A dimensional measure of schizotypy: cross-cultural adaptation and validation of the Oxford-Liverpool Inventory of Feelings and Experiences short version for Brazilian Portuguese (O-LIFE-S)

Abstract Introduction The Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE) is a widely-used scale, and the first to include a dimensional approach to understanding schizotypy. Objective To adapt the short version of the O-LIFE (O-LIFE-S) into Brazilian Portuguese. Method a) Two independent bilingual professionals translated the original instrument into Brazilian Portuguese; b) a third bilingual professional summarized the two translations; c) a fourth bilingual expert translated the Portuguese version back into English; d) this back-translation was adjusted by a committee of psychology experts; e) a pilot study was conducted with 10 participants from the general population. Results O-LIFE-S was considered ready to be used in a formal validation study in Brazil. Conclusion The scale appears to cover the dimensional approach to schizotypy. However, a future validation study needs to be conducted to determine the internal consistency and reliability of the Brazilian Portuguese version of the O-LIFE-S .


Introduction
was the first author to identify "moderate schizophrenia" as a discrete expression of psychosis. Since then, there have been several interpretations of schizophrenia, one of which is a dimensional model of psychosis encompassing healthy expressions of psychotic-like features, particularly as a personality trait -schizotypy. 1,2 Claridge and colleagues describe schizotypy as a personality trait that, within a general population, is underpinned by creativity, spirituality, and divergent thinking, but in its extreme form is a personality disorder. 3 Schizotypy is thus a multi-factorial construct, which can manifest as well-being or mental illness, depending on environmental context and life events. 4 Following this characterization, one of the most widely-used schizotypy scales, the Oxford-Liverpool

Cognitive disorganization: problems with
attention, concentration, decision making, lack of purpose, and social anxiety. 5,6 3. Introvertive anhedonia: lack of pleasure in physical or social contact, avoidance of intimacy, schizoid solitude, and flat affect. 6 4. Impulsive nonconformity: disinhibition, impulsivity, violence, and recklessness. 5 The need for a schizotypy measure with a dimensional approach Although the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) has maintained the categorical/symptom-based approach, it has also included many transnosological specifiers, symptom or syndrome-related severity, and dimensional assessments. 7 Schizotypal personality disorder is included in the DSM-5 chapter on schizophrenia spectrum disorders. 8 In addition, the manual also presents two different approaches to personality disorders: a) categorical (similar to the Diagnostic and Statistical

Manual of Mental Disorders, 4th edition, Text Revision
[DSM-IV-TR]); and b) categorical-dimensional (hybrid), known as the alternative model for personality disorders. 9 The aim of this alternative model was to preserve clinical practice, but also to remedy some of the major problems of categorical diagnosis of such disorders. 9 Several studies using this dimensional approach to schizotypy have robustly showed that psychotic-like experiences can be associated with mental health and well-being outcomes (benign schizotypy). 10 15 German, 16 French, 17 Polish, 18 and Hungarian. 19     and reliability for each of its 4 subscales. 5,6 The O-LIFE-S also showed good reliability and content and concurrent validity. 6

Procedures
Although there is no absolute consensus on how to adapt and validate scales for different languages and cultural contexts, we followed the guidelines offered by various experts. 24 Accordingly, the procedures involved in adaptation of the O-LIFE-S were as follows: A. The original instrument was translated by two independent bilingual professionals.      Dimensions in English and Brazilian Portuguese and items for each dimension will be described afterwards. Scores: 1 for yes and 0 for no, except for items marked with*, which have inverted scores: 0 for yes and 1 for no.

Por favor, leia as instruções antes de continuar:
Este questionário contém questões que podem se relacionar com seus pensamentos, sentimentos, experiências e preferências. Não existem respostas certas ou erradas, então, por favor, seja tão honesto quanto possível. Para cada questão coloque um círculo em volta do "SIM" ou do "NÃO". Não gaste muito tempo em cada questão, mas coloque a resposta mais próxima do que você sente. Por favor, não discuta o questionário com pessoa alguma que poderia vir também a completá-lo, pois isto poderia afetar suas respostas. Ele é melhor preenchido a sós, sem necessidade de pressa.   States, China, Australia, Spain, Switzerland, New Zealand, Canada, Italy, Norway, Belgium, and Tunisia). 28 As in our sample, most of the participants in these 12 countries were women and they scored higher in the positive dimension (UnEx). We observed a significant Brazilian studies also reported a majority of women, of middle age, and with an educational level between undergraduate and graduate. 29,30 The subscale with the highest score in those Brazilian studies was UnEx, followed by CogDis, as we found in our sample.
In the confirmatory factor analysis, five specific items from the original inventory had factor loadings  Figure 2) is not very high, which indicates that this is not a very severe item, meaning it is not so unlikely that a person will endorse this question.
Another example is item 30, which loaded strongly onto the subscale Introverted Anhedonia (r = 0.75) and has the highest threshold in the analysis ( Figure   2). Question 30 is: "Do you like mixing with people?" (translated into Brazilian Portuguese as "Você gosta de se relacionar com as pessoas?" It is reverse coded, meaning that someone with high introvertive anhedonia will answer "no" and will score 1 for the item). For instance, we can see that not only can question 30 be impacted by some change in the negative dimension of schizotypy (IntAn), but also that it is very unlikely that people will endorse score 1 on this item, so it is indicative of the severity of the trait. To score 1 on question 30 would mean that the subject demonstrates a high absence of social bonding and a lack of affect. Cultural aspects could also play an important role in the threshold of this item, although we couldn't find any literature exploring these characteristics. Nonetheless, Brazil is well-known for its sociable and friendly people. The dimensional perspective of schizotypy cannot be found in scales such as the Schizotypal Personality Questionnaire (SPQ), 12,13 linked to categorical models and the DSM III-R checklist for personality disorder.
Contemporary approaches to proneness to psychosis assume schizotypy is a personality trait that is a complex, dynamic, and multi-factorial construct. [8][9][10] The O-LIFE does not assume a pathological perspective a priori, as we can see from the instrument's name.
Environmental interactions will lead feelings and experiences, as personality traits, to well-being or to mental illness, according to a broad spectrum of possibilities. 4 This study includes certain limitations that should be considered. First, our sample is not representative of all Brazilian citizens, but we were able to assess a sample from the South and the Southeast of our large country, which itself is of great value. Nevertheless, we recommend researchers from the North and Northeast of Brazil make adjustments as they see fit.

Conclusions
In summary, the present study was able to validate a dimensional tool to assess schizotypy for the Brazilian setting. The O-LIFE-S achieved an optimal correspondence with our language and is well-adapted to our culture. Fortunately, this allows Brazilian researchers and clinicians to investigate the schizotypy continuum in Brazil. Future studies should compare clinical and nonclinical populations cross-culturally.