The document discusses how the study of schizotypy helps advance our understanding of schizophrenia. It defines schizotypy as a latent personality organization that harbors liability for schizophrenia. Studying schizotypy offers a unifying framework as it represents a spectrum of expressions from subtle abnormalities to psychosis. Schizotypy is assessed through various approaches including genetics, laboratory measures, clinical features, and psychometric indexes. High scores on measures of schizotypy like the Perceptual Aberration Scale are associated with features like attention deficits and genetic risk factors. While schizotypy is measured dimensionally, evidence suggests it may have an underlying discontinuous nature. Longitudinal studies find that some schizotypic individuals develop psychosis over time.

1. How the study of schizotypy helps to advanceHow the study of schizotypy helps to advance
our understanding of schizophrenia:our understanding of schizophrenia:
The SRF WebinarThe SRF Webinar
(July 6, 2015)(July 6, 2015)
Mark F. Lenzenweger, PhDMark F. Lenzenweger, PhD
Department of PsychologyDepartment of Psychology
State University of New York at BinghamtonState University of New York at Binghamton
&&
Department of PsychiatryDepartment of Psychiatry
Weill Cornell Medical CollegeWeill Cornell Medical College
Copyright © 2015 by Mark F. Lenzenweger

2. Goals of the Webinar
• Introduce the schizotypy concept to an audience
consisting of technical and non-technical
interested parties, including consumers
• Define the concept and illustrate its potential
utility, with some historical review
• Seek connections with other schizophrenia
research domains through our discussants
(prodromal schizophrenia studies; genetics;
neurocognition)
• Point out misconceptions or misunderstandings

4. What can the study of schizotypy offer to schizophrenia research?
A unifying investigative framework
Lenzenweger (2006)r

5. • Clinical schizophrenia is but one psychotic expression of
schizophrenia-liability (another is delusional disorder)
• Unexpressed liability has been confirmed (e.g., Gottesman & Bertelsen,
1989) and can be transmitted “quietly”
• Schizophrenia liability expressions are likely variable (ranging from
psychosis to schizotypic clinical features through subtle laboratory
assessed abnormalities) [endophenotypes]
• Genetics research (GWAS) has found relatively few genes of
schizophrenia relevance despite a heritability > .80.
• Prodromal cases “convert” to schizophrenia less than 36% of the
time; leaving the other 64% to be explained.
Pulling together threads in the
panorama of schizophrenia liability

6. Terminology
• Schizotypy: a latent personality organization
that harbors the liability for schizophrenia
• Schizotype: one who possesses schizotypy as a
personality organization
• Schizotypic pathology: Observable
psychopathology deriving from schizotypy
(ranging from psychosis through SRPD
features)

7. Case 4: Claire, a 27 year old married woman, works as a code writer for a large
software company in a Northern California city. Claire tends to dress in an
unusual manner, tending to wear clothing that often seems far too heavy for the
warm climate in which she lives. Throughout childhood she had only one friend,
who she continues to talk to on the phone on a weekly basis. She has no other
close friends to speak of beyond her husband. In college, she pursued a double
major in German literature and computer science. She met the man she would
later marry in a college computer science class. He told her that he was drawn to
her because she was “quirky” and “eccentric.” Claire has described an “unusual
ability to sense what will happen in the world,” something akin to a “sixth-
sense” and she maintains it goes beyond simply intuition. She also feels that she
can influence events with her mind, for example she thinks that she can make a
red light turn green (though she denies that she really “believes” she can do so).
She collects small figurines and amulets that she feels help her to “find her way
through the world.” Claire’s co-workers do not know her very well, but they
find her “pleasant enough, although sort of flaky.” When speaking to most
people she appears ill at ease (anxiety) and seems relieved when the
conversation ends. She shows emotional reciprocity, but it is strained. On
occasion she grimaces or giggles in response to some aspect of her contribution
to a conversation that other people in the conversation regard as odd or “weird.”
Her face, otherwise, displays little in the way of emotion.

8. Possible features of non-psychotic
schizotypic psychopathology
• Being a loner and lacking close friends outside of the immediate family
• Incorrect interpretation of events, including feeling that external events have personal
meaning
• Peculiar, eccentric or unusual thinking, beliefs or behavior
• Dressing in peculiar ways
• Belief in special powers, such as telepathy
• Perceptual alterations, in some cases bodily illusions or body-image distortions,
including phantom pains or other distortions in the sense of touch (exteroception,
proprioception)
• Persistent and excessive social anxiety (e.g., the ‘carrot grater’ experience)
• Peculiar style of speech, such as loose or vague patterns of speaking or rambling oddly
and endlessly during conversations
• Suspicious or paranoid ideas, hypersensitivity, and constant doubts about the loyalty
and fidelity of others (“Why did the government change the $20 bill appearance?”)
• Flat emotions, or limited or inappropriate emotional responses
Do not confuse with Asperger’s Syndrome
Adapted from Mayo Clinic

9. Two vantage points on the
schizotypy construct
• Schizotypy as the underlying liability
for schizophrenia, schizophrenia-
related psychopathology, and
schizophrenia endophenotypes
• Schizotypy as a normal personality
dimension

10. Two vantage points on the
schizotypy construct
• Schizotypy as the underlying liability
for schizophrenia, schizophrenia-
related psychopathology, and
schizophrenia endophenotypes
• Schizotypy as a normal personality
dimension
Normal Personality?: agentic extraversion, affiliative extraversion, anxiety, fear, nonaffective
constraint

11. Early Observations from Masters of
Schizotypic Phenomenology
• “... in the families attacked there comes under observation with
relative frequency besides dementia praecox a series of other
anomalies, especially manic-depressive insanity and eccentric
personalities [italics added]. ... the latter are probably for the
most part to be regarded as “latent schizophrenias” and therefore
essentially the same as the principal malady” (Kraepelin,
1919/1971).
• “There is also a latent schizophrenia, and I am convinced that
this is the most frequent form, although admittedly these people
hardly ever come for treatment ...In this form we see in nuce all
the symptoms and all combinations of symptoms which are
present in the manifest types of the disease” (Bleuler,
1911/1950).

12. Kraepelin Bleuler Rado
Meehl Gottesman
Meehl & Gottesman

13. Interest in schizotypy from differing
methodological vantage points
Paul H. Hoch
David Rosenthal
Seymour S. Kety

14. Rado, S. (1960)

15. Major papers: 1962, 1989, 1990; Checklist for schizotypic signs (1964)
Paul E. Meehl, PhD
(1920-2003)

16. Meehl, P.E. (1962)

17. Schizotypy
Liability for
Schizophrenia
Schizotypy is a latent construct
invisible to the naked, unaided eye
Plane of
observation
Schizotypy and schizotypy indicators:
Don’t confuse the latent construct with the
measured indicator of the construct
STY, PAR,
SZD, AVD
PD Features
Psychometric
indexes
(Endo-
phenotypes)
Laboratory
measures
(Endo-
phenotypes)
Indicators are not
isomorphic with the latent
construct.
Schizophrenia
and related
psychoses

18. SZ gene(s) Schizotypy
SL? SL? S?
PGP?
PGP?
Social
Learning
Influences
Stressors and
polygenetic
potentiators
Personality
organization
Latent level
(unobservable)
Schizotypic
disorders
Endophenotypes
Schizophrenia
Schizotaxia
“2nd hit”
S
c
h
i
z
o
t
y
p
e
s
Manifest level
(observable)
CNS
The Brain
DNA
Not visible to “naked” eye
Candidates: sustained attention, eye
tracking,working memory, motor function,
thought disorder (secondary cognitive
slippage), psychometrics
S?
Epigenetic
Factors?
Schizophrenia
related
psychoses
Prodrome ?
Plane of observation
(Synaptic slippage due
to hypokrisia)
Optional
Copyright © 2010 M.F. Lenzenweger

19. Schizotypy
Liability for
Schizophrenia
Schizotypy is a latent construct
invisible to the naked, unaided eye
Plane of
observation
Schizotypy and schizotypy indicators:
Don’t confuse the latent construct with the
measured indicator of the construct
STY, PAR,
SZD, AVD
PD Features
Psychometric
indexes
(Endo-
phenotypes)
Laboratory
measures
(Endo-
phenotypes)
Indicators are not
isomorphic with the latent
construct.
Schizophrenia
and related
psychoses

20. Recognizing Schizotypy Indications
• Clinical schizophrenia, schizophreniform illness,
delusional disorder are recognizable. (psychotic
illnesses are reasonably discernible by
experienced clinicians)
• How do we recognize schizotypy indications?
(non-psychotic variants)
• Personality disorder symptoms are assessed
using existing technologies (e.g., IPDE).
• Specialized psychological inventories

21. Approaches to Defining the Presence of
Schizotypy
• Genetic
• Laboratory
• Clinical
• Expectancies for
illness based on
parental affection
status
• Deviance on
quantitative indexes
(endophenotypes)
• Clinically visible
dysfunction / signs /
symptoms
• Traditional Genetic
High-Risk Studies
• Psychometric High-
Risk Studies
• A. Sub-syndromal or
“prodromal” quasi-
psychotic individuals
B. SRPDs

22. Approaches to Defining the Presence of
Schizotypy
• Genetic
• Laboratory
• Clinical
• Expectancies for
illness based on
parental affection
status
• Deviance on
quantitative indexes
(endophenotypes)
• Clinically visible
dysfunction / signs /
symptoms
• Traditional Genetic
High-Risk Studies
• Psychometric High-
Risk Studies
• A. Sub-syndromal or
“prodromal” quasi-
psychotic individuals
B. SRPDs

23. What is an endophenotype?
• Gottesman and Shields (1972) advanced the
argument that endophenotypes should be
considered internal phenotypes that might
someday be detectable in families of
schizophrenics “…either biological or
behavioral (psychometric pattern), which will
not only discriminate schizophrenics from
other psychotics, but will also be found in all
identical co-twins of schizophrenics whether
concordant or discordant” (1972, p. 336).

26. A Research IllustrationA Research Illustration::
Consider the features associated withConsider the features associated with
individuals who display elevations on aindividuals who display elevations on a
well-known schizotypy endophenotypewell-known schizotypy endophenotype.
The Perceptual Aberration ScaleThe Perceptual Aberration Scale
(Chapman, Chapman, & Raulin, 1978)

27. PAS: Sample Items
• Occasionally I have felt as though my body did
not exist (T)
• I have never felt that my arms and legs have
momentarily grown in size (F)
• Sometimes people whom I know well begin to
look like strangers (T)
• Ordinarily colors seem much too bright for me
(without taking drugs) (T)
• It has seemed at times as if my body was
melting into my surroundings (T)

28. PAS as Endophenotype
• Associated with schizophrenia and non-
psychotic schizotypic symptoms
• State factors do not explain associations
• Reliability (internal consistency)
• Reliability (test-retest)
• Heritable
• Higher in biological relatives where
schizophrenia is present in the family
• Associated with many other criteria of validity

29. High PAS Schizotypic persons display:
• Increased rate of familial schizophrenia
• Sustained attention deficits
• Spatial working memory deficits
• Smooth pursuit eye movement deficits
• MMPI schizophrenia-related deviance
• Executive functioning deficits (WCST)
• Antisaccade performance patterns
• Subtle thought disorder
• Schizotypic clinical PD features
• Social cognition deficits
Not explained
by anxiety or
depression

30. What we know about schizotypic
perceptual aberrations and
molecular genetic findings?
• PAS is clearly heritable (Miller & Chapman, 1993;
MacDonald et al., 2001)
• Neuregulin 1
• ZNF804A variations (zinc finger protein)
• Val158Met COMT (val/val) [catechol–O-methyl transferase]
• Perhaps more in light of 108 schizophrenia-related loci (Nature, 2014)

31. What is the underlying nature
of the schizotypy construct?
• Psychopathologists often ask: “Does schizotypy
have a qualitative or discontinuous nature
(on/off) or is it perfectly quantitative or
dimensional (graded) in nature?”
• Statistical evidence to date favors evidence for a
relatively strong discontinuity, which could
reflect a type difference or a strong threshold
effect (e.g., presence of the deleterious amount
and/or combination of genetic influences)
• Think of a liquid turning into a solid (water/ice)

32. Misunderstandings regarding
dimensionality
• Measuring a phenomenon in a dimensional
manner at the surface level does not ensure
dimensionality at the latent level;
• Factor analysis does not provide evidence of
dimensionality;
• Finding sub-threshold features of schizophrenia
in non-psychotic people does not mean the
liability for schizophrenia is dimensional;
• Histograms do not confirm dimensionality at
latent level

33. Schizotypic persons display:
• Increased rate of familial schizophrenia
• Sustained attention deficits
• Spatial working memory deficits
• Smooth pursuit eye movement deficits
• MMPI schizophrenia-related deviance
• Executive functioning deficits (WCST)
• Antisaccade performance patterns
• Subtle thought disorder
• Schizotypic clinical features
• Social cognition deficits
Not explained
by anxiety or
depression

34. What happens to schizotypic
persons over time?
• The information available on this topic
is somewhat limited.
• Longitudinal studies of 10 years or
greater duration suggest that some
schizotypic persons go on to develop
psychosis (schizophrenia related)
• Lenzenweger 17 year follow-up study:
(At follow-up: psychosis, SRPD features, schizotypal
features, impaired social adjustment, more treatment, and so
on.)

35. Rational Hierarchical Expanded
Schizophrenia Phenotype
• Level I: Schizophrenia, Schizophreniform
• Level II: I + Delusional Disorder, Psychosis NOS
(mainly schiz), or Schizoaffective (mainly schiz)
• Level III: I + II + Schizotypal PD or Paranoid PD
• Level IV: I + II + III + Schizoid PD or Avoidant PD

36. A rational and empirically
supported expanded phenotype
Level I
Level II
Level III
Level IV

38. Thank you forThank you for
your kindyour kind
attention!attention!