Personality Traits as Markers of Psychosis Risk in Kenya: Assessment of Temperament and Character

Abstract

Specific personality traits have been proposed as a schizophrenia-related endophenotype and confirmed in siblings at risk for psychosis. The relationship of temperament and character with psychosis has not been previously investigated in Africa. The study was conducted in Kenya, and involved participants at clinical high-risk (CHR) for psychosis (n=268) and controls (n=251), aged 15-25 yrs. CHR status was estimated using the Structured Interview of Psychosis-Risk Syndromes (SIPS) and the Washington Early Psychosis Center Affectivity and Psychosis (WERCAP) Screen. Student’s t tests were used to assess group differences on the Temperament and Character Inventory (TCI). Neurocognitive functioning, stress severity and substance use were correlated with the TCI, correcting for psychosis severity. CHR participants were more impulsive (i.e., higher novelty seeking (NS)) and asocial (i.e., lower reward dependence) than controls. They were also more schizotypal (i.e., high self-transcendence (ST) and lower self-directedness (SD) and cooperativeness (CO) than controls). CO was related to logical reasoning, abstraction and verbal memory. Stress severity correlated with high HA and schizotypal character traits. Lifetime tobacco use was related to NS, and lifetime marijuana use to high NS, low SD and high ST. Temperament and character of Kenyan CHR youth is similar to that observed in schizophrenia. Psychosis risk in Kenya is associated with impulsive, asocial and schizotypal traits. CHR adolescents and young adults with schizophrenia-specific personality traits may be most at risk for developing a psychotic disorder, and to require early intervention to improve outcomes.

Magical thinking in individuals with high polygenic risk for schizophrenia but no non-affective psychoses—a general population study

“…Some previous cross-sectional findings have proposed that magical thinking may relate to an increased risk for psychosis [ 32 , 53 ]. Additionally, a review stated that high schizotypy (one domain of schizotypy being magical thinking) may play a role in the etiology of schizophrenia-spectrum disorders [ 54 ].…”

“…Individuals at clinical high risk for psychosis are shown to have higher scores of Spiritual acceptance [ 32 ]. Moreover, high scores of “self-transcendence” are shown to be more common in schizophrenia patients (vs. controls) [ 33 , 34 ] and schizophrenia patients’ relatives with schizotypal features (vs. controls) [ 35 ], to correlate with a schizotypal personality style in a non-clinical sample [ 36 , 37 ], and to correlate with higher psychotic-like experiences [ 38 , 39 ].…”

Temperament & Character account for brain functional connectivity at rest: A diathesis-stress model of functional dysregulation in psychosis

“…For example, personality traits measured by the Temperament and Character Inventory (TCI) are complex in their genetic and environmental antecedents as well as in cognitive and emotional features that influence health [ 9 , 61 ]. Different TCI trait configurations provide specific measures of schizotypal personality disorder and susceptibility to psychosis [ 16 , 62 , 63 ], cyclothymia, neuroticism and susceptibility to mood disorders [ 64 , 65 ], and learning by behavioral conditioning, intentional self-control, and self-awareness [ 12 , 13 ]. Such configural analysis allows deconstruction of a complex system into its components as well as the analysis of integrative interactions among components, as we did for human personality [ 12 , 13 , 58 ].…”

“…The strong self-regulatory functioning of their self-directed and cooperative characters dominates and shapes their habits to be in accord with their rational goals and prosocial values [ 12 , 13 , 18 , 111 ]. In contrast, the personalities of unhealthy adults, particularly those with or at risk for psychosis, have strong emotional drives opposite to reliable temperaments (namely, H, N, r, p) that dominate the weak and unrealistic self-regulatory functioning typical of people with apathetic (sct), schizotypal (scT), or cyclothymic characters (sCT) [ 12 , 62 , 63 , 112 , 113 ]. Consequently, if psychosis results from dysfunctional variation in the same rsFC networks found in healthy individuals (rather than secondary to unique and discrete pathogenic traits [ 114 , 115 ]), we hypothesized that in psychoses, strong emotional reactivity (as measured by temperament and/or by rsFC of bottom-up prefrontal networks) would dominate the weak and dysfunctional self-regulation of psychotic individuals (as measured by character and/or by rsFC of top-down prefrontal networks).…”

Affective temperaments of Lebanese patients with schizophrenia: comparison by gender and severity of psychosis

“…It can, however, highlight the degree of variation between two groups (schizophrenic patients and healthy control group) and might further highlight differences in gender and severity of psychotic symptoms. There have been studies linking temperaments and risk of having a psychotic episode [ 13 – 15 ] specifically how abnormal rates in temperament act as a precursor to a first time onset of schizophrenia [ 16 ], which have been conducted in Kenya [ 15 ], Finland [ 14 ] and Mexico [ 16 ].…”