ORIGINAL RESEARCH article
Front. Psychiatry
Sec. Public Mental Health
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1560774
Negative symptoms and self-reflection increase alienation in individuals at clinical high-risk for psychosis (CHR)
Provisionally accepted
Melina Mendonça1
Natalia Mansur Haddad1Leonardo Peroni de Jesus1
Julio Andrade1
Feten Fekih-Romdhane2
Mauricio Henriques Serpa1
Martinus Theodorus Van De Bilt1
Wagner F Gattaz1
Wulf Rössler3
Alexandre Andrade Loch4*- 1Laboratory of Neurosciences, Institute of Psychiatry, Clinical Hospital, Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
- 2Faculty of Medicine, Tunis El Manar University, Tunis, Tunis, Tunisia
- 3Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Berlin, Baden-Wurttemberg, Germany
- 4Institute of Psychiatry, University of São Paulo, São Paulo, Sao Paulo, Brazil
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Objective: To assess stigma and cognitive insight, and their interplay with symptoms in individuals at clinical high risk for psychosis (CHR). Methods: Individuals were screened for CHR status and then assessed with the Internalized Stigma of Mental Illness, Beck Cognitive Insight Scale and Perceived Devaluation and Discrimination Scale. Spearman's rho correlations were used to analyze data on scales and symptoms. Mediation analysis models were performed. Results: 56 CHR and 18 controls were drawn from the general population. CHRs showed lower perceived discrimination and greater cognitive insight than controls. CHR individuals showed a positive correlation between alienation and both positive and negative symptoms, a positive correlation between cognitive insight and both negative and general symptoms. Strong correlations between cognitive insight and internalized stigma were observed. In the mediation analysis, alienation had an influence of negative symptoms and self-reflection. Also, alienation had the influence of negative symptoms via self-reflection. Conclusions: Our data highlights the importance of identifying pronounced negative symptoms in CHR individuals as a reinforcer of internalized stigma. In this sense, addressing stigma in CHR should carefully consider negative symptoms, given their influence on alienation both directly and indirectly via self-reflection.
Keywords: Schizophrenia, at risk mental state, Attenuated psychosis, stereotype, Prejudice, Discrimination
Received: 14 Jan 2025; Accepted: 15 Aug 2025.
Copyright: © 2025 Mendonça, Haddad, de Jesus, Andrade, Fekih-Romdhane, Serpa, Van De Bilt, Gattaz, Rössler and Loch. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Alexandre Andrade Loch, Institute of Psychiatry, University of São Paulo, São Paulo, Sao Paulo, Brazil
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