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.

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).

Introduction According to current diagnostic systems, affective symptoms do not represent a fundamental criterion for the diagnosis of DD. However, numerous studies have highlighted frequent comorbidity between DD and Mood Disorders and have elucidated the importance of the affective state in the development and persistence of delusions. Thus, some factor analysis studies have identified the existence of a depressive dimension in DD, suggesting a substantial psychopathological heterogeneity in DD. However, these important affective features have not evaluated from a phenomenological point of view and in their relationship with delusions. Objectives The aim of the present study is to investigate the relationship between personality, trait affectivity and severity of delusions in patients with Delusional Disorder (DD). Methods Thirty-two outpatients affected by DD were administered the Structured Interview for DSM-IV-TR Personality Disorders (SIDP-IV), the Pathological Narcissism Inventory (NPI), the Positive and Negative Affect Schedule (PANAS) and the Psychotic Symptom Rating Scale (PSYRATS). Next, we analysed the prevalence of personality disorder in our sample of patients with DD and studied the correlations between the severity of delusions and the different affective variables. Finally, we obtained a multivariate explanatory model of the severity of the delusions. Results The severity of delusions was directly associated with “Grandiose Fantasy” item of narcissistic personality and inversely related with the feelings of shame, fear and guilt. In the multivariate model, the feeling of shame was the only independent variable capable of accounting for the severity of the delusions, that, in in DD patients, would lie on an affective core of shame. Table 2. Pearson correlation coefficient VARIABLES DRS total score GRANDIOSE FANTASY p = 0.045 SHAME p = 0.048 GUILT p = 0.016 AGITATION p = 0.049 FEAR p = 0.041 Table 3. Standardized coefficients in linear standard regression (DRS) DRS: total score R² β t p Step 1 0.157 - - - GRANDIOSE FANTASY - 0.396 1.89 0.048 Step 2 0.460 - - - GRANDIOSE FANTASY - 0.291 1.65 0.116 SHAME - -0.560 -3.17 0.005 Conclusions The severity of delusional beliefs in DD patients would lie on an affective core of shame upon predisposing personality traits. These findings could help to develop a psychotherapeutic approach for delusional patients focused in the feeling of shame. Disclosure of Interest None Declared

Through a strictly dimensional approach, the present study aimed at evaluating the interplay between cognitive-perceptual disturbances and emotional dispositions, particularly shame proneness, in schizophrenia delusion. One hundred one outpatients with schizophrenia were administered the Peters et al. Delusions Inventory, the Referential Thinking Scale (REF), the Magical Ideation Scale (MIS), the Perceptual Aberration Scale (PAS), the Positive and Negative Affect Schedule and the Experiences of Shame Scale (ESS). The severity of delusional ideation was positively related to all the cognitive-perceptual scales (REF, MIS, and PAS) and to shame proneness (ESS). Referential thinking (REF) emerged as the strongest predictor of delusion severity. The experience of shame played a mediation role in the relationship between cognitive-perceptual traits and delusional severity. These data suggest that severity delusion in schizophrenia depends, at least in part, on a complex interplay between cognitive-perceptual disturbances and experiences of shame.

Background Studies investigating obsessive-compulsive disorder from an ethological approach have highlighted a specific motor pattern of compulsive rituals with respect to corresponding ordinary behaviors. Particularly, compulsive motor profile is built through the repetition of acts, with prevalence of nonfunctional ones and redirection of attention to its basic structural units. These formal features would characterize ritual behavior throughout evolution, from nonhuman animals to human cultures. However, no study to date has investigated a possible relationship between such motor profile and underlying psychopathology. Therefore, the first objective of the study was to confirm previous findings on a larger sample size of obsessive patients; the second objective was to elucidate whether motor profile might be associated with obsessive-compulsive psychopathology and/or prepsychotic symptoms of schizophrenia. Methods Twenty-one obsessive-compulsive outpatients provided a videotape of their rituals. An equal number of healthy controls, matched for sex and age, were registered for corresponding ordinary acts. Obsessive patients were administered the Yale-Brown Obsessive-Compulsive Scale, the Brown Assessment of Beliefs Scale, the Hamilton Rating Scale for Depression, and the Frankfurt Complaint Questionnaire. Results The results of the present study confirm that ritual compulsions present a specific motor structure characterized by repetition of both functional and nonfunctional acts and their longer duration. Such a motor pattern is independent from obsessive-compulsive psychopathology, whereas it results specifically associated with prepsychotic symptoms of schizophrenia. Conclusions We argue that this association may reflect the adaptive significance of ritual behavior across evolution, that is, its homeostatic function in conditions of unpredictability.

Introduction Evidence from contemporary research has highlighted abnormal subjective pre-psychotic experiences as an expression of schizotropic vulnerability, for which trajectories up to First Rank Symptoms have been described. Embodiment is crucial to the conceptualisation of these experiences as the distinctive feature of schizophrenic phenomena. In fact, these are embedded in precise experiential frameworks such as Diminished Self-Affection and Hyperreflexivity, which constitute in nuce the experience of Dis-Embodiment. The latter responds poorly to conventional therapies, thereby affecting considerably the prognosis quoad valetudinem of Schizophrenia. Objectives This study is intended to explore the use of specific psychomotor therapy protocols aimed at fostering Embodiment in patients with Schizophrenia, especially by investigating its efficacy and specificity on self-perceived body disorders, on characteristic motor abnormalities and on psychopathological dimensions. Methods The study involves the participation of 20 patients throughout 10 weekly 90-minute meetings of Embodied Psychomotor Therapy (EPT) in groups of approximately 5 participants. Despite being partially inspired by current approaches, EPT is conceived as a specific activity intended for patients with schizophrenia: each meeting combines intersubjective coordination activities (complex motor sequences, harmonious control of voluntary movement and movement in space, body-awareness), intra-subjective coordination (mirroring, demarcation and identification of one’s own boundaries, single-group dynamics), and exercises aimed at developing motor skills (proprioception, balance, posture, rhythm and speed). At the beginning of the activity (T0) and after 10 meetings (T1) participants will carry out self-administered and externally administered assessments, for the evaluation of motor (BMS, LOFOPT, BBS, AIMS, SRRS), psychopathological (PANSS, FBF, ABP), social functioning (SOFAS) and daily physical activity level (IPAQ) dimensions. Results The study is still ongoing, due to limitations dictated by the Sars-CoV-2 pandemic. Preliminary results at T0 indicate a positive correlation between low levels of daily physical activity (IPAQ) and poor functioning (SOFAS). Significantly higher motor impairment with respect to the general population is also confirmed in all motor scales used. Moreover, a positive correlation between low levels of motor coordination (BMS_MC) and balance (BSS_TOT) was found together with basic symptoms related to loss of control or self-agency (FCQ_KO). Furthermore, the first results suggest an overall improvement in motor performance at T1. Conclusions The longitudinal analysis will enable the extent of the impact of EPT on functioning, motor and psychopathological dimensions of the patients to be determined, providing useful elements for planning specific rehabilitation interventions for schizophrenia. Disclosure of Interest None Declared

Compared to peers, children and adolescents with obsessive-compulsive disorder (OCD) are at increased risk of developing psychotic disorders. Yet very few studies have examined early indicators of psychosis in pediatric OCD. In the present study, 52 youth with a primary diagnosis of OCD (Mage = 15.66 [SD = 2.33], 59.6

Abstract Through a strictly dimensional approach, the present study aimed at evaluating the interplay between cognitive-perceptual disturbances and emotional dispositions, particularly shame proneness, in schizophrenia delusion. One hundred one outpatients with schizophrenia were administered the Peters et al. Delusions Inventory, the Referential Thinking Scale (REF), the Magical Ideation Scale (MIS), the Perceptual Aberration Scale (PAS), the Positive and Negative Affect Schedule and the Experiences of Shame Scale (ESS). The severity of delusional ideation was positively related to all the cognitive-perceptual scales (REF, MIS, and PAS) and to shame proneness (ESS). Referential thinking (REF) emerged as the strongest predictor of delusion severity. The experience of shame played a mediation role in the relationship between cognitive-perceptual traits and delusional severity. These data suggest that severity delusion in schizophrenia depends, at least in part, on a complex interplay between cognitive-perceptual disturbances and experiences of shame.

The aim of the present study is to investigate the relationship between personality, trait affectivity, and severity of delusions in patients with delusional disorder (DD). Thirty-two outpatients affected by DD were administered the Structured Interview for DSM-IV-TR Personality Disorders (SIDP-IV), the Pathological Narcissism Inventory (PNI), the Positive and Negative Affect Schedule (PANAS), and the Psychotic Symptom Rating Scale (PSYRATS). We analyzed the prevalence of personality disorder in our sample of patients with DD and studied the correlations between the severity of delusions and the different affective variables. Finally, we obtained a multivariate explanatory model of the severity of the delusions. The severity of delusions was directly associated with "grandiose fantasy" item of narcissistic personality and inversely related with the feelings of shame, fear, and guilt. In the multivariate model, the feeling of shame was the only independent variable capable of accounting for the severity of delusions that, in DD patients, would lie on an affective core of shame.

Insight in Obsessive–Compulsive Disorder (OCD) is currently viewed as a dimensional phenomenon, with poor-insight forms posited at the more severe end of a OCD continuum or, alternatively, as expression of an underlying schizophrenia spectrum. Aim of the present study was to evaluate exhaustively the role of clinical features of OCD (severity of obsessions and concomitant depressive symptoms) and of trait conditions (personality traits and basic symptoms of schizophrenia) on the levels of insight over obsessive–compulsive phenomena, adopting a pure dimensional approach. Fifty OCD outpatients were administered the Yale-Brown Obsessive Compulsive Scale (YBOCS), the Brown Assessment of Beliefs Scale (BABS), the Hamilton Rating Scale for Depression (HAM-D), the Frankfurt Complaint Questionnaire (FCQ) and the Structured Clinical Interview for DSM-5 (SCID-5). Current comorbid depressive or psychotic diagnoses represented exclusion criteria. Poor insight was significantly correlated with the severity of obsessive symptoms and with obsessive–compulsive and schizotypal personality traits, while no correlations were found with depressive symptoms or with prepsychotic subjective experiences of schizophrenia. OCD severity resulted the only predictor of poor insight, as confirmed by regression analysis. Therefore, even though poor-insight OCD may underpin different psychopathological pathways, poor-insight is mainly associated with a higher OCD severity.

Childhood-onset Obsessive-Compulsive Disorder (OCD) shows distinct comorbidity patterns and developmental pathways, as well as an increased risk of psychosis with respect to adult-onset forms. Nevertheless, little is known about the prodromal symptoms of psychosis in children and adolescents with a primary diagnosis of OCD. The present study was aimed at evaluating the occurrence of Cognitive-Perceptual basic symptoms (COPER) and high- risk criterion Cognitive Disturbances (COGDIS) in pediatric and adults OCD patients, verifying if they might vary according to the age of onset of OCD. The study included 90 outpatients with a primary diagnosis of obsessive-compulsive disorder. The study sample was collapsed into three groups according to the age at onset: 1) very early onset group (< 10 years); 2) early onset group (11-18 years); 3) adult-onset group (> 18 years). All patients were administered the Yale-Brown Obsessive- Compulsive Scale (Y-BOCS) and its Child version (CY-BOCS), the Schizophrenia Proneness Instrument-Adult (SPIA) and its Child and Adolescent version (SPI-CY) and the Social and Occupational Functioning Assessment Scale (SOFAS). COPER and COGDIS symptoms were positively associated with OCD severity and detectable, respectively, in 28.9 and 26.7% of our study sample. The very early onset group significantly had higher COPER and COGDIS symptoms than the adult-onset group. Our data suggest that COPER and COGDIS symptoms are frequent in obsessive patients, in particular in those with earlier onset; therefore, their detection in childhood-onset OCD may represent an early and specific indicator of psychotic vulnerability.

Introduction Delusions are a key feature of schizophrenia psychopathology. From a phenomenological approach, Jaspers (1913) differentiates between “primary” or true schizophrenic delusions, defined as an unmediated phenomenon that cannot be understood in terms of prior psychological origin or motivation, and “secondary” delusions, understandable from the patient’s mood state or personality. Primary delusions have been considered the hallmark of reality distorsion dimension in schizophrenia, disregarding a possible affective patwhay to delusional belief. Objectives The present study was aimed at elucidating the psychopathological trajectories to delusion in schizophrenia through the investigation of both affective and schizotypal trait dispositions. Methods Seventy-eight participants affected by schizophrenia were administered the Peters Delusional Inventory (PDI), the Positive and Negative Affective Scale (PANAS), the Experience of Shame Scale (ESS), the Referential Thinking Scale (REF), the Magical Ideation Scale (MIS) and the Perceptual Aberration Scale (PAS). Results The severity of delusional ideation (PDI) was positively related to both affective (PANAS positive dimension, ESS) and schizotypal traits (MIS, PAS and REF). Moreover, referential thinking (REF) mediated the relationship between “magical ideation” (MIS) and delusions severity (Fig. 1), whereas experience of shame (ESS) was a moderating factor in the between referential thinking and delusion severity (Fig. 2). Conclusions The study findings suggest that in schizophrenia patients, severity of delusions is underpinned by an intertwining of both affective and schizotypal pathways. Disclosure No significant relationships.

The objective of the study was to investigate the relationship between cognitive functions and obsessive-compulsive dimension in schizophrenia and a possible moderating effect of schizophrenia symptom dimensions on this association. Sixty-one schizophrenia patients were administered the Positive and Negative Syndrome Scale, the Yale-Brown Obsessive-Compulsive Scale (YBOCS), and the Matrics Consensus Cognitive Battery. A U-shaped curve described a gradual transition from an inverse association to a positive relationship between YBOCS and processing speed scores, along a severity gradient of obsessive dimension. This effect ("the obsessive paradox") was not moderated by other symptom dimensions. The present study suggests that severe obsessive-compulsive symptoms may participate to counterbalance processing speed impairment independently from other symptom dimensions. These results highlight the complexity of the relationship between cognitive and obsessive dimensions in schizophrenia.

The relationship between personality and Delusional Disorder in still debated. The present study aimed to evaluate the role of personality features and emotional dispositions on the proneness to delusional beliefs, through the lens of a dimensional approach. 91 outpatients were administered the Structured Interview for DSM-IV Personality Disorders, the Pathological Narcissism Inventory, the Positive and Negative Affect Schedule and the Peters et al. Delusions Inventory. Delusion proneness was positively related to the "Hiding the Self" domain of narcissistic vulnerability and to paranoid traits and negatively related to "Positive Affect". Paranoid traits and "Hiding the Self" significantly interacted in influencing delusion ideation. These data suggest that proneness to delusion depends, at least in part, on a complex interplay between specific emotional and paranoid dispositions within personality.

ObjectiveRecent research has suggested a dual impact of obsessive-compulsive dimension on functioning in schizophrenia with a gradual transition from an improving to a worsening effect depending on obsessive-compulsive symptom (OCS) severity (from mild to moderate-severe). Aim of the present study was to investigate whether this varying effect of OCS on functioning might be mediated or moderated by schizophrenia symptom dimensions or occur independently.MethodSeventy-five patients affected by schizophrenia were administered the SCID-IV, the PANSS, the YBOCS and the SOFAS.The sample was divided into two groups according to the severity of OCS (absent/mild and moderate/high).ResultsIn both groups, a significant interaction between OCS and disorganization dimension was found: the dual effect of OCS on functioning occurred only among patients with low disorganization symptoms while it was no more apparent at higher levels of disorganization (Figure 1).ConclusionData suggest that in patients with schizophrenia, functioning at least in part depends on the interaction between disorganization and OCS. Particularly, mild OCS contributes to higher levels of functioning in patients with psychosis at low levels of disorganization. In keeping with the historical concept of “pseudoneurotic schizophrenia”, we speculate that obsessive dimension might have a pathoplastic influence in milder forms of schizophrenia spectrum disorders, balancing the effect of underlying low disorganization symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

ObjectiveThe relationship between personality and delusional ideation in still debated. The present study was aimed to evaluate the role of personality features and trait affectivity on the severity of delusional beliefs, through the lens of a dimensional approach. In fact, robust evidence suggests that delusional experience presents a dimensional structure rather than an all-or-nothing fashion with a severity gradient of delusional beliefs from general population to full-blown delusional disorder (DD).MethodForty-nine inpatients affected by DD and 42 non-delusional outpatients were administered the structured interview for DSM-IV Personality Disorders, the Pathological Narcissism Inventory–Italian Version, the Positive and Negative Affect Schedule and the Peters et al. 33–Italian version.ResultsSeverity of delusional ideation was positively related to “hiding the self” (HS) domain of narcissistic vulnerability and to paranoid traits and negatively related to “positive affect” (PA). Paranoid traits and HS significantly interacted in influencing delusional dimension severity (Fig. 1). Low PA represents a trait affectivity of sadness and lethargy whereas HS is closely related to the experience of shame. We speculate that lower levels of PA and higher levels of HS may grasp the “asthenic” pole of Kretschmer's “sensitive character”.ConclusionThe study findings suggest that the severity of delusional ideation depends, at least in part, on a complex interplay between specific affective and paranoid dispositions within personality. Delusion may constitute the superficial shell, which develops from and cover inner affective vulnerabilities of personality.Fig. 1Disclosure of interestThe authors have not supplied their declaration of competing interest.

OBJECTIVE:Recent research has suggested a dual impact of obsessive-compulsive dimension on functioning in schizophrenia with a gradual transition from an improving to a worsening effect depending on obsessive-compulsive symptoms (OCS) severity (from mild to moderate-severe). Aim of the present study was to investigate whether this varying effect of OCS on functioning might be mediated or moderated by schizophrenia symptom dimensions or occur independently. METHOD:Seventy-five patients affected by schizophrenia were administered the Structured Clinical Interview for DSM-IV Disorders, the Positive and Negative Syndrome Scale, the Yale-Brown Obsessive-Compulsive Scale and the Social and Occupational Functioning Assessment. The sample was divided into two groups according to the severity of OCS (absent/mild and moderate/high OCS group). RESULTS:In both groups, the effect of OCS on functioning was not mediated by their effect on positive, negative or disorganization symptoms. Conversely, a significant interaction between OCS and disorganization dimension was found: the dual effect of OCS on functioning occurred only among patients with low disorganization symptoms while it was no more apparent at high levels of disorganization. CONCLUSION:Data suggest that in patients with schizophrenia, functioning at least in part depends on the interaction between disorganization and OCS.

The impact of obsessive–compulsive symptoms on functioning in schizophrenia is still debated. This study investigated the relationship between OC symptoms and functioning along a severity gradient of obsessive–compulsive dimension. Sixty patients affected by schizophrenia completed the SCID-IV, the Positive and Negative Syndrome Scale, the Yale-Brown Obsessive–Compulsive Scale and the Social and Occupational Functioning Assessment Scale. The relationship between functioning and obsessive–compulsive dimension was described by a reverse U-shaped curve; functioning was positively related to the presence of mild obsessive–compulsive symptoms and inversely related to moderate and severe symptoms, after controlling for the severity of positive, negative, disorganization and general psychopathological symptoms. The role of obsessive–compulsive symptoms on social functioning in schizophrenia occurs along a severity continuum with a gradual transition from a positive correlation (from absent to mild symptoms) to an inverse correlation (for symptoms ranging from moderate to severe) and independently from schizophrenia symptom dimensions.