Tensor factorization approach for ERP-based assessment of schizotypy in a novel auditory oddball task on perceived family stress.

Objective. Schizotypy, a potential phenotype for schizophrenia, is a personality trait that depicts psychosis-like signs in the normal range of psychosis continuum. Family communication may affect the social functioning of people with schizotypy. Greater family stress, such as irritability, criticism and less praise, is perceived at a higher level of schizotypy. This study aims to determine the differences between people with high and low levels of schizotypy using electroencephalography (EEG) during criticism, praise and neutral comments. EEGs were recorded from 29 participants in the general community who varied from low schizotypy to high schizotypy (HS) during a novel emotional auditory oddball task.Approach. We consider the difference in event-related potential parameters, namely the amplitude and latency of P300 subcomponents (P3a and P3b), between pairs of target words (standard, positive, negative and neutral). A model based on tensor factorization is then proposed to detect these components from the EEG using the CANDECOMP/PARAFAC decomposition technique. Finally, we employ the mutual information estimation method to select influential features for classification.Main results.The highest classification accuracy, sensitivity, and specificity of 93.1%, 94.73%, and 90% are obtained via leave-one-out cross validation.Significance. This is the first attempt to investigate the identification of individuals with psychometrically-defined HS from brain responses that are specifically associated with perceiving family stress and schizotypy. By measuring these brain responses to social stress, we achieve the goal of improving the accuracy in detection of early episodes of psychosis.

[Clinical and psychological assessment of the variability of schizotypal personality disorder in children and adolescents]. / Kliniko-psikhologicheskaya otsenka variativnosti shizotipicheskogo rasstroistva u detei i podrostkov.

OBJECTIVE: To analyze the variability of violations of cognitive and emotional-personal parameters in schizotypal disorder (STD) in children and adolescents according to the pathopsychological profile. MATERIAL AND METHODS: 47 patients with STD were examined, 21 of them with psychopathic variant (F21.4), 16 with neurotic (F21.3) and 10 with personality schizotypal disorder (F21.8) aged 9 to 16 years (37 boys and 10 girls). All patients were examined in detail by a psychiatrist and clinical psychologists. The method of integrative assessment of the pathopsychological profile was used, including the assessment of the presence and severity of impairments in cognitive functioning, emotional-personal and motivational-volitional spheres (the assessment was carried out according to detailed psychological reports). Mathematical processing of the obtained data was carried out. RESULTS: Cluster analysis of clinical and psychological indicators showed that patients differ in the level of intellectual impairment, as well as in the characteristics of motivational-volitional and personal spheres. Three clusters are described, two of which included patients (10 and 31 patients) with individual variants of STD with a greater severity of various cognitive deficits, and parameters of the emotional and personal sphere, the last cluster included 6 patients with personality variants of STD. A separate largest cluster included all three analyzed variants of STD in approximately equal proportions, with a mildly pronounced intellectual decline and more noticeable changes (deficiency) in the emotional and personal sphere. CONCLUSION: Thus, patients with STD differ in the severity and structure of deficient changes. At the same time, the nature and degree of involvement of a particular area in the overall picture of the pathopsychological profile is of great importance. Patients with STD differ in the severity and structure of deficient changes. The identified clusters differed in age, in the presence of patients of both sexes, and in various indicators of the pathopsychological profile. At the same time, the nature and degree of involvement of a particular area in the overall picture of the pathopsychological profile is important for diagnosis.

[Assessment of the initial period of schizotypal disorder in childhood]. / Otsenka nachal'nogo perioda shizotipicheskogo rasstroistva v detskom vozraste.

OBJECTIVE: To identify developmental features, the presence of hereditary burden, social adaptation, the structure of early psychopathological disorders in pediatric patients with schizotypal disorder (STD) and their relationship with the age of manifestation and the clinical structure of the disease. MATERIAL AND METHODS: The study included 150 patients aged 7 to 16 years with a diagnosis of SD, of which 48 were female and 102 were male. Based on the age of onset of the first stable psychopathological disorders, at the stage preceding the diagnosis of SD, 5 groups of patients were identified: up to 3 years (n=38), from 4 to 6 years (n=36), from 7 to 10 years (n=15), 11-13 (n=41), 14-16 years old (n=20). The study used clinical-psychopathological, clinical-catamnestic, with a retrospective analysis, neurological, pathopsychological, psychometric and statistical research methods. RESULTS: A high frequency of deviations from normative parameters in early psychomotor development was found in 99 (65%) patients with STD. Mental retardation was observed in 23 (15%) patients, dissociation in mental development was detected in a significant number of patients - 62 (41%). At the same time, the most significantly more frequent and pronounced were violations in the two youngest groups with the onset of psychopathological disorders up to 6 years. In these groups, there was also more often a deficit in three areas at once - emotional, motivational and volitional (38%) compared with the 4th group (13%). In groups 1 and 2, a deficit in intellectual development was also characteristic, which was reflected in academic indicators. High performance in the primary grades was observed in 16% of patients in the 1st group versus 60% in the 5th, and poor performance was found in 37% in the 1st group and only 5% in the 5th. The relationship of clinical variants of STD with the selected groups was revealed. The diagnosis of schizotypal personality disorder was significantly more often (66%) diagnosed in patients from group 1 compared with groups 3 and 5. In group 2, this diagnosis was established in a third of cases. The diagnosis of the psychopathic variant of STD was predominant in patients with the onset of the disorder between 7 and 13 years of age. The neurosis-like variant had a clear tendency to become more frequent with older age, reaching statistically significant differences in group 5 compared to group 1. CONCLUSION: The age of onset and duration of persistence of psychopathological disorders determines the level of negative changes that have formed at the stage of the disease preceding the onset of distinct clinical symptoms of STD. Age at onset determines the predominant positive disorder.

Sharing positive events: Ecological momentary assessment of emotion regulation via social capitalization in schizotypy.

Emotional deficits are prominent in schizophrenia-spectrum psychopathology and linked with poorer outcomes. Schizotypy, an underlying personality organization that putatively confers vulnerability to developing schizophrenia, has been associated with increased negative affect, decreased positive affect, and some difficulty with emotion regulation. This study explored the role of social capitalization, the upregulation of positive emotion when positive life events are shared with others, in schizotypy. Social capitalization is relevant for schizotypy given its association with social functioning and social motivation abnormalities. Using mobile assessment methods, a sample of college students (N=73) completed daily surveys via a mobile application two times per day for seven days and made daily ratings of mood and answered questions regarding any capitalization attempt for a positive event. Results indicated that higher schizotypy and not sharing an event were independently associated with lower happiness and increased sadness and anxiety. When an event was shared, lower schizotypy and supportive/enthusiastic response perception were independently associated with increased happiness. No significant interactions were observed between schizotypy and social capitalization variables. Future research would benefit from exploring the role that other common schizotypy concomitants, e.g., social anxiety or social disconnection, play in social capitalization and the extent this is helped or hindered via mass personal technological mediums.

Development of indicators for a nationwide cross-sectoral quality assurance procedure for mental health care of patients with schizophrenia, schizotypal and delusional disorders in Germany.

PURPOSE: This paper describes the development of quality indicators for an external statutory and cross-sectoral quality assurance (QA) procedure in the context of the German health care system for adult patients suffering from schizophrenia, schizotypal and delusional disorders (F20-F29). METHODS: Indicators were developed by a modified RAND/UCLA Appropriateness Method with 1) the compilation of an indicator register based on a systematic literature search and analyses of health care claims data, 2) the selection of indicators by an expert panel that rated them for relevance and for feasibility regarding implementation. Indicators rated positive for both relevance and feasibility formed the final indicator set. RESULTS: 847 indicators were identified by different searches. Out of these, 56 were selected for the indicator register. During the formal consensus process the expert panel recommended another 45 indicators so that a total of 101 indicators needed to be considered by the panel. Of these, 27 indicators rated both relevant and feasible were included in the final set of indicators: this set included 4 indicators addressing structures, 19 indicators addressing processes and 4 indicators addressing outcomes. 17 indicators of the set will be reported by hospitals and 8 by psychiatric outpatient facilities. Two indicators considered to be cross-sectoral will be reported by both sectors. DISCUSSION: F20-F29 and its treatment show some specific features which so far have not been addressed by any procedure within the statutory QA program of the German health care system. These features include: Schizophrenia and related disorders a) are potentially chronic conditions, b) are mainly treated in outpatient settings, c) require a multi-professional treatment approach and d) are treated regionally in catchment areas. These specific features in combination with the peculiarities of some legal, political and organizational characteristics of the German health care system and its statutory QA program have strongly influenced the development of indicators. The result was a seemingly "imbalanced" set of indicators with a greater number of indicators for inpatient than for outpatient care despite the fact that clinical reality is otherwise. CONCLUSIONS: The circumstances of the German health care system that restricted the development of this cross-sectoral QA procedure addressing care for F20-F29 are also most likely to emerge with the development of cross-sectoral QA procedures for other (potentially) chronic conditions that are mainly treated in the outpatient setting by multi-professional teams or by networks of different providers. In order to be able to develop a QA procedure that mirrors the reality of service provision for (potentially) chronic diseases such as F20-F29 we need to explore further current and new data sources, diminish sectoral borders, and implement health care responsibility on the level of catchment areas.

The Conceptualization and Assessment of Schizotypal Traits: A Comparison of the FFSI and PID-5.

The purpose of the present study was to compare the cognitive and perceptual aberration scales from the Five-Factor Schizotypal Inventory (FFSI; Edmundson, Lynam, Miller, Gore, & Widiger, 2011) and the Personality Inventory for DSM-5 (Krueger, Derringer, Markon, Watson, & Skodol,, 2012), as well as to address more generally the validity of the FFSI as a measure of both schizotypal personality traits and the FFM. Two independent samples were obtained, including 259 college students (55 of whom were preselected with elevated scores on a measure of schizotypal personality disorder [STPD]) and 346 adult MTurk participants (43% of whom had been or were currently in mental health treatment). Administered were the FFSI, the PID-5 Psychoticism scales, and alternative measures of general personality, openness, STPD, and schizotypal cognitive-perceptual aberrations. The results of the study are discussed with respect to the validity of the FFSI and PID-5 schizotypal cognitive and perception scales.

The Biological Rhythms Interview of Assessment in Neuropsychiatry in patients with bipolar disorder: correlation with affective temperaments and schizotypy

Objective: To assess the relationship of biological rhythms, evaluated by the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), with affective temperaments and schizotypy. Methods: The BRIAN assessment, along with the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A) and the Oxford-Liverpool Inventory for Feelings and Experiences (O-LIFE), was administered to 54 patients with remitted bipolar disorder (BD) and 54 healthy control (HC) subjects. Results: The TEMPS-A cyclothymic temperament correlated positively and the hyperthymic temperament correlated negatively with BRIAN scores in both the BD and HC groups, although the correlation was stronger in BD subjects. Depressive temperament was associated with BRIAN scores in BD but not in HC; conversely, the irritable temperament was associated with BRIAN scores in HC, but not in BD. Several positive correlations between BRIAN scores and the schizotypal dimensions of the O-LIFE were observed in both BD and HC subjects, especially with cognitive disorganization and less so with unusual experiences and impulsive nonconformity. A correlation with introversion/anhedonia was found only in BD subjects. Conclusion: Cyclothymic and depressive temperaments predispose to disturbances of biological rhythms in BD, while a hyperthymic temperament can be protective. Similar predispositions were also found for all schizotypal dimensions, mostly for cognitive disorganization.

The Biological Rhythms Interview of Assessment in Neuropsychiatry in patients with bipolar disorder: correlation with affective temperaments and schizotypy.

OBJECTIVE:: To assess the relationship of biological rhythms, evaluated by the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN), with affective temperaments and schizotypy. METHODS:: The BRIAN assessment, along with the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A) and the Oxford-Liverpool Inventory for Feelings and Experiences (O-LIFE), was administered to 54 patients with remitted bipolar disorder (BD) and 54 healthy control (HC) subjects. RESULTS:: The TEMPS-A cyclothymic temperament correlated positively and the hyperthymic temperament correlated negatively with BRIAN scores in both the BD and HC groups, although the correlation was stronger in BD subjects. Depressive temperament was associated with BRIAN scores in BD but not in HC; conversely, the irritable temperament was associated with BRIAN scores in HC, but not in BD. Several positive correlations between BRIAN scores and the schizotypal dimensions of the O-LIFE were observed in both BD and HC subjects, especially with cognitive disorganization and less so with unusual experiences and impulsive nonconformity. A correlation with introversion/anhedonia was found only in BD subjects. CONCLUSION:: Cyclothymic and depressive temperaments predispose to disturbances of biological rhythms in BD, while a hyperthymic temperament can be protective. Similar predispositions were also found for all schizotypal dimensions, mostly for cognitive disorganization.

The assessment of schizotypy by the O-LIFE (Oxford-Liverpool Inventory for Feelings and Experiences) in patients with schizophrenia and affective disorders. / Badanie schizotypii skala O-LIFE (Oxford-Liverpool Inventory for Feelings and Experiences) u chorych na schizofrenie i zaburzenia afektywne.

OBJECTIVES: The aim of the study was to assess schizotypy by using the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE), in the groups of patients with schizophrenia, bipolar disorder (BD) and unipolar (recurrent) depression (UD). An important element of the study was to compare - in terms of similarity - the results obtained in schizophrenia and BD, and - in terms of differences - the results obtained in BD and UD. METHODS: The study involved 58 patients with schizophrenia (35 men, 23 women, mean age = 34.0, SD = 9.8), 52 patients with BD (22 men, 30 women, mean age = 40.3, SD = 13.6) and 57 UD patients (24 men, 33 women, mean age = 50.2, SD = 11.9), treated in the Department of Adult Psychiatry, Poznan University of Medical Sciences. For the assessment of schizotypy, the full version of the O-LIFE questionnaire (104 questions) was used, including such dimensions as: unusual experiences, cognitive disorganization, introvertive anhedonia and impulsive nonconformity. RESULTS: The biggest differences between diagnostic groups were found in the dimensions of unusual experiences and impulsive nonconformity. Similarities between schizophrenia and BD were found for unusual experiences, cognitive disorganization and introvertive anhedonia. Differences between BD and UD were obtained for unusual experiences and impulsive nonconformity. CONCLUSIONS: The assessment of schizotypy in three diagnostic groups (it was the first study in patients with UD), allowed to address contemporary pathogenic and clinical concepts pertaining to similarities between schizophrenia and BD as well as to differences between two types of affective disorders.

Assessment of empathy via self-report and behavioural paradigms: data on convergent and discriminant validity.

INTRODUCTION: Research on empathy has a long tradition in clinical research, as deficits in empathy have been found in many mental disorders. Over decades, a large amount of measures for empathy have been developed, but in many cases these have not been analysed with respect to validity. Therefore, this paper aims to relate various assessment methods for empathy, schizotypy and autistic traits to gain knowledge on their convergent and discriminant validity. METHODS: A total of N = 108 participants were tested with two of the most widespread empathy questionnaires (Interpersonal Reactivity Index, Empathy Quotient), two behavioural paradigms (Reading the Mind in the Eyes Test, Cambridge Face-Voice Battery) and a rotation task. Furthermore, questionnaires assessing schizotypal and autistic traits were administered. RESULTS: Results indicate convergent validity of the applied empathy self-report measures, although their association with measures of schizotypal and autistic traits is inconsistent. However, results of the behavioural testing barely correlate either with the self-report measures or among each other. CONCLUSIONS: The questionnaire measures of empathy seem valid and exchangeable, and therefore suitable for capturing self-reported empathy in clinical research. The behavioural paradigms cover distinct endophenotypes of empathy and should only be used for very specific research questions.

A multidimensional assessment of social cognition in psychometrically defined schizotypy.

Individuals with schizophrenia exhibit impairments in multiple social cognitive domains. There is evidence that these impairments may be trait-related vulnerability markers for schizophrenia. However, the literature focusing on individuals vulnerable to developing schizophrenia-spectrum disorders, referred to as schizotypy, has produced inconsistent findings. This study's primary aim was to provide a more comprehensive understanding of social cognitive functioning within schizotypy than previous studies by employing a broad array of measures to assess multiple social cognitive domains, and examine how these domains relate to specific schizotypy traits (i.e., positive, negative, and disorganized) and Quality of Life (QOL). Facial emotion recognition, Theory of Mind (ToM), and aspects of emotional intelligence related to regulating one's own emotions (emotion management) and other's emotions (social management) were measured. Individuals with psychometrically defined schizotypy (n=36) and controls (n=26) were examined. The schizotypy group performed significantly worse than controls on facial emotion recognition, ToM, and emotion management, but not social management. Generally speaking, poorer social cognition performance was not a function of specific schizotypy traits. However, negative traits were associated with poorer facial emotion recognition, and disorganized traits were associated with better social management. Facial emotion recognition was associated with QOL in the schizotypy group.

Affective disturbances in psychometrically defined schizotypy across direct, but not indirect assessment modes.

Affective disturbances in social domains are characteristic features and potential vulnerability markers of schizophrenia-spectrum pathology. The present study employed a comprehensive and multidimensional approach to understanding affect in individuals with psychometrically defined schizotypy and the controls. Measures were employed assessing trait and state social affective experiences across direct--involving explicit deliberative responses, and indirect domains--involving implicit, behavioral or otherwise non-deliberative responses. The indirect assessments included a modified Implicit Association Test and computerized lexical analysis of natural speech procured during a laboratory speech task. Our affect measures were also unique in that they allowed for separate measurement of pleasant and unpleasant affect. On all direct trait and "in-the-moment" state measures of social affect, individuals with schizotypy reported dramatically decreased pleasant and increased unpleasant affect compared to controls. This was not the case for the indirect measures, which indicated no significant group differences. This pattern was generally consistent regardless of positive, negative and disorganized schizotypal trait severity. These data suggest that affective deficits in schizotypy reflect deliberative rather than implicit/automatic processes. Implications of these findings are discussed.

Psychometric properties of two measures for the assessment of Schizotypy in adolescents.

The purpose of this study was to examine the psychometric properties of the Thinking and Perceptual Style Questionnaire (TPSQ) and the Multidimensional Schizotypal Traits Questionnaire-Reduced (MSTQ-R) in non-clinical adolescents. The final sample consisted of 991 participants with a mean age of 14.7 years (S.D.=1.8). The internal consistency of the TPSQ subscales ranged from 0.77 to 0.89, and that of the MSTQ-R subscales ranged from 0.62 to 0.81. Construct validity analysis from the TPSQ subscales showed a three-dimensional solution based on the factors social disorganisation, aberrant processing and anhedonia. For its part, factor analysis of the MSTQ-R also showed a three-dimensional solution based on the factors: positive symptoms, negative symptoms and impulsive-nonconformity. The TPSQ and MSTQ-R appear to have good psychometric properties and to be useful instruments for the measurement of schizotypy in adolescence. Moreover, the factor structure of these measures resembles that seen in young adult samples and provides further empirical evidence of the multidimensional structure of the instruments that we use to measure the complex schizotypy construct. Future research should explore in more depth the psychometric properties of these self-report instruments and improve our understanding of schizotypy in adolescents.

[How to differentiate schizophrenia from bipolar disorder using cognitive assessment?]. / L'évaluation cognitive permet-elle de distinguer la schizophrénie du trouble bipolaire ?

BACKGROUND: Historical aspects of the dichotomy between manic-depressive disorders and schizophrenia raise the question of a continuum between the two entities. Griesinger (1817-1868) proposed a unitary concept of psychosis: "Einheitspsychose", adaptations of which have survived until the present day. Although Kraepelin's traditional dichotomy is still a common base for clinicians every day: diagnosis, prognosis and treatment of psychotic disorders, recent epidemiological and neurobiological data are congruent with a dimensional aspect of psychosis. Epidemiological data are consistent with the existence of an individual and a familial overlap between bipolar disorder and schizophrenia. Schizophrenia is probably the most debilitating psychological disorder. It was primarily considered as a behavioural disorder, characterized by socially inappropriate and bizarre behaviour, but much attention has been focussed nowadays on the cognitive component and the cognitive pathology underlying schizophrenia. On the other hand, bipolar, or manic depressive disorder has been primarily considered as a mood or affective disorder, characterized by excessive swings of emotion and motivation. Manic depression is more about recurrent dimensions. However, symptoms associated with the diagnosis of schizophrenia can be associated with psychotic mood disorders: hallucinations and delusions (50%), disorganised speech and behaviour (all patients with moderate to severe mania or mixed episode), negative symptoms (all patients with moderate to severe depression). The social and job dysfunction may be due to disturbances in the volitional system in patients with schizophrenia or severe bipolar disorder. LITERATURES FINDINGS: A considerable body of literature exists concerning the relationship between cognitive impairment in schizophrenia, but there is less data about cognition in bipolar disorder. However, there are some notable similarities between data observed in schizophrenia and bipolar disorder. Many domains of cognition are disrupted in schizophrenia with varying degrees of deficit. Concerning mood disorders, cognitive dysfunction could be considered as a state marker. Globally some studies indicate that, compared with schizophrenia, those with bipolar disorder display a similar but less severe neuropsychological pattern of impairment. However, it is only recently that cognitive dysfunction has been recognized as a primary and enduring core deficit in schizophrenia and further studies in bipolar disorder are needed. DISCUSSION: In this way, it has been suggested that psychotic symptoms may be distributed along a continuum that extends from schizophrenia to psychotic mood disorders with increasing level of severity. An explicative theory has to explain the evolution and the similarities between those affections including genetic and environmental liability. Some individuals, who are at high risk for psychosis, can even develop bipolar disorder or schizophrenia. Likewise, common factors can explain cognitive and social disorders in psychosis. So, there are various arguments for the dimensional approach of psychosis. These data are not completely in contradiction with Kraepelin: schizophrenia is a chronic affection and bipolar disorder is a cyclic pathology. However, common symptoms are not in favour of a strict categorization.

Socioeconomic background and the developmental course of schizotypal and borderline personality disorder symptoms.

Low socioeconomic status (SES) background has been identified as a risk for several mental disorders. However evidence regarding SES and the developmental course of personality disorder (PD) has not been addressed. Nor is it clear whether an SES relationship to PD symptom course may be attributable to known associated risks. Further, specificity of such relationships to a particular PD diagnostic pattern independent of comorbidity with other PD or with depression has not been investigated. Data are from a general population studied longitudinally between ages 10 and 36 in four assessment waves. Effects of SES-associated risks on the level of symptoms of schizotypal and borderline disorders are estimated and compared to effects on depressive symptoms. Low family SES had robust modest independent effects on both PDs over the entire age span despite substantial cumulative effects of trauma history, stressful recent life events, IQ, poor parenting, and comorbid symptoms. SES effects on depressive symptoms were generally absent, but a small "protective" effect of low SES appeared when comorbidity with PD symptoms was taken into account. Cumulatively, these risks account for developmental failures of substantial magnitude and consequence, marking the importance of understanding the remaining mechanisms of SES effects and programmatic implications for minimizing associated risk.

Reliability of measuring anomalous experience: the Bonn Scale for the Assessment of Basic Symptoms.

BACKGROUND: Studying subjective experience, apart from preformed self-rating questionnaires, has nearly vanished in psychiatry, partly due to reliability concerns. Recent research in early detection of schizophrenia has entailed an increasing interest in the subtle experiential anomalies that may assist in identifying the patients at risk of psychosis. Some of these anomalies are described in the Bonn Scale for the Assessment of Basic Symptoms (BSABS). We examined the reliability of this instrument. SAMPLING AND METHOD: 18 hospitalised patients accepted to participate in a psychopathological interview assessing BSABS items, affective and psychotic symptoms. RESULTS: Out of the total 79 BSABSitems examined,we found an interrater reliability kappa >0.60 in 68 items (86%). CONCLUSION: Good reliability can be achieved using BSABS.

Ecological assessment of executive dysfunction in the psychosis prodrome: a pilot study.

Individuals with psychosis have prominent executive functioning (EF) deficits on neuropsychological tests, but their relationship to EF deficits in daily life is unclear. This study evaluates behavioral manifestations of EF deficits, assessed by the Behavioral Rating Inventory of Executive Functioning (BRIEF), and their clinical correlates in individuals at ultra-high-risk for psychosis (UHR). UHR subjects showed significantly elevated BRIEF scores, particularly on the Working Memory scale. BRIEF scores were associated with positive symptoms and functioning, but not with neuropsychological performance. The BRIEF appears to capture unique aspects of executive dysfunction, possibly associated with illness progression and functioning in the psychosis prodrome.

Cluster A personality disorders: considering the 'odd-eccentric' in psychiatric nursing.

Psychiatric nurses are familiar with the concept of personality disorder because of their contact with persons with the most common personality disorder in clinical settings - borderline type, who frequently engage mental health services. Perhaps it is this familiarity that has focused research and clinical attention on borderline personality disorder compared with the other personality disorders. The significance of cluster A personality disorders for nursing is multifaceted because of their severity, prevalence, inaccurate diagnosis, poor response to treatment, and similarities to axis I diagnoses. Despite this, literature reviews have established that relatively few studies have focused on the treatment of the cluster A personality disorders - paranoid, schizotypal, and schizoid - resulting in a dearth of evidence-based interventions for this group of clients. A discussion of these disorders in the context of personality disorder and their individual characteristics demonstrates the distinctive and challenging engagement techniques required by psychiatric nurses to provide effective treatment and care. It is also strongly indicated that the discipline of psychiatric nursing has not yet begun to address the care of persons with cluster A personality disorders.

Validity of the EQ-5D in assessing and valuing health status in patients with schizophrenic, schizotypal or delusional disorders.

PURPOSE: The EQ-5D is a generic questionnaire generating a health profile and a single index score for health-related quality of life. This study aimed to analyse the discriminative ability and validity of the EQ-5D in patients with schizophrenic, schizotypal or delusional disorders. SUBJECTS AND METHODS: One hundred sixty-six patients with schizophrenic, schizotypal or delusional disorders (ICD-10 F2) completed the EQ-5D. Measures of quality of life (WHOQOL-BREF), utility (TTO), subjective (SCL-90R) and objective (PANSS, CGI-S) psychopathology, and functioning (GAF, GARF, SOFAS, HoNOS) provided comparison. Discriminative ability was analysed by assessing frequency distributions of EQ-5D scores. Validity of the EQ-5D self-classifier was analysed by assessing differences in related other scores grouped by response levels of EQ-5D items. Validity of the visual analogue scale (EQ VAS) and the EQ-5D index (UK social tariff) was analysed by assessing their correlation with all other scores. RESULTS: Seventy-nine percent of respondents reported problems in at least one of the EQ-5D dimensions (anxiety/depression 57%, usual activities 45%, pain/discomfort 44%, self-care 29%, mobility 22%). The mean EQ VAS score/EQ-5D index was 65.7/0.71. The four most frequently reported EQ-5D health states covered 45% of all respondents. For almost all EQ-5D dimensions, different response levels were associated with significantly different scores of measures used for comparison. Correlation of EQ VAS score and EQ-5D index were largest with scores of subjective measures (SCL-90R: -0.50 and -0.73; WHOQOL mental subscore 0.62 and 0.58; always P<0.001). DISCUSSION AND CONCLUSION: The EQ-5D showed a moderate ceiling effect and seems to be reasonably valid in this patient group.