<p>Cognitive impairments in schizophrenia (SZ) include abnormalities in executive function, attention, and semantic processing. Event-related potentials (ERPs) are used as neurophysiological measures of cognitive impairment that have been shown to map onto symptom dimensions of psychotic disorders, such as schizophrenia. While much research exists on schizophrenia, less is understood about the longitudinal relationships between ERPs and symptom dimensions among individuals at risk for psychosis. Of published work in risk samples, most have been cross-sectional, leaving clinical inferences regarding longitudinal patterns non-specific. The current study aimed to bridge this gap by recording ERPs (P300, ERN, N400) across a battery of tasks within a single risk sample, and measured positive, negative, and disorganized symptom severity via the Multidimensional Schizotypy Scale (MSS). Participants exhibiting psychosis-risk were recruited from the community (N=60), and completed a baseline and 6-month follow-up assessment (n=29). The primary goal of the baseline assessment aimed to replicate ERP-symptom dimension relationships observed in the SZ literature. Effect sizes for P300-positive and ERN-negative relationships were observed to be in the same directionality as noted in the clinical SZ literature. While not statistically significant, the small effects suggest that P300 and ERN may be similarly effected by presence of positive and negative symptoms, respectively. By contrast, N400, however, was found to have an effect size directionality opposite to that reported in the literature. This finding is consistent with mixed presentation of disorganized symptoms in clinical SZ populations. The follow-up assessment aimed to examine the relationship of symptom dimensions over time in a single at-risk sample, and leveraged ERPs as potential prospective predictors of worsening of symptoms. As expected, baseline symptoms prospectively predicted corresponding symptoms at follow-up. However, only N400 amplitude at baseline correlated with disorganized symptoms at follow-up, and no ERP prospectively predicted corresponding symptom dimensions at follow-up. Overall, examining the relationship between multiple ERPs and symptom dimensions in a single sample and via a longitudinal design is a novel addition to the literature. Future research will be necessary to clarify the use of ERPs as neural biomarkers to identify and predict symptom severity over time, ultimately reducing subjectivity in clinical diagnosis and treatment. </p>

Abstract Psychotic disorders usually become evident during adolescence and early adulthood and are commonly preceded by psychosis risk states. Young people at risk for developing psychosis may already have cognitive deficits. This research examined factors associated with psychosis risk and adverse cognitive performance, particularly in those at risk for developing psychosis. We aimed to characterise genetic risk factors for psychosis risk and adverse cognitive performance. Additionally, early and later biological risk markers for adverse cognitive performance and psychosis risk were explored. Two longitudinal birth cohorts, the Northern Finland Birth Cohort 1986 (NFBC 1986, n=6,985 at 16 years) and Avon Longitudinal Study of Parents and Children (ALSPAC, n=5,217 at 17 years), two NFBC 1986 sub-studies, the Oulu Brain and Mind 1 (n=182 for these analyses) and Oulu Brain and Mind 2 (n=471 for these analyses) studies, and two Irish case control studies, the Adolescent Brain Development (n=212) and Challenging Times (n=211) studies, were utilised. Predictors of interest were selected Single Nucleotide Polymorphisms (SNPs at COMT, BDNF and DRD2), prenatal exposure to maternal cigarette smoking (PEMCS) and adolescent metabolic measures. Though not directly associated with psychotic experiences, the COMT-Val158Met Val-Val genotype interacted with experience of childhood trauma to predict more psychotic experiences. Two DRD2 SNPs were associated with poorer cognitive performance, though only in those with risk for psychotic disorders. PEMCS was associated with adult vocabulary and matrix reasoning performance in males, though not in males with adolescent psychotic experiences. Adolescent academic performance, but not psychotic experiences, were associated with metabolic measures, especially with ratios of omega-3 to total fatty acids. These findings impact on prevention strategies for long-term adverse outcomes. Some risk factors differ for those with psychotic experiences compared to the general population, while others do not. SNPs at COMT and DRD2 may be more relevant in those with psychotic experiences. Interventions targeting these groups may be particularly beneficial. Smoking in pregnancy, however, is harmful to male cognitive performance across the population, suggesting elimination of this risk is more broadly relevant. Fatty acid-related metabolic measures may mark risk for cognitive deficits or may represent a developmental feature that is potentially open to intervention. / Tiivistelmä Psykoottiset häiriöt puhkeavat tavallisesti nuoruusiässä tai varhaisessa aikuisiässä. Varsinaista psykoosijaksoa edeltää usein psykoosialttiusvaihe. Nuoruusiän psykoosialttiusvaiheeseen liittyy kognitiivisia puutoksia. Tässä tutkimuksessa selvitettiin tekijöitä, jotka liittyvät psykoosialttiuteen ja heikkoon kognitiiviseen suoriutumiseen, etenkin nuorilla, jotka olivat psykoosiriskissä. Tutkimuksessa tarkasteltiin psykoosialttiuteen ja heikkoon kognitiiviseen suoriutumiseen liittyviä geneettisiä tekijöitä. Lisäksi tutkittiin biologisia varhaisia ja myöhempiä psykoosialttiutta ja heikkoa kognitiivista suoriutumista ennustavia tekijöitä. Tutkimusaineisto käsitti kaksi pitkittäistä syntymäkohorttia: Pohjois-Suomen syntymäkohortti 1986 (n=6,985 16-vuotiaana) ja englantilainen Avon Longitudinal Study of Parents and Children (ALSPAC, n=5,217 17-vuotiaana) -tutkimukset. Pohjois-Suomen syntymäkohortti 1986:sta analysoitiin kahta ala-otosta eli Aivot ja Mieli I (n=182) ja Aivot ja Mieli II (n=471) tutkimusta. Lisäksi tutkimusaineistoon kuului kaksi irlantilaista tapaus-verrokki tutkimusta: Adolescent Brain Development (n=212) ja Challenging Times (n=211) tutkimukset. Ennustavina tekijöinä tarkasteltiin yhden nukleotidin polymorfismia (Single Nucleotide Polymorphisms, SNP; COMT, BDNF ja DRD2 -geeneissä), äidin raskaudenaikaista tupakointia, lapsuuden traumaattisia kokemuksia ja nuoruusiän metabolisia arvoja. COMT-Val158Met geenin Val-Val genotyyppi ei ollut suoraan yhteydessä psykoottisiin kokemuksiin, mutta yhdessä lapsuuden traumaattisten kokemusten kanssa ennusti suurempaa psykoosioireiden määrää. Kaksi DRD2 SNP-varianttia assosioituivat heikompaan kognitiiviseen suoriutumiseen, vaikkakin vain tutkittavilla jotka olivat psykoosialttiita. Äidin raskaudenaikainen tupakointi ennusti huonompaa kognitiivista suoriutumista pojilla, tosin ei pojilla joilla oli nuoruusiässä psykoosioireita. Metaboliset tekijät, erityisesti omega-3 rasvahapon suhde kokonaisrasvahapon määrään oli yhteydessä koulumenestykseen. Tutkimuksen tulosten perusteella voidaan mahdollisesti suunnitella ennaltaehkäiseviä toimia myöhempien haittojen ehkäisemiseksi. Jotkut tutkituista riskitekijöistä assosioituivat eri tavalla kognitioon psykoosialttiilla kuin yleisväestössä. COMT ja DRD2 geenien variantit psykoosialttiilla saattavat olla keskeisiä. Interventiot nuorille, joilla on nämä variantit ja psykoosioireita, voisivat olla erityisesti hyödyllisiä. Äidin raskauden aikaisen tupakointi ennusti poikien kognitiivista suoriutumista. Äidin raskaudenaikaisen tupakoinnin vähentämisellä olisi suotuinen vaikutus tässäkin suhteessa. Rasvahappoihin liittyvät metaboliset suureet voivat olla riski kognitiivisille puutoksille tai ne voivat merkitä kehityksellistä piirrettä, joka voisi mahdollistaa varhaisen ennaltaehkäisyn.

Cannabis use is considered a component cause of psychotic disorder interacting with genetic and environmental risk factors in increasing psychosis risk (Henquet et al., 2008). Recently, two cross-sectional and one prospective study provided evidence that cannabis use interacts additively with trauma to increase psychosis risk (Houston et al., 2008, Harley et al., 2010 and Konings et al., 2011). In an attempt at further replication, we examined prospective data from the German Early Developmental Stages of Psychopathology (EDSP) study (Wittchen et al., 1998b and Lieb et al., 2000).

Family functioning has long been a focus of research in psychopathology. Decades of research has shown that family factors are associated with symptom severity, relapse, functional outcomes, and conversion to psychosis among at-risk individuals. Previous studies suggest family functioning varies across cultures, which raises the possibility that associations between family factors and psychopathology may also differ by culture. Furthermore, family functioning assessment generally involves instruments that have not been systematically validated for use with individuals from diverse cultural backgrounds. The current study used data from the Adolescent Brain Cognitive Development study (N = 11,138) to: (1) evaluate three family functioning scales (i.e., Family Environment Scale, Child's Report of Parental Behavior Inventory, Parental Monitoring Survey) and the Prodromal Questionnaire – Brief Child version for measurement invariance across racial/ethnic groups; (2) investigate the relations between family factors and psychosis; and (3) compare relations derived from Step 2 between racial/ethnic groups. Full scalar invariance was tenable for the CRPBI and the PQ-BC, providing statistical support for mean comparisons across groups. The FES and the PMQ lacked scalar invariance, which suggests mean comparisons across groups may not be appropriate. The CRPBI and the PMQ are significantly associated with the PQ-BC, and all three family scales had equivalent relations with the PQ-BC across groups. The current study highlights the importance of evaluating assessment instruments for measurement invariance across racial/ethnic groups. Results also help to connect specific family factors to the etiology of psychotic disorders among US children and adolescents.

Background. Evidence suggests that in affective, non-psychotic disorders: (i) environmental exposures increase risk of subthreshold psychotic experiences (PEs) and strengthen connectivity between domains of affective and subthreshold psychotic psychopathology; and (ii) PEs are a marker of illness severity. Method. In 3021 adolescents from the Early Developmental Stages of Psychopathology cohort, we tested whether the association between PEs and presence of DSM-IV mood disorder (MD)/obsessive–compulsive disorder (OCD) would be moderated by risk factors for psychosis (cannabis use, childhood trauma and urbanicity), using the interaction contrast ratio (ICR) method. Furthermore, we analysed whether the interaction between environment and PEs was mediated by non-psychotic psychopathology. Results. The association between PEs and MD/OCD was moderated by urbanicity (ICR = 2.46, p = 0.005), cannabis use (ICR = 3.76, p = 0.010) and, suggestively, trauma (ICR = 1.91, p = 0.063). Exposure to more than one environmental risk factor increased the likelihood of co-expression of PEs in a dose–response fashion. Moderating effects of environmental exposures were largely mediated by the severity of general non-psychotic psychopathology (percentage explained 56–68%, all p < 0.001). Within individuals with MD/OCD, the association between PEs and help-seeking behaviour, as an index of severity, was moderated by trauma (ICR = 1.87, p = 0.009) and urbanicity (ICR = 1.48, p = 0.005), but not by cannabis use. Conclusions. In non-psychotic disorder, environmental factors increase the likelihood of psychosis admixture and helpseeking behaviour through an increase in general psychopathology. The findings are compatible with a relational model of psychopathology in which more severe clinical states are the result of environment-induced disturbances spreading through a psychopathology network.

Abstract Schizophrenia and other psychotic disorders are severe and disabling mental disorders that break out during early adulthood, often when a person is in his/her early 20s. Furthermore, functional decline in many cognitive areas, including the ability to communicate in social interactions and impaired facial expression recognition, is typical to patients with schizophrenia. Understanding the risk factors of psychosis is essential as these disorders may be more amenable to treatment in their early stages. However, recognition of those at the highest risk of psychosis is challenging as no definitive biomarkers are available. Functional MRI is a promising tool that can potentially identify neural signals relating to the individual’s risk of psychosis onset. Psychotic disorders are etiologically heterogeneous disorders — both environmental and genetic factors have been linked to the onset of psychotic disorders. The most influential risk factor for a psychotic disorder is familial risk with genetic loading. The present study examines whether familial risk of psychosis (FR), the polygenic risk score for schizophrenia (PRS) and early adversity associate with brain response to faces. We used fMRI to measure blood oxygen level dependent (BOLD) response to faces. Our study showed that FR associated with deviant prefrontal cortex BOLD responses. In addition, we detected that interregional BOLD signal and grey matter volume varied as a function of PRS; the lowest functional and structural covariance was detected in individuals with high PRS. We also detected that early adversities associated with brain response to faces and that this association varied as a function of glucocorticoid receptor gene expression. Our findings indicate that the above risk factors of psychosis associate with brain response to faces. / Tiivistelmä Skitsofrenia ja muut psykoosisairaudet ovat vakavia mielenterveyden häiriöitä, jotka puhkeavat usein nuorella aikuisiällä. Eräs tyypillinen piirre psykoosisairauksille on vaikeus tunnistaa muiden ihmisten kasvonilmeitä. Psykoosisairauksien riskitekijöiden ymmärtäminen on tärkeää, sillä hoito tehoaa parhaiten sairastumisen alkuvaiheessa. Suurimmassa psykoosivaarassa olevien henkilöiden tunnistaminen on kuitenkin haastavaa, sillä luotettavia tautiin liittyviä biomarkkereita ei ole saatavilla. Toiminnallinen magneettikuvaus (fMRI) on lupaava työkalu, jolla saattaa olla tulevaisuudessa käyttöarvoa psykoosivaaraan liittyvien aivomuutosten tunnistamisessa. Etiologialtaan psyykoosisairaudet ovat heterogeenisiä: sekä ympäristö että perinnölliset tekijät vaikuttavat yksilön sairastumisriskiin. Voimakkain riskitekijä on suvullinen psykoosialttius. Tässä osajulkaisuväitöskirjassa tutkitaan suvullisen psykoosialttiuden, skitsofrenian polygeenisen riskipisteen (PRS) sekä varhaisten vastoinkäymisten yhteyttä aivojen kasvonilmeitä tulkitsevaan järjestelmään. Tutkimuksessa on hyödynnetty fMRI-kuvausta kasvonilmestimuluksen aikana. Tutkimuksessamme suvullinen psykoosialttius oli yhteydessä etuotsalohkon fMRI-signaalimuutoksiin. Tämän lisäksi havaitsimme, että kasvonilmejärjestelmän fMRI-signaalin ja harmaan aineen kovarianssi oli yhteydessä PRS:ään: matalin aivoalueiden välinen korrelaatio havaittiin henkilöillä, joiden PRS oli korkea. Havaitsimme myös, että varhaiset vastoinkäymiset ovat yhteydessä kasvonilmeiden aikaansaamiin aivovasteisiin. Tämä assosiaatio oli myös yhteydessä glukokortikoidireseptorin geenin ilmentymiseen. Väitöskirjan löydökset viittaavat siihen, että edellä mainitut psykoosin riskitekijät ovat yhteydessä kasvonilmeitä tulkitsevaan järjestelmään.