This study examined the association of subclinical bipolar spectrum psychopathology (BSP) with the expression of schizotypic and psychotic-like experiences in daily life. Bipolar psychopathology has traditionally been classified as relatively rare, categorical diagnoses; however, there is emerging evidence that bipolar psychopathology can be better conceptualized as a dynamic continuum of subclinical and clinical symptoms with varying levels of impairment. Patients with bipolar disorders often exhibit psychotic symptoms, and preliminary findings suggest that subclinical BSP may be associated with psychotic-like and schizotypic experiences. This study employed experience sampling methodology (ESM) to examine the associations of subclinical BSP, as assessed by the Hypomanic Personality Scale, with repeated daily-life measures of positive, negative, and disorganized schizotypic experiences, and with suspiciousness in a sample of 203 young adults. The analytic plan was pre-registered. As hypothesized, BSP was positively associated with positive schizotypic (psychotic-like) experiences, disorganized schizotypic experiences, suspiciousness, and negative affect in daily life, while unrelated to momentary negative schizotypic experiences, positive affect, and positive appraisals of situations. Our results indicate that subclinical BSP is associated with schizotypic experiences in daily life, consistent with the established expression of psychotic experiences in bipolar disorder, especially during manic episodes. Furthermore, ESM offers a useful approach for assessing real-world expressions of psychopathology.
Objective Minimal efficacy differences have been found between cognitive behavioural therapy (CBT) and short-term psychodynamic supportive psychotherapy (SPSP) but it is unclear which of these treatments work best for whom. This study aimed to explore the feasibility of applying a Personalized Advantage Index (PAI) as a proof‑of‑concept approach to optimize treatment outcomes by tailoring the selection of Cognitive Behavioral Therapy (CBT) or Short-term Psychodynamic Supportive Psychotherapy (SPSP) for individuals with depression. Method Data gathered from a randomized controlled trial comparing short-term psychodynamic supportive psychotherapy (SPSP, n = 148) and cognitive behavioural therapy (CBT, n = 142) for adults with depression were used. Elastic-Net regularization was applied to identify pre-treatment patient characteristics associated with treatment outcome, explicitly to reduce overfitting and manage multicollinearity given the exploratory nature and sample size of the study. The PAI approach was utilized to generate personalized treatment recommendations. Finally, we examined whether outcomes differed between individuals who did or did not receive their PAI-indicated treatment. Results A significant difference in post-treatment depression severity scores was found between those receiving their PAI-indicated treatment and those receiving their non-indicated PAI treatment (d = 0.36). Conclusion Although based on a modest sample and without external validation, the findings suggest that the Personalized Advantage Index (PAI) may hold promise as a feasibility‑oriented, proof‑of‑concept approach for precision in psychotherapy allocation. However, the results should be interpreted cautiously, and replication in independent samples is required before clinical implementation can be considered.
