Inflammatory subgroups of schizophrenia and their association with brain structure: A semi-supervised machine learning examination of heterogeneity.

OBJECTIVE: Immune system dysfunction is hypothesised to contribute to structural brain changes through aberrant synaptic pruning in schizophrenia. However, evidence is mixed and there is a lack of evidence of inflammation and its effect on grey matter volume (GMV) in patients. We hypothesised that inflammatory subgroups can be identified and that the subgroups will show distinct neuroanatomical and neurocognitive profiles. METHODS: The total sample consisted of 1067 participants (chronic patients with schizophrenia n = 467 and healthy controls (HCs) n = 600) from the Australia Schizophrenia Research Bank (ASRB) dataset, together with 218 recent-onset patients with schizophrenia from the external Benefit of Minocycline on Negative Symptoms of Psychosis: Extent and Mechanism (BeneMin) dataset. HYDRA (HeterogeneitY through DiscRiminant Analysis) was used to separate schizophrenia from HC and define disease-related subgroups based on inflammatory markers. Voxel-based morphometry and inferential statistics were used to explore GMV alterations and neurocognitive deficits in these subgroups. RESULTS: An optimal clustering solution revealed five main schizophrenia groups separable from HC: Low Inflammation, Elevated CRP, Elevated IL-6/IL-8, Elevated IFN-γ, and Elevated IL-10 with an adjusted Rand index of 0.573. When compared with the healthy controls, the IL-6/IL-8 cluster showed the most widespread, including the anterior cingulate, GMV reduction. The IFN-γ inflammation cluster showed the least GMV reduction and impairment of cognitive performance. The CRP and the Low Inflammation clusters dominated in the younger external dataset. CONCLUSIONS: Inflammation in schizophrenia may not be merely a case of low vs high, but rather there are pluripotent, heterogeneous mechanisms at play which could be reliably identified based on accessible, peripheral measures. This could inform the successful development of targeted interventions.

Co-occurrence of autistic and psychotic traits: implications for depression, self-harm and suicidality.

BACKGROUND: There is increasing interest in the clinical and aetiological overlap between autism spectrum disorders and schizophrenia spectrum disorders, reported to co-occur at both diagnostic and trait levels. Individually, sub-clinical autistic and psychotic traits are associated with poor clinical outcomes, including increased depressive symptomatology, self-harming behaviour and suicidality. However, the implications when both traits co-occur remain poorly understood. The study aimed to (1) examine the relationship between autistic and psychotic traits and (2) determine if their co-occurrence increases depressive symptomatology, self-harm and suicidality. METHODS: Cross-sectional data from a self-selecting (online and poster advertising) sample of the adult UK population (n = 653) were collected using an online survey. Validated self-report measures were used to assess sub-clinical autistic and psychotic traits, depressive symptomatology, self-harming behaviour and suicidality. Correlation and regression analyses were performed. RESULTS: A positive correlation between sub-clinical autistic and positive psychotic traits was confirmed (rs = 0.509, p < 0.001). Overall, autistic traits and psychotic traits were, independently, significant predictors of depression, self-harm and suicidality. Intriguingly, however, depression was associated with a negative interaction between the autistic domain attention to detail and psychotic traits. CONCLUSIONS: This study supports previous findings that sub-clinical autistic and psychotic traits are largely independently associated with depression, self-harm and suicidality, and is novel in finding that their combined presence has no additional effect on depression, self-harm or suicidality. These findings highlight the importance of considering both autistic and psychotic traits and their symptom domains in research and when developing population-based depression prevention and intervention strategies.

The impact of psychotic experiences in the early stages of mental health problems in young people.

BACKGROUND: Anxiety and depressive symptoms and psychotic experiences constitute common features of emerging mental disorders in young people. Psychotic experiences and the ultra-high risk (UHR) state for psychosis appear to have a particular importance for clinical presentation, progression of symptomatology, quality of life and functioning, but the impact of psychotic experiences in individuals seeking help at non-UHR services, compared to UHR services, is under-researched. METHODS: Sixty-nine young people (Mage ± SD at baseline = 20.8 ± 2.6, range 16-26 years, 48 females) presenting to mental health services were grouped according to UHR and non-UHR status. They were assessed at baseline for anxiety and depressive symptoms, psychological distress, psychosocial functioning and quality of life. They were followed up at three, six, and 12 months. Data were analysed using mixed linear modelling. RESULTS: UHR individuals reported higher levels of depressive symptoms and psychological distress, and lower levels of role functioning and quality of life compared to non-UHR individuals. No differences were reported for anxiety symptoms or social functioning. Decline in psychosocial functioning was not associated with clinical deterioration or reduction of quality of life. CONCLUSIONS: Psychotic experiences appear to be particularly associated with depressive symptoms and psychological distress, impaired role functioning and quality of life in help-seeking young people in the medium-term. It is therefore important to pay special attention to psychotic experiences in the early stages of mental health problems even if psychotic symptoms are not the main motivation for help-seeking.

Clinical staging in severe mental disorder: evidence from neurocognition and neuroimaging.

A new approach to understanding severe mental illnesses such as schizophrenia and affective disorders is to adopt a clinical staging model. Such a model defines the extent of the illness such that earlier and milder phenomena are distinguished from later, more impairing features. Part of the appeal of such a model is that it should have cross-diagnostic applications, but to date there has been no attempt to examine imaging or neurocognitive evidence for staging in this way. We review these two domains of study with particular focus on major depression and bipolar affective disorder. Although there is some support for the staging model in affective disorders, conclusions are limited by the large variability in the clinical samples studied, especially with regard to the presence of psychotic symptoms. We suggest that future research needs to take a transdiagnostic and longitudinal approach.

Transdiagnostic structural neuroimaging features in depression and psychosis: A systematic review.

BACKGROUND: Previous research suggests that there may be similarities in structural brain changes seen in patients with depression and psychosis compared to healthy controls. However, there is yet no systematic review collating studies comparing structural brain changes in depression and psychosis. Establishing shared and specific neuroanatomical features could aid the investigation of underlying biological processes. AIMS: To identify structural neuroimaging similarities and differences between patients with depression and psychosis. METHOD: We searched PubMed, PsychInfo, Embase, NICE Evidence, Medline and the Cochrane Library were searched from inception to 30/06/2021 using relevant subject headings (controlled vocabularies) and search syntax. Papers were assessed for quality using the Newcastle-Ottawa Scale. RESULTS: Five-hundred and twenty papers were retrieved, seven met inclusion criteria. In narrative collation of results, grey matter volume (GMV) reductions were found in the medial frontal gyrus (MFG), hippocampus and left-sided posterior subgenual prefrontal cortex in both psychosis and depression. GMV reductions affected more brain regions in psychosis, including in the insula and thalamus. White matter volume (WMV) decline was found in both depression and psychosis. Reduced fractional anisotropy (FA) was more commonly seen in depression. CONCLUSIONS: Our results suggest potential transdiagnostic patterns of GMV and WMV reductions in areas including the MFG, hippocampus, and left-sided posterior subgenual prefrontal cortex. These could be investigated as a future biomarker of transdiagnostic signature across mental illnesses. However, due to the limited number and poor quality of studies future research in large samples and harmonised imaging data is first needed.

Prevalence and assessment of self-disorders in the schizophrenia spectrum: a systematic review and meta-analysis.

Self-disorders have been proposed as the "clinical core" of the schizophrenia spectrum. This has been explored in recent studies using self-disorder assessment tools. However, there are few systematic discussions of their quality and utility. Therefore, a literature search was performed on Medline, Embase, PsychINFO, PubMed and the Web of Science. Studies using these assessment tools to explore self-disorders within schizophrenia spectrum disorders (SSDs) were included. A meta-analysis was performed on the outcomes of total self-disorder score and odds ratios of self-disorders, using Comprehensive Meta-Analysis software. Weighted pooled effect sizes in Hedge's g were calculated using a random-effects model. 15 studies were included, giving a sample of 810 participants on the schizophrenia spectrum. Self-disorders showed a greater aggregation within schizophrenia spectrum groups compared to non-schizophrenia spectrum groups, as measured with the Bonn Scale for the Assessment of Basic Symptoms (Hedge's g = 0.774, p < 0.01) and Examination of Anomalous Self-Experiences (Hedge's g = 1.604, p < 0.01). Also, self-disorders had a greater likelihood of occurring within SSDs (odds ratio = 5.435, p < 0.01). These findings help to validate self-disorders as a core clinical feature of the broad schizophrenia spectrum.

Neurobiologically Based Stratification of Recent-Onset Depression and Psychosis: Identification of Two Distinct Transdiagnostic Phenotypes.

BACKGROUND: Identifying neurobiologically based transdiagnostic categories of depression and psychosis may elucidate heterogeneity and provide better candidates for predictive modeling. We aimed to identify clusters across patients with recent-onset depression (ROD) and recent-onset psychosis (ROP) based on structural neuroimaging data. We hypothesized that these transdiagnostic clusters would identify patients with poor outcome and allow more accurate prediction of symptomatic remission than traditional diagnostic structures. METHODS: HYDRA (Heterogeneity through Discriminant Analysis) was trained on whole-brain volumetric measures from 577 participants from the discovery sample of the multisite PRONIA study to identify neurobiologically driven clusters, which were then externally validated in the PRONIA replication sample (n = 404) and three datasets of chronic samples (Centre for Biomedical Research Excellence, n = 146; Mind Clinical Imaging Consortium, n = 202; Munich, n = 470). RESULTS: The optimal clustering solution was two transdiagnostic clusters (cluster 1: n = 153, 67 ROP, 86 ROD; cluster 2: n = 149, 88 ROP, 61 ROD; adjusted Rand index = 0.618). The two clusters contained both patients with ROP and patients with ROD. One cluster had widespread gray matter volume deficits and more positive, negative, and functional deficits (impaired cluster), and one cluster revealed a more preserved neuroanatomical signature and more core depressive symptomatology (preserved cluster). The clustering solution was internally and externally validated and assessed for clinical utility in predicting 9-month symptomatic remission, outperforming traditional diagnostic structures. CONCLUSIONS: We identified two transdiagnostic neuroanatomically informed clusters that are clinically and biologically distinct, challenging current diagnostic boundaries in recent-onset mental health disorders. These results may aid understanding of the etiology of poor outcome patients transdiagnostically and improve development of stratified treatments.

The QCAE: a Questionnaire of Cognitive and Affective Empathy.

Empathy has been inconsistently defined and inadequately measured. This research aimed to produce a new and rigorously developed questionnaire. Exploratory (n1 = 640) and confirmatory (n2 = 318) factor analyses were employed to develop the Questionnaire of Cognitive and Affective Empathy (QCAE). Principal components analysis revealed 5 factors (31 items). Confirmatory factor analysis confirmed this structure in an independent sample. The hypothesized 2-factor structure (cognitive and affective empathy) was tested and provided the best and most parsimonious fit to the data. Gender differences, convergent validity, and construct validity were examined. The QCAE is a valid tool for assessing cognitive and affective empathy.

Exploring multimodal hallucinations and disturbances in the basic and bodily self: A cross-sectional study in a non-clinical sample.

The bodily self is key to emotional embodiment, which is important for social functioning and emotion regulation. There is a paucity of research systematically assessing how basic and bodily self-disturbances relate to multimodal hallucinations. This study hypothesised that participants with greater hallucination-proneness would report greater degrees of basic and bodily self-disturbance and would demonstrate more ambiguous and less discrete mapping of emotional embodiment. Stage one screened non-clinical participants' degree of hallucination-proneness. Stage two participants completed seven further questionnaires. Hierarchical linear regression modelled the influence of hallucination-proneness and covariates on measures of basic and bodily self-disturbance and sensed presence. Stage two participants also completed a computerised body mapping task (EmBODY) which assessed emotional embodiment. Topographical maps were generated to compare patterns of embodiment between high and low hallucination-proneness groups. 55 respondents participated in stage two, with 18 participants from the high or low hallucination-proneness groups completing EmBODY. In the hierarchical regression analyses, the addition of a measure of hallucination proneness in the final step only increased predictive power where the dependent variable assessed sensed presence (p = 0.035 and p = 0.009, respectively). The EmBODY data revealed that participants with low hallucination-proneness consistently reported more bodily activation across 14 emotional states, whereas the high hallucination-proneness group reported more deactivation. In conclusion, hallucination-proneness was most strongly associated with sensed presence experiences. Patterns of embodiment appeared similar between the two groups, despite consistent differences in activation and deactivation. These findings are exploratory and need to be confirmed in a larger sample.

A review of functional and structural neuroimaging studies to investigate the inner speech model of auditory verbal hallucinations in schizophrenia.

Although the pathophysiology of auditory verbal hallucinations remains uncertain, the inner speech model remains a prominent theory. A systematic review and meta-analyses of both functional and structural neuroimaging studies were performed to investigate the inner speech model. Of the 417 papers retrieved, 26 met the inclusion criteria. Meta-analyses found the left insula to be significantly active during auditory verbal hallucinations and to have a significantly reduced grey matter volume in hallucinators. Dysfunction of the left insula may contribute to the misattribution of inner speech due to its suggested roles in both inner speech production and the salience network. No significant activity was found at Broca's area or Heschl's gyrus during auditory verbal hallucinations. Furthermore, no structural abnormalities were found at these sites or in the arcuate fasciculi. Overall, evidence was found to both support and oppose the inner speech model. Further research should particularly include a systematic review of task-based trait studies with a focus on inner speech production and self-referential processing, and analyses of additional language-related white matter tracts.

An Investigation of Behavioural and Self-Reported Cognitive Empathy Deficits in Adolescents With Autism Spectrum Disorders and Adolescents With Behavioural Difficulties.

Deficits in empathy have been considered hallmarks in individuals with autism spectrum disorders (ASD) but are also considered to underlie antisocial behaviour associated with individuals with callous unemotional traits (CU). Research has suggested that individuals with autism spectrum disorders show more difficulties with cognitive empathy, and that individuals diagnosed with behaviours difficulties, characterised by CU traits and antisocial behaviour, demonstrate low affective empathy. In the current manuscript we present findings of two studies. The first study describes the validation of a new stimulus set developed for the empathic accuracy task, focused on its cognitive component. The second study compares the performance of 27 adolescents with ASD, 27 age matched typically developing adolescents and 17 adolescents with behavioural difficulties on the empathic accuracy task and a self-report measure of empathy. While, no differences were observed between the three groups across the empathy accuracy task, the adolescents with ASD and CD showed deficits in their cognitive empathy across the self-report measure. Adolescents with ASD showed lower scores in particularly their perspective taking abilities, whereas the adolescences with behavioural difficulties showed more difficulties with their online simulation. No differences in self-reported affective empathy across the three groups were observed. Clinical implications of the findings are discussed.

Gender differences in the experience of psychotic-like experiences and their associated factors: A study of adolescents from the general population.

"Psychotic-Like Experiences" (PLEs) are common in the general population. While they are usually transient and resolve spontaneously, they can be distressing and signify increased risk for later psychosis or other psychopathology. It is important to investigate factors associated with PLEs which could be targeted to reduce their prevalence and impact. Males and females are known to experience PLEs differently, but any gender differences in the relationships between PLEs and other, potentially targetable, factors are currently unknown. 302 adolescents (175 females, mean age = 16.03, SD = 0.75; 127 males, mean age = 16.09, SD = 0.74) from secondary schools in the West Midlands region of the UK completed baseline self-report measures of positive PLEs, measured by the Community Assessment of Psychic Experiences (CAPE-P), and several potentially related factors including: cannabis use, perceived stress, anxiety, depression, and daily hassles. PLEs were common in this sample, with 67.5% of individuals experiencing at least one CAPE-P item 'often' or 'almost always'. Females reported significantly higher levels of PLEs, and associated distress, than males. Anxiety, depressive, and stress symptoms were similarly associated with PLEs in both genders. However, there was a significant interaction of gender and daily hassles in the association with PLEs. In summary, there were significant gender differences in the experience of PLEs in this sample. Although daily hassles were more common in females, they had a significantly stronger association with PLEs in males. Thus, addressing "daily life stress" in adolescents may require tailoring towards the more emotional perception of stress in females, and towards everyday life hassles in males.

Heterogeneity and Classification of Recent Onset Psychosis and Depression: A Multimodal Machine Learning Approach.

Diagnostic heterogeneity within and across psychotic and affective disorders challenges accurate treatment selection, particularly in the early stages. Delineation of shared and distinct illness features at the phenotypic and brain levels may inform the development of more precise differential diagnostic tools. We aimed to identify prototypes of depression and psychosis to investigate their heterogeneity, with common, comorbid transdiagnostic symptoms. Analyzing clinical/neurocognitive and grey matter volume (GMV) data from the PRONIA database, we generated prototypic models of recent-onset depression (ROD) vs. recent-onset psychosis (ROP) by training support-vector machines to separate patients with ROD from patients with ROP, who were selected for absent comorbid features (pure groups). Then, models were applied to patients with comorbidity, ie, ROP with depressive symptoms (ROP+D) and ROD participants with sub-threshold psychosis-like features (ROD+P), to measure their positions within the affective-psychotic continuum. All models were independently validated in a replication sample. Comorbid patients were positioned between pure groups, with ROP+D patients being more frequently classified as ROD compared to pure ROP patients (clinical/neurocognitive model: χ2 = 14.874; P < .001; GMV model: χ2 = 4.933; P = .026). ROD+P patient classification did not differ from ROD (clinical/neurocognitive model: χ2 = 1.956; P = 0.162; GMV model: χ2 = 0.005; P = .943). Clinical/neurocognitive and neuroanatomical models demonstrated separability of prototypic depression from psychosis. The shift of comorbid patients toward the depression prototype, observed at the clinical and biological levels, suggests that psychosis with affective comorbidity aligns more strongly to depressive rather than psychotic disease processes. Future studies should assess how these quantitative measures of comorbidity predict outcomes and individual responses to stratified therapeutic interventions.

The Psychopathology and Neuroanatomical Markers of Depression in Early Psychosis.

Depression frequently occurs in first-episode psychosis (FEP) and predicts longer-term negative outcomes. It is possible that this depression is seen primarily in a distinct subgroup, which if identified could allow targeted treatments. We hypothesize that patients with recent-onset psychosis (ROP) and comorbid depression would be identifiable by symptoms and neuroanatomical features similar to those seen in recent-onset depression (ROD). Data were extracted from the multisite PRONIA study: 154 ROP patients (FEP within 3 months of treatment onset), of whom 83 were depressed (ROP+D) and 71 who were not depressed (ROP-D), 146 ROD patients, and 265 healthy controls (HC). Analyses included a (1) principal component analysis that established the similar symptom structure of depression in ROD and ROP+D, (2) supervised machine learning (ML) classification with repeated nested cross-validation based on depressive symptoms separating ROD vs ROP+D, which achieved a balanced accuracy (BAC) of 51%, and (3) neuroanatomical ML-based classification, using regions of interest generated from ROD subjects, which identified BAC of 50% (no better than chance) for separation of ROP+D vs ROP-D. We conclude that depression at a symptom level is broadly similar with or without psychosis status in recent-onset disorders; however, this is not driven by a separable depressed subgroup in FEP. Depression may be intrinsic to early stages of psychotic disorder, and thus treating depression could produce widespread benefit.

A Narrative Review of Stigma Related to Infectious Disease Outbreaks: What Can Be Learned in the Face of the Covid-19 Pandemic?

Infectious disease pandemics are associated with social consequences and stigma that are noticeably similar in various health conditions, health systems, and cultures. Stigma impacts health-related outcomes, not only as a barrier to receiving the timely diagnosis and appropriate treatment but also as an important variable that increases mental health issues such as anxiety and depression. The COVID-19 outbreak has been associated with stigma too. Studying similarities as well as differences in the features of stigma observed in each outbreak can provide us with the knowledge and deeper understanding of the situation, which is necessary for approaching the issue comprehensively. The stigma needs to be addressed rigorously by professionals and health care providers as well as authorities. Here, we narratively review stigma due to some well-known infectious diseases and how it parallels to the current COVID-19 situation. After discussing its effects on both individuals and societies, we provide solutions to manage this important issue.

Neural correlates of top-down guidance of attention to food: An fMRI study.

We investigated the neural correlates of working memory guided attentional selection of food versus non-food stimuli in young women. Participants were thirty-two women, aged 20.6y (± 0.5) who were presented with a cue (food or non-food item) to hold in working memory. Subsequently, they had to search for a target in a 2-item display where target and distractor stimuli were each flanked by a picture of a food or a non-food item. The behavioural data showed that attention is particularly efficiently drawn to food stimuli when thinking about food. Using fMRI, we found that holding a non-food versus food stimulus in working memory was associated with increased activity in occipital gyrus, fusiform, inferior and superior frontal gyrus. In the posterior cingulum, retrosplenial cortex, a food item that re-appeared in the search array when it was held in memory led to a reduced response, compared to when it did not re-appear. The reverse effect was found for non-food stimuli. The extent of the reappearance effect correlated with the attentional capture of food as measured behaviourally. In conclusion, these results suggest that holding food in mind may bias attention because thinking of food facilitated neuronal responses to sensory input related to food stimuli and because holding food-related information in mind is less taxing on memory.

Adding a Dimension to the Dichotomy: Affective Processes Are Implicated in the Relationship Between Autistic and Schizotypal Traits.

INTRODUCTION: There is a recognized increase in vulnerability to psychosis in autistic people (AP). However, the construct of psychosis (particularly schizophrenia) contains several distinct factors, making understanding the relationship between autism and psychosis complex. Previous research has suggested that affective lability may be particularly related to psychotic experiences for AP who have experienced psychosis (AP-P). There is also a suggestion that psychosis might be a state of extreme (over)empathizing, perhaps related to emotional processes. METHOD: We recruited three groups: AP-P (N = 23), a group of AP who had not experienced psychosis (AP-NP; N = 59) and a neurotypical control group (NC, N = 41). Participants completed measures of autistic traits, schizotypal traits (as a proxy for psychosis-proneness), emotional processes, and perspective taking (as a proxy for the type of empathizing most theoretically likely to be linked to psychosis). As well as comparisons between groups, regression analyses were used to understand the influence of dependent variables on schizotypal traits. RESULTS: We found that AP-P had significantly higher rates of schizotypy (positive and disorganized), as well as higher rates of emotional difficulties. Across all groups, affective lability had a positive and significant association with positive and disorganized schizotypal traits. Differences in perspective taking between groups were small and generally non-significant, particularly in adjusted comparisons; additionally, its impact on schizotypy was small and non-significant. DISCUSSION: Our findings suggest that positive and disorganized schizotypy, in particular, have a relationship with affective lability. This, in turn, supports the idea of emotional processes as related to the development of schizotypal traits and psychosis across all individuals, regardless of autism diagnostic status. We found no evidence of empathy relating to any subscale of schizotypy, or the total schizotypy score. We contend that emotional processes should be considered in exploration of the relationship between autism and schizotypy in future. This may help to explain some of the findings of overlap between these constructs in previous research. Factors known to affect neurodevelopment of emotion systems such as history of early trauma, challenges during pregnancy and birth, and early childhood experiences of adversity during critical windows of development need further consideration in future research.

Does cortical brain morphology act as a mediator between childhood trauma and transition to psychosis in young individuals at ultra-high risk?

BACKGROUND: Childhood trauma, particularly sexual abuse, has been associated with transition to psychosis in individuals at "ultra-high risk" (UHR). This study investigated whether the effects of various forms of childhood trauma on transition to psychosis are mediated by cortical thickness and surface area abnormalities. METHODS: This prospective study used data from 62 UHR individuals from a previous (PACE 400) cohort study. At follow-up, 24 individuals had transitioned to psychosis (UHR-T) and 38 individuals had not transitioned (UHR-NT). Student-t/Mann-Whitney-U tests were performed to assess morphological differences in childhood trauma (low/high) and transition. Mediation analyses were conducted using regression and bootstrapping techniques. RESULTS: UHR individuals with high sexual trauma histories presented with decreased cortical thickness in bilateral middle temporal gyri and the left superior frontal gyrus compared to those with low sexual trauma. Participants with high physical abuse had increased cortical thickness in the right middle frontal gyrus compared to those with low physical abuse. No differences were found for emotional abuse or physical/emotional neglect. Reduced cortical thickness in the right middle temporal gyrus and increased surface area in the right cingulate were found in UHR-T compared to UHR-NT individuals. Sexual abuse had an indirect effect on transition to psychosis, where decreased cortical thickness in the right middle temporal gyrus was a mediator. CONCLUSIONS: Results suggest that childhood sexual abuse negatively impacted on cortical development of the right temporal gyrus, and this heightened the risk of transition to psychosis in our sample. Further longitudinal studies are needed to precisely understand this link.

Depressive and socially anxious symptoms, psychosocial maturity, and risk perception: Associations with risk-taking behaviour.

Risk-taking behaviour and onset of mental illness peak in adolescence and young adulthood. This study evaluated the interconnectedness of the domains of risk-taking behaviour, mental health (symptoms of depression and social anxiety), psychosocial maturity, risk perception, age, and gender in a sample of 306 adolescents and young adults. Participants between the ages of 16 and 35 completed online self-report measures assessing risk-taking behaviour, depressive symptoms, socially anxious symptoms, psychosocial maturity and risk perception. Socially anxious symptoms, psychosocial maturity, and risk perception were directly associated with risk-taking behaviour. Correlations between depressive symptoms, socially anxious symptoms, and psychosocial maturity were found. Psychosocial maturity proved a better predictor of risk-taking behaviour than age in this cohort. The findings indicate that mental health impacts upon risk-taking behaviour and that consideration should be given to psychosocial maturity in attempts to reduce adolescent and young adult risk-taking behaviour.

Psychometric properties of the questionnaire of cognitive and affective empathy in a Portuguese sample.

Empathy is an important concept in psychology and cognitive neuroscience. Despite the controversy around its definition, most researchers would agree that empathy is a multidimensional phenomenon which involves a vicarious experience of another person's affective state and an understanding of another person's affective experience. Self-report measures of empathy constitute an important tool for both research and clinical practice. The main goal of this study was to adapt and study the psychometric properties of the Questionnaire of Cognitive and Affective Empathy (QCAE), a worldwide used measure of empathy, in a Portuguese community sample (N = 562). Confirmatory factor analyses supported the factor structure of the original QCAE. Results show that the Portuguese version of the QCAE has sound psychometric properties, with good structural validity and internal consistency for both scales (i.e., affective and cognitive) and respective subscales of the instrument (i.e., Emotion Contagion, Proximal Responsivity, Peripheral Responsivity, Perspective Taking and Online Simulation). We tested both a five correlated factor structure (Model 1) and a second-order model that postulates the affective and cognitive dimensions (Model 2). Our results show that while both models present acceptable goodness of fit indices, Model 1 performs slightly better. In conclusion, the Portuguese version of the QCAE may prove a useful tool for future cross-cultural assessments of empathy in both research and clinical practice.