Investigating the associations between personality functioning, cognitive biases, and (non-)perceptive clinical high-risk symptoms of psychosis in the community

Background. Beyond psychosis prediction, clinical high-risk (CHR-P) symptoms show clinical relevance by their association with functional impairments and psychopathology, including personality pathology. Impaired personality functioning is prioritized in recent dimensional personality disorder model...

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Main Authors: Rinaldi, Giulia (Author) , Lerch, Stefan (Author) , Schultze-Lutter, Frauke (Author) , Schmidt, Stefanie Julia (Author) , Cavelti, Marialuisa (Author) , Kaess, Michael (Author) , Michel, Chantal (Author)
Format: Article (Journal)
Language:English
Published: 22 January 2025
In: European psychiatry
Year: 2025, Volume: 68, Issue: 1, Pages: 1-12
ISSN:1778-3585
DOI:10.1192/j.eurpsy.2024.1812
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1192/j.eurpsy.2024.1812
Verlag, kostenfrei, Volltext: https://www.cambridge.org/core/journals/european-psychiatry/article/investigating-the-associations-between-personality-functioning-cognitive-biases-and-nonperceptive-clinical-highrisk-symptoms-of-psychosis-in-the-community/9015D0F7C457C7DC0C340D614E78B404
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Author Notes:Giulia Rinaldi, Stefan Lerch, Frauke Schultze-Lutter, Stefanie Julia Schmidt, Marialuisa Cavelti, Michael Kaess, and Chantal Michel

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520 |a Background. Beyond psychosis prediction, clinical high-risk (CHR-P) symptoms show clinical relevance by their association with functional impairments and psychopathology, including personality pathology. Impaired personality functioning is prioritized in recent dimensional personality disorder models (DSM-5, ICD-11), yet underexplored in CHR-P, as are associations with cognitive biases, which early studies indicate as possibly linking CHR-P-symptoms and personality pathology. Methods. A community sample (N = 444, 17–60 years, 61.8% female) was assessed via clinical telephone interview and online questionnaires. Using zero-inflated Poisson models, we explored associations of personality functioning, cognitive biases, current psychopathology, and psycho-social functioning with likelihood and severity of overall CHR-P, as well as perceptive (per-) and non-perceptive (nonper-)CHR-P-symptoms distinctly. Results. Higher nonnper-CHR-P-symptom likelihood was associated with more impaired personality functioning and psychosocial functioning, while more severe cognitive biases were associated with higher CHR-P- and per-CHR-P-symptom likelihood, alongside higher CHR-P- and nonper-CHR-P-symptom severity. Further, more axis-I diagnoses were linked to higher CHR-P-, per-CHR-P-, and nonper-CHR-P-symptom likelihood, and younger age to higher CHR-P- and per-CHR-P-symptom severity, with CHR-P-symptom severity appearing higher in females. In an exploratory analysis, personality functioning elements identity and self-direction, and cognitive biases dichotomous thinking, emotional reasoning, and catastrophizing, respectively, showed multifaceted associations with nonper-CHR-P-symptom likelihood and overall CHR-P-symptom expression. Conclusions. Our study supports the association of CHR-P-symptoms with multiple mental health factors. Findings suggest intricate associations between personality functioning impairments and cognitive biases with CHR-P-symptom expression in non-help-seeking populations, possibly contributing to different per-CHR-P- and nonper-CHR-P-symptom expression patterns. Therefore, they should be targeted in future longitudinal studies, aiming at better understanding CHR-P-manifestations to inform preventive intervention. 
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