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Comprehensive Psychiatry 65 (2016) 44 49
www.elsevier.com/locate/comppsych

Anomalous self-experiences and their relationship with symptoms,


neuro-cognition, and functioning in at-risk adolescents and young adults
Anna Comparelli a,, Valentina Corigliano a , Antonella De Carolis b , Daniela Pucci a ,
Massimiliano Angelone c , Simone Di Pietro a , Giorgio D. Kotzalidis a , Laura Terzariol d ,
Luigi Manni d , Alberto Trisolini d , Paolo Girardi a
a
Sapienza UniversityRome, School of Medicine and Psychology, NESMOS Department (Neurosciences, Mental Health and Sense Organs), and Unit of Psychiatry,
SantAndrea Hospital, Rome, Italy
b
Sapienza UniversityRome, School of Medicine and Psychology, NESMOS Department (Neurosciences, Mental Health and Sense Organs), and Unit of Neurology,
SantAndrea Hospital, Rome, Italy
c
Residential Care Home San Raffaele, Unit of Psychiatry, Montecompatri, Rome, Italy
d
Department of Mental Health, ASL of Viterbo, Italy

Abstract

Empirical and theoretical studies support the notion that anomalous self-experience (ASE) may constitute a phenotypic aspect of vulnerability to
schizophrenia, but there are no studies examining the relationship of ASE with other clinical risk factors in a sample of ultra-high risk (UHR)
subjects. The aim of the present study was to explore the relationship between ASE, prodromal symptoms, neurocognition, and global functioning
in a sample of 45 UHR adolescents and young adults (age range 1525 years) at first contact with Public Mental Health Services. Prodromal
symptoms and global functioning were assessed through the SIPS interview. ASE was evaluated through the Examination of Anomalous
Self-Experience (EASE); for neurocognition, we utilized a battery of tests examining seven cognitive domains as recommended by the
Measurement And Treatment Research to Improve Cognition in Schizophrenia.
In the UHR group, higher levels in two domains of the EASE (stream of consciousness and self-awareness) were found in comparison
with help-seeking subjects. Correlational analysis corrected for possible confounding variables showed a strong association (p N 0.001)
between higher EASE scores and global functioning. A principal factor analysis with Varimax rotation yielded a two-factor solution, jointly
accounting for 70.58% of the total variance in the UHR sample. The first factor was comprised of SOPS domains, while the second was
comprised of EASE-total, EASE-10, and GAF variables. Our findings provide support for the notion that disorders of self-experience are
present early in schizophrenia and are related to global functioning. As such, they may constitute a potential marker of risk supplementing the
UHR approach.
2015 Elsevier Inc. All rights reserved.

1. Introduction attenuated or brief self-limited psychotic symptoms, the first


episode of psychosis is generally preceded by a prodromal
In schizophrenia, the development of standardized assess- phase that is characterized by non-specific negative symptoms,
ment instruments and specific criteria defining the so-called difficulty in social and age-appropriate role functioning,
ultra-high risk (UHR) paradigm [1] with good predictive self-experienced cognitive symptoms, and impaired neuro-
validity has encouraged research on early detection and and social cognition.
establishment of early recognition and intervention worldwide. Although the UHR approach has shown diagnostic validity
The resulting perspective research has confirmed that, as well as and feasibility of prospective ascertainment of individuals at
risk for psychosis [2,3] and provided a platform for studies
assessing the risks and benefits of early interventions [4,5],
Corresponding author at: NESMOS Department, Sapienza University,
there is a wide consensus that it suffers from several conceptual
2nd Medical School, SantAndrea Hospital, Via di Grottarossa 1035-1039, and methodological shortcomings that need to be addressed in
00189 Rome, Italy. Tel. +39 0633775664; fax: +39 0633775342. order to improve its scientific and clinical utility. In fact, UHR
E-mail address: anna.comparelli@uniroma1.it (A. Comparelli). predictive criteria, which use increasing intensity of positive
http://dx.doi.org/10.1016/j.comppsych.2015.09.011
0010-440X/ 2015 Elsevier Inc. All rights reserved.
A. Comparelli et al. / Comprehensive Psychiatry 65 (2016) 4449 45

psychotic symptoms to predict psychosis, in contrast to a Table 1


comprehensive psychopathological theory about the nature of Demographic and psychopathological features of the sample.
psychosis, are rather limited in their informative value about UHR(45) HS (70) P value
the phenotypic markers of vulnerability for psychosis. (SE) (SE)
Moreover, there is a large body of evidence that calls into Age 21.04 (0.4) 20.63 (0.3) 0.4
question the specificity of attenuated psychotic symptoms, Sex (Males) 22 (48.9%) 42 (60%) 0.2
Education 12.40 (0.3) 11.00 (0.3) 0.009
which are quite common in a broad range of non-psychotic
Unusual Thought Content (SOPS P1) 2.76 (0.1) 1.11 (0.1) b0.001
psychiatric conditions [6] and even in the general population Suspiciousness (SOPS P2) 2.09 (0.2) 1.46 (0.1) 0.02
[7]. Addressing these problems has become increasingly Grandiosity (SOPS P3) .91 (0.2) .43 (0.1) 0.08
important in light of the reducing rates of transition to Perceptual Abnormalities (SOPS P4) 1.09 (0.2) 0.71 (0.1) 0.2
psychosis and growing number of false positives in more Disorganized Communication (SOPS P5) 1.09 (0.2) .40 (0.1) 0.01
EASE 1 19.02 (2.0) 9.03 (1.1) b0.001
recent UHR cohorts [8].
EASE 2 24.73 (1.9) 14.73 (1.4) b0.001
Empirical and theoretical studies support the notion that EASE 3 2.64 (0.5) 2.12 (0.3) 0.04
anomalous self-experience (ASE) may constitute a phenotypic EASE 4 1.71 (0.4) .88 (0.2) 0.08
aspect of vulnerability to schizophrenia [9]. Recent prospective EASE 5 3.04 (0.6) 1.91 (0.6) 0.2
findings suggest that identifying ASE in a UHR population EASE total 51.09 (4.4) 28.67 (4.6) 0.001
EASE 10 subscale 12.3 (1.4) 6.8 (6.9) 0.02
may provide a means of further closing in on individuals who
Diagnosis (DSM-IV)
are truly at high risk of psychotic disorders, and particularly of Anxiety Disorders 10 18
schizophrenia spectrum disorders [10]. However, there are Relational Problems 5 17
currently no empirical data that elucidate how UHR criteria and Personality Disorders 12 16
ASE might differentially characterize the risk for psychosis. Adjusting Disorders 1 9
Affective Disorders 16 7
In this study, we examined the relationship between ASE
Eating Disorders 1 3
and other clinical risk factors for psychosis. More specifically,
our aims were: (1) to compare the prevalence and nature of
ASE between a group of non-psychotic, help-seeking neurological disorders; (5) current drug abuse. Of the 159
adolescents and young adults and a group of UHR subjects; subjects initially screened, 39 were excluded for current
(2) to examine the relationship between ASE and other risk substance abuse, 11 presented a diagnosis of current or past
factors such as prodromal negative, disorganized and general psychosis and 4 presented with severe medical conditions,
symptoms, global functioning, and neurocognitive impairment neurological disease, or past diagnosis of developmental
in a group of UHR patients; (3) to examine the mutual disorder. Forty-five patients met the criteria for psychosis risk
relationships between ASE and the domains of clinical risk syndrome according to McGlashan et al. [11], based on the
encompassed in the UHR paradigm. In this way, we expect to presence of Attenuated Psychotic Symptoms (APS), Brief
improve the informative value of the phenotypic markers for Intermittent Psychotic Symptoms (BIPS), or functional decline
vulnerability to psychosis. and family history of schizophrenia or Schizotypal Personality
Disorder (Genetic Risk and Deterioration, GRD). The UHR
group was stratified as follows: 35 (78%) in the APS group,
2. Materials and methods 4 (9%) in the GRD group, 1 (2%) in the BLIPS group, and
2.1. Subjects 5 (11%) in both the APS and the GRD groups. Based on the
Structured Interview for DSM-IV Disorders-I (SCID-I) [12],
The population recruited for this study included 159 patients met the diagnoses shown in Table 1. Patients were free
adolescents and young adults who consecutively came to seek from any psychotropic medication at the time of first
help for emotional and behavioral difficulties in two clinical evaluation. All participants (or a stable guardian for minors)
outpatient settings: (1) the Outpatient Clinic for Psychosis provided informed consent for participation in the study and
Prevention at SantAndrea Hospital in Rome; (2) the publication of results. The research was approved by the local
Adolescent Care Unit at the Mental Health Service of Viterbo. Ethics Committee.
Data were collected as part of an ongoing prospective clinical
trial on prevention of mental health disorders.
2.2. Assessment
Enrolled patients met all of the following criteria: (1) first
contact with the mental health service; (2) age between 15 2.2.1. Psychopathology
and 25 years; (3) a level of understanding that was sufficient Data on socio-demographic and psychopathological
to communicate with investigators and to understand the variables were collected at clinical interview. Criteria for
nature of the study. prodromal syndrome were determined using the Italian
Exclusion criteria included: (1) current or past diagnosis of version of the Structured Interview for Psychosis Risk
psychosis; (2) comorbid or past diagnosis of autistic disorder Syndrome (SIPS) [13,14], including the Scale of Prodromal
or other pervasive developmental disorder; (3) history of Symptoms (SOPS). The SIPS also includes the Global
severe head injury; (4) severe medical conditions or major Assessment of Functioning (GAF) scale, used to determine
46 A. Comparelli et al. / Comprehensive Psychiatry 65 (2016) 4449

the general level of current functioning and functional Table 2


deterioration, which is operationally defined as a 30% or Neuropsychological test battery according to the domains of the Measurement
and Treatment Research to Improve Cognition in Schizophrenia.
greater decrease in the GAF score during the last 12 months.
The raters (A.C. and V.C.) are expert clinicians trained in the Cognitive domain Variables
administration of the SIPS/SOPS. Cohen's for inter-rater Speed of processing
reliability was 0.85. Trail Making Test-A subtest (TM A) 1. time in seconds
(nonverbal) [32]
For qualitative and quantitative semi-structured phenome-
Stroop Word Test (Stroop W): word 2. number of words read correctly
nological exploration of ASE the Italian version of Examination reading (verbal) [33] in 30 s
of Anomalous Self- Experience (EASE) [15] was used. The Verbal Phonemic Fluency (all words 3. sum of words produced in 60 s
EASE [16] consists of 57 main items and explores five starting with F, P, and L) [34]
overlapping domains of experience: (1) stream of conscious- Sustained attention/vigilance
Wisconsin Card Sorting Test 4. number of non perseverative
ness; (2) sense of presence/basic identity; (3) bodily experience;
(WCST) [35] errors (NPEs)
(4) sense of demarcation; (5) existential reorientation and Working memory
solipsistic experiences. The raters (M.A. and S.D.P.) are expert Corsi block test: spatial span [36] 5. raw score correct
clinicians trained in the administration of the EASE. Cohen's Trail Making B-A subtest 6. differential score between
for inter-rater reliability was 0.78. (TM B-A) [32] subtests B and A
(time in seconds)
According to Koren et al. [17], for our analysis we selected
Verbal learning
10 EASE items (EASE-10) that reflect most prototypically the Buschke Verbal Selective Reminding 7. delayed recall 15 min after
disorders of self-experience. These comprised: (1) hyper- Test (BVSRT) [37] 6 learning trials
reflectivity; (2) loss of common sense/perplexity; (3) mirror- Visual learning
related phenomena; (4) loss of thought ipseity (i.e. directly ReyOsterrieth Complex Figure 8. delayed recall after 15 min
(ROCF) [38]
given, pre-reflective sense of mineness); (5) spatialization of
Reasoning and problem solving
experience; (6) ambivalence; (7) diminished sense of basic WCST [35] 9. number of completed
self; (8) loss of first person perspective; (9) perceptualization categories (CCs)
of inner speech; and (10) thought pressure. Raven's Colored Progressive 10. number of correct answers
Matrices (RCPM) [21]
Social cognition
2.2.2. Neuropsychological measures Facial Affect Recognition (FAR): 11. sums of named (subtest A)
In the UHR group, neuropsychological assessment was photographs of emotional faces and and recognized
carried out according to the recommendations of the emotion labels were presented on a (subtest B) emotions
Measurement And Treatment Research to Improve Cogni- computer screen. Participants were
asked to choose 1 of 6 emotions
tion in Schizophrenia (MATRICS) [18,19], including the
explicitly specified on the monitor
exploration of seven domains, e.g. speed of processing, for a given face (subtest A) or to
sustained attention/vigilance, working memory, verbal select 1 of 6 faces that corresponded
learning, visual learning, reasoning/problem-solving, and to the emotion displayed
social cognition [20]. The tests used and the parameters (subtest B) [39]
considered for each domain are described in Table 2. Current
IQ was estimated using Raven's Standard Progressive
Matrices [21]. Minimum initial eigenvalues 1.0 and reliability (Cronbachs
alpha) of factors N0.7 were the criteria used to determine the
2.3. Statistical analysis number of factors retained in each model. To be included in
a given factor, an item had to possess a factor loading N0.50
Differences between UHR and HS patients in socio- in its factor. A factor, to qualify as such, had to possess an
demographic and psychopathological features were analyzed eigenvalue N N 1. A significance level of 0.05 was used for all
using a t-test for independent samples (pretesting for homoge- statistical tests, and two-tailed tests were applied. Tests were
neity of variance). In the UHR subgroup, we correlated the carried out using the Statistical Package for Social Sciences
EASE-total and EASE-10 scores with SOPS positive, negative, software program version 17.0.1 (SPSS Inc. Chicago, IL).
disorganized, and general subscale scores, with neurocognitive
domain z-scores, and with global functioning. Correlations were
corrected for possible confounding variables (age, years of 3. Results
education, and IQ). A Bonferroni correction was performed on
the multiple correlational analysis. Finally, the mutual relation- Data on socio-demographic and psychopathological
ships between all domains of clinical risk were assessed using (SOPS and EASE) features of the sample are presented in
an exploratory principal component analysis (PCA) with a Table 1. Prodromal patients and HS subjects did not differ
Varimax rotation. Seven variables were entered in the PCA for sex and age, whereas years of education were
(SOPS Pos, SOPS Neg, SOPS Dis, SOPS Gen, EASE-total, significantly higher in the UHR group. As expected, the
EASE-10, GAF). two subgroups differed significantly for SOPS items P1, P2,
A. Comparelli et al. / Comprehensive Psychiatry 65 (2016) 4449 47

Table 3
Correlation between Anomalous Self-Experiences and psychopathology, functioning and neuropsychological domains and in the UHR sample.
SOPS Pos SOPS Neg SOPS Dis SOPS Gen GAF SP WM SA VeL ViL R&PS SC
EASE-total .485 .049 .139 .137 .602 253 .124 .287 .049 .094 .357 .043
EASE-10 .182 .064 .044 .013 .599 .077 .247 .202 .131 .006 .250 .151
SP: Speed of Processing; WM: Working Memory; SA: Sustained Attention; VeL: Verbal Learning; ViL: Visual Learning; R&PS: Reasoning and Problem
Solving; SC: Social Cognition.
p b 0.05.
p b 0.001.

and P5. The level of ASE was significantly higher in the The two groups differed for being or not at risk for an
UHR group than in HS-non UHR subjects for EASE impending psychosis.
domains 1 and 2, EASE-total score, and the EASE-10 As expected, ASE was present in the entire sample, but in
subscale. In the UHR subgroup, the mean IQ and GAF the UHR group scores were significantly higher in the first and
scores were 99.42 (SD = 7.75) and 57.75 (SD = 8.11), second domains of EASE, i.e. stream of consciousness and
respectively. Among UHR subjects, partial correlations self-awareness. Nelson et al. [10] showed that the level of all
between ASE domains and psychopathological features EASE domains was significantly higher in a group of UHR
showed that higher EASE total score correlated with higher subjects compared with healthy volunteers; interestingly, in
SOPS Positive score (p b 0.05); higher EASE total and the same study, stream of consciousness, and self-awareness
EASE-10 scores were correlated with a lower GAF score predicted the onset of illness over a mean follow-up of
(p b 0.001). No significant correlations were found between 1.5 years in the UHR group.
EASE total and EASE 10 scores and neuropsychological In agreement with previous reports, these results provide
measures (Table 3). After Bonferroni correction (all further support for the notion that disorders of self-experience
p b 0.001), only the association between EASE-total and are present early in the illness and, as such, may constitute a
EASE-10 scores with the GAF score retained statistical potential marker of risk supplementing the UHR approach.
significance. Since ASE, as a possible phenotypic precursor of schizophrenia,
The factorial analysis of prodromal symptoms, ASE, and is qualitatively different from subthreshold psychosis, it may
functioning yielded a two-factor solution, jointly accounting have the potential to introduce further specificity into current
for 70.58% of the total variance in the entire sample. The first high-risk identification strategies. This hypothesis is also
factor was comprised of SOPS domains, and was thus termed advanced by Koren et al. [17] who proposed that ASE is a
prodromal symptoms. The second factor was comprised of trait-marker and predicts schizophrenia or schizotypy, whereas
EASE-total, EASE-10, and GAF variables, and was termed prodromal symptoms are general markers of psychosis (across
ASE/functioning (Table 4). diagnostic categories). In this view, our study may be
considered an extension of the previous cited report [17].
The second and most important finding of the present study
4. Discussion is that in the UHR group higher levels of ASE are associated
with lower global functioning. This result is strongly confirmed
The first aim of this study was to compare the level of by both statistical and factor analyses. In the literature, there are
ASE in two groups of help-seeking adolescents and young two studies exploring this relationship, even if in quite different
adults at their first admission to public psychiatric services. cohorts. The first [17] examined this relationship in a sample of
help-seekers and found a relationship between EASE-10 and
Table 4 total scores with social and role functioning measures; the
Factor analysis. second study [22] showed that high levels of ASE were
Component significantly associated with poorer social functioning in the
1 2 early phases of schizophrenia and psychotic bipolar disorder
regardless of diagnosis. Of note, Velthorst et al. [23]
SOPS Pos .697 .433
SOPS Neg .800 .061 demonstrated that transition to psychosis in UHR patients is
SOPS Dis .888 .013 strongly predicted by lower global functioning scores as
SOPS Gen .678 .103 measured by the GAF. Consistent with other reports [24,25] it
EASE-total .108 .938 has been shown that level of functioning, as measured by the
EASE-10 .130 .906
GAF, improved with symptomatic remission in false positive
GAF .472 .644
UHR. Such a phenomenon may be highly improbable in
Extraction method: principal component analysis. Rotation method: subjects that are at true UHR for psychosis, as decreased levels
Varimax with Kaiser normalization.
Primary loadings are in bold typeface.
of functioning have been a persistent core phenomenon along
Explained variance (extraction sums of squared loadings): the entire prodrome of at-risk subjects who later converted to
Whole sample: Total = 70.58% (factor 1 = 37.49%; factor 2 = 33.09%). psychosis [26].
48 A. Comparelli et al. / Comprehensive Psychiatry 65 (2016) 4449

On the whole, our findings appear to be in agreement with research may indicate the specific role of clinical risk
the hypothesis of Koren et al. [17], suggesting that in UHR markers in prediction of long-term outcome.
subjects the presence of self-disturbances, with concomitant
low functioning, may represent a more specific, even if less
sensitive, condition of risk. References
As well as reducing the number of false positives, greater
specificity of risk criteria would allow differentiating affective [1] Yung AR, McGorry PD. The prodromal phase of first-episode psychosis:
past and current conceptualizations. Schizophr Bull 1996;22:353-70.
from non-affective psychosis risk, since the bipolar prodrome
[2] Cannon TD, Cornblatt B, McGorry P. The empirical status of the ultra
may be indistinguishable from the schizophrenia prodrome high-risk (prodromal) research paradigm. Schizophr Bull 2007;33:661-4.
based on currently used clinical and neurocognitive measures [3] Woods SW, Addington J, Cadenhead KS, Cannon TD, Cornblatt BA,
[27]. This differentiation may have implications for both Heinssen R, et al. Validity of the prodromal risk syndrome for first
treatment and neurodevelopmental research. psychosis: findings from the North American Prodrome Longitudinal
Regarding the lack of association with other prodromal Study. Schizophr Bull 2009;35:894-908.
[4] McGorry PD, Killackey E, Yung A. Early intervention in psychosis:
symptoms, inconsistent results have emerged to date. concepts, evidence and future directions. World Psychiatry 2008;7:148-56.
According to Koren et al. [17] there is a moderate correlation [5] Cannon TD. Clinical and genetic high-risk strategies in understanding
between ASE and positive and negative symptoms. Never- vulnerability to psychosis. Schizophr Res 2005;79:35-44.
theless, their sample was composed of help-seekers and not [6] Yung AR, Stanford C, Cosgrave E, Killackey E, Phillips L, Nelson B, et al.
only at-risk subjects. Testing the ultra high risk (prodromal) criteria for the prediction of
psychosis in a clinical sample of young people. Schizophr Res
Considering the lack of association with neurocognition, 2006;84:57-66.
this finding is in accordance with previous studies, and only [7] van Os J, Kenis G, Rutten BP. The environment and schizophrenia.
one investigation [28] found a relationship between EASE Nature 2010;468:203-12.
total score and verbal memory, with a general lack of [8] Yung AR, Yuen HP, Berger G, Francey S, Hung TC, Nelson B, et al.
association between the two variables. Declining transition rate in ultra high risk (prodromal) services:
dilution or reduction of risk? Schizophr Bull 2007;33:673-81.
Our study has some limitations that should be considered [9] Mass R. Characteristic subjective experiences of schizophrenia.
to ameliorate further research in this area. First of all, the Schizophr Bull 2000;26:921-31.
study design is cross-sectional, and therefore we do not know [10] Nelson B, Thompson A, Yung AR. Basic self-disturbance predicts
how many subjects in the UHR group will develop the psychosis onset in the ultra high risk for psychosis "prodromal"
illness. Second, our study does not include a comparison population. Schizophr Bull 2012;38:1277-87.
[11] McGlashan T, Walsh B, Woods S. The psychosis-risk syndrome.
group of non-help-seeking adolescents, and consequently it Handbook for diagnosis and follow-up1st ed. . New York: Oxford
is unclear whether our results are generalizable to the entire University Press; 2010.
population of adolescents and young adults who are at risk. [12] First MB, Spitzer RL, Gibbon M, Williams JBW. Structured clinical
In fact, not all individuals who may be at risk seek help [29]. interview for DSM-IV axis I disorders SCID-I: clinician version.
Washington: American Psychiatric Press; 1996.
Another limitation of the study is that it lacks follow-up data
[13] Comparelli A, Savoja V, Kotzalidis GD, Woods SW, Mosticoni S,
on clinical and functional outcomes. Finally, it has been Vassallo F, et al. Factor-structure of the Italian version of the Scale Of
recently hypothesized that ASE may be associated with the Prodromal Symptoms (SOPS): a comparison with the English version.
neurocognitive disturbances of source monitoring and Epidemiol Psychiatr Sci 2011;20:45-54.
aberrant salience [30,31]. Unfortunately, measures of these [14] Comparelli A. Lo stato mentale a rischio e la sua valutazione. 1st ed.
constructs (such as binocular depth inversion, perceptual Rome: Alpesitalia; 2011.
[15] Parnas J, Mller P, Kircher T, Thalbitzer J, Jansson LB, Handest P, et al.
closure, learned irrelevance, spurious messages from noise, Esame dell'abnorme esperienza del s (EASE). Rome: Giovanni Fioriti
mismatch negativity, salience attribution, reversal learning Editore; 2009.
tasks, and temporal binding tasks) are not standardized in [16] Parnas J, Mller P, Kircher T, Thalbitzer J, Jansson L, Handest P, et al.
a consensus battery, and are not currently utilized in EASE: examination of anomalous self-experience. Psychopathology
naturalistic studies on neuropsychological assessment of 2005;38:236-58.
[17] Koren D, Reznik N, Adres M, Scheyer R, Apter A, Steinberg T, et al.
at-risk adolescents and young adults. Disturbances of basic self and prodromal symptoms among non-
psychotic help-seeking adolescents. Psychol Med 2013;43:1365-76.
[18] Kern RS, Nuechterlein KH, Green MF, Baade LE, Fenton WS, Gold
5. Conclusion JM, et al. The MATRICS Consensus Cognitive Battery, part 2: co-
norming and standardization. Am J Psychiatry 2008;165:214-20.
[19] Nuechterlein KH, Green MF, Kern RS, Baade LE, Barch DM, Cohen
The present study provides preliminary support for the JD, et al. The MATRICS Consensus Cognitive Battery, part 1: test
possibility that ASE is associated with decreased global selection, reliability, and validity. Am J Psychiatry 2008;165:203-13.
functioning and that ASE represents a clinical phenotype [20] Corigliano V, De Carolis A, Trovini G, Dehning J, Di Pietro S, Curto
that may characterize a specific subgroup of UHR subjects M, et al. Neurocognition in schizophrenia: from prodrome to multi-
evolving towards a schizophrenia spectrum disorder. episode illness. Psychiatry Res 2014;15:129-34.
[21] Raven JC. SPM Standard Progressive Matrices, Matrici Progressive di
Moreover, our findings provide preliminary support for the Raven. Serie A, B, C, D, E (Italian translation). Firenze: GiuntiOS; 2008.
possibility of supplementing and refining current criteria for [22] Haug E, ie M, Andreassen OA, Bratlien U, Raballo A, Nelson B, et al.
early detection of risk through assessment of ASE. Future Anomalous self-experiences contribute independently to social dysfunction
A. Comparelli et al. / Comprehensive Psychiatry 65 (2016) 4449 49

in the early phases of schizophrenia and psychotic bipolar disorder. Compr Integrating phenomenology and neurocognition. Part 1 (source
Psychiatry 2014;55:475-82. monitoring deficits). Schizophr Res 2014;152:12-9.
[23] Velthorst E, Nieman DH, Becker HE, van de Fliert R, Dingemans PM, [31] Nelson B, Whitford TJ, Lavoie S, Sass LA. What are the
Klaassen R, et al. Baseline differences in clinical symptomatology neurocognitive correlates of basic self-disturbance in schizophrenia?
between ultra high risk subjects with and without a transition to Integrating phenomenology and neurocognition: part 2 (aberrant
psychosis. Schizophr Res 2009;109:60-5. salience). Schizophr Res 2014;152:20-7.
[24] Simon AE, Umbricht D. High remission rates from an initial ultra-high [32] Reitan RM, Wolfson D. The HalsteadReitan Neuropsychological
risk state for psychosis. Schizophr Res 2010;116:168-72. Test Battery: therapy and clinical interpretation. 2nd ed. Tucson, AZ:
[25] Velthorst E, Nieman DH, Klaassen RM, Becker HE, Dingemans PM, Neuropsychological Press; 1985.
Linszen DH, et al. Three-year course of clinical symptomatology in [33] Stroop J. Studies of interference in serial verbal reactions. J Exp
young people at ultra high risk for transition to psychosis. Acta Psychol 1935;18:643-62.
Psychiatr Scand 2011;123:36-42. [34] Novelli G, Papagno C, Capitani E, Laiacona M, Vallar G, Cappa SF.
[26] Hfner H, Lffler W, Maurer K, Hambrecht M, an der Heiden W. Tre tests clinici di ricerca e produzione lessicale. Taratura su soggetti
Depression, negative symptoms, social stagnation and social decline in the normali. Arch Psicol Neurol Psichiatr 1986;47:477-506.
early course of schizophrenia. Acta Psychiatr Scand 1999;100(2):105-18. [35] Grant DA, Berg EA. A behavioral analysis of damage of reinforcement
[27] Olvet DM, Stearns WH, McLaughlin D, Auther AM, Correll CU, Cornblatt and ease of shifting to new responses in a Weigl type card sorting
BA. Comparing clinical and neurocognitive features of the schizophrenia problem. J Exp Psychol 1948;38:404-11.
prodrome to the bipolar prodrome. Schizophr Res 2010;123:59-63. [36] Orsini A, Grossi D, Capitani E, Laiacona M, Papagno C, Vallar G.
[28] Haug E, ie M, Melle I, Andreassen OA, Raballo A, Bratlien U, et al. Verbal and spatial immediate memory span: normative data from 1355
The association between self-disorders and neurocognitive dysfunction adults and 1112 children. Ital J Neurol Sci 1987;8:539-48.
in schizophrenia. Schizophr Res 2012;135:79-83. [37] Buschke H. Selective reminding for analysis of memory and learning.
[29] Addington J, Epstein I, Reynolds A, Furimsky I, Rudy L, Mancini B, et al. J Verbal Learn Verbal Behav 1973;12:543-50.
Early detection of psychosis: finding those at clinical high risk. Early Interv [38] Osterrieth PA. Le test de copied'une f igure complex:contributional
Psychiatry 2008;2:147-53. 'tude de la percept ion et la mmor ie. Arch Psychol 1944;30:286-356.
[30] Nelson B, Whitford TJ, Lavoie S, Sass LA. What are the [39] Ekman P, Friesen WV. Constants across cultures in the face and
neurocognitive correlates of basic self -disturbance in schizophrenia? emotion. J Pers Soc Psychol 1971;17:124-9.