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Djordjevic M, Farhang S, Shirzadi M, Mousavi SB, Bruggeman R, Malek A, Mohagheghi A, Ranjbar F, Shafiee-Kandjani AR, Jongsma HE, Veling W. Self-stigma, religiosity, and perceived social support in people with recent-onset psychosis in the Islamic Republic of Iran: Associations with symptom severity and psychosocial functioning. Int J Soc Psychiatry 2024; 70:542-553. [PMID: 38312047 PMCID: PMC11067409 DOI: 10.1177/00207640231221090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
AIMS Most evidence on psychosocial factors in recent-onset psychosis comes from high-income countries in Europe, Australia, Canada and the USA, while these factors are likely to differ under varying sociocultural and economic circumstances. In this study, we aimed to investigate associations of self-stigma, religiosity and perceived social support with symptom severity and psychosocial functioning in an Iranian cohort of people with recent-onset psychosis (i.e. illness duration of <2 years). METHODS We used baseline data of 361 participants (N = 286 [74%] male, mean age = 34 years [Standard Deviation = 10.0]) from the Iranian Azeri Recent-onset Acute Phase Psychosis Survey (ARAS). We included assessments of self-stigma (Internalized Stigma of Mental Illness, ISMI), religiosity (based on Stark & Glock), perceived social support (Multidimensional Scale of Perceived Social Support, MSPSS), symptom severity (Positive And Negative Syndrome Scale, PANSS) and psychosocial functioning (clinician-rated Global Assessment of Functioning Scale, GAF, and self-reported World Health Organization Disability Assessment Schedule 2.0, WHODAS 2.0). Descriptive analyses were employed to characterize the study sample. Covariate-adjusted ordinal and multivariable linear regression analyses were performed to investigate cross-sectional associations of baseline ISMI, religiosity and MSPSS with concurrent PANSS, GAF and WHODAS 2.0. RESULTS Higher self-stigma was associated with poorer self-reported functioning (B = 0.375 [95% Confidence Interval (CI): 0.186, 0.564]) and more severe concurrent symptoms (B = 0.436 [95% CI: 0.275, 0.597]). Being more religious was associated with poorer clinician-rated functioning (OR = 0.967 [95% CI: 0.944, 0.991]), but with less severe symptoms (B = -0.258 [95% CI: -0.427, -0.088]). Stronger social support was associated with poorer clinician-rated (OR = 0.956 [95% CI: 0.935, 0.978]) and self-reported functioning (B = 0.337 [95% CI: 0.168, 0.507]). CONCLUSION This study shows that self-stigma, religiosity and perceived social support were associated with symptom severity and clinician-rated as well as self-reported psychosocial functioning in an Iranian cohort of people with recent-onset psychosis. The findings extend previous evidence on these psychosocial factors to one of the largest countries in the Middle East, and suggest that it may be worthwhile to develop strategies aimed at tackling stigma around psychosis and integrate the role of religiosity and social support in mental ill-health prevention and therapy.
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Affiliation(s)
- M Djordjevic
- University Center for Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
| | - S Farhang
- Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Iran
| | - M Shirzadi
- Clinical Research Development Center, Imam Khomeini, Mohammad Kermanshahi and Farabi Hospitals, Kermanshah University of Medical
Sciences, Kermanshah, Iran
| | - SB Mousavi
- Department of Psychiatry, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - R Bruggeman
- Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
| | - A Malek
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Iran
| | - A Mohagheghi
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Iran
| | - F Ranjbar
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Iran
| | - AR Shafiee-Kandjani
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Iran
| | - HE Jongsma
- University Center for Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
| | - W Veling
- University Center for Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
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Rantala MJ, Luoto S, Borráz-León JI, Krams I. Schizophrenia: the new etiological synthesis. Neurosci Biobehav Rev 2022; 142:104894. [PMID: 36181926 DOI: 10.1016/j.neubiorev.2022.104894] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 08/25/2022] [Accepted: 09/25/2022] [Indexed: 10/31/2022]
Abstract
Schizophrenia has been an evolutionary paradox: it has high heritability, but it is associated with decreased reproductive success. The causal genetic variants underlying schizophrenia are thought to be under weak negative selection. To unravel this paradox, many evolutionary explanations have been suggested for schizophrenia. We critically discuss the constellation of evolutionary hypotheses for schizophrenia, highlighting the lack of empirical support for most existing evolutionary hypotheses-with the exception of the relatively well supported evolutionary mismatch hypothesis. It posits that evolutionarily novel features of contemporary environments, such as chronic stress, low-grade systemic inflammation, and gut dysbiosis, increase susceptibility to schizophrenia. Environmental factors such as microbial infections (e.g., Toxoplasma gondii) can better predict the onset of schizophrenia than polygenic risk scores. However, researchers have not been able to explain why only a small minority of infected people develop schizophrenia. The new etiological synthesis of schizophrenia indicates that an interaction between host genotype, microbe infection, and chronic stress causes schizophrenia, with neuroinflammation and gut dysbiosis mediating this etiological pathway. Instead of just alleviating symptoms with drugs, the parasite x genotype x stress model emphasizes that schizophrenia treatment should focus on detecting and treating possible underlying microbial infection(s), neuroinflammation, gut dysbiosis, and chronic stress.
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Affiliation(s)
- Markus J Rantala
- Department of Biology, University of Turku, FIN-20014 Turku, Finland.
| | - Severi Luoto
- School of Population Health, University of Auckland, 1023 Auckland, New Zealand
| | | | - Indrikis Krams
- Institute of Ecology and Earth Sciences, University of Tartu, 51014 Tartu, Estonia; Department of Zoology and Animal Ecology, Faculty of Biology, University of Latvia, 1004, Rīga, Latvia
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3
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Rek-Owodziń K, Tyburski E, Plichta P, Waszczuk K, Bielecki M, Wietrzyński K, Podwalski P, Rudkowski K, Michalczyk A, Grąźlewski T, Sagan L, Kucharska-Mazur J, Samochowiec J, Mak M. The Relationship between Cognitive Functions and Psychopathological Symptoms in First Episode Psychosis and Chronic Schizophrenia. J Clin Med 2022; 11:jcm11092619. [PMID: 35566742 PMCID: PMC9102246 DOI: 10.3390/jcm11092619] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/31/2022] [Accepted: 04/26/2022] [Indexed: 11/22/2022] Open
Abstract
Impairments in cognitive functions are one of the main features of schizophrenia. A variety of factors can influence the extent of cognitive deficits. In our study, we examined the severity of cognitive deficits at different stages of the disease and the relationship between psychopathological symptoms and cognitive functions. We recruited 32 patients with first-episode psychosis (FEP), 70 with chronic schizophrenia (CS), and 39 healthy controls (HC). Psychopathological symptoms were evaluated with the Positive and Negative Syndrome Scale (PANSS) and cognitive functions were measured with the MATRICS Cognitive Consensus Battery (MCCB). Cognitive deficits were present in both FEP and CS participants. CS individuals had lower overall scores and poorer working memory; however, clinical variables appeared to play a significant role in these scores. In FEP, disorganization correlated negatively with verbal and visual learning and memory, social cognition, and overall score; negative symptoms negatively correlated with social cognition. In CS participants, disorganization correlated negatively with speed of processing, reasoning, problem solving, and overall score; negative symptoms were negatively correlated with speed of processing, visual learning, memory, and overall score; positive symptoms were negatively correlated with reasoning and problem solving. Our findings indicate that psychopathological symptoms have a significant impact on cognitive functions in FEP and CS patients.
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Affiliation(s)
- Katarzyna Rek-Owodziń
- Department of Health Psychology, Pomeranian Medical University in Szczecin, 71-457 Szczecin, Poland; (E.T.); (P.P.); (M.B.); (K.W.); (M.M.)
- Correspondence: ; Tel.: +48-91-351-13-00
| | - Ernest Tyburski
- Department of Health Psychology, Pomeranian Medical University in Szczecin, 71-457 Szczecin, Poland; (E.T.); (P.P.); (M.B.); (K.W.); (M.M.)
| | - Piotr Plichta
- Department of Health Psychology, Pomeranian Medical University in Szczecin, 71-457 Szczecin, Poland; (E.T.); (P.P.); (M.B.); (K.W.); (M.M.)
| | - Katarzyna Waszczuk
- Department of Psychiatry, Pomeranian Medical University in Szczecin, 71-457 Szczecin, Poland; (K.W.); (P.P.); (K.R.); (A.M.); (T.G.); (J.K.-M.); (J.S.)
| | - Maksymilian Bielecki
- Department of Health Psychology, Pomeranian Medical University in Szczecin, 71-457 Szczecin, Poland; (E.T.); (P.P.); (M.B.); (K.W.); (M.M.)
| | - Krzysztof Wietrzyński
- Department of Health Psychology, Pomeranian Medical University in Szczecin, 71-457 Szczecin, Poland; (E.T.); (P.P.); (M.B.); (K.W.); (M.M.)
| | - Piotr Podwalski
- Department of Psychiatry, Pomeranian Medical University in Szczecin, 71-457 Szczecin, Poland; (K.W.); (P.P.); (K.R.); (A.M.); (T.G.); (J.K.-M.); (J.S.)
| | - Krzysztof Rudkowski
- Department of Psychiatry, Pomeranian Medical University in Szczecin, 71-457 Szczecin, Poland; (K.W.); (P.P.); (K.R.); (A.M.); (T.G.); (J.K.-M.); (J.S.)
| | - Anna Michalczyk
- Department of Psychiatry, Pomeranian Medical University in Szczecin, 71-457 Szczecin, Poland; (K.W.); (P.P.); (K.R.); (A.M.); (T.G.); (J.K.-M.); (J.S.)
| | - Tomasz Grąźlewski
- Department of Psychiatry, Pomeranian Medical University in Szczecin, 71-457 Szczecin, Poland; (K.W.); (P.P.); (K.R.); (A.M.); (T.G.); (J.K.-M.); (J.S.)
| | - Leszek Sagan
- Department of Neurosurgery, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland;
| | - Jolanta Kucharska-Mazur
- Department of Psychiatry, Pomeranian Medical University in Szczecin, 71-457 Szczecin, Poland; (K.W.); (P.P.); (K.R.); (A.M.); (T.G.); (J.K.-M.); (J.S.)
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University in Szczecin, 71-457 Szczecin, Poland; (K.W.); (P.P.); (K.R.); (A.M.); (T.G.); (J.K.-M.); (J.S.)
| | - Monika Mak
- Department of Health Psychology, Pomeranian Medical University in Szczecin, 71-457 Szczecin, Poland; (E.T.); (P.P.); (M.B.); (K.W.); (M.M.)
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Mackey C. Moving Beyond Current Treatment: Responding to Extreme States With Compassion and Dignity. JOURNAL OF HUMANISTIC PSYCHOLOGY 2022. [DOI: 10.1177/00221678221078659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Newer research around extreme experiences is showing that recovery is far more prevalent than has been represented in the past. In addition, some aspects that have traditionally been considered the first line of treatment are now being found to be less effective than once believed or even harmful. However, approaches that combine new information, compassion, and that restore dignity to the individual are finally being recognized as the underpinnings of successful outcomes. Individuals who have gone through an extreme state deserve to learn about the impact of cultural aspects and childhood experiences on such. They should be reminded that many will experience positive growth from the extreme state itself. It should be normalized how frequently these experiences arise throughout the world and how often people do recover. It is important for individuals to understand the beneficial impact of enhancing relationships and connections in their daily life and of fostering empowerment for themselves and their choices. By incorporating research findings and inviting the individual to seek out a meaningful life, as determined by themselves, people can and do recover from these experiences.
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Affiliation(s)
- Chelsea Mackey
- Vantage Point Center for Psychotherapy, Sacramento, CA, USA
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van der Zeijst M, Veling W, Makhathini EM, Susser E, Burns JK, Hoek HW, Susser I. Ancestral calling, traditional health practitioner training and mental illness: An ethnographic study from rural KwaZulu-Natal, South Africa. Transcult Psychiatry 2021; 58:471-485. [PMID: 32151201 DOI: 10.1177/1363461520909615] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This qualitative ethnographic study complements an epidemiological study on first episode psychosis in Vulindlela, a rural area in KwaZulu-Natal, South Africa. It focuses on two themes that emerged from our data: (1) the calling of the ancestors to become a traditional health practitioner and (2) ukuthwasa, the training to become a traditional health practitioner. The purpose of this study is to describe the ancestral calling, and to explore whether ukuthwasa may help with the management of mental disturbances, including unusual perceptual experiences. We also provide a discussion of the changing sociopolitical context of healing in KwaZulu-Natal, as a background to our study. In-depth interviews were conducted with 20 (apprentice) traditional health practitioners, formal health practitioners, patients and relatives recruited through local traditional health practitioners and a health care clinic. Our results show that the ancestral calling might announce itself with symptoms of mental illness including unusual perceptual experiences, for which some participants consider ukuthwasa as the only effective cure. We found indications that in some individuals successful completion of ukuthwasa might promote recovery from their illness and lead to a profession in which the unusual perceptual experiences become a legitimate and positively valued aspect. We suggest that - in this particular community today, which has been subject to several sociopolitical changes - ukuthwasa may be a culturally sanctioned healing process which moderates experiences that a Western psychiatric system might characterize as psychotic symptoms, providing some individuals with a lucrative and respected role in society.
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Affiliation(s)
| | | | | | - Ezra Susser
- Columbia University.,27424New York State Psychiatric Institute
| | - Jonathan K Burns
- University of KwaZulu-Natal.,171002University of Exeter Medical School
| | - Hans W Hoek
- Parnassia Psychiatric Institute, The Netherlands.,University of Groningen.,Columbia University
| | - Ida Susser
- Columbia University.,City University of New York
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6
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van der Zeijst MCE, Veling W, Makhathini EM, Mtshemla S, Mbatha ND, Shabalala SS, Susser I, Burns JK, Susser E, Hoek HW. Psychopathology among apprentice traditional health practitioners: A quantitative study from rural KwaZulu-Natal, South Africa. Transcult Psychiatry 2021; 58:486-498. [PMID: 33021152 DOI: 10.1177/1363461520949672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Sociocultural context seems to influence the epidemiology, phenotype, treatment, and course of psychosis. However, data from low- and middle-income countries is sparse. This research is part of a multidisciplinary and multimethod study on possible mental disturbances, including hallucinations, among (apprentice) traditional health practitioners (THPs) who have experienced the "ancestral calling to become a THP" in rural KwaZulu-Natal, South Africa. The aim of the current article is to examine whether the calling-related experiences can be assessed according to a psychiatric taxonomy. We included individuals who were identified with the calling and who were undergoing training to become a THP (ukuthwasa). IsiZulu-speaking formal mental health practitioners conducted thorough psychiatric interviews that measured psychological experiences with and without distress using the Community Assessment of Psychic Experiences, and psychiatric symptoms and disorders using the Schedule for Clinical Assessment in Neuropsychiatry. Of the 48 individuals who participated, 92% had psychotic experiences (PE), causing distress in 75%; and 23% met DSM-5 criteria for an unspecified psychotic disorder (15%) or mood disorder (8%). In conclusion, in rural KwaZulu-Natal, the ancestral calling may resemble phenomena that psychiatry would understand in the context of psychosis, ranging from subclinical PE to clinical psychotic disorder. Ukuthwasa might have a beneficial influence on the course of psychotic symptoms in some individuals, potentially because it reduces stigma and promotes recovery. Further multidisciplinary research is needed to investigate the psychopathology of the apprentice THPs and the underlying processes of ukuthwasa.
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Affiliation(s)
| | - Wim Veling
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elliot Mqansa Makhathini
- Durban University of Technology, Durban, South Africa.,University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | | | | | | | - Ida Susser
- City University of New York, New York, NY, USA.,Columbia University, New York, NY, USA
| | - Jonathan K Burns
- University of KwaZulu-Natal, KwaZulu-Natal, South Africa.,University of Exeter, Exeter, UK
| | - Ezra Susser
- New York State Psychiatric Institute, New York, NY, USA
| | - Hans W Hoek
- Parnassia Psychiatric Institute, The Hague, The Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Columbia University, New York, NY, USA
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Utility of a multidimensional recovery framework in understanding lived experiences of Chilean and Brazilian mental health service users. REVISTA IBEROAMERICANA DE PSICOLOGÍA 2021. [DOI: 10.33881/2027-1786.rip.14212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
La comprensión y aplicación del concepto de recuperación, a pesar de sus posibles beneficios para los servicios de salud mental, aún se encuentra en incipiente desarrollo en América Latina. Si bien la reforma psiquiátrica en la región ha tenido algunos avances, el marco de la recuperación no ha sido suficientemente explorado. Whitley y Drake (2010) sugirieron un marco conceptual integral para la recuperación que incluye cinco dimensiones: clínica, existencial, funcional, física y social. El presente estudio tuvo como objetivo explorar las perspectivas de los usuarios chilenos y brasileños sobre la recuperación identificando su adscripción y aplicabilidad de estas cinco dimensiones. Se entrevistó a treinta participantes de la Intervención en Momento Crítico-Delegación de Funciones (CTI-TS) realizada en Santiago (Chile) y en Río de Janeiro (Brasil) sobre sus experiencias de recuperación. Se exploró la aplicabilidad del marco de Whitley y Drake al contexto de Chile y de Brasil. Los resultados mostraron que: 1. El marco era aplicable a esta población; 2. Las dimensiones presentaban un tipo particular de entrelazamiento y estaban influenciadas por una serie de procesos tales como la continuidad en el proceso de atención/cuidado/autocuidado, y sobresalía la funcionalidad y la esfera social; 3. Los valores culturales, el estigma y los determinantes sociales emergieron como factores cruciales que afectan el tratamiento y la recuperación. Se propuso una reinterpretación del esquema referencial. Los hallazgos representan un aporte a la literatura internacional sobre recuperación al aumentar la validez de este marco referencial multidimensional y su aplicabilidad a diversas poblaciones.
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Nonmedical Interventions for Schizophrenia: A Review of Diet, Exercise, and Social Roles. Holist Nurs Pract 2020; 34:73-82. [PMID: 32049694 DOI: 10.1097/hnp.0000000000000369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Schizophrenia is a major mental illness with a disease course that is influenced by lifestyle. The risk-benefit ratio for alternative interventions is more favorable than for antipsychotics in long-term treatment. Dietary interventions may target autoimmune features, vitamin or mineral deficiencies, abnormal lipid metabolism, gluten sensitivity, or others. Examples of interventions involving diet, physical activity, or physical processes or social interventions including talk therapy exist in the literature. Notwithstanding, the general utility of these types of interventions remains inconclusive, awaiting long-term randomized trials. A perspective that separates the cause of the disease from its symptoms may be helpful in treatment planning and is warranted to distinguish between short-term and long-term recovery goals.
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Khaled SM, Wilkins SS, Woodruff P. Lifetime prevalence and potential determinants of psychotic experiences in the general population of Qatar. Psychol Med 2020; 50:1110-1120. [PMID: 31133090 PMCID: PMC7253618 DOI: 10.1017/s0033291719000977] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/23/2019] [Accepted: 04/09/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND To estimate the lifetime prevalence and potential determinants of psychotic experience(s) (PEs) in the general population of Qatar - a small non-war afflicted, conservative, high-income, middle-eastern country with recent rapid urbanization including an influx of migrants. METHODS A probability-based sample (n = 1353) of non-migrants and migrants were interviewed face-to-face and administered a 7-item psychosis screener adapted from the Composite International Diagnostic Interview, the Kessler 6-item psychological distress scale, and the 5 items assessing odd (paranormal) beliefs and magical thinking (OBMT) from the Schizotypal Personality Questionnaire. Using bivariate and logistic regression analyses, lifetime prevalence rates of PEs were estimated then compared before and after adjustment for socio-demographics, Arab ethnicity, psychological distress, and OBMT. RESULTS Prevalence of PEs was 27.9%. Visual hallucinations were most common (12.8%), followed by persecutory delusions (6.7%) and auditory hallucinations (6.9%). Ideas of reference (3.6%) were least prevalent. PEs were significantly higher in Arabs (34.7%) compared with non-Arabs (16.4%, p < 0.001) with the exception of ideas of reference and paranoid delusions. Female gender was associated with a higher prevalence of PEs in the Arab group only (p < 0.001). Prevalence of PEs was significantly higher among Arabs (48.8% v. 15.8%, p < 0.001) and non-Arabs (35.2% v. 7.3%, p < 0.001) with OBMT. Arab ethnicity (OR = 2.10, p = 0.015), psychological distress (OR = 2.29 p = 0.003), and OBMT (OR = 6.25, p < 0.001) were independently associated with PEs after adjustment for all variables. CONCLUSIONS Ethnicity, but not migration was independently associated with PEs. Evidence linking Arab ethnicity, female gender, and psychological distress to PEs through associations with OBMT was identified for future prospective investigations.
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Affiliation(s)
- Salma M. Khaled
- Social and Economic Survey Research Institute, Qatar University, Doha, Qatar
| | - Stacy Schantz Wilkins
- Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, CA, USA
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Peter Woodruff
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
- Weil Cornell – Medicine, Education City, Qatar Foundation, Doha, Qatar
- National Institute of Health Research – Sheffield Biomedical Research Centre, University of Sheffield, Sheffield, UK
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Turley D, Drake R, Killackey E, Yung AR. Perceived stress and psychosis: The effect of perceived stress on psychotic-like experiences in a community sample of adolescents. Early Interv Psychiatry 2019; 13:1465-1469. [PMID: 30712294 DOI: 10.1111/eip.12795] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/08/2019] [Accepted: 01/13/2019] [Indexed: 11/29/2022]
Abstract
AIMS Psychotic-like experiences (PLE) are sub-threshold, non-clinical forms of psychosis which can place an individual at greater risk of development of a psychotic disorder. Subtypes of PLE have also been shown to exist (bizarre experiences, persecutory ideation, perceptual abnormalities and magical thinking). Perceived stress relates to how two individuals may deal with the same objectively stressful event in different ways. The objective of our study was to investigate the extent to which perceived stress is associated with PLE in a community sample of adolescents, whether certain subtypes of PLE correlate more with perceived stress than others and to explore the role of depression with these associations. METHODS A total of 655 students completed the community assessment of psychic experiences (CAPE) and perceived stress scale (PSS). Pearson's correlation was used to investigate the relationship between PSS and CAPE and also between perceived stress and the four subtypes of PLE. Regression then explored the effect of perceived stress on PLE when accounting for depressive symptomatology. RESULTS Positive correlation was found between PSS and total CAPE (r = 0.405, P = 0.000). Positive significant correlation was also found between PSS and each subtype of PLE, with persecutory ideation correlating the strongest and magical thinking the least. Perceived stress was significantly associated with PLE even after adjusting for depression. CONCLUSIONS We recommend that more regular screening of perceived stress in adolescent populations could lead to earlier recognition of PLE. Early treatment has shown to reduce rates of transition to psychosis, and so could benefit our adolescent community in the future.
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Affiliation(s)
- Dan Turley
- Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Richard Drake
- School of Community Based Medicine, The University of Manchester, Manchester, UK
| | - Eoin Killackey
- Orygen, The National Centre for Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Alison R Yung
- Divison of Psychology and Mental Health, School of Heath Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Loch AA, Freitas EL, Hortêncio L, Chianca C, Alves TM, Serpa MH, Andrade JC, van de Bilt MT, Gattaz WF, Rössler W. Hearing spirits? Religiosity in individuals at risk for psychosis-Results from the Brazilian SSAPP cohort. Schizophr Res 2019; 204:353-359. [PMID: 30266512 DOI: 10.1016/j.schres.2018.09.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 08/06/2018] [Accepted: 09/17/2018] [Indexed: 12/15/2022]
Abstract
In the last decades, biological and environmental factors related to psychosis were investigated in individuals at ultra-risk for psychosis (UHR) to predict conversion. Although religion relates to psychosis in a variety of ways, it is understudied in subclinical samples. Therefore, we assessed the interplay between religion and prodromal symptoms in 79 UHR and 110 control individuals. They were interviewed with the Duke University Religion Index and the Structured Interview for Prodromal Syndromes (SIPS). Organizational religious activity, a measure of how often someone attends churches/temples, was positively related to perceptual abnormalities/hallucinations (Spearman's rho = 0.262, p = 0.02). This relationship was replicated in a path analysis model (β = 0.342, SE = 0.108, p = 0.002), as well as a link between organizational religious activity and lower ideational richness (β = 0.401, SE = 0.105, p = 0.000) with no influence of sex, age, religious denomination, or socioeconomic class. Intrinsic religious activity was negatively correlated with suspiciousness (SIPS P2) (β = -0.028, SE = 0.009, p = 0.002), and non-organizational religious activity was correlated with higher ideational richness (N5) (β = -0.220, SE = 0.097, p = 0.023). We hypothesize that subjects with subclinical psychosis may possibly use churches and other religious organizations to cope with hallucinations. Indeed, Brazil is characterized by a religious syncretism and a strong influence of Spiritism in the popular culture. The mediumistic idea that some might be able to hear and/or see spirits is probably employed to explain subclinical hallucinations in the lay knowledge. Our results emphasize the importance of assessing religion and other region-specific aspects of various cultures when studying UHR individuals. This sort of assessment would enhance understanding of differences in conversion rates, and would help to transpose prevention programs from high-income countries to other settings.
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Affiliation(s)
- Alexandre Andrade Loch
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, Brazil.
| | - Elder Lanzani Freitas
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, Brazil
| | - Lucas Hortêncio
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, Brazil
| | - Camille Chianca
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, Brazil
| | - Tania Maria Alves
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, Brazil
| | - Maurício Henriques Serpa
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, Brazil
| | - Julio Cesar Andrade
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, Brazil
| | - Martinus Theodorus van de Bilt
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, Brazil
| | - Wagner Farid Gattaz
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, Brazil
| | - Wulf Rössler
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, Brazil; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland; Department of Psychiatry and Psychotherapy, Charité University of Medicine, Berlin, Germany
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Fonseca-Pedrero E, Chan RCK, Debbané M, Cicero D, Zhang LC, Brenner C, Barkus E, Linscott RJ, Kwapil T, Barrantes-Vidal N, Cohen A, Raine A, Compton MT, Tone EB, Suhr J, Muñiz J, de Albéniz AP, Fumero A, Giakoumaki S, Tsaousis I, Preti A, Chmielewski M, Laloyaux J, Mechri A, Lahmar MA, Wuthrich V, Larøi F, Badcock JC, Jablensky A, Ortuño-Sierra J. Comparisons of schizotypal traits across 12 countries: Results from the International Consortium for Schizotypy Research. Schizophr Res 2018; 199:128-134. [PMID: 29567403 DOI: 10.1016/j.schres.2018.03.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/05/2018] [Accepted: 03/12/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Schizotypal traits are expressions of underlying vulnerability to psychotic disorders which have a potential impact on mental health status, neurocognition, quality of life, and daily functioning. To date, little research has examined epidemiologic landscape of schizotypal traits at the cross-national level. Our aim was to study the expression of schizotypal traits by sex, age, and country in a combined sample gathered from 12 countries. METHODS A total of 27,001 participants completed the Schizotypal Personality Questionnaire (SPQ). The mean age of participants was 22.12 (SD=6.28); 37.5% (n=10,126) were males. RESULTS Schizotypal traits varied according to sex, age, and country. Females scored higher than males in the positive dimension, whereas males scored higher in the disorganization dimension. By age, a significant decrease in the positive schizotypal traits was observed. Epidemiological expression of schizotypal traits varied by country. Moreover, several interactions by sex, age, and country were found. CONCLUSIONS This pattern is similar to those found in patients with psychosis and psychotic-like experiences. These findings provide new insights and the opportunity to explore the phenotypic expression of schizotypal traits at cross-national level.
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Affiliation(s)
- Eduardo Fonseca-Pedrero
- Department of Educational Sciences, University of La Rioja, Spain; Centro de Investigación en Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijng, China
| | - Martin Debbané
- Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland; Department of Clinical, Educational and Health Psychology, University College London, UK
| | - David Cicero
- Department of Psychology, University of Hawaii at Manoa, USA
| | - Lisa C Zhang
- Department of Psychology, University of British Columbia, Canada
| | - Colleen Brenner
- Department of Psychology, University of British Columbia, Canada
| | - Emma Barkus
- School of Psychology, University of Wollongong, Wollongong, Australia
| | | | - Thomas Kwapil
- Department of Psychology, University of North Carolina at Greensboro, USA
| | - Neus Barrantes-Vidal
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Spain
| | - Alex Cohen
- Department of Psychology, Louisiana State University, USA
| | - Adrian Raine
- Departments of Criminology, Psychiatry, and Psychology, University of Pennsylvania, USA
| | | | - Erin B Tone
- Department of Psychology, Georgia State University, USA
| | - Julie Suhr
- Department of Psychology, Ohio University, USA
| | - José Muñiz
- Centro de Investigación en Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain; Department of Psychology, University of Oviedo, Spain
| | | | - Axit Fumero
- Department of Psychology, University of La Laguna, Spain
| | - Stella Giakoumaki
- Department of Psychology, University of Crete, Rethymno, Crete, Greece
| | - Ioannis Tsaousis
- Department of Psychology, University of Crete, Rethymno, Crete, Greece
| | | | | | - Julien Laloyaux
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; NORMENT - Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Norway; Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Anwar Mechri
- Psychiatry Department, University Hospital of Monastir Monastir, Tunisia
| | | | - Viviana Wuthrich
- Macquarie Centre for Cognitive Science, Macquarie University, Sydney, Australia
| | - Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; Psychology and Neuroscience of Cognition Research Unit, Cognitive Psychopathology Unit, University of Liège, Liège, Belgium
| | - Johanna C Badcock
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - Assen Jablensky
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
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Nicastro N, Picard F. Joan of Arc: Sanctity, witchcraft or epilepsy? Epilepsy Behav 2016; 57:247-50. [PMID: 26852074 DOI: 10.1016/j.yebeh.2015.12.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 12/26/2015] [Accepted: 12/28/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The objective of this article is to describe whether Joan of Arc had epilepsy and how that may have influenced her sense of mission and ability to encourage thousands of people to help her to chase the English out of France. METHODS Documentation of her Trial of Condemnation in 1431 provides a description of her episodes of experienced voices and visions. RESULTS From the age of thirteen, Joan of Arc experienced frequent episodes of auditory hallucinations associated with elementary or complex visual hallucinations (e.g., a great light or human faces). These had sudden onset, lasting seconds or minutes at most, and occurred when awake or during sleep, arousing her. Some could be triggered by an auditory stimulus. She had no disorganized thought between the episodes. CONCLUSIONS The semiology of the episodes is very suggestive of epileptic seizures, which have been considered as ecstatic by some authors or as partial epilepsy with auditory features by others, which seems more concordant with the ictal symptoms. The auditory and visual hallucinations could have had a religious content because during her childhood and adolescence, she was brought up in a religious environment, insomuch as this content first undefined only appeared after a few seizures. We can suppose that such hallucinations, without the knowledge of their medical origin, gave her a sense of divine mission, hence, a real strength to try to accomplish the orders she heard during the episodes. Her role during the Hundred Years' War and her narration of her strange episodes led her to be burned for heresy at the age of nineteen, yet rehabilitated 25 years later and to be canonized for her achievements in 1920. This article is part of a Special Issue entitled "Epilepsy, Art, and Creativity".
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Affiliation(s)
- Nicolas Nicastro
- Neurology Department, Geneva University Hospitals, 4 Avenue G. Perret-Gentil, 1205 Geneva, Switzerland.
| | - Fabienne Picard
- Neurology Department, Geneva University Hospitals, 4 Avenue G. Perret-Gentil, 1205 Geneva, Switzerland
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Hollander AC, Dal H, Lewis G, Magnusson C, Kirkbride JB, Dalman C. Refugee migration and risk of schizophrenia and other non-affective psychoses: cohort study of 1.3 million people in Sweden. BMJ 2016; 352:i1030. [PMID: 26979256 PMCID: PMC4793153 DOI: 10.1136/bmj.i1030] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether refugees are at elevated risk of schizophrenia and other non-affective psychotic disorders, relative to non-refugee migrants from similar regions of origin and the Swedish-born population. DESIGN Cohort study of people living in Sweden, born after 1 January 1984 and followed from their 14th birthday or arrival in Sweden, if later, until diagnosis of a non-affective psychotic disorder, emigration, death, or 31 December 2011. SETTING Linked Swedish national register data. PARTICIPANTS 1,347,790 people, including people born in Sweden to two Swedish-born parents (1,191,004; 88.4%), refugees (24,123; 1.8%), and non-refugee migrants (132,663; 9.8%) from four major refugee generating regions: the Middle East and north Africa, sub-Saharan Africa, Asia, and Eastern Europe and Russia. MAIN OUTCOME MEASURES Cox regression analysis was used to estimate adjusted hazard ratios for non-affective psychotic disorders by refugee status and region of origin, controlling for age at risk, sex, disposable income, and population density. RESULTS 3704 cases of non-affective psychotic disorder were identified during 8.9 million person years of follow-up. The crude incidence rate was 38.5 (95% confidence interval 37.2 to 39.9) per 100,000 person years in the Swedish-born population, 80.4 (72.7 to 88.9) per 100,000 person years in non-refugee migrants, and 126.4 (103.1 to 154.8) per 100,000 person years in refugees. Refugees were at increased risk of psychosis compared with both the Swedish-born population (adjusted hazard ratio 2.9, 95% confidence interval 2.3 to 3.6) and non-refugee migrants (1.7, 1.3 to 2.1) after adjustment for confounders. The increased rate in refugees compared with non-refugee migrants was more pronounced in men (likelihood ratio test for interaction χ(2) (df=2) z=13.5; P=0.001) and was present for refugees from all regions except sub-Saharan Africa. Both refugees and non-refugee migrants from sub-Saharan Africa had similarly high rates relative to the Swedish-born population. CONCLUSIONS Refugees face an increased risk of schizophrenia and other non-affective psychotic disorders compared with non-refugee migrants from similar regions of origin and the native-born Swedish population. Clinicians and health service planners in refugee receiving countries should be aware of a raised risk of psychosis in addition to other mental and physical health inequalities experienced by refugees.
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Affiliation(s)
- Anna-Clara Hollander
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Henrik Dal
- Centre for Epidemiology and Community Medicine, Stockholm County Council, SE-171 77 Stockholm, Sweden
| | - Glyn Lewis
- Division of Psychiatry, University College London, London W1T 7NF, UK
| | - Cecilia Magnusson
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden Centre for Epidemiology and Community Medicine, Stockholm County Council, SE-171 77 Stockholm, Sweden
| | - James B Kirkbride
- Division of Psychiatry, University College London, London W1T 7NF, UK
| | - Christina Dalman
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden Centre for Epidemiology and Community Medicine, Stockholm County Council, SE-171 77 Stockholm, Sweden
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Sallin K, Lagercrantz H, Evers K, Engström I, Hjern A, Petrovic P. Resignation Syndrome: Catatonia? Culture-Bound? Front Behav Neurosci 2016; 10:7. [PMID: 26858615 PMCID: PMC4731541 DOI: 10.3389/fnbeh.2016.00007] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 01/11/2016] [Indexed: 12/12/2022] Open
Abstract
Resignation syndrome (RS) designates a long-standing disorder predominately affecting psychologically traumatized children and adolescents in the midst of a strenuous and lengthy migration process. Typically a depressive onset is followed by gradual withdrawal progressing via stupor into a state that prompts tube feeding and is characterized by failure to respond even to painful stimuli. The patient is seemingly unconscious. Recovery ensues within months to years and is claimed to be dependent on the restoration of hope to the family. Descriptions of disorders resembling RS can be found in the literature and the condition is unlikely novel. Nevertheless, the magnitude and geographical distribution stand out. Several hundred cases have been reported exclusively in Sweden in the past decade prompting the Swedish National Board of Health and Welfare to recognize RS as a separate diagnostic entity. The currently prevailing stress hypothesis fails to account for the regional distribution and contributes little to treatment. Consequently, a re-evaluation of diagnostics and treatment is required. Psychogenic catatonia is proposed to supply the best fit with the clinical presentation. Treatment response, altered brain metabolism or preserved awareness would support this hypothesis. Epidemiological data suggests culture-bound beliefs and expectations to generate and direct symptom expression and we argue that culture-bound psychogenesis can accommodate the endemic distribution. Last, we review recent models of predictive coding indicating how expectation processes are crucially involved in the placebo and nocebo effect, delusions and conversion disorders. Building on this theoretical framework we propose a neurobiological model of RS in which the impact of overwhelming negative expectations are directly causative of the down-regulation of higher order and lower order behavioral systems in particularly vulnerable individuals.
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Affiliation(s)
- Karl Sallin
- Centre for Research Ethics and Bioethics (CRB), Uppsala UniversityUppsala, Sweden
- Department of Women’s and Children’s Health, Division of Neonatology, Karolinska InstituteSolna, Sweden
| | - Hugo Lagercrantz
- Department of Women’s and Children’s Health, Division of Neonatology, Karolinska InstituteSolna, Sweden
| | - Kathinka Evers
- Centre for Research Ethics and Bioethics (CRB), Uppsala UniversityUppsala, Sweden
| | - Ingemar Engström
- School of Health and Medical Sciences, Örebro UniversityÖrebro, Sweden
| | - Anders Hjern
- Centre for Health and Equity Studies (CHESS), Karolinska Institute and Stockholm UniversityStockholm, Sweden
| | - Predrag Petrovic
- Department of Clinical Neuroscience, Karolinska InstituteSolna, Sweden
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Mortensen GL, De J, Holme M, Neve T, Torell PG, Eberhard J. Social Aspects of the Quality of Life of Persons Suffering from Schizophrenia. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojpsych.2016.61005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jenkins R, Othieno C, Ongeri L, Ogutu B, Sifuna P, Kingora J, Kiima D, Ongecha M, Omollo R. Adult psychotic symptoms, their associated risk factors and changes in prevalence in men and women over a decade in a poor rural district of Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:5310-28. [PMID: 25996885 PMCID: PMC4454969 DOI: 10.3390/ijerph120505310] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/09/2015] [Accepted: 05/11/2015] [Indexed: 11/16/2022]
Abstract
There have been no repeat surveys of psychotic symptoms in Kenya or indeed subSaharan Africa. A mental health epidemiological survey was therefore conducted in a demographic surveillance site of a Kenyan household population in 2013 to test the hypothesis that the prevalence of psychotic symptoms would be similar to that found in an earlier sample drawn from the same sample frame in 2004, using the same overall methodology and instruments. This 2013 study found that the prevalence of one or more psychotic symptoms was 13.9% with one or more symptoms and 3.8% with two or more symptoms, while the 2004 study had found that the prevalence of single psychotic symptoms in rural Kenya was 8% of the adult population, but only 0.6% had two symptoms and none had three or more psychotic symptoms. This change was accounted for by a striking increase in psychotic symptoms in women (17.8% in 2013 compared with 6.9% in 2004, p < 0.001), whereas there was no significant change in men (10.6% in 2013 compared with 9.4% in 2004, p = 0.582). Potential reasons for this increase in rate of psychotic symptoms in women are explored.
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Affiliation(s)
- Rachel Jenkins
- Health Services and Population Research Department, Institute of Psychiatry, Kings College London, de Crespigny Park, London SE 5 8AF, UK.
| | - Caleb Othieno
- Department of Psychiatry, University of Nairobi, P.O. Box 19676-00202, Kenya.
| | - Linnet Ongeri
- Kenya Medical Research Institute, Nairobi, P.O. Box 54840-00200, Kenya.
| | - Bernards Ogutu
- Kenya Medical Research Institute, Nairobi, P.O. Box 54840-00200, Kenya.
| | - Peter Sifuna
- Kombewa Health and Demographic Surveillance Systems, Kombewa, P.O Box 54-40100, Kisumu, Kenya.
| | - James Kingora
- Kenya Medical Training College, Nairobi, P.O. Box 30195, GPO-00100, Kenya.
| | - David Kiima
- Kenya Medical Research Institute, Kisian, Kisumu P.O. Box 1578-40100, Kenya.
| | - Michael Ongecha
- Ministry of Health, Nairobi P.O. Box 30016, GPO-00100, Kenya.
| | - Raymond Omollo
- Kenya Medical Research Institute, Nairobi, P.O. Box 54840-00200, Kenya.
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Larøi F, Luhrmann TM, Bell V, Christian WA, Deshpande S, Fernyhough C, Jenkins J, Woods A. Culture and hallucinations: overview and future directions. Schizophr Bull 2014; 40 Suppl 4:S213-20. [PMID: 24936082 PMCID: PMC4141319 DOI: 10.1093/schbul/sbu012] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 01/19/2014] [Accepted: 01/22/2014] [Indexed: 01/08/2023]
Abstract
A number of studies have explored hallucinations as complex experiences involving interactions between psychological, biological, and environmental factors and mechanisms. Nevertheless, relatively little attention has focused on the role of culture in shaping hallucinations. This article reviews the published research, drawing on the expertise of both anthropologists and psychologists. We argue that the extant body of work suggests that culture does indeed have a significant impact on the experience, understanding, and labeling of hallucinations and that there may be important theoretical and clinical consequences of that observation. We find that culture can affect what is identified as a hallucination, that there are different patterns of hallucination among the clinical and nonclinical populations, that hallucinations are often culturally meaningful, that hallucinations occur at different rates in different settings; that culture affects the meaning and characteristics of hallucinations associated with psychosis, and that the cultural variations of psychotic hallucinations may have implications for the clinical outcome of those who struggle with psychosis. We conclude that a clinician should never assume that the mere report of what seems to be a hallucination is necessarily a symptom of pathology and that the patient's cultural background needs to be taken into account when assessing and treating hallucinations.
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Affiliation(s)
- Frank Larøi
- Department of Psychology, University of Liège, Liège, Belgium
| | | | - Vaughan Bell
- King's College London, Institute of Psychiatry, London, UK
| | - William A Christian
- Department of Social Anthropology, Autonomous University of Barcelona, Bellaterra, Spain
| | - Smita Deshpande
- Department of Psychiatry and Addiction Services, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | | | - Janis Jenkins
- Department of Anthropology, University of California San Diego, San Diego, CA
| | - Angela Woods
- Centre for Medical Humanities, Durham University, Durham, UK
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Mazhari S, Parvaresh N, Eslami Shahrbabaki M, Sadeghi MM, Nakhaee N, Keefe RSE. Validation of the Persian version of the brief assessment of cognition in schizophrenia in patients with schizophrenia and healthy controls. Psychiatry Clin Neurosci 2014; 68:160-6. [PMID: 24552637 DOI: 10.1111/pcn.12107] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 07/03/2013] [Accepted: 08/06/2013] [Indexed: 11/29/2022]
Abstract
AIMS The Brief Assessment of Cognition in Schizophrenia (BACS) is designed for assessment of cognitive function in patients with schizophrenia. Versions of the BACS in English and other languages have been shown to be as sensitive to cognitive dysfunction as a standard test battery, with the advantage of brief administration and scoring time. The present study aimed to test the concurrent validity of the Persian version of the BACS (Persian-BACS). METHODS A group of 50 patients with schizophrenia-spectrum disorders and a group of 50 healthy controls received the Persian-BACS in a first session, and in a second session a standard neurocognitive battery. RESULTS Cronbach's alpha for the Persian-BACS was 0.74. All the Persian-BACS subscales were significantly correlated with the corresponding standard neurocognitive subscales and the Pearson correlation of the composite scores from the two instruments was 0.71. Moreover, a one-factor solution was found that accounted for 67.9% of the variance. Finally, the Persian-BACS demonstrated high ability to discriminate patients with schizophrenia from healthy controls. CONCLUSION Good psychometric properties of the Persian-BACS suggest that it is a useful tool for assessing cognition in schizophrenic patients with Persian as their primary language.
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Affiliation(s)
- Shahrzad Mazhari
- Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
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Cristofaro SL, Cleary SD, Wan CR, Broussard B, Chapman C, Haggard PJ, Jananeh S, Myers NL, Compton MT. Measuring trauma and stressful events in childhood and adolescence among patients with first-episode psychosis: initial factor structure, reliability, and validity of the Trauma Experiences Checklist. Psychiatry Res 2013; 210:618-25. [PMID: 23850437 PMCID: PMC3816125 DOI: 10.1016/j.psychres.2013.06.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 05/22/2013] [Accepted: 06/13/2013] [Indexed: 11/29/2022]
Abstract
Past trauma and stressful events, especially in childhood and adolescence, are common among individuals with serious mental illnesses like schizophrenia. Traumatic experiences are thought to be a socio-environmental risk factor not only for poorer outcomes, but also potentially for the onset of these disorders. Because improved measurement tools are needed, we developed and studied, among 205 first-episode psychosis patients, the factor structure, internal consistency reliability, and initial validity of the Trauma Experiences Checklist (TEC), our measure of trauma and stressful events during childhood/adolescence. We assessed validity of subscales using correlations with Childhood Trauma Questionnaire-Short Form, Parental Harsh Discipline, Violence Exposure, and TEC-Informant Version scores. Exploratory factor analysis resulted in two internally consistent subscales (Cronbach's α=0.79 and 0.80, respectively), interpersonal abuse and family stress, and violence, death, and legal involvement. Scores from the former subscale were substantially associated with CTQ-SF physical, emotional, and sexual abuse (r=0.42-0.57, all p<0.001) and Violence Exposure (r=0.49, p<0.001). On the other hand, violence, death, and legal involvement scores were most highly correlated with Violence Exposure (r=0.49, p<0.001), and not with most CTQ-SF subscales. The TEC is a potentially useful tool in assessing diverse traumatic life events across various social contexts during childhood and adolescence.
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Affiliation(s)
- Sarah L. Cristofaro
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, Georgia, USA
| | - Sean D. Cleary
- The George Washington University School of Public Health and Health Services, Department of Epidemiology and Biostatistics, Washington, DC, USA
| | - Claire Ramsay Wan
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, Georgia, USA
| | - Beth Broussard
- The George Washington University School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Sciences, Washington, DC, USA
| | - Colby Chapman
- The George Washington University School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Sciences, Washington, DC, USA
| | - Patrick J. Haggard
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, Georgia, USA
| | - Sara Jananeh
- University of Georgia, Department of Psychology, Athens, GA, USA
| | - Neely L. Myers
- The George Washington University School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Sciences, Washington, DC, USA
| | - Michael T. Compton
- The George Washington University School of Medicine and Health Sciences, Department of Psychiatry and Behavioral Sciences, Washington, DC, USA
,Corresponding author. Tel.: +202 741 3554; fax: 202 741 2891.
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Abstract
Psychosis following traumatic brain injury (PFTBI) has received modest empirical investigation, and is subsequently poorly understood, identified and treated. The current article reports on consistencies in PFTBI phenomenology according to the existing peer-reviewed literature. The potential for psychotic symptoms post TBI, aetiological propositions, prevalence, significance of onset latency and injury severity, clinical and cognitive neuropsychological presentation and injury localisation/neuroimaging data are reviewed. Substantial methodological limitations associated with the majority of publications informing this work are also discussed. Despite controversies in the literature, psychosis following TBI appears to be three times more prevalent than psychotic disorders in the general population, and comparable in presentation to other idiopathic psychotic spectrum disorders, including schizophrenia.
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Khan A, Yavorsky C, Liechti S, Opler M, Rothman B, DiClemente G, Lucic L, Jovic S, Inada T, Yang L. A rasch model to test the cross-cultural validity in the positive and negative syndrome scale (PANSS) across six geo-cultural groups. BMC Psychol 2013; 1:5. [PMID: 25566357 PMCID: PMC4270028 DOI: 10.1186/2050-7283-1-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 02/14/2013] [Indexed: 11/30/2022] Open
Abstract
Background The objective of this study was to examine the cross-cultural
differences of the PANSS across six geo-cultural regions. The specific
aims are (1) to examine measurement properties of the PANSS; and (2) to
examine how each of the 30 items function across geo-cultural
regions. Methods Data was obtained for 1,169 raters from 6 different regions: Eastern
Asia (n = 202), India (n = 185), Northern Europe (n = 126), Russia &
Ukraine (n = 197), Southern Europe (n = 162), United States (n = 297). A
principle components analysis assessed unidimensionality of the
subscales. Rasch rating scale analysis examined cross-cultural
differences among each item of the PANSS. Results Lower item values reflects items in which raters often showed less
variation in the scores; higher item values reflects items with more
variation in the scores. Positive Subscale: Most regions found item P5
(Excitement) to be the most difficult item to score. Items varied in
severity from −0.93 [item P6. Suspiciousness/persecution (USA) to 0.69
item P4. Excitement (Eastern Asia)]. Item P3 (Hallucinatory Behavior) was
the easiest item to score for all geographical regions. Negative
Subscale: The most difficult item to score for all regions is N7
(Stereotyped Thinking) with India showing the most difficulty Δ = 0.69,
and Northern Europe and the United States showing the least difficulty Δ
= 0.21, each. The second most difficult item for raters to score was N1
(Blunted Affect) for most countries including Southern Europe (Δ = 0.30),
Eastern Asia (Δ = 0.28), Russia & Ukraine (Δ = 0.22) and India (Δ =
0.10). General Psychopathology: The most difficult item for raters to
score for all regions is G4 (Tension) with difficulty levels ranging from
Δ = 1.38 (India) to Δ = 0.72. Conclusions There were significant differences in response to a number of items on
the PANSS, possibly caused by a lack of equivalence between the original
and translated versions, cultural differences among interpretation of
items or scoring parameters. Knowing which items are problematic for
various cultures can help guide PANSS training and make training
specialized for specific geographical regions.
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Affiliation(s)
- Anzalee Khan
- ProPhase, LLC, New York, NY United States of America ; Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY United States of America ; Manahttan Psychiatric Center, Wards Island, NY United States of America
| | - Christian Yavorsky
- ProPhase, LLC, New York, NY United States of America ; CROnos Clinical Consulting Services, Hamilton, NJ United States of America
| | - Stacy Liechti
- The PANSS Research Institute, Inc, New York, NY United States of America
| | - Mark Opler
- ProPhase, LLC, New York, NY United States of America ; New York University, School of Medicine, New York, NY United States of America
| | - Brian Rothman
- ProPhase, LLC, New York, NY United States of America
| | | | - Luka Lucic
- ProPhase, LLC, New York, NY United States of America ; Pratt Institute, Brooklyn, NY United States of America
| | - Sofija Jovic
- ProPhase, LLC, New York, NY United States of America
| | - Toshiya Inada
- Institute of Neuropsychiatry, Seiwa Hospital, Shinjuku-ku, Tokyo, Japan
| | - Lawrence Yang
- ProPhase, LLC, New York, NY United States of America ; Department of Epidemiology, Columbia University, New York, NY United States of America
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Rice CE, Rosanoff M, Dawson G, Durkin MS, Croen LA, Singer A, Yeargin-Allsopp M. Evaluating Changes in the Prevalence of the Autism Spectrum Disorders (ASDs). Public Health Rev 2012; 34:1-22. [PMID: 26236074 DOI: 10.1007/bf03391685] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Autism spectrum disorders (ASDs) are estimated to occur among about one percent of children in the United States. This estimate is in line with estimates from other industrialized countries. However, the identified prevalence of ASDs has increased significantly in a short time period based on data from multiple studies including the U.S. Centers for Disease Control and Prevention's (CDC) Autism and Developmental Disabilities Monitoring (ADDM) Network. Whether increases in ASD prevalence are partly attributable to a true increase in the risk of developing ASD or solely to changes in community awareness and identification patterns is not known. It is clear that more children are identified with an ASD now than in the past and the impact on individuals, families, and communities is significant. However, disentangling the many potential reasons for ASD prevalence increases has been challenging. Understanding the relative contribution of multiple factors such as variation in study methods, changes in diagnostic and community identification, and potential changes in risk factors is an important priority for the ADDM Network and for CDC. This article summarizes the discussion from a workshop that was co-sponsored by CDC and Autism Speaks as a forum for sharing knowledge and opinions of a diverse range of stakeholders about changes in ASD prevalence. Panelists discussed recommendations for building on existing infrastructure and developing new initiatives to better understand ASD trends. The information, research, and opinions shared during this workshop add to the knowledge base about ASD prevalence in an effort to stimulate further work to understand the multiple reasons behind increasing ASD prevalence.
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Affiliation(s)
- Catherine E Rice
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, USA
| | | | - Geraldine Dawson
- Autism Speaks, USA ; University of North Carolina at Chapel Hill, USA
| | | | | | | | - Marshalyn Yeargin-Allsopp
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, USA
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Myers NAL. TOWARD AN APPLIED NEUROANTHROPOLOGY OF PSYCHOSIS: THE INTERPLAY OF CULTURE, BRAINS, AND EXPERIENCE. ANNALS OF ANTHROPOLOGICAL PRACTICE 2012. [DOI: 10.1111/j.2153-9588.2012.01095.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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