Corresponding Author Information: Brynn Huguenel
Session Abstract: Background and Purpose: Paranoia, psychotic experiences, disorganized thinking, and associational quality are typically associated with schizophrenia and other psychosis-related disorders; however, such psychological traits are found across other psychiatric groups as well. Despite the prevalence of these traits, research has yet to explore how they may group together in a general outpatient population of adults. Further, identifying empirical indicators of psychological profiles can help clinicians and researchers to better understand the link between life events and personality. The purpose of this study was to explore psychological profiles related to schizophrenia (e.g., unusual sensory experiences, disorganized thinking) across diagnostic groups, and to examine connections between life span data and profile membership. It was hypothesized that three profiles would emerge 1) a group of patients who did not experience elevations for any of the paranoia or psychosis-related traits, 2) a group of patients who had both elevated paranoid and psychotic traits, and 3) a group of patients with elevated paranoid traits and social detachment. The connections between profile membership and life event data were exploratory in nature.
Subjects: This study included 894 outpatient adults who presented for psychological assessment at an academic medical center. Patients ranged from 16 to 92 years old (M=43.24, SD=15.65 years), and 54.2% identified as male. In terms of ethnic/racial background, 84.3% of patients identified as White, 5.2% as Latino, 4.8% as Black, 2.7% as Other, 2.4% as Asian American, and & 1% each as Native Hawaiian/Pacific Islander, American Indian/Alaskan Native, and mixed ethnicity.
Methods and Materials: Data used in this study were derived from patients' psychological assessments, which included a clinical interview and the administration of psychological and neuropsychological tests as part of a larger battery. Life history data was collected during the clinical interview, and all patients completed the Personality Assessment Inventory (PAI). The following six subscales of the PAI were included in the current study: paranoia- hypervigilance, paranoia- persecution, paranoia- resentment, schizophrenia- psychotic experience, schizophrenia- social detachment, and schizophrenia- thought disorder.
Analyses: Hierarchical cluster analysis with Ward's method was used to explore profiles of patients based on the paranoia and schizophrenia personality subscales. Chi-square analyses and independent t-tests were used to examine differences in life-space data between the profiles.
Results: Analyses identified a four-cluster solution based on the examination of the agglomeration coefficient. Profile 1 (non-clinical profile) included 27.5% of the sample (N=246) and was characterized by the lowest, non-clinical levels of all examined traits. Profile 2 (negative symptoms profile) captured 42.1% of the sample (N=376) and was characterized by clinically elevated social detachment and cognitive symptoms. Profile 3 (paranoid profile) included 17.6% of participants (N=157) and was marked by the highest levels of all traits, all of which, except psychotic experiences, were clinically elevated. Finally, profile 4 (cognitively impaired profile) captured 12.9% of participants (N=115) with clinically elevated thought disorder symptoms. Profile membership was significantly associated with patient marital status (chi-sqr(18)= 48.02, p - .001), education level (F= 22.13, p - .001), past suicide attempts (F= 3.00, p= .030), history of self-harm behaviors (chi-sqr(3)= 21.81, p - .001), and past trauma (chi-sqr(9)= 62.60, p - .001). Meanwhile, profile membership was not significantly associated with past homicide attempts or substance detoxification treatment.
Conclusions: This study suggests that psychological traits typically associated with psychotic disorders combine meaningfully into distinct profiles across a broad range of psychiatric patients. While a subset of patients did not exhibit any psychosis-related traits, the largest percentage of patients ‚Äùnearly half of the sample‚Äù exhibited traits of asociality and disorganized thinking. Further, the group of patients experiencing the most numerous psychosis-related traits may map onto patients experiencing disorders with psychotic symptoms (e.g., schizophrenia, bipolar disorder with psychotic features). Finally, the smallest group of patients included those who exclusively demonstrated impaired thought processes. Importantly, these profiles of psychological traits had meaningful connections across a range of life-space data, which will be further explored for the conference. Of note, the current sample is limited to a single hospital, the patients of which were predominantly White, and thus the findings may not be generalizable to other settings and populations. Future research would benefit from exploring how these profiles map onto different diagnostic categories, and to replicate the current findings using longitudinal data.
Brynn Huguenel | Massachusetts General Hospital, Boston, MA
Michelle Stein | Massachusetts General Hospital, Boston, MA
Mark Blais | Massachusetts General Hospital, Boston, MA
Brynn Huguenel, M.A. is a graduate student in Loyola University Chicago’s Clinical Psychology doctoral program and a current intern at Harvard Medical School/Massachusetts General Hospital.