The notion that stress plays a role in the etiology of psychotic disorders, especially schizophrenia, is longstanding. However, it is only in recent years that the potential neural mechanisms mediating this effect have come into sharper focus. The introduction of more sophisticated models of the interplay between psychosocial factors and brain function has expanded our opportunities for conceptualizing more detailed psychobiological models of stress in psychosis. Further, scientific advances in our understanding of adolescent brain development have shed light on a pivotal question that has challenged researchers; namely, why the first episode of psychosis typically occurs in late adolescence/young adulthood. In this paper, we begin by reviewing the evidence supporting associations between psychosocial stress and psychosis in diagnosed patients as well as individuals at clinical high risk for psychosis. We then discuss biological stress systems and examine changes that precede and follow psychosis onset. Next, research findings on structural and functional brain characteristics associated with psychosis are presented; these findings suggest that normal adolescent neuromaturational processes may go awry, thereby setting the stage for the emergence of psychotic syndromes. Finally, a model of neural mechanisms underlying the pathogenesis of psychosis is presented and directions for future research strategies are explored.

First-episode psychosis typically emerges during late adolescence or young adulthood, interrupting achievement of crucial educational, occupational, and social milestones. Recoveryoriented approaches to treatment may be particularly applicable to this critical phase of the illness, but more research is needed on the life and treatment goals of individuals at this stage. Open-ended questions were used to elicit life and treatment goals from a sample of 100 people hospitalized for first-episode psychosis in an urban, public-sector setting in the southeastern United States. Employment, education, relationships, housing, health, transportation were the most frequently stated life goals. When asked about treatment goals, participants' responses included wanting medication management, reducing troubling symptoms, uncertainty, a desire to simply be well, engaging in counseling, and attending to their physical health. In response to queries about specific services, most indicated a desire for both vocational and educational services, as well as assistance with symptom and drug abuse. These findings are interpreted and discussed in light of emerging or recently advanced treatment paradigms—recovery and empowerment, shared decision-making, community and social reintegration, and phase-specific psychosocial treatment. Integration of these paradigms would likely promote recovery-oriented tailoring of early psychosocial interventions, such as supported employment and supported education, for first-episode psychosis.

While mode of onset is a reliable illness-related determinant of DUP, further research is needed on the complex ways in which family-related variables influence DUP.

Objective Although several exploratory and confirmatory factor analyses have supported the initially proposed factor structure of the Schizotypal Personality Questionnaire (SPQ) in which its nine subscales are grouped into cognitive-perceptual, interpersonal, and disorganized domains, others have revealed different latent structures. This study determined the best-fitting factor structure from among five models that have been proposed in the literature, as well as five additional hierarchically related models.Method Undergraduate college students (n=825) completed the SPQ as well as the Perceptual Aberration Scale (PAS) and the Revised Social Anhedonia Scale (SAS). Confirmatory factor analyses involving the nine SPQ subscales were conducted using the Linear Structural RelationsProgram (LISREL 8.72).Results The best fitting model was a previously described 4-factor model including cognitiveperceptual, paranoid, negative, and disorganized domains. Correlations between the derived SPQ domains and the PAS score ranged r=.26-.39, and correlations between the SPQ domains and the SAS ranged r=.07-.41. ConclusionsThe present findings support a 4-factor model over the standard 3-factor model that is typically used to derive SPQ subscale scores. The four derived domains are minimally to moderately correlated with other measures of psychosis-proneness.

Background-Because dropping out of high school (i.e., secondary education) contributes prominently to numerous social, economic, and health conditions, formal public health initiatives promoting population health and social justice, especially in at-risk populations, are increasingly encouraged to address high school drop-out. The relative dearth of research attention on school dropout prior to first treatment contact in young adults with psychotic disorders indicates a need for investigation of the associations between school drop-out and illness-related variables so that interventions may be tailored appropriately to this unique population.Methods-This study provides a descriptive characterization of the prevalence and correlates of high school drop-out in a sample of 109 patients hospitalized for the evaluation and treatment of a first episode of nonaffective psychosis.Results-Findings from this urban, socially disadvantaged, predominantly African American sample indicate that school drop-out is a marker of diverse detrimental social problems in firstepisode psychosis, and that further research is required to fully characterize the most appropriate interventions for such individuals.Conclusions-Future research might seek to intervene through an integrated treatment approach that incorporates supported education, symptom reduction and management, and comorbid substance use treatment in first-episode patients.

Esterberg, Michael L.; Goulding, Sandra M.; McClure-Tone, Erin B.; and Compton, Michael T., "Schizotypy and Nicotine, Alcohol, and Cannabis Use in a Non-Psychiatric Sample" (2009). Psychology Faculty Publications. Paper 131.

Background-Little is known about how family-level factors are associated with duration of untreated psychosis (DUP), especially in ethnic/racial minority groups, such as African Americans. This study involved African American first-episode patients and their family members who initiated evaluation and treatment for them. It was hypothesized that a longer DUP would be predicted by family members' endorsement of: (1) less knowledge about schizophrenia, (2) greater perceptions of stigma, (3) lower levels of insight, (4) fewer family strengths, (5) more limited family coping capacity, and (6) lower levels of caregiver strain.Methods-From a sample of 109 patients, 42 African American patients with family-level data were included. Cox proportional hazards models quantified associations between family-level predictors and DUP, and analyses controlled for effects of three previously determined patient-level predictors of DUP-mode of onset of psychosis, living with family members versus alone or with others, and living above versus below the federal poverty level.Results-The median DUP was 24.5 weeks. Greater family strengths and a better family coping capacity were associated with a shorter DUP, whereas higher insight among informants and greater level of perceived caregiver strain were associated with a longer DUP.Conclusions-Whereas family strengths and coping likely account for a significant portion of variability in DUP, both insight and caregiver strain probably evolve as a consequence of DUP. Efforts to strengthen families and tap into existing strengths of families in specific cultural groups would likely enhance early treatment-seeking for psychotic disorders.

Cluster A personality disorders (PD), including schizotypal personality disorder (SPD), paranoid personality disorder (PPD), and schizoid PD, are marked by odd and eccentric behaviors, and are grouped together because of common patterns in symptomatology as well as shared genetic and environmental risk factors. The DSM-IV-TR describes personality disorders as representing stable and enduring patterns of maladaptive traits, and much of what is understood about Cluster A personality disorders in particular stems from research with adult populations. Less in known about these disorders in children and adolescents, and controversy remains regarding diagnosis of personality disorders in general in youth. The current paper reviews the available research on Cluster A personality disorders in childhood and adolescence; specifically, we discuss differentiating between the three disorders and distinguishing them from other syndromes, measuring Cluster A disorders in youth, and the nature and course of these disorders throughout childhood and adolescence. We also present recent longitudinal data from a sample of adolescents diagnosed with Cluster A personality disorders from our research laboratory, and suggest directions for future research in this important but understudied area.