Imperial College London

Dr. Maria de Gracia Dominguez-Barrera, MD. PhD

Faculty of MedicineFaculty of Medicine Centre

Honorary Clinical Senior Lecturer



+44 (0)20 3312 1145m.dominquez-barrera




Queen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus





Publication Type

10 results found

Dominguez M-D-G, Fisher HL, Major B, Chisholm B, Rahaman N, Joyce J, Woolley J, Lawrence J, Hinton M, Marlowe K, Aitchison K, Johnson S, Hodes Met al., 2013, Duration of untreated psychosis in adolescents: Ethnic differences and clinical profiles, SCHIZOPHRENIA RESEARCH, Vol: 150, Pages: 526-532, ISSN: 0920-9964

Journal article

Smeets F, Lataster T, Dominguez M-D-G, Hommes J, Lieb R, Wittchen H-U, van Os Jet al., 2012, Evidence that onset of psychosis in the population reflects early hallucinatory experiences that through environmental risks and affective dysregulation become complicated by delusions., Schizophr Bull, Vol: 38, Pages: 531-542

OBJECTIVE: To examine the hypothesis that the "natural" combination of delusions and hallucinations in psychotic disorders in fact represents a selection of early subclinical hallucinatory experiences associated with delusional ideation, resulting in need for care and mental health service use. METHODS: In the Early Developmental Stages of Psychopathology study, a prospective, 10-year follow-up of a representative cohort of adolescents and young adults in Munich, Germany (n = 2524), clinical psychologists assessed hallucinations and delusions at 2 time points (T2 and T3). Analyses compared differences in psychopathology, familial liability for nonpsychotic disorder, nongenetic risk factors, persistence, and clinical outcome between groups characterized by: (1) absence of positive psychotic symptoms, (2) presence of isolated hallucinations, (3) isolated delusions, and (4) both hallucinations and delusions. RESULTS: Delusions and hallucinations occurred together much more often (T2: 3.1%; T3: 2.0%) than predicted by chance (T2: 1.0%; T3: 0.4%; OR = 11.0; 95% CI: 8.1, 15.1). Content of delusions was contingent on presence of hallucinations but modality of hallucinations was not contingent on presence of delusions. The group with both hallucinations and delusions, compared to groups with either delusions or hallucinations in isolation, displayed the strongest associations with familial affective liability and nongenetic risk factors, as well as with persistence of psychotic symptoms, comorbidity with negative symptoms, affective psychopathology, and clinical need. CONCLUSIONS: The early stages of psychosis may involve hallucinatory experiences that, if complicated by delusional ideation under the influence of environmental risks and (liability for) affective dysregulation, give rise to a poor prognosis hallucinatory-delusional syndrome.

Journal article

Schutters SIJ, Dominguez M-D-G, Knappe S, Lieb R, van Os J, Schruers KRJ, Wittchen H-Uet al., 2012, The association between social phobia, social anxiety cognitions and paranoid symptoms., Acta Psychiatr Scand, Vol: 125, Pages: 213-227

OBJECTIVE: Previous research suggests high levels of comorbidity between social phobia and paranoid symptoms, although the nature of this association remains unclear. METHOD: Data were derived from the Early Developmental Stages of Psychopathology study, a 10-year longitudinal study in a representative German community sample of 3021 participants aged 14-24 years at baseline. The Munich-Composite International Diagnostic Interview was used to assess social phobia and paranoid symptoms, along with data on social phobia features. Cross-sectional and longitudinal analyses were conducted. Differential associations with environmental risk factors and temperamental traits were investigated. RESULTS: Lifetime social phobia and paranoid symptoms were associated with each other cross-sectionally (OR = 1.80, 95% CI = 1.31-2.47). Lifetime paranoid symptoms were associated specifically with social anxiety cognitions. Lifetime cognitions of negative evaluation predicted later onset of paranoid symptoms, whereas onset of social phobia was predicted by cognitions of loss of control and fear/avoidance of social situations. Lifetime social phobia and paranoid symptoms shared temperamental traits of behavioural inhibition, but differed in environmental risks. CONCLUSIONS: The present study showed that paranoid symptoms and social phobia share similarities in cognitive profile and inhibited temperament. Avoidance appears to be important in the development of social phobia, whereas cannabis use and traumatic experiences may drive paranoid thinking in vulnerable individuals.

Journal article

van Rossum I, Dominguez M-D-G, Lieb R, Wittchen H-U, van Os Jet al., 2011, Affective dysregulation and reality distortion: a 10-year prospective study of their association and clinical relevance., Schizophr Bull, Vol: 37, Pages: 561-571

Evidence from clinical patient populations indicates that affective dysregulation is strongly associated with reality distortion, suggesting that a process of misassignment of emotional salience may underlie this connection. To examine this in more detail without clinical confounds, affective regulation-reality distortion relationships, and their clinical relevance, were examined in a German prospective cohort community study. A cohort of 2524 adolescents and young adults aged 14-24 years at baseline was examined by experienced psychologists. Presence of psychotic experiences and (hypo)manic and depressive symptoms was assessed at 2 time points (3.5 and up to 10 years after baseline) using the Munich-Composite International Diagnostic Interview. Associations were tested between level of affective dysregulation on the one hand and incidence of psychotic experiences, persistence of these experiences, and psychotic Impairment on the other. Most psychotic experiences occurred in a context of affective dysregulation, and bidirectional dose-response was apparent with greater level of both affective dysregulation and psychotic experiences. Persistence of psychotic experiences was progressively more likely with greater level of (hypo)manic symptoms (odds ratio [OR] trend=1.51, P<.001) and depressive symptoms (OR trend=1.15, P=.012). Similarly, psychotic experiences of clinical relevance were progressively more likely to occur with greater level of affective dysregulation (depressive symptoms: OR trend=1.28, P=.002; (hypo)manic symptoms: OR trend=1.37, P=.036). Correlated genetic liabilities underlying affective and nonaffective psychotic syndromes may be expressed as correlated dimensions in the general population. Also, affective dysregulation may contribute causally to the persistence and clinical relevance of reality distortion, possibly by facilitating a mechanism of aberrant salience attribution.

Journal article

van der Werf M, Thewissen V, Dominguez MD, Lieb R, Wittchen H, van Os Jet al., 2011, Adolescent development of psychosis as an outcome of hearing impairment: a 10-year longitudinal study., Psychol Med, Vol: 41, Pages: 477-485

BACKGROUND: It has long been acknowledged that hearing impairment may increase the risk for psychotic experiences. Recent work suggests that young people in particular may be at risk, indicating a possible developmental mechanism. METHOD: The hypothesis that individuals exposed to hearing impairment in early adolescence would display the highest risk for psychotic symptoms was examined in a prospective cohort study of a population sample of originally 3021 adolescents and young adults aged 14-24 years at baseline, in Munich, Germany (Early Developmental Stages of Psychopathology Study). The expression of psychosis was assessed at multiple time points over a period of up to 10 years, using a diagnostic interview (Munich Composite International Diagnostic Interview; CIDI) administered by clinical psychologists. RESULTS: Hearing impairment was associated with CIDI psychotic symptoms [odds ratio (OR) 2.04, 95% confidence interval (CI) 1.10-3.81], particularly more severe psychotic symptoms (OR 5.66, 95% CI 1.64-19.49). The association between hearing impairment and CIDI psychotic symptoms was much stronger in the youngest group aged 14-17 years at baseline (OR 3.28, 95% CI 1.54-7.01) than in the older group aged 18-24 years at baseline (OR 0.82, 95% CI 0.24-2.84). CONCLUSIONS: The finding of an age-specific association between hearing impairment and psychotic experiences suggests that disruption of development at a critical adolescent phase, in interaction with other personal and social vulnerabilities, may increase the risk for psychotic symptoms.

Journal article

Dominguez MDG, Wichers M, Lieb R, Wittchen H-U, van Os Jet al., 2011, Evidence that onset of clinical psychosis is an outcome of progressively more persistent subclinical psychotic experiences: an 8-year cohort study., Schizophr Bull, Vol: 37, Pages: 84-93

This study examined the hypothesis that developmental expression of psychometric risk in the form of subclinical psychotic experiences in the general population is usually transitory but in some instances may become abnormally persistent and progress to a clinical psychotic state. A prospective cohort study was conducted in a general population sample of 845 adolescents, aged 14-17 years, in Munich, Germany (Early Developmental Stages of Psychopathology Study). Expression of psychosis was assessed 4 times (T0-T3) over a period of 8.4 years. Transition from subclinical psychosis at T0-T2 to clinical psychosis in terms of impairment at T3 was examined as a function of the level of prior persistence of subclinical psychosis (present never, once, twice, or thrice). The more the subclinical psychosis persisted over the period T0-T2, the greater the risk of transition to clinical psychosis at T3 in a dose-response fashion (subclinical psychosis expression once over T0-T2: odds ratio [OR] = 1.5 [95% confidence interval {CI} = 0.6-3.7], posttest probability [PP] = 5%; twice: OR = 5.0 [95% CI = 1.6-15.9], PP = 16%; at all 3 measurements: OR = 9.9 [95% CI = 2.5-39.8], PP = 27%). Of all clinical psychosis at T3, more than a third (38.3%) was preceded by subclinical psychotic experiences at least once and a fifth (19.6%) at least twice. Consequently, a significant proportion of psychotic disorder may be conceptualized as the rare poor outcome of a common developmental phenotype characterized by persistence of psychometrically detectable subclinical psychotic experiences. This may be summarized descriptively as a psychosis proneness-persistence-impairment model of psychotic disorder.

Journal article

Fett A-KJ, Viechtbauer W, Dominguez M-D-G, Penn DL, van Os J, Krabbendam Let al., 2011, The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: a meta-analysis., Neurosci Biobehav Rev, Vol: 35, Pages: 573-588

The current systematic review and meta-analysis provides an extended and comprehensive overview of the associations between neurocognitive and social cognitive functioning and different types of functional outcome. Literature searches were conducted in MEDLINE and PsycINFO and reference lists from identified articles to retrieve relevant studies on cross-sectional associations between neurocognition, social cognition and functional outcome in individuals with non-affective psychosis. Of 285 studies identified, 52 studies comprising 2692 subjects met all inclusion criteria. Pearson correlations between cognition and outcome, demographic data, sample sizes and potential moderator variables were extracted. Forty-eight independent meta-analyses, on associations between 12 a priori identified neurocognitive and social cognitive domains and 4 domains of functional outcome yielded a number of 25 significant mean correlations. Overall, social cognition was more strongly associated with community functioning than neurocognition, with the strongest associations being between theory of mind and functional outcomes. However, as three-quarters of variance in outcome were left unexplained, cognitive remediation approaches need to be combined with therapies targeting other factors impacting on outcome.

Journal article

Dominguez M-D-G, Saka MC, Lieb R, Wittchen H-U, van Os Jet al., 2010, Early expression of negative/disorganized symptoms predicting psychotic experiences and subsequent clinical psychosis: a 10-year study., Am J Psychiatry, Vol: 167, Pages: 1075-1082

OBJECTIVE: The cognitive and motivational impairments observed in psychotic disorders may reflect early developmental alterations that, when combined with later environmental exposures, may drive the onset of positive psychotic symptoms. The epidemiological predictions of this model were tested. METHOD: A longitudinal prospective cohort study (the Early Developmental Stages of Psychopathology Study) was conducted with a representative general population sample of adolescents and young adults from Munich (N=3,021), who were 14-24 years of age at baseline. Sociodemographic factors, environmental exposures, and measures of psychopathology and associated clinical relevance were assessed across three waves, covering a period of up to 10 years, by clinical psychologists using the Composite International Diagnostic Interview. RESULTS: Both negative/disorganized and positive psychotic symptoms were frequent (5-year cumulative prevalence rates of around 12%) and occurred in combination more often than predicted by chance. Negative/disorganized symptoms revealed a pattern of sociodemographic associations indicative of developmental impairment, whereas the positive symptoms were associated with environmental exposures such as trauma, cannabis use, and urbanicity. Negative/disorganized symptoms predicted positive symptoms over time, and co-occurrence of positive and negative/disorganized symptoms was predictive of clinical relevance in terms of secondary functional impairment and help-seeking behavior. CONCLUSION: The results suggest that the negative/disorganized features associated with psychotic disorder are distributed at the population level and drive the ontogenesis of positive psychotic experiences after exposure to environmental risks, increasing the likelihood of impairment and need for care.

Journal article

Simons CJP, Tracy DK, Sanghera KK, O'Daly O, Gilleen J, Dominguez M-D-G, Krabbendam L, Shergill SSet al., 2010, Functional magnetic resonance imaging of inner speech in schizophrenia., Biol Psychiatry, Vol: 67, Pages: 232-237

BACKGROUND: Auditory verbal hallucinations in schizophrenia have been linked to defective monitoring of one's own verbal thoughts. Previous studies have shown that patients with auditory verbal hallucinations show attenuated activation of brain regions involved with auditory processing during the monitoring of inner speech. However, there are no functional magnetic resonance imaging studies explicitly comparing the perception of external speech with internal speech in the same patients with schizophrenia. The present study investigated the functional neuroanatomy of inner and external speech in both patients with schizophrenia and healthy control subjects. METHODS: Fifteen patients with schizophrenia and 12 healthy control subjects were studied using functional magnetic resonance imaging while listening to sentences or imagining sentences. RESULTS: Significant interactions between group (control subjects vs. patients) and task (listening vs. inner speech) were seen for the left superior temporal gyrus, as well as regions within the cingulate gyrus. CONCLUSIONS: Attenuated deactivation of the left superior temporal gyrus in schizophrenia patients during the processing of inner speech may reflect deficits in the forward models subserving self-monitoring.

Journal article

Dominguez MDG, Viechtbauer W, Simons CJP, van Os J, Krabbendam Let al., 2009, Are psychotic psychopathology and neurocognition orthogonal? A systematic review of their associations., Psychol Bull, Vol: 135, Pages: 157-171, ISSN: 0033-2909

A systematic review (58 studies, 5,009 individuals) is presented of associations between psychopathological dimensions of psychosis and measures of neurocognitive impairment in subjects with a lifetime history of nonaffective psychosis. Results showed that negative and disorganized dimensions were significantly but modestly associated with cognitive deficits (correlations from -.29 to -.12). In contrast, positive and depressive dimensions of psychopathology were not associated with neurocognitive measures. The patterns of association for the 4 psychosis dimensions were stable across neurocognitive domains and were independent of age, gender, and chronicity of illness. In addition, significantly higher correlations were found for the negative dimension in relation to verbal fluency (p = .005) and for the disorganized dimension in relation to reasoning and problem solving (p = .004) and to attention/vigilance (p = .03). Psychotic psychopathology and neurocognition are not entirely orthogonal, as heterogeneity in nonaffective psychosis is weakly but meaningfully associated with measures of neurocognition. This association suggests that differential latent cerebral mechanisms underlie the cluster of disorganized and negative symptoms versus that of positive and affective symptoms.

Journal article

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