The importance of loneliness in psychotic-like symptoms: Data from three studies

• Published in: Psychiatry research Vol. 282; p. 112625
• Main Authors: Le, Thanh P., Cowan, Tovah, Schwartz, Elana K., Elvevåg, Brita, Holmlund, Terje B., Foltz, Peter W., Barkus, Emma, Cohen, Alex S.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.12.2019
• Subjects: Adolescent; Adult; Ambulatory technology; Clinical medical disciplines: 750; Cross-Sectional Studies; Female; Hallucinations; Hallucinations - physiopathology; Humans; Klinisk medisinske fag: 750; Loneliness; Male; Medical disciplines: 700; Medisinske Fag: 700; Middle Aged; Psychiatry, child psychiatry: 757; Psychotic Disorders - physiopathology; Psychotic-like symptoms; Psykiatri, barnepsykiatri: 757; Schizotypal Personality Disorder - physiopathology; Schizotypy; VDP; Young Adult; Loneliness; Ambulatory technology; Psychotic-like symptoms; Schizotypy; Hallucinations
• ISSN: 0165-1781; 1872-7123; 1872-7123
• DOI: 10.1016/j.psychres.2019.112625

•Interactions among multidimensional schizotypy and loneliness predicting psychotic-like symptoms in undergraduate and patient samples were examined.•Trait schizotypy (e.g., positive, disorganized) exacerbated psychotic-like symptoms, but only for those with elevated loneliness.•Ambulatory approaches provide the opportunity for ecologically valid identification of risk states across psychopathology, thus informing early intervention. Poor social connection or loneliness is a prominent feature of schizotypy and may exacerbate psychosis risk. Previous studies have examined the inter-relationships between loneliness and psychosis risk, but critically, they have largely been conducted in non-clinical samples or exclusively used laboratory questionnaires with limited consideration of the heterogeneity within schizotypy (i.e., positive, negative, disorganized factors). The present study examined links between loneliness and psychotic-like symptoms across the dimensions of schizotypy through cross-sectional, laboratory-based questionnaires (Study 1; N = 160), ambulatory assessment (Study 2; N = 118) in undergraduates, and ambulatory assessment in inpatients in a substance abuse treatment program (Study 3; N = 48). Trait positive schizotypy consistently predicted cross-sectional and state psychotic-like symptoms. Loneliness, assessed via cross-sectional and ambulatory means, was largely linked with psychotic-like symptoms. Importantly, psychotic-like symptoms were dynamic: psychotic-like symptoms largely increased with loneliness in individuals with elevated positive and disorganized schizotypal traits, though there were some inconsistency related to disorganized schizotypy and state psychotic-like symptoms. Negative schizotypy and loneliness did not significantly interact to predict psychotic-like symptoms, suggesting specificity to positive schizotypy. Ambulatory approaches provide the opportunity for ecologically valid identification of risk states across psychopathology, thus informing early intervention.