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Shades of vulnerability: latent structures of clinical caseness in prodromal and early phases of schizophrenia

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Abstract

The underlying structures of clinical caseness and need of care in prodromal (i.e., at-risk) and early phases of schizophrenia remain poorly characterized in their essential psycho-behavioral coherence. To identify the schizophrenia proneness-related subtypes within a population of young help-seekers referred to a dedicated, community-based early detection program (Programma 2000). A sample of consecutive referrals (n = 168) for suspected psychosis or first-episode schizophrenia spectrum psychosis received a detailed clinical assessment, including the early recognition inventory for the retrospective assessment of the onset of schizophrenia checklist. We used exploratory factor analysis (EFA) to determine the underlying dimensional structure and latent class analysis (LCA) to identify putative vulnerability subtypes. EFA identified four factors: dysphoria (irritability tension), paranoid autocentrism, introversive withdrawal, and disturbed subjective experience. LCA distinguished three classes, interpretable as carrying different degrees of “proneness to schizophrenia psychosis,” which best captured the underlying continuum of clinical severity. The validity of the three classes was supported by distinct patterns of association with major clinical variables (i.e., diagnostic staging at referral). Vulnerability to schizophrenia psychosis in young help-seekers may manifest in three major clinical prototypes, presenting common levels of dysphoria and social withdrawal but different degrees of paranoid autocentrism and disturbed subjective experience. Overall, the results provide the empirical background to dissect shared features of clinical caseness from more schizophrenia-specific vulnerability components. This is of value for the refinement of the clinical staging model as well as for the pragmatic implementation of multiple-gate screening programs.

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Acknowledgments

Programma 2000 is entirely funded by a grant of the Lombardy Regional Health Authority, Milan, Italy. M.T.C. is the recipient of a Grant of the Regione Sardegna (Grant n. T2-MAB-A2008-138).

Conflict of interest

The authors declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Mental Health, AUSL di Reggio Emilia, Reggio Emilia, Italy

    Andrea Raballo

  2. Department of Psychiatry, Mental Health Center Hvidovre, University of Copenhagen, Copenhagen, Denmark

    Andrea Raballo

  3. Dipartimento di Salute Mentale, Centro per l’Individuazione e l’Intervento Precoce nelle Psicosi-Programma 2000, Ospedale Niguarda Ca’ Granda, Via Livigno, 3, 20128, Milan, Italy

    Anna Meneghelli, Angelo Cocchi, Andrea Alpi, Maria T. Cascio & Antonio Preti

  4. Institute of Biomathematics. Polo Scientifico-Loc. Crocicchia, University of Urbino, 61029, Urbino, PU, Italy

    Davide Sisti & Marco B. L. Rocchi

  5. Centro Medico Genneruxi, via Costantinopoli 42, 09129, Cagliari, Italy

    Antonio Preti

  6. Central Institute of Mental Health, J5, 68159, Mannheim, Germany

    Kurt Maurer & Heinz Häfner

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  1. Andrea Raballo
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  2. Anna Meneghelli
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  3. Angelo Cocchi
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  9. Kurt Maurer
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Corresponding author

Correspondence to Angelo Cocchi.

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Table 6 ERIraos-Checklist synopsis
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Raballo, A., Meneghelli, A., Cocchi, A. et al. Shades of vulnerability: latent structures of clinical caseness in prodromal and early phases of schizophrenia. Eur Arch Psychiatry Clin Neurosci 264, 155–169 (2014). https://doi.org/10.1007/s00406-013-0421-4

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