Shades of vulnerability: latent structures of clinical caseness in prodromal and early phases of schizophrenia

Abstract

The underlying structures of clinical caseness and need of care in prodromal (i.e., at-risk) and early phases of schizophrenia remain poorly characterized in their essential psycho-behavioral coherence. To identify the schizophrenia proneness-related subtypes within a population of young help-seekers referred to a dedicated, community-based early detection program (Programma 2000). A sample of consecutive referrals (n = 168) for suspected psychosis or first-episode schizophrenia spectrum psychosis received a detailed clinical assessment, including the early recognition inventory for the retrospective assessment of the onset of schizophrenia checklist. We used exploratory factor analysis (EFA) to determine the underlying dimensional structure and latent class analysis (LCA) to identify putative vulnerability subtypes. EFA identified four factors: dysphoria (irritability tension), paranoid autocentrism, introversive withdrawal, and disturbed subjective experience. LCA distinguished three classes, interpretable as carrying different degrees of "proneness to schizophrenia psychosis," which best captured the underlying continuum of clinical severity. The validity of the three classes was supported by distinct patterns of association with major clinical variables (i.e., diagnostic staging at referral). Vulnerability to schizophrenia psychosis in young help-seekers may manifest in three major clinical prototypes, presenting common levels of dysphoria and social withdrawal but different degrees of paranoid autocentrism and disturbed subjective experience. Overall, the results provide the empirical background to dissect shared features of clinical caseness from more schizophrenia-specific vulnerability components. This is of value for the refinement of the clinical staging model as well as for the pragmatic implementation of multiple-gate screening programs.

Sex differences in first-episode psychosis and in people at ultra-high risk

“…All the patients referred for evaluation undergo a comprehensive, multidimensional evaluation. For the purpose of this study, the following standardized assessment instruments were considered: (i) a socio-demographic form; (ii) the Early Recognition Inventory Retrospective Assessment of Symptoms (ERIraos) Raballo et al, 2013), a 17-item screening checklist intended to select the subjects requiring a more in-depth assessment; (iii) the Health of the Nation Outcome Scale (HoNOS) (Wing et al, 1998;Preti et al, 2012b), which was used to assess psychopathology and disability; it includes 12 five-point items to evaluate clinical and social functioning in the past 2 weeks; (iv) the 24-item Brief Psychiatric Rating Scale (Overall and Gorham, 1962;Roncone et al, 1999), to assess general psychopathology; (v) the Global Assessment of Functioning (GAF) (Moos et al, 2000).…”

Early intervention in psychosis: a feasibility study financed by the Italian Center on Control of Maladies

“…Scores are: 0 -1 -2 (absent, doubtfully present, certainly present) for the first 13 items; 0 -2 -4 (same assignment) for two items about changes in perception and thought interference; and 0 -3 -6 for two items about paranoid ideation and hallucinations, which assign greater weight to those symptoms that are more clearly indicative of psychosis. 29 The BRPS is a 24-item measure of general psychopathology in a Likert format, with scores ranging from 1 (absent) to 7 (extremely severe). 33 The range of possible BPRS total scores is 24 to 168, with higher scores indicating higher levels of psychopathology.…”

Tracking salience in young people: A psychometric field test of the Aberrant Salience Inventory (ASI)

“…The intrusiveness or frequency of such PLEs, combined with psychosocial or biological protective or risk factors, may probabilistically influence the individual progression from subtle pre‐clinical experiential anomalies to full‐blown psychosis (Preti, Cella, Raballo, & Vellante, ; Raballo & Larøi, ). AS might be situated at the entry level of such a continuum, with abnormal attribution of significance to otherwise neutral or inconspicuous stimuli, thereby catalysing the onset (and crystallization) of cognitive–perceptual positive symptoms (Preti, Cella, & Raballo, ; Raballo et al, ).…”