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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

In schizophrenia, the development of standardized assess-
ment instruments and specific criteria defining the so-called
ultra-high risk (UHR) paradigm [1] with good predictive
validity has encouraged research on early detection and
establishment of early recognition and intervention worldwide.
The resulting perspective research has confirmed that, as well as
Corresponding author at: NESMOS Department, Sapienza University,
2nd Medical School, SantAndrea Hospital, Via di Grottarossa 1035-1039,
00189 Rome, Italy. Tel. +39 0633775664; fax: +39 0633775342.
E-mail address: anna.comparelli@uniroma1.it (A. Comparelli).
http://dx.doi.org/10.1016/j.comppsych.2015.09.011
0010-440X/ 2015 Elsevier Inc. All rights reserved.
episode of psychosis is generally preceded by a prodromal
phase that is characterized by non-specific negative symptoms,
difficulty in social and age-appropriate role functioning,
self-experienced cognitive symptoms, and impaired neuro-
and social cognition.
Although the UHR approach has shown diagnostic validity
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],
there is a wide consensus that it suffers from several conceptual
and methodological shortcomings that need to be addressed in
order to improve its scientific and clinical utility. In fact, UHR
predictive criteria, which use increasing intensity of positive
 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
UHR group than in HS-non UHR subjects for EASE
domains 1 and 2, EASE-total score, and the EASE-10
subscale. In the UHR subgroup, the mean IQ and GAF
scores were 99.42 (SD = 7.75) and 57.75 (SD = 8.11),
respectively. Among UHR subjects, partial correlations
between ASE domains and psychopathological features
showed that higher EASE total score correlated with higher
SOPS Positive score (p b 0.05); higher EASE total and
EASE-10 scores were correlated with a lower GAF score
(p b 0.001). No significant correlations were found between
EASE total and EASE 10 scores and neuropsychological
measures (Table 3). After Bonferroni correction (all
p b 0.001), only the association between EASE-total and
EASE-10 scores with the GAF score retained statistical
significance.
The factorial analysis of prodromal symptoms, ASE, and
functioning yielded a two-factor solution, jointly accounting
for 70.58% of the total variance in the entire sample. The first
factor was comprised of SOPS domains, and was thus termed
prodromal symptoms. The second factor was comprised of
EASE-total, EASE-10, and GAF variables, and was termed
ASE/functioning (Table 4).
4. Discussion
The first aim of this study was to compare the level of
ASE in two groups of help-seeking adolescents and young
adults at their first admission to public psychiatric services.
Table 4
Factor analysis.
Component
1 2
SOPS Pos .697
SOPS Neg .800
SOPS Dis .888
SOPS Gen .678
EASE-total .108
EASE-10 .130
GAF .472
Extraction method: principal component analysis. Rotation method:
Varimax with Kaiser normalization.
Primary loadings are in bold typeface.
Explained variance (extraction sums of squared loadings):
Whole sample: Total = 70.58% (factor 1 = 37.49%; factor 2 = 33.09%).
The two groups differed for being or not at risk for an
impending psychosis.
As expected, ASE was present in the entire sample, but in
the UHR group scores were significantly higher in the first and
second domains of EASE, i.e. stream of consciousness and
self-awareness. Nelson et al. [10] showed that the level of all
EASE domains was significantly higher in a group of UHR
subjects compared with healthy volunteers; interestingly, in
the same study, stream of consciousness, and self-awareness
predicted the onset of illness over a mean follow-up of
1.5 years in the UHR group.
In agreement with previous reports, these results provide
further support for the notion that disorders of self-experience
are present early in the illness and, as such, may constitute a
potential marker of risk supplementing the UHR approach.
Since ASE, as a possible phenotypic precursor of schizophrenia,
is qualitatively different from subthreshold psychosis, it may
have the potential to introduce further specificity into current
high-risk identification strategies. This hypothesis is also
advanced by Koren et al. [17] who proposed that ASE is a
trait-marker and predicts schizophrenia or schizotypy, whereas
prodromal symptoms are general markers of psychosis (across
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
is that in the UHR group higher levels of ASE are associated
with lower global functioning. This result is strongly confirmed
by both statistical and factor analyses. In the literature, there are
two studies exploring this relationship, even if in quite different
cohorts. The first [17] examined this relationship in a sample of
help-seekers and found a relationship between EASE-10 and
total scores with social and role functioning measures; the
second study [22] showed that high levels of ASE were
significantly associated with poorer social functioning in the
early phases of schizophrenia and psychotic bipolar disorder
regardless of diagnosis. Of note, Velthorst et al. [23]
.433
.061 demonstrated that transition to psychosis in UHR patients is
.013 strongly predicted by lower global functioning scores as
.103 measured by the GAF. Consistent with other reports [24,25] it
.938 has been shown that level of functioning, as measured by the
.906
GAF, improved with symptomatic remission in false positive
.644
UHR. Such a phenomenon may be highly improbable in
subjects that are at true UHR for psychosis, as decreased levels
of functioning have been a persistent core phenomenon along
the entire prodrome of at-risk subjects who later converted to
psychosis [26].
48 A. Comparelli et al. / Comprehensive Psychiatry 65 (2016) 4449
On the whole, our findings appear to be in agreement with
the hypothesis of Koren et al. [17], suggesting that in UHR
subjects the presence of self-disturbances, with concomitant
low functioning, may represent a more specific, even if less
sensitive, condition of risk.
As well as reducing the number of false positives, greater
specificity of risk criteria would allow differentiating affective
from non-affective psychosis risk, since the bipolar prodrome
may be indistinguishable from the schizophrenia prodrome
based on currently used clinical and neurocognitive measures
[27]. This differentiation may have implications for both
treatment and neurodevelopmental research.
Regarding the lack of association with other prodromal
symptoms, inconsistent results have emerged to date.
According to Koren et al. [17] there is a moderate correlation
between ASE and positive and negative symptoms. Never-
theless, their sample was composed of help-seekers and not
only at-risk subjects.
Considering the lack of association with neurocognition,
this finding is in accordance with previous studies, and only
one investigation [28] found a relationship between EASE
total score and verbal memory, with a general lack of
association between the two variables.
Our study has some limitations that should be considered
to ameliorate further research in this area. First of all, the
study design is cross-sectional, and therefore we do not know
how many subjects in the UHR group will develop the
illness. Second, our study does not include a comparison
group of non-help-seeking adolescents, and consequently it
is unclear whether our results are generalizable to the entire
population of adolescents and young adults who are at risk.
In fact, not all individuals who may be at risk seek help [29].
Another limitation of the study is that it lacks follow-up data
on clinical and functional outcomes. Finally, it has been
recently hypothesized that ASE may be associated with the
neurocognitive disturbances of source monitoring and
aberrant salience [30,31]. Unfortunately, measures of these
constructs (such as binocular depth inversion, perceptual
closure, learned irrelevance, spurious messages from noise,
mismatch negativity, salience attribution, reversal learning
tasks, and temporal binding tasks) are not standardized in
a consensus battery, and are not currently utilized in
naturalistic studies on neuropsychological assessment of
at-risk adolescents and young adults.
5. Conclusion
The present study provides preliminary support for the
possibility that ASE is associated with decreased global
functioning and that ASE represents a clinical phenotype
that may characterize a specific subgroup of UHR subjects
evolving towards a schizophrenia spectrum disorder.
Moreover, our findings provide preliminary support for the
possibility of supplementing and refining current criteria for
early detection of risk through assessment of ASE. Future
research may indicate the specific role of clinical risk
markers in prediction of long-term outcome.
References
[1] Yung AR, McGorry PD. The prodromal phase of first-episode psychosis:
past and current conceptualizations. Schizophr Bull 1996;22:353-70.
[2] Cannon TD, Cornblatt B, McGorry P. The empirical status of the ultra
high-risk (prodromal) research paradigm. Schizophr Bull 2007;33:661-4.
[3] Woods SW, Addington J, Cadenhead KS, Cannon TD, Cornblatt BA,
Heinssen R, et al. Validity of the prodromal risk syndrome for first
psychosis: findings from the North American Prodrome Longitudinal
Study. Schizophr Bull 2009;35:894-908.
[4] McGorry PD, Killackey E, Yung A. Early intervention in psychosis:
concepts, evidence and future directions. World Psychiatry 2008;7:148-56.
[5] Cannon TD. Clinical and genetic high-risk strategies in understanding
vulnerability to psychosis. Schizophr Res 2005;79:35-44.
[6] Yung AR, Stanford C, Cosgrave E, Killackey E, Phillips L, Nelson B, et al.
Testing the ultra high risk (prodromal) criteria for the prediction of
psychosis in a clinical sample of young people. Schizophr Res
2006;84:57-66.
[7] van Os J, Kenis G, Rutten BP. The environment and schizophrenia.
Nature 2010;468:203-12.
[8] Yung AR, Yuen HP, Berger G, Francey S, Hung TC, Nelson B, et al.
Declining transition rate in ultra high risk (prodromal) services:
dilution or reduction of risk? Schizophr Bull 2007;33:673-81.
[9] Mass R. Characteristic subjective experiences of schizophrenia.
Schizophr Bull 2000;26:921-31.
[10] Nelson B, Thompson A, Yung AR. Basic self-disturbance predicts
psychosis onset in the ultra high risk for psychosis "prodromal"
population. Schizophr Bull 2012;38:1277-87.
[11] McGlashan T, Walsh B, Woods S. The psychosis-risk syndrome.
Handbook for diagnosis and follow-up1st ed. . New York: Oxford
University Press; 2010.
[12] First MB, Spitzer RL, Gibbon M, Williams JBW. Structured clinical
interview for DSM-IV axis I disorders SCID-I: clinician version.
Washington: American Psychiatric Press; 1996.
[13] Comparelli A, Savoja V, Kotzalidis GD, Woods SW, Mosticoni S,
Vassallo F, et al. Factor-structure of the Italian version of the Scale Of
Prodromal Symptoms (SOPS): a comparison with the English version.
Epidemiol Psychiatr Sci 2011;20:45-54.
[14] Comparelli A. Lo stato mentale a rischio e la sua valutazione. 1st ed.
Rome: Alpesitalia; 2011.
[15] Parnas J, Mller P, Kircher T, Thalbitzer J, Jansson LB, Handest P, et al.
Esame dell'abnorme esperienza del s (EASE). Rome: Giovanni Fioriti
Editore; 2009.
[16] Parnas J, Mller P, Kircher T, Thalbitzer J, Jansson L, Handest P, et al.
EASE: examination of anomalous self-experience. Psychopathology
2005;38:236-58.
[17] Koren D, Reznik N, Adres M, Scheyer R, Apter A, Steinberg T, et al.
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
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
JD, et al. The MATRICS Consensus Cognitive Battery, part 1: test
selection, reliability, and validity. Am J Psychiatry 2008;165:203-13.
[20] Corigliano V, De Carolis A, Trovini G, Dehning J, Di Pietro S, Curto
M, et al. Neurocognition in schizophrenia: from prodrome to multi-
episode illness. Psychiatry Res 2014;15:129-34.
[21] Raven JC. SPM Standard Progressive Matrices, Matrici Progressive di
Raven. Serie A, B, C, D, E (Italian translation). Firenze: GiuntiOS; 2008.
[22] Haug E, ie M, Andreassen OA, Bratlien U, Raballo A, Nelson B, et al.
Anomalous self-experiences contribute independently to social dysfunction
 A. Comparelli et al. / Comprehensive Psychiatry 65 (2016) 4449
in the early phases of schizophrenia and psychotic bipolar disorder. Compr
Psychiatry 2014;55:475-82.
[23] Velthorst E, Nieman DH, Becker HE, van de Fliert R, Dingemans PM,
Klaassen R, et al. Baseline differences in clinical symptomatology
between ultra high risk subjects with and without a transition to
psychosis. Schizophr Res 2009;109:60-5.
[24] Simon AE, Umbricht D. High remission rates from an initial ultra-high
risk state for psychosis. Schizophr Res 2010;116:168-72.
[25] Velthorst E, Nieman DH, Klaassen RM, Becker HE, Dingemans PM,
Linszen DH, et al. Three-year course of clinical symptomatology in
young people at ultra high risk for transition to psychosis. Acta
Psychiatr Scand 2011;123:36-42.
[26] Hfner H, Lffler W, Maurer K, Hambrecht M, an der Heiden W.
Depression, negative symptoms, social stagnation and social decline in the
early course of schizophrenia. Acta Psychiatr Scand 1999;100(2):105-18.
[27] Olvet DM, Stearns WH, McLaughlin D, Auther AM, Correll CU, Cornblatt
BA. Comparing clinical and neurocognitive features of the schizophrenia
prodrome to the bipolar prodrome. Schizophr Res 2010;123:59-63.
[28] Haug E, ie M, Melle I, Andreassen OA, Raballo A, Bratlien U, et al.
The association between self-disorders and neurocognitive dysfunction
in schizophrenia. Schizophr Res 2012;135:79-83.
[29] Addington J, Epstein I, Reynolds A, Furimsky I, Rudy L, Mancini B, et al.
Early detection of psychosis: finding those at clinical high risk. Early Interv
Psychiatry 2008;2:147-53.
[30] Nelson B, Whitford TJ, Lavoie S, Sass LA. What are the
neurocognitive correlates of basic self -disturbance in schizophrenia?
49
Integrating phenomenology and neurocognition. Part 1 (source
monitoring deficits). Schizophr Res 2014;152:12-9.
[31] Nelson B, Whitford TJ, Lavoie S, Sass LA. What are the
neurocognitive correlates of basic self-disturbance in schizophrenia?
Integrating phenomenology and neurocognition: part 2 (aberrant
salience). Schizophr Res 2014;152:20-7.
[32] Reitan RM, Wolfson D. The HalsteadReitan Neuropsychological
Test Battery: therapy and clinical interpretation. 2nd ed. Tucson, AZ:
Neuropsychological Press; 1985.
[33] Stroop J. Studies of interference in serial verbal reactions. J Exp
Psychol 1935;18:643-62.
[34] Novelli G, Papagno C, Capitani E, Laiacona M, Vallar G, Cappa SF.
Tre tests clinici di ricerca e produzione lessicale. Taratura su soggetti
normali. Arch Psicol Neurol Psichiatr 1986;47:477-506.
[35] Grant DA, Berg EA. A behavioral analysis of damage of reinforcement
and ease of shifting to new responses in a Weigl type card sorting
problem. J Exp Psychol 1948;38:404-11.
[36] Orsini A, Grossi D, Capitani E, Laiacona M, Papagno C, Vallar G.
Verbal and spatial immediate memory span: normative data from 1355
adults and 1112 children. Ital J Neurol Sci 1987;8:539-48.
[37] Buschke H. Selective reminding for analysis of memory and learning.
J Verbal Learn Verbal Behav 1973;12:543-50.
[38] Osterrieth PA. Le test de copied'une f igure complex:contributional
'tude de la percept ion et la mmor ie. Arch Psychol 1944;30:286-356.
[39] Ekman P, Friesen WV. Constants across cultures in the face and
emotion. J Pers Soc Psychol 1971;17:124-9.