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. 2025 Jul 7;51(4):1104-1117.
doi: 10.1093/schbul/sbae149.

Psychosis Risk: Time to Look Empirically at a First-step Economical-pragmatic Way to Examine Anomalous Self-experience. Exploring the SQuEASE-11

Paul Møller  1 , Barnaby Nelson  2   3 , Patrick D McGorry  2   3 , Cristina Mei  2   3 , G Paul Amminger  2   3 , Hok Pan Yuen  2   3 , Melissa Kerr  2   3 , Jessica Spark  2   3 , Nicky Wallis  2   3 , Andrea Polari  2   3   4 , Shelley Baird  2   3 , Kate Buccilli  2   3 , Sarah-Jane A Dempsey  2   3 , Natalie Ferguson  2   3 , Melanie Formica  2   3 , Marija Krcmar  2   3 , Amelia L Quinn  2   3 , Yohannes Mebrahtu  2   3 , Arlan Ruslins  2   3 , Rebekah Street  2   3 , Lisa Dixon  5 , Cameron Carter  6 , Rachel Loewy  7 , Tara A Niendam  6 , Martha Shumway  7 , Cassandra Wannan  2   3
Affiliations

Psychosis Risk: Time to Look Empirically at a First-step Economical-pragmatic Way to Examine Anomalous Self-experience. Exploring the SQuEASE-11

Paul Møller et al. Schizophr Bull. .

Abstract

Background: Since the late 1990s, there has been a worldwide surge of scientific interest in the pre-psychotic phase, resulting in the introduction of several clinical tools for early detection. The predictive accuracy of these tools has been limited, motivating the need for methodological and perspectival improvements. The EASE manual supports systematic assessment of anomalous self-experience, and proposes an overall model of understanding how most psychotic experiences may be initially generated on the basis of a unifying, fundamental, pre-reflective distortion of subjectivity.

Study design: The EASE is time-consuming, so in order to spread the use of this essential perspective of psychosis risk we selected prototypical and frequent phenomena from the EASE, combining them into SQuEASE-11. To investigate this instrument for clinical relevance, basic psychometric properties, factor structure, and relationships with gold standard instruments and the full EASE, it was administered as an interview in the STEP intervention trial (Melbourne, Australia), with 328 clinical high-risk for psychosis (CHR-P) patients.

Study results: The SQuEASE-11 had moderate internal consistency and revealed two correlated factors. Significant relationships were observed between the SQuEASE-11 and the widely used and validated instruments CAARMS, BPRS, SANS, MADRS, DACOBS, and SOFAS. The correlation with the full EASE was very strong.

Conclusions: These 11 items do not necessarily relate specifically to ipseity disturbance, but the SQuEASE-11 seems to be a clinically relevant and brief supplementary first-line interview in CHR-P subjects. It may give a qualified indication of the need for a complete EASE interview, and it may also, importantly, inform treatment planning.

Keywords: anomalous self-experience; basic self-disturbance; clinical high-risk for psychosis; pre-psychotic detection; psychosis risk assessment; psychotic disorders.

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Figures

Fig. 1.
Fig. 1.
SQuEASE descriptive statistics: (A) item severity frequencies (0–4). Numbers before item names refer to the full EASE scale item numbers, (B) inter-item correlations for the SQuEASE-11. White squares indicate that no significant correlation was observed, (C) number of SQuEASE items rated as definitely present (severity 2–4), and (D) distribution of mean SQuEASE scores (severity 0–4).
Fig. 2.
Fig. 2.
Factor structure and loadings for the SQuEASE-11.
Fig. 3.
Fig. 3.
Correlations between mean SQuEASE scores (continuous severity scores) at baseline and symptom measures at baseline and follow-up, including (A) CAARMS, (B) MADRS, (C) BPRS, (D) SANS. Grey squares indicate that no significant correlation was observed. Note: CAARMS, Comprehensive Assessment of At-Risk Mental States; BPRS, Brief Psychiatric Rating Scale; SANS, Scale for the Assessment of Negative Symptoms; MADRS, Montgomery Asberg Depression Rating Scale.
Fig. 4.
Fig. 4.
Associations between mean SQuEASE scores (continuous severity scores) at baseline and (A) DACOBS and (B) SOFAS scores at baseline and follow-up. Grey squares indicate that no significant association was observed for this item. Note: DACOBS, Davos Assessment of Cognitive Biases Scale; SOFAS, Social and Occupational Functioning Scale.
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