Investigating the Psychiatric Manifestations of Joint Hypermobility, Psychotic Experiences and Social Emotional Processing: A Large Cohort Study of Adolescents.

Z Saeed*, NA Harrison**, KA Davies***, HD Critchley****, A Bulbena*****, JA Eccles******
Brighton & Sussex Medical School*, Department of Neuroscience, Brighton and Sussex Medical School, Sussex Partnership NHS Foundation Trust**, Department of Clinical and Experimental Medicine, Brighton & Sussex University Hospitals, Brighton & Sussex Medical School***, Department of Psychiatry at Brighton & Sussex Medical School, Sussex Partnership NHS Foundation Trust****, Department of Psychiatry and Forensic Medicine, Universitat Autonoma Barcelona*****, Department of Neuroscience, Brighton and Sussex Medical School, Sussex Partnership NHS Foundation Trust******
Joint hypermobility (JH), a common yet poorly recognized variant of connective tissue, has been linked with psychiatric symptomatology such as anxiety disorders and depression in adults. The aim of the present study was to assess whether JH is associated with the following in adolescence: Altered performance on the Emotional Triangles task, a test that assesses recognition of emotion from social motion cues. Psychotic experiences (PEs) such as hallucinations, delusions and thought interference are measured using the Psychosis-Like Symptoms interview (PLIKSi).
ALSPAC (Avon Longitudinal Study of Parents and Children) birth cohort was analysed. Children underwent assessment for JH (mean age 13.8 years) using the Beighton Scale (n=6105); those scoring 4 or more were classified as hypermobile. At the same time point they undertook the Emotional Triangles Task. 6001 children (49% male) underwent both assessments. Linear regression models were used to assess the contribution of hypermobility to performance. Children underwent the PLIKSi at mean age 17.8 years (n=4718); with the primary outcome for the 12 core experiences being assessed as ‘not present’, ‘suspected’, or ‘definitely present’. In line with other reported studies, PEs were coded as present in adolescents with one or more PE ‘definitely present’. 3916 adolescents underwent both JH and PLIKSi assessments. Missing data was imputed and regression models were used to assess the contribution of hypermobility to the presence of PEs, corrected for age at assessment.
Hypermobility status significantly predicted enhanced recognition of sadness on the Emotional Triangles Task, (p=0.037, t=2.085, β=0.030). Hypermobility was not associated with differences in the detection of the other emotions. Hypermobility significantly predicted the increased occurrence of PEs in adolescent males (p=0.043, OR 1.626, 95% CI 1.015-2.605). Additionally, the total PLIKSi score (indicating degree of psychotic experience) was significantly greater in males with hypermobility (p=0.037). Hypermobility was not significantly associated with PEs in females.
We demonstrate the significantly increased ability to detect ‘sadness’ in hypermobile individuals, which differs from previous findings in autism spectrum conditions. However, it is line with a previous brain functional imaging study which demonstrates that healthy hypermobile adult individuals show enhanced reactivity to sad images in insular cortex, and may go some way in exploring their over-representation in anxiety and depressive disorders. Furthermore, we build upon prior case study evidence linking JH and PEs which merits further research to clarify a possible common etiology, and how this may render males more susceptible than females.
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