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Background: The Community Assessment of Psychic Experiences (CAPE) is a 42-item self-report questionnaire that has been developed and validated to measure the dimensions of psychosis in the general population. The CAPE has a three-factor structure with dimensions of positive, negative and depression. Assessing the cross-national equivalence of a questionnaire is an essential prerequisite before pooling data from different countries. In this study, our aim was to investigate the measurement invariance of the CAPE across different countries. Methods: Data were drawn from the European Union Gene-Environment Interaction (EU-GEI) study. Participants (incident cases of psychotic disorder, controls and siblings of cases) were recruited in Brazil, France, Italy, the Netherlands, Spain and UK. To analyse the measurement invariance across these samples, we tested configural invariance (i.e. identical structures of the factors), metric invariance (i.e. equivalence of the factor loadings) and scalar invariance (i.e. equivalence of the thresholds) of the three CAPE dimensions using multigroup categorical confirmatory factor analysis methods. Results: The configural invariance model fits well, providing evidence for identical factorial structure across countries. In comparison with the configural model invariance, the fit indices were very similar in the metric and scalar invariance models, indicating that factor loadings and thresholds did not differ across the six countries. Conclusion: We found that, across six countries, the CAPE showed equivalent factorial structure, factor loadings and thresholds. Thus, differences observed in scores between individuals from different countries should be considered as reflecting different levels of psychosis. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the validity of the Evaluation of Cognitive Processes involved in Disability in Schizophrenia scale (ECPDS) to discriminate for cognitive impairment in schizophrenia. Design: This multicentre cross-sectional study used a validation design with receiver operating characteristic (ROC) curve analysis. Settings: The study was undertaken in a French network of seven outward referral centres. Subjects: We recruited individuals with clinically stable schizophrenia diagnosed based on the Structured Clinical Interview for assessing Diagnostic and Statistical Manual of Mental Disorders (4th ed., rev.; DSM-IV-R) criteria. Main measures: The index test for cognitive impairment was ECPDS (independent variable), a 13-item scale completed by a relative of the participant. The reference standard was a standardized test battery that evaluated seven cognitive domains. Cognitive impairment was the dependent variable and was defined as an average z-score more than 1 SD below the normative mean in two or more cognitive domains. Results: Overall, 97 patients were included (67 with schizophrenia, 28 with schizoaffective disorder, and 2 with schizophreniform disorder). The mean age was 30.2 (SD 7.7) years, and there were 75 men (77.3%). There were 59 (60.8%) patients with cognitive impairment on the neuropsychological battery, and the mean ECPDS score was 27.3 (SD 7.3). The ROC curve analysis showed that the optimal ECPDS cut-off was 29.5. The area under the curve was 0.77, with 76.3% specificity and 71.1% sensitivity to discriminate against cognitive impairment. Conclusion: The ECPDS is a valid triage tool for detecting cognitive impairment in schizophrenia, before using an extensive neuropsychological battery, and holds promise for use in everyday clinical practice. [ABSTRACT FROM AUTHOR]

Objective: Individuals with psychotic symptoms may actually correspond to various subgroups, characterized by different patterns of psychotic symptoms as well as specific sociodemographic and clinical correlates. We aimed to identify groups of individuals from the general population with specific patterns of psychotic symptoms. Methods: In a 38,694-subject survey, a latent class analysis was performed to identify subgroups based on the distribution of seven psychotic symptoms taken from the Mini International Neuropsychiatric Interview. The different classes were subsequently compared according to sociodemographic and clinical correlates. Results: The best fit was obtained with a four-class solution, including the following: (1) a class with a low prevalence of all psychotic symptoms ('LOW', 85.9%); (2) a class with a high prevalence of all psychotic symptoms ('HAL + DEL', 1.7%); and classes with a high prevalence of (3) hallucinations ('HAL', 4.5%) or (4) delusions ('DEL', 7.9%). The HAL + DEL class displayed higher rates of history of trauma, social deprivation and migrant status, while the HAL and DEL classes displayed intermediate rates between HAL + DEL and LOW. HAL + DEL displayed the highest rates of psychotic and non-psychotic disorders and the use of mental health treatment, while HAL and DEL displayed intermediate rates of these disorders between HAL + DEL and LOW. In comparison to the HAL class, psychotic and substance use disorders were more frequent in the DEL class, while anxiety and mood disorders were less frequent. Conclusion: These findings support the hypothesis of a continuum model relating the level of psychotic symptoms to the level of global psychopathology. [ABSTRACT FROM AUTHOR]

• There is no accelerated telomere erosion in subjects suffering from first episode psychosis. • Excessive shortening of telomeres occurs during the course of schizophrenia. • Psycho-social stress /adversities and stressful situations are probably the cause of telomere erosion in schizophrenia. • Inflammatory processes and oxidative stress may be involved in the relationship between chronic stress and telomere erosion. • Telomere alterations may be considered as a biomarker of illness progression. Both shorter telomeres and schizophrenia have been associated with a decrease in life expectancy. Furthermore, several studies found a shorter telomere length (TL) in schizophrenia. Understanding whether or not telomere shortening is directly related to pathophysiology of schizophrenia or is a consequence of a cumulative exposure to chronic stress is of major importance. Comparing the TL of subjects at the very beginning of the disease (FEP) and control subjects could help to decide between these two hypotheses. The aim of the present study was to compare TL between FEP subjects (N=91) and controls (N=137). After accounting for multiple potential confounders, no significant association was observed between FEP and TL. Our result is consistent with the hypothesis that psycho-social stress / adversities and stressful situations in people with schizophrenia affect TL rather than that telomere erosion contributes to the development of this disorder. [ABSTRACT FROM AUTHOR]

Background: Several have suggested a link between discrimination phenomena and psychotic disorders. Since this is a potentially modifiable factor, it seems important to clarify the links between discrimination and psychotic disorders. In the hypothesis of the psychotic continuum, schizotypal features in the general population are intermediate phenotypes in schizophrenia studies. In this study, the aim was to study the links between discrimination and level of schizotypy in the general population. We assumed that exposure to discrimination experiences is associated with increased levels of schizotypy. Methods: Subjects from the general population (N = 1456), without psychotic disorders, were recruited in 17 cities and 6 countries (Brazil, Spain, France, Holland, Italy, UK). Each subject completed the Community Assessment of Psychic Experiences (CAPE), a autoquestionaire considered to assess the level of psychometric schizotypy (with positive, negative and depressive dimensions) and the 20-item Perceived Discrimination Scale developed by Williams et al. Linear regression analyzes were used with discrimination as an explanatory variable and CAPE scores as variables to be explained. Results: We show that an increase in the perceived discrimination score was associated with significantly higher levels of schizotypy, in the positive (p = 1.7.10-10), negative (p = 3.4.10-10) and the depressed dimensions (p = 2.1.10-10). In more than half of the subjects who reported discrimination experiences, the reason for the discrimination invoked was not one of the reasons given. Ethnicity remains, however, a major cause of reported discrimination. Discussion: The stress-vulnerability model could explain the link between discrimination and schizotypy, though dysregulation of the hypothalamopituitary axis and cortisol secretion in subjects with schizotypy, preventing them from responding adaptively to social stress. Psychological and social factors also seem to play a role in stress management. [ABSTRACT FROM AUTHOR]

Purpose of Review: This review will aim to summarize the current body of epidemiological, clinical and therapeutic knowledge concerning specific co-occurrence of obsessive-compulsive symptoms (OCSs) and schizophrenia spectrum disorder. Recent Findings: Almost 30% of the patients with schizophrenia display OCS, and three main contexts of emergence are identified: prodromal symptoms of schizophrenia, co-occurrence of OCS and schizophrenia and antipsychotics-induced OCS. Recent clinical studies show that patients with SZ and OCS have more severe psychotic and depressive symptoms, higher suicidality and lower social functioning. A recent cognitive investigation found that OCS and delusions share specific metacognitive profiles, particularly through a heightened need to control thoughts. Finally, a recent cross-sectional study of clozapine-induced OCS found a dose-response relationship between clozapine and OCS. Summary: OCS appeared reliably as linked to poorer outcomes among patients with schizophrenia. However, the specific clinical value of OCS among other prodromal symptoms of schizophrenia remains unknown. [ABSTRACT FROM AUTHOR]

Current medical research has focused on diseases and their associated risk factors. As such, these factors are assumed to have a deleterious effect. An alternative hypothesis is that some of these risk factors would also increase the chance for an opposite, positive outcome. To test this hypothesis, we considered exceptional social achievement and schizophrenia as opposite outcomes. Sixty years ago, researchers in France collected data on socio-demographic factors associated with exceptional social achievement. As the number of female subjects in the original database was very limited, we restricted our analyses to men. We tested the odds of achieving prominence in the presence of factors known to be associated with an increased risk of schizophrenia, namely migration, urbanicity, seasonality of birth, birth order, and paternal age. Three of the five factors tested significantly increased the odds for exceptional social achievement (urban birth, being the first-born and father's age over 35). Our findings suggest that some of the factors that are currently considered as risk factors for schizophrenia could diversifying factors. Widening the focus of research to include all potential effects of factors associated with disease could have important consequences on our understanding of causal mechanisms and for designing public health interventions. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of psychotic disorders varies between geographical areas, however less is known about whether it varies over time in the same region. Analyzing this temporal variation of incidence could improve the allocation of healthcare resources and our understanding of the aetiology of psychotic disorders. This study aimed to determine whether there was a change in the incidence of psychotic disorders over a six-year period.Methods: Young people aged 15 to 24 presenting with a first episode of psychosis (FEP) attending an early intervention service in Melbourne between 2011 and 2016 were included. The population at-risk was determined from the two corresponding census periods and analyses were adjusted for age, sex and migrant status.Results: A total of 1217 young people presented with a FEP over the six-year period and the crude incidence rate in 2011 was 102.4 per 100,000 population at-risk, compared to 125.4 in 2016. There was an increase in the incidence by 33% in 2015 (aIRR = 1.33, 95% CI 1.09-1.63) and 28% in 2016 (aIRR = 1.28, 95% CI 1.05-1.56). When examined according to diagnostic groups, there was an increase in the incidence of substance-induced psychotic disorders among females in 2015 (aIRR = 4.62, 95% CI 1.02-20.8).Discussion: This study shows significant temporal variations in the incidence of treated psychotic disorders. These findings demonstrate that early intervention services should continually monitor incidence case numbers and funding should be provided accordingly, to ensure the required intensive and comprehensive treatments can be sustained. [ABSTRACT FROM AUTHOR]

Childhood Attention-deficit/hyperactivity disorder (C-ADHD) is a neurodevelopmental disorder, associated with an increased risk of subsequent schizophrenia. The objective of the present study was to determine the prevalence of C-ADHD in schizophrenia and the clinical and cognitive characteristics associated with C-ADHD history in schizophrenia. 569 subjects with schizophrenia (74 % men, mean age 30.8) were included in ten expert centers at a national level and tested with a comprehensive battery of clinician-rated, patient-reported scales and cognitive tests. C-ADHD was assessed with the WURS (Wender Utah Rating Scale) self-report questionnaire. Multivariate, correlation, and principal component analyses (PCA) were conducted. Thirty-nine subjects (N = 39, 6.9 %) were classified in the C-ADHD group. Compared to those without C-ADHD, subjects with C-ADHD were more frequently male, had lower education levels, more severe positive clinical symptoms, more subjective cognitive deficits complaints, and lower medication adherence with small to medium effect sizes. Two cognitive components emerged from the PCA, one component including perceptual reasoning and working memory, and another component including visuospatial search and graphomotor speed, cognitive inhibition/flexibility and central executive functioning. Both components were associated with lower performances in the C-ADHD group. C-ADHD is frequent in schizophrenia and associated with more severe positive symptoms and impaired cognitive performances compared to those without C-ADHD. This suggests that the pathophysiological mechanisms contributing to these disorders may lead to the worsening of the cognitive functioning in patients with both disorders. C-ADHD is a relevant clinical marker to discriminate subgroups of schizophrenia with different profiles for a precision-psychiatry approach. [ABSTRACT FROM AUTHOR]

Catatonia has been defined by ICD-11 as a nosologically unspecific syndrome. Previous neuropsychiatric conceptions of catatonia such as Wernicke-Kleist-Leonhard's (WKL) one, have isolated chronic catatonic entities, such as progressive periodic catatonia (PPC) and chronic system catatonias (CSC). This study aimed at comparing the clinical and neuropsychological features of PPC, CSC and non-catatonic patients, all diagnosed with a schizophrenia spectrum disorder (SSD). The clinical and cognitive measures were compared among 53 SSD patients, first by separating catatonic (C-SSD, n = 27) and non-catatonic patients (NC-SSD, n = 26), and second, by separating PPC (n = 20), CSC (n = 6) and NC-SSD patients. Bayes factors were used to compare the model with 1 or 2 catatonic groups. We found that PPC had a more frequent schizo-affective presentation, higher levels of depression and less positive psychotic symptoms than both CSC and NC-SSD. CSC patients had an earlier illness onset, a poorer cognitive functioning, and higher antipsychotics doses than both PPC and NC-SSD. Most differences between C- and NC-SSD were accounted by characteristics of either PPC or CSC. The model with 2 catatonic groups clearly outperformed that with 1 catatonic group. Our results point to a substantial clinical heterogeneity of 'catatonia' within the SSD population and suggest that distinguishing (at least) 2 chronic catatonic phenotypes (PPC and CSC) may represent a relevant step to apprehend this heterogeneity. It is also a more parsimonious attempt than considering the around 32.000 distinct catatonic presentations resulting from the combinations of 3 out of 15 polythetic criteria for ICD-11 catatonia. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Longitudinal studies of cognition in schizophrenia: meta-analysis," by A. Szöke in the 2008: 192 issue.

Schizophrenia is associated with early neurodevelopmental disorders, including most frequently learning disorders (LD), among them dyslexia and dyspraxia. Despite the demonstrated links between schizophrenia and LD, specific clinical patterns of the schizophrenia with a history of LD subgroup remain unknown. The aim of the present study was to investigate cognitive impairment, symptoms and functional outcome associated with a history of LD in a large cross-sectional, multicentric, sample of schizophrenia subjects. 492 community-dwelling subjects with schizophrenia (75.6% male, mean age 30.8 years) were consecutively included in the network of the FondaMental Expert Centers for Schizophrenia in France and received a thorough clinical assessment. The 51 (10.4%) subjects identified with a history of LD had significantly impaired general cognitive ability (Wechsler Adult Intelligence Scale Full Scale Total IQ: Cohen's d = 0.50, p = 0.001), processing speed (d = 0.19), verbal comprehension (d = 0.29), working memory (d = 0.31), cognitive inhibition and flexibility (d = 0.26), central executive functioning (d = 0.26), phonemic verbal fluency (d = 0.22) and premorbid intellectual ability (d = 0.48), as well as with a worse functional outcome (Global Assessment of Functioning, d = 0.21), independently of age, sex, education level, symptoms, treatments, and addiction comorbidities. These results indicate that a history of LD is associated with later cognitive impairment and functional outcome in schizophrenia. This suggests that history of LD is a relevant clinical marker to discriminate subgroups of patients with schizophrenia with different profiles in a precision psychiatry framework. [ABSTRACT FROM AUTHOR]

Background: Childhood adversity and cannabis use are considered independent risk factors for psychosis, but whether different patterns of cannabis use may be acting as mediator between adversity and psychotic disorders has not yet been explored. The aim of this study is to examine whether cannabis use mediates the relationship between childhood adversity and psychosis. Methods: Data were utilised on 881 first-episode psychosis patients and 1231 controls from the European network of national schizophrenia networks studying Gene–Environment Interactions (EU-GEI) study. Detailed history of cannabis use was collected with the Cannabis Experience Questionnaire. The Childhood Experience of Care and Abuse Questionnaire was used to assess exposure to household discord, sexual, physical or emotional abuse and bullying in two periods: early (0–11 years), and late (12–17 years). A path decomposition method was used to analyse whether the association between childhood adversity and psychosis was mediated by (1) lifetime cannabis use, (2) cannabis potency and (3) frequency of use. Results: The association between household discord and psychosis was partially mediated by lifetime use of cannabis (indirect effect coef. 0.078, s.e. 0.022, 17%), its potency (indirect effect coef. 0.059, s.e. 0.018, 14%) and by frequency (indirect effect coef. 0.117, s.e. 0.038, 29%). Similar findings were obtained when analyses were restricted to early exposure to household discord. Conclusions: Harmful patterns of cannabis use mediated the association between specific childhood adversities, like household discord, with later psychosis. Children exposed to particularly challenging environments in their household could benefit from psychosocial interventions aimed at preventing cannabis misuse. [ABSTRACT FROM AUTHOR]

Purpose: In line with the psychotic continuum theory, the study of psychometric schizotypy in non-clinical samples has been proposed as a convenient yet powerful method for studying the etiology of psychosis. Based on this paradigm, several studies explored the association between season of birth (SoB) and schizotypy but led to inconsistent results. Building on the analysis of the previous studies, in the present study, we aimed to advance our understanding by improving the methodology (using a homogeneous group, eliminating unreliable respondents, taking into account potential confounders) and the reporting.Subjects were recruited among undergraduate students from 3 Romanian Universities. To limit the potential influence of invalid response, we applied methods for detecting unreliable and/or biased questionnaires and excluded subjects with unreliable/ biased answers from the analyses. Schizotypal dimensions were measured using the Romanian translation of the 22-items Schizotypal Personality Questionnaire-Brief (SPQ-B). The association between schizotypy scores and season of birth was explored using linear regression.In a sample of 484 undergraduate students from Romania, we found that being born in late winter/early spring (February and March) was associated to higher total schizotypy score and disorganization. Furthermore, we found that restricting the sample to subjects born in an urban environment increased the strength of the association.This study is consistent with an association between SoB and the risk of psychotic disorders.Methods: In line with the psychotic continuum theory, the study of psychometric schizotypy in non-clinical samples has been proposed as a convenient yet powerful method for studying the etiology of psychosis. Based on this paradigm, several studies explored the association between season of birth (SoB) and schizotypy but led to inconsistent results. Building on the analysis of the previous studies, in the present study, we aimed to advance our understanding by improving the methodology (using a homogeneous group, eliminating unreliable respondents, taking into account potential confounders) and the reporting.Subjects were recruited among undergraduate students from 3 Romanian Universities. To limit the potential influence of invalid response, we applied methods for detecting unreliable and/or biased questionnaires and excluded subjects with unreliable/ biased answers from the analyses. Schizotypal dimensions were measured using the Romanian translation of the 22-items Schizotypal Personality Questionnaire-Brief (SPQ-B). The association between schizotypy scores and season of birth was explored using linear regression.In a sample of 484 undergraduate students from Romania, we found that being born in late winter/early spring (February and March) was associated to higher total schizotypy score and disorganization. Furthermore, we found that restricting the sample to subjects born in an urban environment increased the strength of the association.This study is consistent with an association between SoB and the risk of psychotic disorders.Results: In line with the psychotic continuum theory, the study of psychometric schizotypy in non-clinical samples has been proposed as a convenient yet powerful method for studying the etiology of psychosis. Based on this paradigm, several studies explored the association between season of birth (SoB) and schizotypy but led to inconsistent results. Building on the analysis of the previous studies, in the present study, we aimed to advance our understanding by improving the methodology (using a homogeneous group, eliminating unreliable respondents, taking into account potential confounders) and the reporting.Subjects were recruited among undergraduate students from 3 Romanian Universities. To limit the potential influence of invalid response, we applied methods for detecting unreliable and/or biased questionnaires and excluded subjects with unreliable/ biased answers from the analyses. Schizotypal dimensions were measured using the Romanian translation of the 22-items Schizotypal Personality Questionnaire-Brief (SPQ-B). The association between schizotypy scores and season of birth was explored using linear regression.In a sample of 484 undergraduate students from Romania, we found that being born in late winter/early spring (February and March) was associated to higher total schizotypy score and disorganization. Furthermore, we found that restricting the sample to subjects born in an urban environment increased the strength of the association.This study is consistent with an association between SoB and the risk of psychotic disorders.Conclusion: In line with the psychotic continuum theory, the study of psychometric schizotypy in non-clinical samples has been proposed as a convenient yet powerful method for studying the etiology of psychosis. Based on this paradigm, several studies explored the association between season of birth (SoB) and schizotypy but led to inconsistent results. Building on the analysis of the previous studies, in the present study, we aimed to advance our understanding by improving the methodology (using a homogeneous group, eliminating unreliable respondents, taking into account potential confounders) and the reporting.Subjects were recruited among undergraduate students from 3 Romanian Universities. To limit the potential influence of invalid response, we applied methods for detecting unreliable and/or biased questionnaires and excluded subjects with unreliable/ biased answers from the analyses. Schizotypal dimensions were measured using the Romanian translation of the 22-items Schizotypal Personality Questionnaire-Brief (SPQ-B). The association between schizotypy scores and season of birth was explored using linear regression.In a sample of 484 undergraduate students from Romania, we found that being born in late winter/early spring (February and March) was associated to higher total schizotypy score and disorganization. Furthermore, we found that restricting the sample to subjects born in an urban environment increased the strength of the association.This study is consistent with an association between SoB and the risk of psychotic disorders. [ABSTRACT FROM AUTHOR]

We aimed to examine the association between religious beliefs and observance and the prevalence of psychiatric disorders, psychotic symptoms and history of suicide attempts in the French general population. The cross-sectional survey interviewed 38,694 subjects between 1999 and 2003, using the MINI. Current religious beliefs and observance were identified by means of two questions: "are you a believer?" and "are you religiously observant?". We studied the association between religiosity and psychiatric outcomes using a multivariable logistic regression model adjusted for sociodemographic characteristics, including migrant status. Religious beliefs were positively associated with psychotic symptoms and disorders [OR = 1.37, 95% CI (1.30–1.45) and OR = 1.38, 95% CI (1.20–1.58)], unipolar depressive disorder [OR = 1.15, 95% CI (1.06–1.23)] and generalized anxiety disorder [OR = 1.13, 95% CI (1.06–1.21)], but negatively associated with bipolar disorder [OR = 0.83, 95% CI (0.69–0.98)], alcohol use disorders [OR = 0.69, 95% CI (0.62–0.77)], substance use disorders [OR = 0.60, 95% CI (0.52–0.69)] and suicide attempts [OR = 0.90, 95% CI (0.82–0.99)]. Religious observance was positively associated with psychotic symptoms and disorders [OR = 1.38, 95% CI (1.20–1.58) and OR = 1.25, 95% CI (1.07–1.45)], but negatively associated with social anxiety disorder [OR = 0.87, 95% CI (0.76–0.99)], alcohol use disorders [OR = 0.60, 95% CI (0.51–0.70)], substance use disorders [OR = 0.48, 95% CI (0.38–0.60)] and suicide attempts [OR = 0.80, 95% CI (0.70–0.90)]. Among believers, religious observance was not associated with psychotic outcomes. Religiosity appears to be a complex and bidirectional determinant of psychiatric symptoms and disorders. In this respect, religiosity should be more thoroughly assessed in epidemiological psychiatric studies, as well as in clinical practice. [ABSTRACT FROM AUTHOR]

The functional outcome in schizophrenia spectrum disorders is affected by multiple factors such as cognitive performance and clinical symptoms. Psychiatric disability may be another important determinant of functional outcome. The purpose of this study was to test whether schizophrenia symptoms and psychiatric disability mediated the association between cognition and functioning. Between April 2013 and July 2017, we included 108 community-dwelling adults with stable schizophrenia spectrum disorder in a multicenter study. Psychiatric disability was assessed with the Evaluation of Cognitive Processes involved in Disability in Schizophrenia (ECPDS) scale by relatives of patients. ECPDS focused on the broad array of motivational, neurocognitive, sociocognitive, and metacognitive impairments that result in activity restrictions. We used a battery of tests to assess seven cognition domains (processing speed, attention/vigilance, working, verbal and visual memory, reasoning and problem solving, and executive functioning) and cross-sectional structural equation modeling (SEM) for the mediation analyses. We estimated the one-year temporal stability of ECPDS scores in 45 participants. The model provided showed good fit and explained 43.9% of the variance in functioning. The effect of neurocognition on functioning was fully mediated by symptoms (proportion mediated: 36.5%) and psychiatric disability (proportion mediated: 31.3%). The ECPDS score had acceptable one-year temporal stability. The ECPDS scale has satisfactory psychometric properties, and shows significant convergence with neurocognition and functioning, suggesting a role for this tool in the routine evaluation of cognitive remediation needs. Our model validates psychiatric disability as a crucial step from cognitive impairment to restricted participation in life situations. [ABSTRACT FROM AUTHOR]