Self-Monitoring for speech and its links to age, cognitive effort, schizotypal trait expression and impulsivity during adolescence.

Introduction: Disruptions in self-monitoring processes represent key cognitive factors associated with schizophrenia spectrum disorders. In the current study, we assessed the effects of age and cognitive effort on self-monitoring for speech in adolescence, as well as its associations with personality dimensions pertaining to schizotypy and impulsivity.Methods: 121 community adolescents undertook a self-monitoring task that assesses the capacity to discriminate between self-generated overt and silent speech, for items requiring different levels of cognitive effort. Self-report measures were used to assess trait dimensions of schizotypy and impulsivity.Results: Cognitive effort, but not age, contributed to the overall rate of self-monitoring errors. Contrary to clinical psychosis and high risk samples, increased cognitive effort in healthy adolescents led to more internalising than externalising self-monitoring errors. Higher scores on the interpersonal dimension of schizotypy were associated with increases in the total rate of self-monitoring errors. No associations were found between positive schizotypy and externalising self-monitoring misattributions. Finally, trait impulsivity dimensions were not associated with self-monitoring performance.Conclusions: The present findings suggest that self-monitoring confusions may be linked to trait-risk for psychosis in adolescence. Future studies can prospectively assess whether the association between negative schizotypal traits and self-monitoring represents a distal marker of psychosis vulnerability.

Longitudinal Relationships Between Reflective Functioning, Empathy, and Externalizing Behaviors During Adolescence and Young Adulthood.

Reflective functioning (RF) refers to the understanding of one's own and others' behaviors in terms of mental states, whereas empathy entails the abilities to understand (cognitive empathy) and to share (affective empathy) the emotions of others. Low RF and low empathy have been previously related to externalizing behaviors, such as aggression and rule breaking. However, few longitudinal studies have simultaneously examined the relationships between these variables during adolescence. The aim of the present study is to investigate the longitudinal effects of both RF and empathy on potential changes in externalizing behaviors over time, in a group of 103 adolescents and young adults from the general population assessed repeatedly up to four times. We conducted multilevel analysis in order to examine the effects of RF and empathy on the initial levels and the trajectories of externalizing behaviors over time, while accounting for other variables previously associated with externalizing behaviors, such as age, gender, internalizing problems, and cognitive abilities. The results suggest that the ability to reflect on behaviors in terms of mental states predicted a sharper decrease in externalizing behaviors over time. Moreover, externalizing behaviors at the first assessment were associated with RF impairments and low affective empathy. Age, gender, cognitive abilities, and cognitive empathy were not associated with externalizing behaviors. We discuss how our results, based on a typically developing population, might inform primary or indicated prevention strategies for externalizing behaviors by focusing on socio-cognitive processes such as RF and affective empathy.

Pathways to care in youth and young adults at clinical high risk for psychosis in Switzerland: Current situation and clinical implementation of the PsyYoung project.

AIM: We aim to give an insight into the current situation in Switzerland concerning the pathways to care of young people with clinical high risk of psychosis. In a second step we propose a procedure of optimizing pathways to care developed within the project PsyYoung. METHODS: A qualitative survey derived and adapted from Kotlicka-Antczak et al. (2020) was conducted in large early detection services of three Swiss cantons (Geneva, Basel-Stadt, Vaud) focusing on pathways to care. More specifically, using questionnaires delivered to the heads of participating services, information was collected on referral sources, on activities to implement outreach campaigns and on the use of a pre-screening tool. RESULTS: Main results on referral source indicated that sources were variable but seemed to come primarily from the medical sector and more so from the psychiatric sector. Very few referrals came from non-medical sectors. Outreach activities included the contact to other clinics as well as through brochures and posters. All services but one used the Prodromal Questionnaire - 16 as pre-screening tool. CONCLUSIONS: All in all, the results indicate a referral and care pathway system implemented mostly within the medical and particularly mental health sector. Accordingly, the PsyYoung project proposes a procedure for pathways to care which could help overcome the obstacle of referrals being restrained to a narrow field of mental health and to harmonize the referral process within services dedicated to the same aim of helping young people at high risk of developing a psychosis.

The role of mentalizing in the relationship between schizotypal personality traits and state signs of psychosis risk captured by cognitive and perceptive basic symptoms.

Objective: Schizotypal traits and disturbances in mentalizing (the capacity to understand the mental states driving one's own and others' behaviors) have been implicated in increased vulnerability for psychosis. Therefore, we explored the associations linking schizotypal traits, mentalizing difficulties and their interactions to clinical high-risk for psychosis (CHR-P), as captured by the Basic Symptoms (BS) approach, during adolescence and young adulthood. Methods: Eighty-seven adolescents and young adults from the general population (46% male, 44% female; age: 14-23 years) were assessed with the Schizophrenia Proneness Interview (SPI-CY/A) for 11 perceptive and cognitive BS, with the Schizotypal Personality Questionnaire (SPQ) for schizotypal traits, and with the Reflective Functioning Questionnaire (RFQ) for self-reported mentalizing abilities. The RFQ evaluates the level of certainty (RFQc scale) and uncertainty (RFQu scale) with which individuals use mental state information to explain their own and others' behaviors. Results: Logistic regression models showed significant positive effects of the SPQ disorganization scale on perceptive BS and of the SPQ interpersonal scale on cognitive BS. Post-hoc analyses revealed that schizotypal features pertaining to odd speech and social anxiety, respectively, were associated with perceptive and cognitive BS. Furthermore, higher scores on the RFQu scale and lower scores on the RFQc scale independently explained the presence of cognitive BS. Finally, significant interaction effects between RFQc and SPQ odd speech on perceptive BS, and between RFQc and SPQ social anxiety on cognitive BS were found. Conclusion: Our findings suggest that schizotypal traits and mentalizing significantly relate both independently and through their interactions to the presence of cognitive and perceptive BS included in CHR-P criteria. Furthermore, mentalizing dysfunction may contribute in the relation between schizotypal traits and early state signs of CHR-P. Mentalizing may support both detection and early treatment of CHR-P among adolescents and young adults who present with trait risk for psychosis.

Improving Pathways to Care for Patients at High Psychosis Risk in Switzerland: PsyYoung Study Protocol.

AIMS: Psychotic disorders are one of the main causes of chronic disability in young people. An at-risk mental state (ARMS) is represented by subclinical symptoms that precede the first episode of psychosis (FEP). The PsyYoung project aims to optimize the detection of an ARMS while reducing unnecessary psychiatric treatments. It investigates the effects of service changes on the referrals and outcomes of young people with ARMS or a FEP. METHODS: Six psychiatric outpatient clinics in three cantons (Basel-Stadt, Vaud, and Geneva) participated in the project. They passed through an implementation phase including service changes and the adaptation of a standardized stepped care model for diagnosis and assessment, in addition to measures for increasing the awareness, networking and training of local professionals. PRELIMINARY RESULTS: All participating cantons had entered the implementation phase. By March 2023, there were 619 referrals to participating sites. A total of 163 patients (37% FEP and 31% ARMS) and 15 close relatives had participated in individual longitudinal assessments, and 26 patients participated in qualitative interviews. CONCLUSION: This national collaborative project addresses the issue of early intervention for emerging psychoses, and creates spaces for fruitful reflections and collaboration in Switzerland. The ultimate aim of PsyYoung is to harmonize clinical practices in early intervention of psychosis on a national level.

Associations between schizotypal personality features, mentalizing difficulties and thought problems in a sample of community adolescents.

AIM: Schizotypal trait expression and mentalizing impairments represent key factors associated with increased vulnerability for schizophrenia. In the current study, we analysed the nature of associations linking specific schizotypal personality features to mentalizing difficulties during adolescence. Furthermore, we examined the extent to which mentalizing difficulties mediate the relationship between schizotypal trait features and self-reported thought problems. METHODS: One hundred and five community adolescents (Mage = 15.72; SD = 1.91) completed a recently developed self-report measure of mentalizing (Reflective Functioning Questionnaire [RFQ]), evaluating the degree of certainty (RFQc-scale) and uncertainty (RFQu-scale) with which individuals utilize mental state information to understand their own and others' behaviour. High scores on the RFQu-scale reflect poor usage of mental state information, while high scores on the RFQc-scale capture adaptive levels of certainty about mental states. Self-report questionnaires were also used to assess schizotypal trait expression, thought problems and symptoms of anxiety/depression. RESULTS: Linear regression models indicated that schizotypal features of social anxiety and odd speech accounted for increased RFQu scores, while odd speech also accounted for reduced RFQc scores. RFQu partially mediated the effects of social anxiety and odd speech on the level of thought problems in the sample. CONCLUSIONS: Present findings suggest that schizotypal features that impede interpersonal communication during adolescence are linked to difficulties in mental state understanding. Our study also provides original data suggesting that the effects of social anxiety and odd speech on psychosis-risk may partially depend upon the level of mentalizing uncertainty. Mentalizing difficulties may constitute important clinical assessment and early prevention treatment targets in adolescents who demonstrate schizotypal features.