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Abstract: The Embedded Figure Test (EFT) requires locating a simple shape embedded within a background of overlapping target-irrelevant scene elements. Observers with autism, or those with high levels of autistic-like traits, typically outperform matched comparison groups on the EFT. This research investigated the critical visual properties which give rise to this improved performance. The EFT is a search task and so here a radial frequency (RF) search task was created to directly explore efficacy of visual search and also the influence of element overlap on performance. In all conditions, the task was to detect whether the target RF3 (a triangular shape chosen for its visual properties) was present among a number of distracter RF4 (a square shape) patterns. The conditions employed were: ‘singles’, where all the patterns were spatially discrete, ‘pairs’, where two overlapping elements formed each cluster, and ‘quads’, comprising four overlapping elements per cluster. Compared to students scoring low on the Autism Spectrum Quotient (AQ; n =27), those scoring high on the AQ (n =23) were faster on the EFT and also significantly less influenced by increasing set size of the stimulus array in all RF search task conditions. However, the group difference in RF search performance was unaffected by the amount of stimulus overlap. Thus a simple search task is sufficient to detect a performance advantage associated with higher levels of autistic traits and has the advantages of a solid footing in visual theory and being readily repeatable for the purpose of assessing performance variability and change with interventions. [Copyright &y& Elsevier]

The current research investigated, firstly, whether individuals with high levels of mild autistic-like traits display a similar profile of embedded figures test (EFT) and global motion performance to that seen in autism. Secondly, whether differences in EFT performance are related to enhanced local processing or reduced global processing in the ventral visual stream was also examined. Results indicated that people who scored high on the Autism-spectrum Quotient (AQ) were faster to identify embedded figures, and had poorer global motion and global form thresholds than low AQ scorers. However, the two groups did not differ on a task assessing lower-level input to the ventral stream. Overall the results indicate that individuals with high levels of autistic-like traits have difficulties with global integration in the visual pathways, which may at least partly explain their superior EFT performance. [ABSTRACT FROM AUTHOR]

Age differences in the prevalence of loneliness have been a key focus among researchers, practitioners, and policy makers. However, the degree to which those reflect genuine differences in the experience of loneliness or the way individuals understand and respond to loneliness measures is yet to be examined. The current study explored the age measurement invariance of the 20-item Revised University of California Los Angeles, Loneliness Scale (UCLA-LSR) and its shorter forms in a U.K. sample of adults aged 18 to 99 years ( M = 50.6, SD = 19.7). The fit of different structures/versions was explored through multigroup confirmatory factor analysis (CFA; N = 4,375) and local structural equation modeling ( N = 19,521). Results indicated a poor and/or inconsistent structure for the 20-item UCLA-LSR and many of its shorter forms. Of the structures considered, 12 showed acceptable model fit and received age measurement invariance testing through multigroup CFA and alignment; 10 of these achieved full, partial, or approximate measurement invariance. Our findings suggest that the age measurement invariance of loneliness measures should not be assumed, and crucially, this must be explored before accurate and meaningful age comparisons can be made. Implications for measurement research, and clinical and community practice, are discussed.

Objective: The purpose of this study was to explore whether self-reported mental wellbeing (anxiety, depression and loneliness) in audiologists has changed over the course of the COVID-19 pandemic and to examine possible factors contributing to audiologists' current state of mental wellbeing. Design: Two cross-sectional surveys were distributed at two different time points during the COVID-19 pandemic screening for psychological distress (PHQ-4: anxiety and depression) and loneliness (UCLA-3). Study sample: 117 audiologists from around the world. Results: Findings demonstrated that over the course of the COVID-19 pandemic audiologists' levels of depression decreased, levels of anxiety were low and stable, whilst levels of loneliness were stable and high. Younger age was associated with lower levels of mental well-being. Responses to open text questions suggests that audiologists could be supported through development of clear and consistent guidelines on COVID-19 workplace restrictions, allowing for more workplace flexibility and providing mental health support through employee assistance programs. Conclusions: The rates of anxiety, depression and loneliness observed highlight the continued need for mental health and workplace interventions to support audiologists throughout the COVID-19 pandemic and the subsequent recovery period.

Objectives: Childhood disturbances in social, emotional, language, motor and cognitive functioning, and schizotypy have each been implicated as precursors of schizophrenia-spectrum disorders. We investigated whether relationships between early childhood developmental vulnerabilities and childhood schizotypy are mediated by educational underachievement in middle childhood., Methods: Participants were members of a large Australian (n = 19,216) population cohort followed longitudinally. Path analyses were used to model relationships between developmental vulnerabilities at age ~5 years, educational underachievement from ages ~8 to 10 years and three distinct profiles of schizotypy at age ~11 years (true, introverted and affective schizotypy)., Results: Early childhood developmental vulnerabilities on five broad domains (related to physical, emotional, social, cognitive and communication development) were associated with schizotypy profiles in middle childhood. Educational underachievement in middle childhood was associated with all schizotypy profiles, but most strongly with the true schizotypy profile (OR = 3.92, 95% CI = 3.12, 4.91). The relationships between schizotypy profiles and early childhood developmental vulnerabilities in 'language and cognitive skills (school-based)' and 'communication skills and general knowledge' domains were fully mediated by educational underachievement in middle childhood, and the relationships with early childhood 'physical health and well-being' and 'emotional maturity' domains were partially mediated., Conclusion: Developmental continuity from early childhood developmental vulnerabilities to schizotypy in middle childhood is mediated by educational underachievement in middle childhood. While some domains of early developmental functioning showed differential relationships with distinct schizotypy profiles, these findings support a developmental pathway to schizotypy in which cognitive vulnerability operates from early childhood through to middle childhood., (© 2022 The Authors. British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Introduction: Anomalous perceptions are characterised by the subjective experience of a range of distorted and/or hallucinatory percepts. Whilst considerable attention has been paid to the neurocognitive processes contributing to anomalous perceptions amongst older adults, less is known about the social factors (e.g. social isolation, loneliness). Furthermore, it is unknown whether loneliness and social isolation are associated with different types of anomalous perceptions, including anomalous body-centred self-experiences and anomalous external experiences., Methods: This study examined the cross-sectional relationships between loneliness, objective social isolation, and anomalous perceptions in a sample of community-dwelling older adults ( N  = 242, M age  = 71.87 ± 7.73, range = 52-91, 67.8% female) using structural equation modelling., Results: Higher levels of loneliness were associated with more anomalous body-centred self-experiences and anomalous external experiences. Those reporting more loneliness also reported higher levels of anxiety and depression; however, the relationship between loneliness and anomalous perceptions was not mediated by these factors. Social disconnection from a religious group was associated with more anomalous external experiences and being married/living with a partner was associated with more anomalous body-centred self-experiences., Conclusions: These findings suggest that loneliness and social isolation have differential associations with anomalous perceptions in older adults and provide additional evidence that attending to loneliness in older adults is important.

Objectives: The detection of young people at high risk for psychotic disorders has been somewhat narrowly focused on overt symptom-based markers that reflect mild reality distortion (e.g., psychotic-like experiences), or prodromal syndromes that are proximal to psychosis onset. The concept of schizotypy represents a broader framework for investigating risk for schizophrenia (and other disorders) in childhood, before the onset of prodromal or overt symptoms. We sought to detect profiles of risk for psychosis (schizotypy) in a general population sample of 22,137 Australian children aged 11-12 years, and to determine early life risk factors associated with these profiles from data available in linked records (registers)., Methods: Fifty-nine self-reported items were used as indicators of schizotypy across six broad domains; z-scores for each domain were subjected to latent profile analyses (LPA). A series of multinomial logistic regressions was used to examine the association between resulting profile (class) membership and several childhood and parental risk factors, and the proportion of children with mental disorders among each schizotypy profile was examined., Results: The LPA revealed three person-centred profiles referred to as True Schizotypy (n = 1,323; 6.0%), Introverted Schizotypy (n = 4,473; 20.2%), and Affective Schizotypy (n = 4,261; 19.2%), as well as a group of children showing no risk (n = 12,080; 54.6%). Prior exposure to perinatal and familial adversities including childhood maltreatment, as well as poor early childhood development and academic functioning, was variously associated with all risk groups. There was a higher proportion of childhood mental disorder diagnoses among children in the True Schizotypy group, relative to other profiles., Conclusion: Subtle differences in the pattern of exposures and antecedents among schizophrenia liability profiles in childhood may reflect distinct pathogenic pathways to psychotic or other mental illness., Practitioner Points: Children aged 11-12 years report characteristics of schizotypy which can be classified into three distinct profiles that may represent different pathological processes towards later mental ill-health. Early life exposure to perinatal and familial adversities including childhood maltreatment, early childhood developmental vulnerability, and poor academic functioning predict membership in all three childhood schizotypy profiles. Latent liability for schizophrenia (and potentially other mental disorders) may be represented by different profiles of functioning observable in childhood., (© 2022 The Authors. British Journal of Clinical Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Objective: People who experience distressing voices frequently report negative (e.g. abusive or threatening) voice content and this is a key driver of distress. There has also been recognition that positive (e.g. reassuring, or guiding) voice content contributes to better outcomes. Despite this, voice content has been neglected as a standalone outcome in evaluations of psychological therapies for distressing voices. We aimed to examine whether a modular cognitive-behavioural therapy (CBT) intervention for voices led to changes in negative and positive voice content., Design/methods: In a naturalistic, uncontrolled pre- and post- service evaluation study, 32 clients at an outpatient psychology service for distressing voices received eight sessions of CBT for distressing voices and completed self-report measures of negative and positive voice content at pre-, mid- and post- therapy., Results: There was no significant change in positive voice content. There was no significant change in negative voice content from pre- to post-therapy; however, there was a significant change in negative voice content between mid and post-treatment in which the cognitive therapy component was delivered. The CBT treatment was also associated with significant changes in routinely reported outcomes of voice-related distress and voice severity., Conclusions: The cognitive component of CBT for distressing voices may be associated with changes in negative, but not positive, voice content. There may be benefit to enhancing these effects by developing treatments targeting specific processes involved in negative and positive voice content and further exploring efficacy in well-powered, controlled trials with more comprehensive measures of voice content., (© 2022 The Authors. Psychology and Psychotherapy: Theory, Research and Practice published by John Wiley & Sons Ltd on behalf of The British Psychological Society.)

Purpose: Audiology clinical guidelines recommend the use of mental health screening tools; however, they remain underutilized in clinical practice. As such, psychological concerns are frequently undetected in adults with hearing loss. This study aimed to better understand audiology clinic staff's perspectives (including audiologists, audiometrists, reception staff, and clinic managers) on how to improve detection of poor mental health by (a) exploring the role of audiology clinic staff in detecting psychological concerns in adults with hearing loss and (b) investigating the appropriateness, acceptability, and usability of several screening tools in an audiology setting., Method: Eleven audiology clinic staff ( M age = 33.9 ± 7.3, range: 25-51 years) participated in a semistructured focus group. First, participants discussed the role of audiology clinic staff in detecting psychological difficulties in adults with hearing loss, including current practices and needs for improving practices. Second, participants discussed the appropriateness, acceptability, and usability of nine standardized mental health screening tools commonly used in wider health care settings., Results: Audiology clinic staff described their role in being aware of, and detecting, psychological difficulties, as well as their part in promoting an understanding of the link between hearing loss and mental health. Participants described the need to provide support following detection, and highlighted barriers to fulfilling these roles. The use of mental health screening tools was considered to be client and context specific. The language used within the screener was identified as an important factor for its acceptability by audiology clinic staff., Conclusions: Audiology clinic staff acknowledged that they have an important role to play in the detection of psychological difficulties and identified the core barriers to using screening tools. Future research may explore the possibility of developing a mental health screening tool specific to the unique experiences of adults with comorbid hearing loss and mental health concerns., Supplemental Material: https://doi.org/10.23641/asha.16702501.

Auditory verbal hallucinations, or voice hearing, is increasingly understood as a common experience. Despite this, voice hearers still experience a great deal of stigma, which can have serious negative impacts on the person's experience of their voices, and their recovery. Research has demonstrated that healthcare professionals may be a major source of the stigma surrounding voice hearing, with service-level implications for the development and delivery of evidence-based interventions. Therefore, reducing this stigma is a critical intervention target. The purpose of this narrative review is to examine evidence for interventions aimed at reducing stigma towards people who hear voices, in populations of healthcare professionals, students, and the general public. The available evidence supports the use of anti-stigma interventions based around direct contact with voice hearers and education about voice hearing. However, further research is necessary in this area to confirm these findings.

Psychological treatments for hallucinations typically target auditory verbal hallucinations (AVH) but neglect the influence of hallucinations in other sensory modalities. This study compared the baseline clinical characteristics and therapeutic outcomes (following brief Coping Strategy Enhancement) of adult clients (N = 100) with multimodal or unimodal (auditory) hallucinations attending an outpatient service for distressing AVH. The results showed that 72.1% of clients reported multimodal hallucinations in the past month. Group comparisons of most baseline clinical characteristics (AVH features, beliefs about AVH, number of traumatic events, personal and social functioning, negative affect) were non-significant. However, in the subgroup (N = 65) reporting ongoing effects of traumatic events, those with multimodal hallucinations reported significantly higher posttraumatic stress symptoms (d = 0.62). Notably, both multimodal and unimodal hallucination groups showed improvement in AVH distress and frequency post-treatment, but group differences in treatment outcomes were not significant. These findings, in a naturalistic service setting, confirm that multimodal hallucinations are common in people seeking help for distressing AVH and may be associated with higher levels of posttraumatic stress symptoms. Importantly, they also suggest that psychological therapy may be suitable and effective for clients experiencing AVH - irrespective of the presence of hallucinations in other sensory modalities., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Loneliness is common in people with psychotic disorders and associated with reduced health and well-being. The relationship between loneliness in psychosis and health service use is unclear. This study examined whether loneliness predicts increased health care utilization in this population, independently of sociodemographics, health and functioning., Methods: We used cross-sectional data from the Second Australian National Survey of Psychosis. Loneliness was assessed using a single-item question, rated on a 4-point scale (not lonely; lonely occasionally; some friends but lonely for company; socially isolated and lonely). Health service use (past 12-months) was measured by the number of general practitioner (GP), emergency department (ED) and outpatient visits, inpatient admissions, and home visits by mental health professionals. Frequent hospital users comprised those in the top 15% of users of at least two services., Results: Negative binomial regression analysis showed that loneliness was associated with an increased number of GP visits, ED visits and inpatient admissions, only. Socially isolated and lonely survey participants were more than twice as likely (OR = 2.6) of being 'frequent users' compared to non-lonely responders. Following stringent adjustment for covariates, loneliness remained significantly associated with being a 'frequent user' and showed a non-significant trend to an increased number of GP visits and inpatient admissions., Conclusions: Loneliness is a complex social and personal problem for people with psychosis, related to greater use of some health services. Better strategies for identifying and responding to loneliness in this population have the potential to increase well-being and contain health service utilization costs., Competing Interests: Declaration of competing interest None., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Loneliness is an established risk factor for poor cardiometabolic health. People with psychotic disorders experience high rates of both cardiometabolic disease and loneliness, but how these factors are associated is poorly understood. Thus, using data from the second Australian National Survey of Psychosis we examined whether loneliness is associated with the likelihood of cardiometabolic disorder in psychotic illness. Loneliness was assessed using a single-item measure, with a 4-point scale (not lonely; lonely occasionally; some friends but lonely for company; socially isolated and lonely) whilst cardiometabolic status was assessed in terms of the criteria used to determine metabolic syndrome (elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose). Logistic regression was employed to examine whether loneliness was associated with metabolic syndrome status, and its individual components, with and without adjustment for confounding variables. Increased loneliness was associated with an increased risk of metabolic syndrome in people with psychosis (OR 1.21, 95% CI 1.08-1.36, p < .001) and to the risk of elevated waist circumference (p < .01), elevated triglycerides (p < .05) and reduced high-density lipoprotein cholesterol (p < .05). Notably, these associations largely persisted when controlling for a range of covariates. Feeling lonely is significantly associated with metabolic syndrome, and dyslipidemia specifically, in people with psychotic disorders. These data suggest that the potential benefits of interventions to reduce loneliness in psychosis may extend to cardiovascular as well as psychosocial functioning, and should be explored in future research., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The FOXP2 gene is hypothesised to be involved in schizophrenia by affecting speech and language development. Associations between common single nucleotide polymorphisms (SNPs) in FOXP2 and language have been inconsistent. We tested five previously associated SNPs for association with language in the Western Australian Family Study of Schizophrenia (n = 709, including n = 333 with schizophrenia/spectrum disorder) and found no significant associations. When we included all common FOXP2 variants, one SNP (rs2189008) was nominally associated with language. This is the most comprehensive analysis to date and indicates that common variants in FOXP2 do not play a major role in speech and language development in a clinical family sample., (Copyright © 2018. Published by Elsevier B.V.)

Background: Schizotypal traits are expressions of underlying vulnerability to psychotic disorders which have a potential impact on mental health status, neurocognition, quality of life, and daily functioning. To date, little research has examined epidemiologic landscape of schizotypal traits at the cross-national level. Our aim was to study the expression of schizotypal traits by sex, age, and country in a combined sample gathered from 12 countries., Methods: A total of 27,001 participants completed the Schizotypal Personality Questionnaire (SPQ). The mean age of participants was 22.12 (SD=6.28); 37.5% (n=10,126) were males., Results: Schizotypal traits varied according to sex, age, and country. Females scored higher than males in the positive dimension, whereas males scored higher in the disorganization dimension. By age, a significant decrease in the positive schizotypal traits was observed. Epidemiological expression of schizotypal traits varied by country. Moreover, several interactions by sex, age, and country were found., Conclusions: This pattern is similar to those found in patients with psychosis and psychotic-like experiences. These findings provide new insights and the opportunity to explore the phenotypic expression of schizotypal traits at cross-national level., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The Schizotypal Personality Questionnaire-Brief (SPQ-B) was developed with the aim of examining variations in healthy trait schizotypy, as well as latent vulnerability to psychotic-spectrum disorders. No previous study has studied the cross-cultural validity of the SPQ-B in a large cross-national sample. The main goal of the present study was to analyze the reliability and the internal structure of SPQ-B scores in a multinational sample of 28,426 participants recruited from 14 countries. The mean age was 22.63years (SD=7.08; range 16-68years), 37.7% (n=10,711) were men. The omega coefficients were high, ranging from 0.86 to 0.92 for the total sample. Confirmatory factor analysis revealed that SPQ-B items were grouped either in a theoretical structure of three first-order factors (Cognitive-Perceptual, Interpersonal, and Disorganized) or in a bifactor model (three first-order factors plus a general factor of schizotypal personality). In addition, the results supported configural but not strong measurement invariance of SPQ-B scores across samples. These findings provide new information about the factor structure of schizotypal personality, and support the validity and utility of the SPQ-B, a brief and easy tool for assessing self-reported schizotypal traits, in cross-national research. Theoretical and clinical implications for diagnostic systems, psychosis models, and cross-national mental health strategies are derived from these results., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Cognitive impairment is a core feature of schizophrenia and impacts negatively the functioning of affected individuals. Cognitive decline correlates with aging, and is the primary cause of loss of independence and reduced quality of life. The klotho gene is a key modulator of aging, with expression deficiency resulting in premature aging, while overexpression extends lifespan and enhances cognition. A haplotype and functional human variant of the gene, KL-VS, increases expression and promotes longevity. KL-VS heterozygosity is associated with enhanced cognition and a larger volume of the right dorsolateral prefrontal cortex, a region involved in planning and decision-making, which is especially susceptible to shrinkage with age. We examined the effect of KL-VS heterozygosity on cognition in 497 schizophrenia patients and 316 healthy controls from the Western Australian Family Study of Schizophrenia (WAFSS) who had been comprehensively characterised by neurocognitive tests and classified into cognitively deficient (CD) and cognitively "spared" (CS) clusters. An older, cognitively normal population sample from the Health in Men Study (HIMS) was included to allow assessment of heterozygosity and memory in aged individuals. We show that heterozygosity is associated with better learning and memory in the younger WAFSS healthy controls but not in the aging HIMS sample. However, in schizophrenia patients, KL-VS has a selective effect on memory, with heterozygotes in CD and CS clusters performing worse than non-carriers. This effect was significant and more severe in the CD cluster, reinforcing the utility of subtyping patients into CD and CS clusters that may differ in their genetic underpinnings., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Despite growing research, it remains unclear if cannabis use is associated with additive cognitive impairment in people with psychotic illness and whether exposure in early adolescence is associated with poorer cognitive performance in adulthood., Methods: This cross-sectional study of a nationally representative sample of 1199 adults with psychotic illness compared current cognition (digit symbol coding) of 297 current users of cannabis (used in the past year), 460 past users (used previously but not in the past year) and 442 non-users (never used). Multiple logistic regression was used to examine whether cognitive performance of cannabis-user groups varied by exposure age and diagnosis (non-affective/affective psychoses)., Results: Unadjusted analysis showed current cannabis users had significantly higher odds of impaired cognitive function compared to non-users (odds ratio=1.52, 95%CI=1.04-2.22). After adjusting for potential confounders, differences between the three groups were not significant. Exposure age was not significant in adjusted analysis. In participants with nonaffective psychoses, cognitive ability of current cannabis users did not differ from non-users. However, in participants with affective psychoses, using cannabis in the last year was a significant predictor of impaired cognitive function (odds ratio=2.25, 95%CI=1.05-4.84)., Conclusion: Among people with psychotic illness, there was no significant difference in cognitive function between current, past and non-users of cannabis. However, when we compared cognitive performance of the three cannabis groups by diagnostic grouping, current cannabis use had a significant negative relationship with cognitive function in people with affective psychoses, but not in those with non-affective psychoses. This finding requires replication and further investigation., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Deficits in action (verb) fluency have previously been reported in schizophrenia spectrum disorders. The degree to which this reflects difficulties generating verbs in different semantic categories is unknown. Here, action fluency responses of 46 patients with schizophrenia spectrum disorders and 76 healthy controls were classified as action or mental state verbs, using well-established taxonomies. The word length, frequency, age of acquisition, valence and concreteness of the verbs produced were also examined. Participants also completed measures of cognitive function, and clinical symptoms. Independent inter-rater agreement of semantic categorization was high. The percentage of action verbs produced was significantly lower in patients than controls, whilst the percentage of mental state verbs produced did not differ. Patients' action verbs were: significantly less concrete; positively correlated with memory and intelligence; and negatively correlated with interpersonal symptoms. Impaired action verb, but intact mental state verb generation is consistent with the neural separability of these processes., (Copyright © 2017 Elsevier B.V. All rights reserved.)

The exome array assays rare-but-recurrent, likely deleterious, exonic variants and represents an intermediary between single nucleotide polymorphism (SNP) arrays and sequencing for genetic association studies. Multiplex families with multiple affected individuals may be enriched for disease-associated variants of this class compared to unrelated populations. We present an exome array study of schizophrenia in 99 multiplex families (n=341, including 118 cases) from the Western Australian Family Study of Schizophrenia (WAFSS). Compared to 55,726 individuals from the DIAGRAM sample not selected for schizophrenia, overall allele frequency of exome variants was higher in the WAFSS (P<2.2E-16). This was pronounced in variants nominally associated (P<0.05) with schizophrenia. Genes harbouring variants present only in WAFSS cases were enriched (FDR-corrected P=0.05) for membership of the 'extracellular matrix (ECM) - receptor interaction' biological pathway, adding to evidence that processes affecting the composition or turnover of ECM may contribute to neuropsychiatric disease. We did not find individual variants significantly associated with schizophrenia, although like previous studies, power to detect associations of small effect size was low. Cases did not exhibit a higher burden of variants compared to their unaffected relatives and the finding of previous exome chip studies of unrelated samples that 'schizophrenia gene-sets' were enriched for case-only variants was not replicated in the WAFSS. The higher frequency of moderately rare, exonic variants in these multiplex families compared to a population-based sample may account for some of their genetic liability to schizophrenia, and adds to evidence for a role of exome array variants from previous studies of unrelated samples., (Copyright © 2016 Elsevier B.V. All rights reserved.)

We used Bayesian cognitive modelling to identify the underlying causes of apparent inhibitory deficits in the stop-signal paradigm. The analysis was applied to stop-signal data reported by Badcock et al. (Psychological Medicine 32: 87-297, 2002) and Hughes et al. (Biological Psychology 89: 220-231, 2012), where schizophrenia patients and control participants made rapid choice responses, but on some trials were signalled to stop their ongoing response. Previous research has assumed an inhibitory deficit in schizophrenia, because estimates of the mean time taken to react to the stop signal are longer in patients than controls. We showed that these longer estimates are partly due to failing to react to the stop signal ("trigger failures") and partly due to a slower initiation of inhibition, implicating a failure of attention rather than a deficit in the inhibitory process itself. Correlations between the probability of trigger failures and event-related potentials reported by Hughes et al. are interpreted as supporting the attentional account of inhibitory deficits. Our results, and those of Matzke et al. (2016), who report that controls also display a substantial although lower trigger-failure rate, indicate that attentional factors need to be taken into account when interpreting results from the stop-signal paradigm.

Background: Auditory verbal hallucinations (AVHs) are known to occur in mood disorders, but there has been scant research in the area. This paper aimed to explore the presence of hallucinations, and AVHs in particular, across affective disorders (with non-affective disorders serving as clinical reference groups). Specific attention was given to i) running commentary, ii) voices conversing, and iii) negative voices. A secondary aim was to examine patterns of associated delusional themes., Method: Participants were 1550 Australians, aged 18-64 years, assigned to one of four groups on the basis of diagnosis: i) bipolar disorder (BD), ii) depressive psychosis (DP), iii) schizophrenia (SCZ), and iv) schizoaffective disorder (SAD). Relevant data collected from the 2010 Australian Survey of High Impact Psychosis (SHIP) was analysed., Results: Current prevalence of hallucinations was such that BD

Negative treatment from others is related to elevated levels of trait schizotypy, signifying increased risk for psychosis, but associations with helpful behaviour have been much less studied. Using the Stereotype Content Model we tested the hypothesis that passive and active forms of help would be associated with increased and decreased expression of schizotypy, respectively. Schizotypal traits were assessed in students (N=631) using positive (Perceptual Aberration) and negative (Social Anhedonia) subscales of the Wisconsin Schizotypy Scales-Brief. Experiences of active (intentional) and passive (less deliberative) harm and help were assessed with the Behaviour from Intergroup Affect and Stereotypes Treatment Scale. As predicted, the results showed that experiences of passive help from others were associated with a 2-3 fold increase in scores on schizotypy scales, whilst reports of active help tended to be associated with a decrease in scores on these scales. Results also showed that increased reports of active and passive harm were associated with elevated scores on negative and positive schizotypy subscales, consistent with prior research. These findings, bridging research on social stereotyping and schizotypal personality, challenge the assumption that helpful behaviour from others is always beneficial for individuals with schizotypal traits who are at increased risk for psychosis., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

A neuropsychological perspective on auditory verbal hallucinations (AVH) links key phenomenological features of the experience, such as voice location and identity, to functionally separable pathways in normal human audition. Although this auditory processing stream (APS) framework has proven valuable for integrating research on phenomenology with cognitive and neural accounts of hallucinatory experiences, it has not yet been applied to other symptoms presumed to be closely related to AVH - such as thought insertion (TI). In this paper, I propose that an APS framework offers a useful way of thinking about the experience of TI as well as AVH, providing a common conceptual framework for both. I argue that previous self-monitoring theories struggle to account for both the differences and similarities in the characteristic features of AVH and TI, which can be readily accommodated within an APS framework. Furthermore, the APS framework can be integrated with predictive processing accounts of psychotic symptoms; makes predictions about potential sites of prediction error signals; and may offer a template for understanding a range of other symptoms beyond AVH and TI.

Background: Loneliness involves subjective, rather than objective, social isolation and has a range of negative effects on mental and physical functioning. The purpose of this study was to examine the prevalence of loneliness in psychotic disorders and its association with symptoms and cognitive performance., Method: Data were drawn from the second Australian National Survey of Psychosis and comprised responses from 1642 participants with an International Classification of Diseases 10 diagnosis of psychotic disorder who had completed a semi-structured interview of symptoms and social functioning (including loneliness), along with standardized assessments of current (digit symbol coding; DSC) and premorbid (National Adult Reading Test) cognitive ability. We examined the prevalence of loneliness across the diagnostic categories of psychosis, and its association with psychotic and non-psychotic symptoms and digit symbol coding scores., Results: The prevalence of loneliness was high, ranging from 74.75% in participants with delusional disorders to 93.8% in depressive psychosis, and was significantly higher than in the general population. Loneliness was also significantly associated with anhedonia and subjective thought disorder. Participants feeling socially isolated/lonely for company had significantly lower DSC scores than those who only felt lonely occasionally. Unexpectedly, participants who reported not feeling lonely had the lowest DSC scores., Conclusions: Loneliness is common across all psychotic disorders, particularly in depressive psychosis. It is specifically associated with ongoing loss of pleasure and disordered thoughts as well as impairment in current cognitive functioning. However, poor cognitive functioning is not inevitably associated with loneliness. Implications for personalized treatment of psychosis are discussed., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: We aimed to examine the association between lifetime cannabis use and estimates of both premorbid and current cognitive function in psychotic disorders in an Australian cohort., Methods: In an Australian multicenter cohort, 1237 participants with an established ICD-10 diagnosis of psychotic disorder were categorised according to history of lifetime cannabis use (non-users, n=354; cannabis users, n=221; cannabis dependency, n=662). Groups were analyzed according to available indices of cognitive ability: the National Adult Reading Test - Revised (NART-R) for ability prior to illness onset; and the Digit Symbol Coding Test (DSCT) for current ability. Two-way analysis of variance was conducted without any covariate, followed by a two-way analysis of covariance (using age, age at onset of psychiatric illness, premorbid IQ and the Socio-Economic Index for Areas (SEIFA) rankings)., Results: Whilst there appeared to be a significant association between cannabis use and mean DSCT (higher DSCT scores in cannabis using groups) F(2,1080)=9.478, p<0.001, η2=0.017), once covariates were used in the analysis there were no significant differences between groups in mean DSCT scores (F(2,1011)=0.929, p=0.395, η2=0.002). Similarly there were no differences between groups in mean NART scores once, age, age at illness onset and SEIFA rankings were used as covariates (F(2,1032)=1.617, p=0.199, η2=0.003)., Conclusions: Confounding variables underpin the association between cannabis use and cognitive function in psychotic disorders. Taken together, it would appear that cannabis use or dependence has no additive effect on cognitive dysfunction in these disorders., (Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.)

Speed of processing is impaired in schizophrenia but intact in schizotypal college students. In view of this disparity, we investigated whether deficient processing speed was associated with schizotypy in adults from the general community. Data were drawn from the Western Australian Family Study of Schizophrenia, including 216 (non-clinical) adults from the general community, and a reference group with schizophrenia spectrum disorder (N=224). Schizotypal traits were assessed with the Schizotypal Personality Questionnaire, whilst processing speed was assessed with a digit-symbol coding task. Community controls had significantly higher digit symbol coding scores than patients with psychosis. However, both correlational and hierarchical regression analysis indicated a lack of association between Cognitive-perceptual, Interpersonal or Disorganized schizotypy traits and digit symbol coding performance. Relative to Australian norms there was also no evidence of a non-linear decline in coding in high schizotypes in young, mature or senior age groups. The results show that speed of information processing is unimpaired in high schizotypes from the general community. The possibility that intact processing speed in at-risk groups confers protection to psychosis onset is discussed. Assessing the trajectory of processing speed throughout development may provide a useful clinical screening tool to distinguish those at heightened risk of developing psychosis., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Design and Aim: a cross sectional survey was undertaken to explore midwives' knowledge of, and attitudes towards, mental health disorders in childbearing women vis-à-vis their perceived mental health learning needs., Setting and Participants: a 50.1% response rate included 238 midwives employed in the only public tertiary maternity hospital in Western Australia from March to June 2013., Method and Findings: The survey comprised a mixture of custom-designed questions and vignettes presenting various disorders. Only 37.6% of midwives felt well-equipped to support women, whilst 50.2% reported insufficient access to information. Demand was highest for education on: personality disorders (77.8%); the impact of childbearing on mental health disorders (74.2%); and skills for handling stress and aggression (57.8%). Knowledge scores were variable: on average eight out of a maximum 13 questions were answered correctly, but few (2.7%) answered more than 11 correctly, and 3.7% scored ≤4 correct. Across disorders, recognition from vignettes was highest for depression (93.9%), and lowest for schizophrenia (65.6%). Surprisingly, there were no associations between general knowledge scores and previous mental health experience, recent professional development, or access to information around mental health. The majority endorsed positive beliefs about midwives' role in mental health assessment, and belief in women's recovery (83.5%), however, cluster analysis of warmth and competence ratings revealed negative stereotyping of mental health disorders., Key Conclusions: Midwives accept it is their role to assess the mental health status of women but many feel ill-equipped to do so and express a strong desire for further knowledge and skills across a range of perinatal mental health topics. Attitudes to recovery are positive but negative stereotypes exist; therefore awareness of potential bias is important to negate their influence on care., Implications for Practice: Learning needs may change due to trends in clinical practice. Strategies are needed to recognise negative beliefs and to ensure education is responsive to local contexts., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Voices provide a wealth of socially-relevant information, including cues to a speaker's identity and emotion. Deficits recognising emotion from voice have been extensively described in schizophrenia, and linked specifically to auditory hallucinations (AH), but relatively little attention has been given to examining the ability to analyse speaker identity. Hence, the current study assessed the ability to discriminate between different speakers in people with schizophrenia (including 33 with and 32 without AH) compared to 32 healthy controls. Participants rated the degree of perceived identity similarity of pairs of unfamiliar voices pronouncing three-syllable words. Multidimensional scaling of the dissimilarity matrices was performed and the resulting dimensions were interpreted, a posteriori, via correlations with acoustic measures relevant to voice identity. A two-dimensional perceptual space was found to be appropriate for both schizophrenia patients and controls, with axes corresponding to the average fundamental frequency (F0) and formant dispersion (D(f)). Patients with schizophrenia did not differ from healthy controls in their reliance on F0 in differentiating voices, suggesting that the ability to use pitch-based cues for discriminating voice identity may be relatively preserved in schizophrenia. On the other hand, patients (both with and without AH) made less use of D(f) in discriminating voices compared to healthy controls. This distorted pattern of responses suggests some potentially important differences in voice identity processing in schizophrenia. Formant dispersion has been linked to perceptions of dominance, masculinity, size and age in healthy individuals. These findings open some interesting new directions for future research., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The continuum model of psychosis has been extremely influential. It assumes that psychotic symptoms, such as auditory verbal hallucinations (AVH), are not limited to patients with psychosis but also occur in healthy, non-clinical individuals - suggesting similar mechanisms of origin. Recent debate surrounding this model has highlighted certain differences, as well as similarities, in the phenomenology of AVH in clinical and non-clinical populations. These findings imply that there may, in fact, be only partial overlap of the mechanism(s) involved in generating AVH in these groups. We review evidence of continuity or similarity, and dissimilarity, in cognitive, and related neural processes, underlying AVH in clinical and non-clinical samples. The results reveal some shared (intrusive cognitions, inhibitory deficits) and some distinct (aspects of source memory and cerebral lateralization) mechanisms in these groups. The evidence, therefore, supports both continuous and categorical models of positive psychotic symptoms. The review considers potential risks of uncritical acceptance of the continuum model and highlights some important methodological issues for future research., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Formal thought disorder (TD) is a key symptom of schizophrenia with a significant impact on interpersonal relationships. Current cognitive models emphasize disordered language functioning and abnormalities accessing semantic representations. The cortical mechanisms for language and motor function are closely linked, hence action-related language may be impaired in TD, yet existing studies have focussed exclusively on object (noun) rather than action (verb) semantics., Method: In order to examine this issue both action (verb) and traditional semantic (tools, fruits, musical instruments) and phonological (FAS) fluency tasks were completed by individuals with schizophrenia (N=53) and healthy controls (N=69). Fluency performance was measured as the total number of correct words generated in 60s. The Schizotypal Personality Questionnaire (SPQ) was used to index odd and disorganized speech, as well as positive and negative symptoms., Results: Fluency on all tasks was impaired in schizophrenia, compared to controls, with a similar effect size. Within the schizophrenia group Odd Speech was correlated with poor fluency for actions, tools and musical instruments but not fruit or phonological fluency. These action-related fluency deficits were also correlated with Constricted Affect and Social Anxiety but not with Unusual Perceptions/Odd Beliefs., Conclusion: These results point to a unique connection and possible common aetiology between action fluency and odd speech in schizophrenia rather than a general impairment in language/executive functions common to fluency tasks. The findings provide the first evidence of a specific role of action-based language production deficits in TD together with a joint effect on social interaction skills., (Crown Copyright © 2010. Published by Elsevier B.V. All rights reserved.)

Emotion regulation involves the use of strategies to influence the experience and expression of emotions. Anxiety and depression are strongly associated with the positive symptoms of schizophrenia, such as auditory hallucinations (AHs). Individuals usually try to down-regulate (decrease) such emotions, consequently abnormal or maladaptive use of one or more of these down-regulatory processes (e.g. increased use of expressive suppression or maladaptive attentional deployment, i.e. rumination/worry) may play an important role in AHs (e.g. increasing AH severity and distress). This study examined the self-reported use of a range of emotion regulation strategies in individuals with schizophrenia and current AHs (SZ AH; N=34) and healthy controls (N=34). Two separable dimensions of hallucinatory experiences (severity and distress) were assessed together with measures of anxiety, depression and happiness. Within the SZ AH group, greater use of expressive suppression was associated with an increase in severity of AHs and greater disruption in daily life. In addition, rumination was significantly positively correlated with the distress (but not with the severity) associated with AHs. Within the control group, expressive suppression, rumination and worry were associated with more anxiety/depression and less happiness, as predicted. The implications of different emotion regulation strategies for the treatment of individuals with schizophrenia and AHs are discussed., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Introduction: The frequency of auditory hallucinations (AH) is associated with efficiency in inhibiting irrelevant memories, suggesting that the presence of AH may be related to the intrusion of strongly activated representations in memory. Therefore, we hypothesised that the inability to suppress irrelevant memories would be found only in patients currently experiencing AH., Method: Performance on a repeated, continuous recognition task was examined in 23 schizophrenia patients with AH present, 20 schizophrenia patients with AH absent, and 24 healthy controls., Results: Patients with current AH made significantly more inappropriate responses (false alarms) to distractors seen on previous runs of the task than nonhallucinating patients. The ability to detect targets (hits) was significantly better in healthy controls than schizophrenia patients, however, there was no significant difference between the two patient subgroups., Conclusions: The findings confirm that the presence of AH involves a failure to suppress memories that are not relevant to ongoing reality. We propose that a combination of deficits in inhibition and (episodic) memory provides a useful model of AH, which can accommodate many of the characteristic features of the symptom and fits well with the neuroanatomical circuitry that is believed to underlie the occurrence of AH.