AIM:Childhood-onset Obsessive-Compulsive Disorder (OCD) has been associated with an increased vulnerability to psychosis, yet no prospective studies have examined this risk in paediatric populations. METHODS:In this pilot prospective study, 59 adolescents with a primary diagnosis of OCD were assessed at baseline for psychotic vulnerability, measured through Cognitive-Perceptual basic symptoms (COPER) and the high-risk criterion Cognitive Disturbances (COGDIS), as well as for OCD severity and psychosocial functioning. The number of subjects who developed a first episode of psychosis (FEP) during the 18-month follow-up period was evaluated. Logistic regression and moderation analyses were performed. RESULTS:During the follow-up period, 18.6% of participants presented with a FEP. These patients were older and displayed poorer psychosocial functioning compared with those who did not develop a FEP. Logistic regression identified higher COPER symptoms and lower psychosocial functioning as the only significant predictors of FEP. Although moderation effects were not statistically significant, exploratory simple slopes suggested that both COPER and COGDIS symptoms were more strongly associated with psychosis onset in adolescents with lower psychosocial functioning. CONCLUSIONS:This study highlights a notable rate of progression to psychosis among adolescents with OCD over an 18-month period. Despite methodological limitations, our findings offer preliminary evidence that COPER symptoms and impaired psychosocial functioning are key risk factors in adolescents with OCD for progression to psychosis.

Introduction: Social exclusion affects patients with schizophrenia (SCZ) both because of a fundamental disposition to introversion and through social discrimination. Here, we explore the emotional and cardiac autonomic responses to ostracism using a ball-tossing experiment. Methods: Through a cross-sectional design, 30 patients with SCZ and 30 healthy controls (HC) performed the Cyberball task. We measured respiratory sinus arrhythmia (RSA) at baseline, immediately after each gameplay (inclusion and ostracism) and after 10 minutes (reflective stage), as well as self-reported ratings of threats toward one’s fundamental need to belong. Results: Participants with SCZ showed reduced RSA at baseline, which remained low for the task’s entire duration, regardless of the experimental condition. When excluded, they self-reported a lower sense of threat to fundamental needs, as compared with HC. Conclusions: Patients with SCZ showed a persistent defensive autonomic state and displayed a blunted emotional response to experimental ostracism, suggesting difficulties in activating social engagement strategies.

Psychopathology has highlighted the pivotal role of revelation in schizophrenic primary delusions. However, empirical studies on the topic remains limited. Therefore, this research aimed to explore the basic forms of subjectivity underpinning delusions in schizophrenia and to compare the experiential structure of these delusional phenomena with the experience of the sacred. The study involved eleven participants diagnosed with schizophrenia and adopted the qualitative methodology of Interpretative Phenomenological Analysis (IPA). Participants' accounts revealed four core experiential themes: 1) fragility of presence, 2) disposition to delusion, 3) apophany, and 4) eccentric existential reorientation. Primary delusional experiences may constitute a state-like phenomenon unfolding in four structural phases toward the formation of delusional contents: 1) a weakened bodily resonance with the world, 2) a predominance of the "physiognomic" properties, 3) an imposition of idiosyncratic and self-referential meanings, and 4) an active elaboration through delusion-like ideas. Formal similarities may be found with the "numinous" experience and with the specific articulations of the manifestation of the sacred or "hierophany." Disembodiment may be posited as the common underlying scaffolding for both delusions in schizophrenia and the sacred, albeit persistent and forced upon the subject in the former, and transient, voluntarily sought, and socio-culturally integrated in the latter.

It is known that the serotonin and norepinephrine systems change with age. Consequently, response to antidepressants having different effects on these two systems may vary between patients of different ages. We systematically searched Embase/Medline/PsychINFO until December 2024 for randomised controlled trials (RCT) in patients with unipolar major depressive disorder comparing response rates to serotonergic versus noradrenergic antidepressants (PROSPERO pre-registration #CRD42020145386). Our primary outcome was to assess the effect of age on response rates to serotonergic versus noradrenergic antidepressants in unipolar depression. We then performed a pooled analysis of individual participant data (IPD). Seventy-four RCTs with a total of 8981 participants (4488 with serotonergic and 4493 with noradrenergic antidepressants) were included in the meta-analysis. We found no differences in the response rates to the two antidepressants, although the improvement in depressive symptoms was greater in the noradrenergic arm (subset of n = 31 studies, z = -2.61; p = 0.009); younger age was associated with a greater response to serotonergic than noradrenergic agents both in terms of response rates (estimate = -0.011; p-value = 0.041) and symptom improvement (estimate = -0.016; p-value<0.0001), even after controlling for year of publication, study design, baseline severity, type of noradrenergic medication, inpatients, and dropout rates. The effect of age on antidepressant response was also confirmed in the IPD pooled analysis (n = 339), in which responders to serotonergic antidepressants were significantly younger than non-responders (p-value = 0.028) and than responders to noradrenergic antidepressants (p-value = 0.034). Our study highlights the importance of age when considering the efficacy of serotonergic versus noradrenergic antidepressants as part of a precision psychiatry-oriented approach.

Background/Objectives: Compulsive rituals in Obsessive-Compulsive Disorder (OCD) are characterized by a specific motor structure, built upon the fragmentation of action flow, obtained through act repetitions and the intrusion of non-functional acts. No study to date has adopted a hierarchical analysis to subtype OCD according to specific behavioral patterns, nor has a possible association between motor profiles and psychopathology been investigated. Methods: This study involved 31 OCD patients (11 female, 35%) and 31 healthy controls (11 female, 35%). The participants were asked to provide videotapes of their behaviors (OCD compulsions for patients and corresponding normal behaviors for healthy controls). BORIS software version 2.84.1 was adopted to analyze the recorded videos. Psychopathology was assessed through the Yale-Brown Obsessive-Compulsive Scale, the Childhood Trauma Questionnaire, the Frankfurt Complaint Questionnaire, and the Social and Occupational Functioning Assessment Scale. Results: Hierarchical analysis revealed three behavioral clusters based on motor profile: Cluster 1 included OCD compulsions structurally characterized by act repetitions ("iterative" rituals); Cluster 2 was represented by OCD compulsions mainly built upon non-functional acts ("idiosyncratic" rituals); and Cluster 3 comprised routinized and normative behaviors, without behavioral ritualization (no act repetitions and few non-functional acts). No significant differences were found in age, age at onset, and OCD severity between "iterative" and "idiosyncratic" rituals. However, patients with "iterative" rituals showed both more severe pre-psychotic symptoms and childhood trauma experiences than patients with "idiosyncratic" rituals. Conclusions: These findings may have significant clinical implications as they hint at a relationship between specific behavioral patterns of OCD compulsions and different underlying psychopathologies and/or vulnerabilities.

AIMS:Borderline personality disorder (BPD) patients show negative emotional reactions to both excluding and including social scenarios, with levels normalizing only during extreme inclusion. Prior research among healthy individuals highlights the right ventrolateral prefrontal cortex (rVLPFC) role in regulating emotional responses to social exclusion, since transcranial direct current stimulation (tDCS) of rVLPFC decreases rejection-related emotions following social exclusion. This pilot study investigated whether, in BPD patients, tDCS over the rVLPFC reduces rejection-related emotions not only after social exclusion but also after fair social inclusion. METHODS:Forty BPD patients randomly received either real or sham tDCS on rVLPFC before participating in the Cyberball paradigm, which involved phases of inclusion, exclusion, and over-inclusion. Participants self-reported their level of rejection-related emotions following each phase. RESULTS:Transcranial direct current stimulation reduced rejection-related emotions during both social exclusion and fair inclusion, but not during over-inclusion. Specifically, those in the Real tDCS group exhibited comparable emotional responses to fair and over-including scenarios, unlike those in the Sham group who experienced heightened rejection-related emotions during fair inclusion compared to over-inclusion. CONCLUSIONS:Transcranial direct current stimulation over the rVLPFC reduces BPD patients' tendency to feel rejected both in fairly including and excluding scenarios. These findings confirm the rVLPFC involvement in emotional regulation and highlight a therapeutic potential for tDCS in moderating BPD's typical heightened rejection-related emotional responses to fairly including scenarios. This study supports the application of tDCS in BPD treatment, providing new insights into neuromodulatory interventions that can aid BPD patients to better regulate their emotions during varying social scenarios.

INTRODUCTION:Social exclusion affects patients with schizophrenia (SCZ) both because of a fundamental disposition to introversion and through social discrimination. Here, we explore the emotional and cardiac autonomic responses to ostracism using a ball-tossing experiment. METHODS:Through a cross-sectional design, 30 patients with SCZ and 30 healthy controls (HC) performed the Cyberball task. We measured respiratory sinus arrhythmia (RSA) at baseline, immediately after each gameplay (inclusion and ostracism) and after 10 minutes (reflective stage), as well as self-reported ratings of threats toward one's fundamental need to belong. RESULTS:Participants with SCZ showed reduced RSA at baseline, which remained low for the task's entire duration, regardless of the experimental condition. When excluded, they self-reported a lower sense of threat to fundamental needs, as compared with HC. CONCLUSIONS:Patients with SCZ showed a persistent defensive autonomic state and displayed a blunted emotional response to experimental ostracism, suggesting difficulties in activating social engagement strategies.

Childhood obsessive-compulsive disorder (OCD) stems from a bunch of restricted and repetitive behaviors, which are part of normal behavioral repertoire up to the age of 7. The persistence of compulsive-like behaviors after that age is often associated with unique comorbidity patterns, which are age-at-onset dependent and reflect different developmental stages. In particular, OCD synchronically co-occurs with a broad constellation of neurodevelopmental disorders, whereas diachronically it is related to an increased risk of major adult psychoses. Moreover, OCD is associated with trait-like sensory phenomena, suggesting a common disrupted sensorimotor grounding.The present study is aimed at exploring the hypothesis that this specific temporal and comorbidity OCD profile may be due to a developmental heterochronic mechanism of delay in attenuation of ontogenetically early behavioral patterns. The developmental shift of highly evolutionarily conserved behavioral phenotypes might be regulated by epigenetic changes induced by different conditions of sensory unbalance. This evolutionary and developmental model allows capturing childhood OCD in light of the ultimate causes of ritual behavior throughout phylogeny, namely its "homeostatic" function over conditions of unpredictability. Moreover, it may have important clinical implications, as OCD symptoms could represent putative biomarkers of early divergent developmental trajectories, with a pathoplastic effect on course and outcome.

People with obsessive compulsive disorder (OCD) are at increased risk of developing psychotic disorders; yet little is known about specific clinical features which might hint at this vulnerability. The present study was aimed at elucidating the pathophysiological mechanism linking OCD to psychosis through the investigation of childhood trauma experiences in adolescents and adults with OCD. One hundred outpatients, aged between 12 and 65 years old, were administered the Yale–Brown Obsessive Compulsive Scale (Y-BOCS) and its Child version (CY-BOCS), as well as the Childhood Trauma Questionnaire (CTQ); Cognitive–Perceptual basic symptoms (COPER) and high-risk criterion Cognitive Disturbances (COGDIS) were assessed in the study sample. Greater childhood trauma experiences were found to predict psychotic vulnerability (p = 0.018), as well as more severe OCD symptoms (p = 0.010) and an earlier age of OCD onset (p = 0.050). Participants with psychotic vulnerability reported higher scores on childhood trauma experiences (p = 0.02), specifically in the emotional neglect domain (p = 0.01). In turn, emotional neglect and psychotic vulnerability were found higher in the pediatric group than in the adult group (p = 0.01). Our findings suggest that childhood trauma in people with OCD may represent an indicator of psychotic vulnerability, especially in those with an earlier OCD onset. Research on the pathogenic pathways linking trauma, OCD, and psychosis is needed.

Schizophrenia is a severe psychiatric disorder, associated with a reduction in life expectancy of 15-20 years. Available treatments are at least partially effective in most affected individuals, and personal resources such as resilience (successful adaptation despite adversity) and coping abilities (strategies used to deal with stressful or threatening situations), are important determinants of disease outcomes and long-term sustained recovery. Published findings support the existence of a genetic background underlying resilience and coping, with variable heritability estimates. However, genome-wide analyses concerning the genetic determinants of these personal resources, especially in the context of schizophrenia, are lacking. Here, we performed a genome-wide association study coupled with accessory analyses to investigate potential genetic determinants of resilience, coping and self-esteem in 490 schizophrenia patients. Results revealed a complex genetic background partly overlapping with that of neuroticism, worry and schizophrenia itself and support the importance of social aspects in shapingthese psychological constructs. Hippocampal neurogenesis and lipid metabolism appear to be potentially relevant biological underpinnings, and specific miRNAs such as miR-124 and miR-137 may warrant further studies as potential biomarkers. In conclusion, this study represents an important first step in the identification of genetic and biological correlates shaping resilience, coping resources and self-esteem in schizophrenia.

Abstract Rituals represent a prominent human behavior in different contexts such as daily routines, life cycle stages, and psychopathology, for example, obsessive compulsive disorder (OCD) where they are referred to as compulsions. OCD compulsions differ from habitual behaviors and stereotypies regarding their formal features: acts repetition, the addition of nonfunctional acts, and attentional focus on basic motor units. This study aims to categorize OCD compulsions based on the motor patterns of acts repetition and inclusion of nonfunctional acts. We analyzed 28 video-recorded OCD compulsions; we adopted a cluster analytic model to identify distinct patterns within the data and determine cluster characteristics. Our findings revealed a moderate negative covariance between nonfunctionality and repetitiveness, indicating that as nonfunctionality increased, repetitiveness decreased. Three distinct clusters in OCD rituals were identified according to the motor pattern: “idiosyncratic rituals,” characterized by strong incorporation of nonfunctional acts; “iterative rituals” showing high repetitiveness; and “routines,” with minimal repetition and limited inclusion of nonfunctional acts. These motor patterns highlight evolutionarily conserved behavioral strategies aimed at coping with conditions of environmental unpredictability. The findings might allow fine-grained discrimination of ritual compulsions and help target personalized interventions.

OBJECTIVE Ethological models have highlighted a specific motor structure of compulsions in obsessive-compulsive disorder (OCD), based on the rigid repetitions of acts, and with the adaptive significance of facing unpredictable conditions. Such an evolutionary mechanism might explain the robust association between childhood traumatic experiences (CTEs) and OCD. However, a relationship between CTEs and the motor structure of compulsions has not been investigated yet. The first objective of the study was to confirm a specific motor structure of OCD compulsions with respect to control behaviors; the second objective was to assess a possible association between the motor structure of compulsions and CTEs severity. METHOD Thirty-two OCD outpatients (13 female, Mage = 44.50 years, SE = 19.71) and 27 healthy controls (10 female, Mage = 37.62 years, SE = 16.20), matched for sex and age, provided a videotape of their compulsions and corresponding ordinary acts, respectively. Behavior was scored with the software "Observer." Participants were administered the Yale-Brown Obsessive Compulsive Scale and the Childhood Trauma Questionnaire. A dependent t test was used to compare the motor structure of behavior between the groups; Pearson's correlations to investigate associations between motor parameters and CTEs. RESULTS Compulsions showed a specific motor structure due to the repetition of functional and nonfunctional acts. CTEs severity was especially associated with the repetition of functional acts, independently from OCD severity. CONCLUSION Our findings, in confirming a peculiar motor structure for OCD compulsions, hint for the first time at a link between CTEs and compulsive repetition of functional acts, which would represent a plastic developmental response to CTEs unpredictability. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

BACKGROUND:Psychotic-like anomalous self-experiences (ASEs) are core and early features of schizophrenia spectrum disorders, which have been recently also postulated to underlie embodiment disturbance in feeding and eating disorders (FEDs). The present study was aimed at investigating the interplay between ASEs and specific psychopathology in FED. METHODS:Ninety persons with Anorexia Nervosa and 41 with Bulimia Nervosa were evaluated with the inventory of psychotic-like anomalous self-experiences (IPASE), identity and eating disorders (IDEA), body uneasiness test (BUT), and eating disorder examination questionnaire (EDE-Q). The same assessment was performed for 92 subjects recruited from the general population. Structural equation modelling was employed to test the role of embodiment/identity disorders in mediating the relationship between ASEs and ED psychopathology. RESULTS:Patients with FED displayed high scores on IPASE, comparable with people with schizophrenia spectrum disorders. A significant correlation was also demonstrated between IPASE, BUT and EDE-Q. All IPASE domains were strongly related to feeling extraneous from one's own body by IDEA. All IPASE domains demonstrated a high relationship with BUT Depersonalization scale. A strong correlation was also reported between total scores of IPASE and IDEA. The mediation model confirmed that ASEs impact on FED symptomatology through the mediation of both embodiment/identity disorders and body image. DISCUSSION:Anomalous interoceptive processes may represent the first step of a maladaptive process-impairing embodiment, selfhood, and identity in FED. Assessment of ASEs might be a valid tool to identify an early-shared vulnerability of severe disorders characterized by embodiment alterations.

Abstract BackgroundA prosodic profile for people with schizophrenia has been previously empirically suggested. However, evidence remains inconclusive, particularly with regards to the possible links with psychopathology and the scarcity of substantial data on Italian-speaking individuals.MethodsWe quantified a large set of prosodic and voice quality features from a free speech task conducted with Italian-speaking individuals with and without schizophrenia (SCZ – 29; CTR – 29), using a fully automated pipeline. Moreover, in the SCZ group we thoroughly assessed psychopathology using the Thought Language and Communication scale (TLC), the Clinical Language Disorder Rating scale (CLANG), the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), the Examination of Anomalous Self Experience Scale (EASE) and the Autism Rating Scale (ARS).ResultsRelative to CTR, SCZ showed a different acoustic profile, with reduced speech rate and increased pause duration, fundamental frequency variability and breathy phonation. Temporal profile features were associated with most of the psychopathology tested, in particular with symptoms related to communication atypicalities but also to subjective experiences related to self and others. Other acoustic features related to pitch and intonation were associated with negative symptoms of schizophrenia and subjective experiences related to others.ConclusionsThis study shows for the first time significant differences in prosody and voice quality in Italian speaking people with schizophrenia, as compared to neurotypical controls. Moreover, significant relationships between speech acoustic profile and fine psychopathology were found. Future research should expand this approach to transdiagnostic and cross-linguistic samples, to test the specificity of the investigated patterns. This could pave the way to new therapeutic approaches.

Individuals with schizophrenia generally show difficulties in interpersonal communication. Linguistic analyses shed new light on speech atypicalities in schizophrenia. However, very little is known about conversational interaction management by these individuals. Moreover, the relationship between linguistic features, psychopathology, and patients’ subjectivity has received limited attention to date. We used a novel methodology to explore dyadic conversations involving 58 participants (29 individuals with schizophrenia and 29 control persons) and medical doctors. High-quality stereo recordings were obtained and used to quantify turn-taking patterns. We investigated psychopathological dimensions and subjective experiences using the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), the Examination of Anomalous Self Experience scale (EASE), the Autism Rating Scale (ARS) and the Abnormal Bodily Phenomena questionnaire (ABPq). Different turn-taking patterns of both patients and interviewers characterised conversations involving individuals with schizophrenia. We observed higher levels of overlap and mutual silence in dialogues with the patients compared to dialogues with control persons. Mutual silence was associated with negative symptom severity; no dialogical feature was correlated with anomalous subjective experiences. Our findings suggest that individuals with schizophrenia display peculiar turn-taking behaviour, thereby enhancing our understanding of interactional coordination in schizophrenia.

INTRODUCTION:Individuals with schizophrenia present anomalies in the extension and plasticity of the peripersonal space (PPS), the section of space surrounding the body, shaped through motor experiences. A weak multisensory integration in PPS would contribute to an impairment of self-embodiment processing, a core feature of the disorder linked to specific subjective experiences. In this exploratory study, we aimed at: (1) testing an association between PPS features, psychopathology, and subjective experiences in schizophrenia; (2) describing the PPS profile in individuals with early-onset schizophrenia. MATERIALS AND METHODS:Twenty-seven individuals with schizophrenia underwent a task measuring the PPS size and boundaries demarcation before and after a motor training with a tool. The Positive And Negative Syndrome Scale (PANSS), the Examination of Anomalous Self Experience scale (EASE) and the Autism Rating Scale (ARS) were used to assess psychopathology. Subsequently, participants were divided into two subgroups, early and adult-onset schizophrenia. The two groups were compared in regard to their PPS and psychopathological profiles. RESULTS:PPS patterns were associated with psychopathology, particularly positively with PANSS negative scale score, and negatively with subjective experiences of existential reorientation (EASE Domain 5 scores) and of social encounters (ARS scores). Only PPS parameters and ARS scores differentiated between early and adult-onset participants. CONCLUSIONS:Our results, although preliminary and exploratory, can suggest a link between PPS patterns, negative symptoms, and disturbances of the subjective experience, particularly in the intersubjective domain, in schizophrenia. Moreover, they seem to suggest that specific PPS profiles and schizophrenic autism traits could be markers of early-onset schizophrenia.