left amygdala-hippocampalregion, they found significant gray-matter tissue loss in theparahippocampal gyrus, the ventral amygdala, and the medial amygdala inpatients with schizotypal features.

Over time, there weresignificantly positive associations between worsening affectiveflattening and gray-matter loss in both the parahippocampal gyrus andventral amygdala, as well as between worsening poverty of speech andgray-matter loss in the parahippocampal gyrus.

The researcherssay: “In summary, in this large group of cognitively impaired youngpeople, we have identified progressive gray matter reductions in theleft amygdala and parahippocampal gyrus in participants that exhibithigh levels of schizotypal features.

“These findings areconcordant with previous high risk studies and suggest that lefttemporal lobe gray matter loss represents an important neuroanatomicalsubstrate of risk for schizophrenia that may be common to cognitive,genetic and ultra high risk populations.”

MedWire News: The risk for developing schizotypal traits inadulthood appears to be influenced by several early life factors,including low birth weight and family socioeconomic status, but in ahighly gender-specific manner, suggest study results.

Sincesimilar factors have been previously linked to schizophrenia, studyco-author Jari Lahti (University of Helsinki, Finland) and colleaguessay the findings add further weight to developmental and genetictheories of the schizophrenia spectrum.

Schizotypy consists ofpositive and negative schizotypal traits, which closely resemblesymptoms characterizing schizophrenia, Lahti et al explain in the British Journal of Psychiatry.

Notinga lack of studies focussing on risk for schizotypy alone, theresearchers examined individuals enrolled on the Northern Finland 1966Birth Cohort Study (n=4976) who completed a questionnaire on positiveand negative schizotypal traits at the age of 31 years in 1997.

Theyfound that in women, but not men, small placental weight, low birthweight, and small head circumference at the age of 12 months predictedmore pronounced positive schizotypal traits.

For every 100-gincrease in placental weight, 1-kg increase in birth weight, and 1-cmincrease in head circumference at 12 months, the positive symptomsdecreased by 0.04, 0.09, and 0.04 standard deviations, respectively.

Inaddition, later birth order predicted augmented positive traits, andwinter or autumn birth predicted negative traits in women but not men.

Conversely,men, but not women, whose mothers smoked during pregnancy showed anelevated physical anhedonia at 31 years. Also in men, positive andnegative schizotypal traits were more pronounced if the motherconsidered the pregnancy undesired, or desired it later.

In bothwomen and men, negative schizotypal traits were more pronounced in theoffspring of farmers, and positive schizotypal traits were morecharacteristic if the childhood family socioeconomic status was low.

Looking for a possible explanation for their findings Lahti et alnote that “suboptimal early-life environment may induce changes infetal physiology and set the stage for less optimal life-coursedevelopment.”

They add that “different previous studies haveshown clear differences in the epidemiology and course of schizophreniabetween women and men; hypothesized to result, in part, fromdifferences in the growth hormone–insulin-like growth factor axis.”

MedWire(www.medwire-news.md) is an independent clinical news service providedby Current Medicine Group, a part of Springer Science+Business Media. ©Current Medicine Group Ltd; 2009

By Caroline Wilbert

Reviewed by Louise Chang, MD

Sept. 30, 2008 -- Long-term psychodynamic psychotherapy (LTPP) is more effective than short-term therapy for patients with complex mental disorders such as personality disorders, according to a new report.

The report's authors, including Falk Leichsenring, DSc, of the University of Giessen in Germany and Sven Rabung, PhD, of the University Medical Center Hamburg-Eppendorf in Hamburg, Germany, analyzed data from 23 existing studies, involving a total of 1,053 patients treated with long-term psychodynamic psychotherapy. In all the studies, LTPP lasted at least a year.

According to the American Psychiatric Association, psychodynamic psychotherapy is a "treatment to help patients understand themselves more fully. This approach may involve uncovering -- and learning to deal more effectively with -- unconscious conflicts. It may also involve assisting patients to understand how certain types of adverse childhood experiences have left them feeling incomplete, anxious, or plagued with low self-esteem that interferes with realistic adult functioning."

The report, published in The Journal of the American Medical Association, concluded that patients with complex mental disorders who completed LTPP were better off than 96% of patients in comparison groups. Complex mental disorders included personality disorders, chronic mental disorders lasting at least a year, complex depressive or anxiety disorders, or those with two or more mental disorders.

"In this meta-analysis, LTPP was significantly superior to shorter-term methods of psychotherapy with regard to overall outcome, target problems, and personality functioning," the study says.

In an accompanying editorial, Richard M. Glass, MD, deputy editor of The Journal of the American Medical Association, argues that LTPP is being used less these days, at least in part because it is not as cost-effective as medication with brief supportive visits.

"This trend appears to be strongly related to financial incentives and other pressures to minimize costs," he writes. "Is that what is really wanted for patients with disabling disorders that could respond to more intensive treatment?"

MedWire News: Childhood trauma and schizotypal dimensions are linked in individuals at high genetic risk for schizophrenia, say scientists in findings that may highlight an interaction between childhood experience and genetic susceptibility.

Previous studies have identified a strong association between childhood trauma and psychotic disorders, explain F Shürhoff, from Pôle Universitaire de Psychiatrie in Créteil, France, and colleagues.

Noting that schizotypy represents a mild imitation of schizophrenia symptoms, the team administered the Diagnostic Interview of Genetic Studies, the Schizotypal Personality Questionnaire (SPQ), and the Childhood Trauma Questionnaire (CTQ) to 67 unaffected first-degree relatives of schizophrenic probands and 71 unaffected first-degree relatives of bipolar disorder probands.

The average age of the two groups was comparable at 54.2 years and 53.1 years, respectively. Schizophrenia relatives were more likely to be parents of the probands than bipolar disorder relatives, at 80.5% versus 59.2%.

There were no significant differences in average SPQ full scores and in CTQ scores between schizophrenia and bipolar disorder relatives, at 10.2 versus 9.6, and 38.6 versus 39.3, respectively.

There was a significant correlation between CTQ score and SPQ full-score, at an r value of 0.27, which was fully explained by a significant correlation among schizophrenia relatives, at an r value of 0.43. In contrast, there was no significant correlation among bipolar disorder relatives, at an r value of 0.13.

The team notes in the journal Psychological Medicine that the odds ratio for having schizoptypal traits in the presence of childhood trauma was higher in schizophrenia than bipolar disorder relatives, at 3.60 and 1.64, respectively.

They write: "In conclusion, our findings suggest that susceptibility genes specific to schizophrenia may influence response to pathogenic environments.

"It is clear that if a gene's connection to the disorder is conditional on the environment, this will have the natural consequence of diminishing the researchers? capacity to detect the association between the gene and the disorder."

Two studies examined the relation between psychological trauma and schizotypal symptoms.

In Study 1, in which 1,510 adults completed telephone interviews, both childhood maltreatment and the experience of an injury or life-threatening event were significantly associated with schizotypal symptoms.

In Study 2, in which 303 adults (oversampled for having elevated levels of schizotypal symptoms) completed extensive in-person assessments, both childhood maltreatment and meeting posttraumatic stress disorder (PTSD) Criterion A were significantly associated with schizotypal symptoms. The links between schizotypal symptoms and at least some forms of psychological trauma could not be fully accounted for by shared variance with antisocial and borderline personality disorders, absorption/dissociation, PTSD symptom severity, family history of psychotic disorder, or signs of neurodevelopmental disturbance (as indexed by minor physical anomalies and inconsistent hand use).

Schizotypal symptoms were more strongly associated with childhood maltreatment among men than among women, whereas schizotypal symptoms were more strongly associated with PTSD Criterion A among women than among men. Finally, among men, the association between childhood maltreatment and schizotypal symptoms was moderated by signs of neurodevelopmental disturbance.

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

Journal of Abnormal Psychology, 0021-843X, 2008, Vol. 117, Issue 3

Psychiatry Res 2008; Advance online publication

MedWire News: The deletion (D) allele of the angiotensin-converting enzyme (ACE) gene appears to offer protection against the development of schizophrenia, Spanish study findings indicate.

ACE is a candidate gene for psychiatric disorders due a number of factors, including interactions with neurotransmitters such as dopamine. In addition, previous studies have revealed that ACE levels are associated with an insertion (I)/D polymorphism in an intron of ACE.

To determine whether the I/D polymorphism is linked to schizophrenia, Amalia Lafuente, from the University of Barcelona, and colleagues genotyped 243 patients with schizophrenia and related disorders and 291 hospital-based controls attending a trauma service.

The average age of patients with schizophrenia and related disorders was 34.05 years, compared with 61.7 years among controls, and the age difference was taken into account in all analyses. The proportion of male patients was 54.3% and 38.4%, respectively.

Of the schizophrenia and related disorders patients, 65.8% had schizophrenia, 12.4% had schizoaffective disorder, 16.1% had acute psychotic disorder, 4.5% had delusional disorder, and 1.2% had schizotypal disorder.

In both patients and controls, the distribution of the ACE I/D polymorphism was in Hardy-Weinberg equilibrium. Analysis revealed that the D allele was associated with a reduced risk for schizophrenia and related disorders, at an odds ratio of 0.6, and a reduced risk for schizophrenia in particular, at an odds ratio of 0.5. The protective effect was greater in D/D homozygotes, at odds ratios of 0.4 and 0.3, respectively.

The additive genotype risk model revealed that the heterozygote risk was intermediate between the two homozygote risks, suggesting that the protection increases with the number of D alleles.

"Our study suggests that the ACE D allele is involved in protection against schizophrenia," the team writes in the journal Psychiatry Research.

"The lack of specific knowledge about the complex relationships between ACE, angiotensin II, substance P and dopamine impedes an interpretation of the precise role of the enzyme in the pathogenesis of schizophrenia."

MedWire News: The presence of schizotypal traits in healthy adults is associated with reduced verbal IQ, supporting the notion of schizotypy being on a continuum from normality to schizophrenia, say Japanese scientists.

Previous studies have indicated that psychometrically identified schizotypes in students are linked to subtle impairments in attention, working memory, and executive function, but the associations between psychometric schizotypy in adults and cognitive function have not been thoroughly explored.

Hiroaki Hori, from the National Center of Neurology and Psychiatry in Tokyo, and colleagues studied 124 healthy adults, administering the Schizotypal Personality Questionnaire, the Wechsler Memory Scale-Revised, the Wechsler Adult Intelligence Scale-Revised, and the Wisconsin Card Sorting Test.

The average age of the participants was 46.3 years and the average number of years in education was 14.4. Total average SPQ scores were 11.09. While age was significantly negatively correlated with total SPQ score, years in education and gender were not correlated with total SPQ score.

The team reports in the journal Psychiatry Research that verbal IQ and its subscales of information, comprehension, and similarities were significantly negatively correlated with at least one of the SPQ subscales, with the "odd beliefs/magical thinking" and "odd speech" SPQ subscales most commonly correlated.

In contrast, memory, attention/concentration, performance IQ (plus its five subscales), and executive functioning were not significantly correlated with any of the SPQ subscales or the total SPQ score.

"The present findings indicate that schizotypal traits in healthy adults are associated with mild verbal IQ decrements, suggesting that schizotypal traits even at a non-clinical level may play unfavorable roles in cognitive function," the researchers comment.

Such a finding is "in line with the viewpoint that schizotypy is a continuum from normality to its extreme expressed as schizophrenia," they add.

MedWire News: Children who are separated from their mothers for 4 weeks or more show an elevated incidence of schizotypal symptoms in later life, especially when separation occurred in the first 2 years of life, a study shows.

In addition, separated children reported to show early angry emotional behavior were more likely to manifest schizotypal symptoms later in life than other children, thereby supporting "the role of early childhood psychosocial risk factors in the development of subsequent schizophrenia spectrum symptoms in emotionally vulnerable children," the researchers say.

A growing number of studies have demonstrated the importance of early childhood experiences in the development of psychosis and schizophrenia in adulthood, Deidre Anglin (Columbia University, New York, USA) and colleagues note.

Attachment theory emphasizes the crucial and formative role of early life experiences, especially during the first 2 years of life, for social and emotional development.

"Through repeated transactions with familiar attachment figures, infants form internal working models, which include affective and cognitive mental representations of expectations about the behavior of self and other," Anglin et al note in the journal Schizophrenia Research.

For the present study, the researchers reviewed data from an epidemiologic cohort of children randomly sampled at an average age of 5 years from families living in upstate New York in 1975.

The children were assessed for axis I and schizotypal personality disorder (SPD) symptoms at a mean age of 13.7 years and again at mean ages of 16.4, 22.4, and 33.2 years. A combination of maternal and child-report items were employed in earlier reports.

Participants who were separated from their mothers for at least a month during the first 5 years of life exhibited a significant increase in average SPD symptoms (b=2.03, SE=1.05).

Further analyses indicated that this effect was largely attributable to separations in the first 2 years of life, especially if the child displayed angry temperament.

Anglin et al speculate that the first 2 years may be a "critical period" in a child's psychologic development, adding that "more attention should focus on early psychologic experiences that may put both genetically vulnerable offspring and perhaps also those without clear genetic vulnerability at risk."