OBJECTIVE: Impaired speech-gesture matching has repeatedly been shown in patients with schizophrenia spectrum disorders. Here, we tested the hypothesis that schizotypal traits in the general population are related to reduced speech-gesture matching performance and reduced self-reports about gesture perception. We further explored the relationships between facets of schizotypy and gesture processing in a network model.
METHODS: Participants (1094 mainly healthy adults) were presented with concrete or abstract sentences accompanied with videos showing related or unrelated gestures. For each video, participants evaluated the alignment between speech and gesture. They also completed self-rating scales about the perception and production of gestures (Brief Assessment of Gesture scale) and schizotypal traits (Schizotypal Personality Questionnaire-Brief 22-item version). We analyzed bivariate associations and estimated a non-regularized partial Spearman correlation network. We characterized the network by analyzing bridge centrality and controllability metrics of nodes.
RESULTS: We found a negative relationship between both concrete and abstract gesture-speech matching performance and overall schizotypy. In the network, disorganization had the highest average controllability and it was negatively related to abstract speech-gesture matching. Bridge centralities indicated that self-reported production of gestures to enhance communication in social interactions connects self-reported gesture perception, schizotypal traits, and gesture processing task performance.
CONCLUSIONS: The association between impaired abstract speech-gesture matching and disorganization supports a continuum between schizophrenia and schizotypy. Using gestures to facilitate communication connects subjective and objective aspects of gesture processing and schizotypal traits. Future interventional studies in patients should test the potential causal pathways implied by this network model.

BACKGROUND: Incidence of first-episode psychosis (FEP) varies substantially across geographic regions. Phenotypes of subclinical psychosis (SP), such as psychotic-like experiences (PLEs) and schizotypy, present several similarities with psychosis. We aimed to examine whether SP measures varied across different sites and whether this variation was comparable with FEP incidence within the same areas. We further examined contribution of environmental and genetic factors to SP.
METHODS: We used data from 1497 controls recruited in 16 different sites across 6 countries. Factor scores for several psychopathological dimensions of schizotypy and PLEs were obtained using multidimensional item response theory models. Variation of these scores was assessed using multi-level regression analysis to estimate individual and between-sites variance adjusting for age, sex, education, migrant, employment and relational status, childhood adversity, and cannabis use. In the final model we added local FEP incidence as a second-level variable. Association with genetic liability was examined separately.
RESULTS: Schizotypy showed a large between-sites variation with up to 15% of variance attributable to site-level characteristics. Adding local FEP incidence to the model considerably reduced the between-sites unexplained schizotypy variance. PLEs did not show as much variation. Overall, SP was associated with younger age, migrant, unmarried, unemployed and less educated individuals, cannabis use, and childhood adversity. Both phenotypes were associated with genetic liability to schizophrenia.
CONCLUSIONS: Schizotypy showed substantial between-sites variation, being more represented in areas where FEP incidence is higher. This supports the hypothesis that shared contextual factors shape the between-sites variation of psychosis across the spectrum.

BACKGROUND: Neuropsychiatric disorders are common in 22q11.2 Deletion Syndrome (22q11DS) with about 25% of affected individuals developing schizophrenia spectrum disorders by young adulthood. Longitudinal evaluation of psychosis spectrum features and neurocognition can establish developmental trajectories and impact on functional outcome.
METHODS: 157 youth with 22q11DS were assessed longitudinally for psychopathology focusing on psychosis spectrum symptoms, neurocognitive performance and global functioning. We contrasted the pattern of positive and negative psychosis spectrum symptoms and neurocognitive performance differentiating those with more prominent Psychosis Spectrum symptoms (PS+) to those without prominent psychosis symptoms (PS-).
RESULTS: We identified differences in the trajectories of psychosis symptoms and neurocognitive performance between the groups. The PS+ group showed age associated increase in symptom severity, especially negative symptoms and general nonspecific symptoms. Correspondingly, their level of functioning was worse and deteriorated more steeply than the PS- group. Neurocognitive performance was generally comparable in PS+ and PS- groups and demonstrated a similar age-related trajectory. However, worsening executive functioning distinguished the PS+ group from PS- counterparts. Notably, of the three executive function measures examined, only working memory showed a significant difference between the groups in rate of change. Finally, structural equation modeling showed that neurocognitive decline drove the clinical change.
CONCLUSIONS: Youth with 22q11DS and more prominent psychosis features show worsening of symptoms and functional decline driven by neurocognitive decline, most related to executive functions and specifically working memory. The results underscore the importance of working memory in the developmental progression of psychosis.

In both classification systems, DSM-5 and ICD-11, the diagnostic criteria of schizophreniaspectrum disorders in minors are identical to those of adults. Nevertheless, recent studies have emphasized important differences in phenomenology and clinical impact of positive psychotic symptoms between children, adolescents and young adults. Among positive psychotic symptoms, hallucinations have a high prevalence in childhood, where they are often described as vivid, multisensory experiences, that mostly remit spontaneously. In children, these symptoms are not necessarily associated with the emergence of schizophrenia-spectrum disorders. However, they can indicate comorbid psychiatric disorders and cause significant stress or, in other cases, be transient symptoms without any significant pathological value. The article provides a review on recent epidemiological and phenomenological findings on positive psychotic symptoms in children and adolescents and proposes diagnostic and therapeutic strategies on the management of these symptoms in minors.
Zusammenfassung Basierend auf der Annahme eines universellen neurobiologischen Entwicklungsmodells folgt die Diagnose von Schizophrenie-Spektrum Störungen im Kindes- und Jugendalter, sowohl im DSM-5 als auch im ICD-11, derjenigen bei Erwachsenen. Dennoch haben neuere Studien auf einige wichtige Unterschiede in der Phänomenologie und klinischen Wertigkeit von Positivsymptomen zwischen Kindern, Jugendlichen und jungen Erwachsenen hingewiesen. Unter den Positivsymptomen zeigen vor allem Halluzinationen eine relativ hohe Prävalenz in der Kindheit. Sie werden als lebendige, multisensorielle Erfahrung berichtet, die meist spontan remittiert. Diese Halluzinationen stehen nicht immer mit Schizophrenie-Spektrum Störung in Verbindung, sondern können eine Reihe anderer psychiatrischer Ursachen haben oder völlig ohne Krankheitswert sein. In diesem Artikel geben wir einen Überblick über neuere epidemiologische und phänomenologische Erkenntnisse zu Positivsymptomen in der Kindheit und Jugend um den klinisch tätigen Kinderpsychiater/innen, Kinderpsycholog/ innen und -psychotherapeut/innen in der Gewichtung dieser komplexen Symptome Orientierung zu bieten und stellen moderne therapeutische Strategien vor.

Negative symptoms in the psychosis continuum are linked to impairments in reward processing and cognitive function. Processes at the interface of reward processing and cognition and their relation to negative symptoms remain little studied, despite evidence suggestive of integration in mechanisms and neural circuitry. Here, we investigated brain activation during reward-dependent modulation of working memory (WM) and their relationship to negative symptoms in subclinical and early stages of the psychosis continuum. We included 27 persons with high schizotypal personality traits and 23 patients with first episode psychosis as well as 27 healthy controls. Participants underwent functional magnetic resonance imaging while performing an established 2-back WM task with two reward levels (5 CHF vs. no reward), which allowed us to assess common reward-cognition regions through whole-brain conjunction analyses and to investigate relations with clinical scores of negative symptoms. As expected for behavior, reward facilitated performance while cognitive load diminished it. At the neural level, the conjunction of high reward and high cognitive load contrasts across the psychosis continuum showed increased hemodynamic activity in the thalamus and the cerebellar vermis. During high cognitive load, more severe apathy but not diminished expression in the psychosis continuum was associated with reduced activity in right lateral orbitofrontal cortex, midbrain, posterior vermal cerebellum, caudate and lateral parietal cortex. Our results suggest that hypoactivity in the cerebellar vermis and the cortical-striatal-midbrain-circuitry in the psychosis continuum relates to apathy possibly via impaired flexible cognitive resource allocation for effective goal pursuit.

This commentary suggests that neuroscience research on young healthy heavy cannabis users and patients with cannabis-induced psychosis using multimodal assessment of sensorimotor dysfunction (e.g. neuroimaging, clinical rating scales, and instrumental assessments) may help to identify both biological resistance and vulnerability without constraints and confounder factors imposed by antipsychotic treatment or disease chronicity.

Clinical interviews and laboratory-based emotional induction paradigms provide consistent evidence that facial affect is blunted in many individuals with schizophrenia. Although it is clear that blunted facial affect is not a by-product of diminished emotional experience in schizophrenia, factors contributing to blunted affect remain unclear. The current study used a combination of ambulatory video recordings that were evaluated via computerized facial affect analysis and concurrently completed ecological momentary assessment surveys to assess whether blunted affect reflects insufficient reactivity to affective or contextual factors. Specifically, whether individuals with schizophrenia require more intense affective experiences to produce expression, or whether they are less reactive to social factors (i.e. being in the presence of others, social motivation). Participants included outpatients with schizophrenia (n = 33) and healthy controls (n = 31) who completed six days of study procedures. Multilevel linear models were evaluated using both Null-Hypothesis Statistical Testing and Bayesian analyses. Individuals with schizophrenia displayed comparable expression of positive and negative emotion to controls during daily life, and no evidence was found for a different intensity of experience required for expression in either group. However, social factors differentially influenced facial expression in schizophrenia compared to controls, such that individuals with schizophrenia did not modulate their expressions based on social motivation to the same extent as controls. These findings suggest that social motivation may play an important role in determining when blunting occurs.

Evidence supports the use of brief psychosis-spectrum screening measures to identify individuals at elevated risk for psychosis, however, there is limited research on psychosis-spectrum screening among adolescents hospitalized for acute mental health concerns. Given the psychiatric vulnerability of this population, screening efforts within inpatient settings may help identify adolescents at greatest risk for ongoing mental health concerns including psychosis. This study investigates the use of two brief screening tools to identify psychosis-spectrum symptoms in psychiatrically hospitalized adolescents. Upon intake, adolescents completed two screening measures, the PRIME Screen-Revised and the Youth Self-Report Thought Problems scale, followed by a brief interview to evaluate psychosis-spectrum diagnoses. Associations between screening scores and diagnostic status were explored to evaluate the use of these tools to identify psychosis-spectrum conditions in this population. The sample included 57 adolescents, 28 of whom met psychosis-spectrum criteria. Psychosis-spectrum status was strongly correlated with PRIME scores (r = 0.59) and Thought Problems T scores (r = 0.55). Logistic regression analyses indicated that both screening measures demonstrate promising accuracy (74-81%) for identifying adolescents meeting psychosis-spectrum criteria. The PRIME and Thought Problems scale may be appropriate screening tools for use in adolescent inpatient settings to identify those experiencing clinically significant psychosis-spectrum symptoms.

BACKGROUND: Affective lability is elevated and associated with increased clinical burden in psychosis spectrum disorders. The extent to which the level, structure and dispersion of affective lability varies between the specific disorders included in the psychosis spectrum is however unclear. To have potential value as a treatment target, further characterization of affective lability in these populations is necessary. The main aim of our study was to investigate differences in the architecture of affective lability in different psychosis spectrum disorders, and if putative differences remained when we controlled for current symptom status.
METHODS: Affective lability was measured with The Affective Lability Scale Short Form (ALS-SF) in participants with schizophrenia (SZ, n = 76), bipolar I disorder (BD-I, n = 105), bipolar II disorder (BD-II, n = 68) and a mixed psychosis-affective group (MP, n = 48). Multiple analyses of covariance were conducted to compare the ALS-SF total and subdimension scores of the diagnostic groups, correcting for current psychotic, affective and anxiety symptoms, substance use and sex. Double generalized linear models were performed to compare the dispersion of affective lability in the different groups.
RESULTS: Overall group differences in affective lability remained significant after adjusting for covariates (p = .001). BD-II had higher affective lability compared to SZ and BD-I (p = .004), with no significant differences between SZ and BD-I. There were no significant differences in the contributions of ALS-SF dimensions to the total affective lability or in dispersion of affective lability between the groups.
CONCLUSIONS: This study provides the construct of affective lability in psychosis spectrum disorders with more granular details that may have implications for research and clinical care. It demonstrates that despite overlap in core symptom profiles, BD-I is more similar to SZ than it is to BD-II concerning affective lability and the BD groups should consequently be studied apart. Further, affective lability appears to be characterized by fluctuations between depressive- and other affective states across different psychosis spectrum disorders, indicating that affective lability may be related to internalizing problems in these disorders. Finally, although the level varies between groups, affective lability is evenly spread and not driven by extremes across psychosis spectrum disorders and should be assessed irrespective of diagnosis.

Psychosis is characterized by both alterations in emotional functioning and environmental stressors including bullying victimization. Recent evidence suggests that some alterations in emotional functioning (e.g., blunted positive facial expressions) are already present in the psychosis risk period. Yet, some clinically relevant facial emotions have not been investigated such as genuine smiles (thought to reflect genuine positive emotions) and non-genuine smiles (thought to fake positive or mask negative emotions) in individuals meeting criteria for a clinical high-risk (CHR) syndrome. Further, despite a compelling conceptual basis to suggest a link between affective expression and exposure to environmental stress, to date, no investigations have sought to examine this association. Here, we aim to assess differences between a sample of CHR (N = 65) and control (N = 67) individuals in genuine and non-genuine smiles and associations with bullying victimization.
Smiles (i.e., genuine; non-genuine) were objectively coded on a second-by-second basis using the Facial Action Coding System during a digitally recorded clinical interview segment. Bullying victimization was measured via parent report.
Findings revealed that the CHR group (1) showed blunted genuine (but not non-genuine) smiles compared to controls. Moreover, (2) bullying victimization was related to blunted genuine smiles, but not non-genuine smiles.
These findings expand our understanding of emotional alterations in this group with implications for diagnosis (highlighting blunted genuine smiles as a specific marker) and etiology (underscoring the role of bullying victimization in the etiology of emotional dysfunction).