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Weiss A, Chaudhry S, Marhefka A, Khunkhun V. Early Intervention in the Treatment of Psychosis. Child Adolesc Psychiatr Clin N Am 2024; 33:645-658. [PMID: 39277317 DOI: 10.1016/j.chc.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2024]
Abstract
This article aims to: (1) describe the evolution of first episode of psychosis (FEP) approaches; (2) define a model of multidisciplinary care; (3) identify challenges and limitations; (4) discuss the unique challenges for those first experiencing psychosis; (5) identify strategies to expand early psychosis interventions. The authors take the medical standpoint and use the differential diagnosis and initial medical work-up as a context for assessment. The remainder of the article will be focused on treatment of FEP in those with schizophrenia-spectrum disorders.
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Affiliation(s)
- Ashley Weiss
- Early Psychosis Intervention Clinic New Orleans (EPIC-NOLA); Department of Psychiatry, Section of Child and Adolescent Psychiatry, Tulane University School of Medicine, 1440 Canal Street, Suite 1000, New Orleans, LA 70112, USA.
| | - Serena Chaudhry
- Early Psychosis Intervention Clinic New Orleans (EPIC-NOLA); Department of Psychiatry, Tulane University School of Medicine, 1440 Canal Street, Suite 1000, New Orleans, LA 70112, USA
| | - Alicia Marhefka
- Department of Psychiatry, University of Maryland School of Medicine, 655 Wset Baltimore Street, Baltimore, MD 21201, USA
| | - Vininder Khunkhun
- Department of Psychiatry, Section of Child and Adolescent Psychiatry, Tulane University School of Medicine, 1440 Canal Street, Suite 1000, New Orleans, LA 70112, USA
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2
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Qiao Z, Lafit G, Lecei A, Achterhof R, Kirtley OJ, Hiekkaranta AP, Hagemann N, Hermans KSFM, Boets B, Reininghaus U, Myin-Germeys I, van Winkel R. Childhood Adversity and Emerging Psychotic Experiences: A Network Perspective. Schizophr Bull 2024; 50:47-58. [PMID: 37318106 PMCID: PMC10754171 DOI: 10.1093/schbul/sbad079] [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: 06/16/2023]
Abstract
BACKGROUND AND HYPOTHESIS Childhood adversity is associated with a myriad of psychiatric symptoms, including psychotic experiences (PEs), and with multiple psychological processes that may all mediate these associations. STUDY DESIGN Using a network approach, the present study examined the complex interactions between childhood adversity, PEs, other psychiatric symptoms, and multiple psychological mediators (ie, activity-related and social stress, negative affect, loneliness, threat anticipation, maladaptive cognitive emotion regulation, attachment insecurity) in a general population, adolescent sample (n = 865, age 12-20, 67% female). STUDY RESULTS Centrality analyses revealed a pivotal role of depression, anxiety, negative affect, and loneliness within the network and a bridging role of threat anticipation between childhood adversity and maladaptive cognitive emotion regulation. By constructing shortest path networks, we found multiple existing paths between different categories of childhood adversity and PEs, with symptoms of general psychopathology (ie, anxiety, hostility, and somatization) as the main connective component. Sensitivity analyses confirmed the robustness and stability of the networks. Longitudinal analysis in a subsample with Wave 2 data (n = 161) further found that variables with higher centrality (ie, depression, negative affect, and loneliness) better predicted follow-up PEs. CONCLUSIONS Pathways linking childhood adversity to PEs are complex, with multifaceted psychological and symptom-symptom interactions. They underscore the transdiagnostic, heterotypic nature of mental ill-health in young people experiencing PEs, in agreement with current clinical recommendations.
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Affiliation(s)
- Zhiling Qiao
- Department of Neurosciences, Research Group Psychiatry, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium
| | - Ginette Lafit
- Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
- Department of Psychology, Group on Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | - Aleksandra Lecei
- Department of Neurosciences, Research Group Psychiatry, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium
| | - Robin Achterhof
- Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Olivia J Kirtley
- Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Anu P Hiekkaranta
- Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Noëmi Hagemann
- Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Karlijn S F M Hermans
- Strategy and Academic Affairs, Administration and Central Services, Leiden University, Leiden, The Netherlands
| | - Bart Boets
- Department of Neurosciences, Research Group Psychiatry, Center for Developmental Psychiatry, KU Leuven, Leuven, Belgium
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany
- ESRC Centre for Society and Mental Health and Social Epidemiology Research Group, King’s College London, London, UK
| | - Inez Myin-Germeys
- Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Ruud van Winkel
- Department of Neurosciences, Research Group Psychiatry, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium
- University Psychiatric Center (UPC), KU Leuven, Leuven, Belgium
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3
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Giannopoulou I, Georgiades S, Stefanou MI, Spandidos DA, Rizos E. Links between trauma and psychosis (Review). Exp Ther Med 2023; 26:386. [PMID: 37456168 PMCID: PMC10347243 DOI: 10.3892/etm.2023.12085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/07/2023] [Indexed: 07/18/2023] Open
Abstract
The relationship between trauma and psychosis is complex and multifaceted, with evidence suggesting that trauma can be both a risk factor for the development of psychosis and a consequence of psychotic experiences. The present review aimed to provide an overview of the current state of knowledge on the relationship between trauma and psychosis, including historical and conceptual considerations, as well as epidemiological evidence. The potential explanation of the link between trauma and psychosis is provided through available models and similarities in their neurobiological associations. Overall, the research confirms the relationship between trauma and psychosis, and suggests that individuals with a co-occurring history of trauma and psychosis may have increased symptom severity and worse functional outcomes compared with individuals with psychosis alone. Future research should focus on elucidating the underlying causal pathways between trauma exposure and psychosis in order to inform effective treatment approaches aiming to prevent the intensification of psychotic symptoms and processes.
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Affiliation(s)
- Ioanna Giannopoulou
- Second Department of Psychiatry, Attikon University General Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Stelios Georgiades
- Department of Basic Clinical Sciences, Medical School, University of Nicosia, 2415 Nicosia, Cyprus
| | - Maria-Ioanna Stefanou
- Second Department of Neurology, School of Medicine, Attikon University General Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Emmanouil Rizos
- Second Department of Psychiatry, Attikon University General Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece
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4
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The impact of childhood trauma and daily life experiences on emotional and psychotic symptom intensity in psychosis: An experience sampling study. Psychiatry Res 2022; 317:114872. [PMID: 36265192 DOI: 10.1016/j.psychres.2022.114872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/14/2022] [Accepted: 09/29/2022] [Indexed: 01/05/2023]
Abstract
Adverse childhood experiences create vulnerability to psychosis through biological and cognitive changes, and that may be observed as an increased emotional and psychotic response to daily life experiences in adulthood. This study aims to examine the effects of childhood maltreatment on psychotic patients' daily stress and emotional and psychotic intensity related to various experiences throughout the day. Daily activities and events, and emotional and psychotic intensity of forty-one psychotic patients were assessed with the Experience Sampling Method. The Childhood Trauma Questionnaire (CTQ) was used to evaluate childhood adversities. Multilevel regression analyses showed that all trauma subtypes, except for sexual abuse, were associated with increased psychosis and event-stress. Emotional maltreatment was the most associated trauma type with high negative and low positive affect and increased daily stress. Patients reported the highest stress and negative affect related to internal experiences but the lowest stress related to recreational actions. Social activities were also associated with higher positive affect and lower stress and psychosis, with the high CTQ group having greater stress in those activities. Our study demonstrates the negative impact of childhood trauma, especially emotional maltreatment, on daily stress and emotional and psychotic intensity in psychotic patients via different daily experiences.
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Muddle S, Jones B, Taylor G, Jacobsen P. A systematic review and meta-analysis of the association between emotional stress reactivity and psychosis. Early Interv Psychiatry 2022; 16:958-978. [PMID: 34904353 DOI: 10.1111/eip.13247] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/25/2021] [Accepted: 11/07/2021] [Indexed: 01/03/2023]
Abstract
AIM Emotional stress reactivity may be a mediating factor in the association between trauma and psychosis. This review aimed to (i) identify, summarise and critically evaluate the link between emotional stress reactivity and psychotic experiences (ii) examine evidence for a 'dose-response' relationship between stress reactivity and psychosis in the wider psychosis phenotype (i.e., sub-clinical symptoms). METHODS Electronic database searches (PsychINFO, MEDLINE, EMBASE) were conducted for studies which investigated the link between stress reactivity and psychosis, psychotic symptoms, or a vulnerability to developing psychosis (wider phenotype). Cross-sectional, experimental and experience sampling method study designs were eligible for inclusion. RESULTS Fourty five eligible articles were identified (N participants = 8830). Narrative synthesis showed that increased emotional stress reactivity was associated with psychosis and subclinical psychotic experiences across all study designs, however, findings were inconsistent across studies. The preliminary meta-analysis (k = 4, n = 383) showed increases in emotional stress reactivity was associated with higher negative affect in response to event-related stress, in those with psychosis compared to controls (mean difference in beta coefficients = 0.05, 95% CI 0.02-0.08, p = .004). However, this difference was small with a considerable degree of heterogeneity (p = .001, I2 = 81%) so results should be interpreted with caution. CONCLUSIONS Overall, the evidence suggests that there is a link between emotional stress reactivity and psychosis in those with psychosis, those at high risk of developing psychosis and in relation to subclinical psychotic-like experiences in the general population.
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Affiliation(s)
- Sarah Muddle
- Department of Psychology, University of Bath, Bath, UK
| | - Bradley Jones
- Department of Psychology, University of Bath, Bath, UK
| | - Gemma Taylor
- Department of Psychology, University of Bath, Bath, UK
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6
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Chen LH, Toulopoulou T. Pathways linking school bullying and psychotic experiences: Multiple mediation analysis in Chinese adolescents and young adults. Front Psychiatry 2022; 13:1007348. [PMID: 36386962 PMCID: PMC9650074 DOI: 10.3389/fpsyt.2022.1007348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/26/2022] [Indexed: 11/21/2022] Open
Abstract
It is found that people with psychotic experiences have a 4-fold increased risk of developing a psychotic disorder later in life. Indeed, accumulating evidence has suggested that the association between school bullying and psychotic experiences works linearly. Previous studies are mainly carried out in a Western context, and only seldomly do studies address whether the association exists in the Chinese population and the related psychological and cognitive mechanisms. Therefore, we carried out the current study to address this gap in the literature focusing on the lifelong school bullying experiences of Chinese adolescents and young adults. We examined them in relation to psychotic experiences while assessing the mediating role of self-esteem, the personality trait of neuroticism, and a cognitive bias in thinking called interpretation bias. We found that multiple victimizations were quite common in Hong Kong secondary schools. In addition to a significant association between school bullying and psychotic experiences, we found partial mediating effects of proposed psychological and cognitive mediators in constructed multiple mediation models utilizing bootstrapping approach. Specifically, bullying quantity reflecting the number of victimizations, had its association with psychotic experiences partially mediated by the personality trait of neuroticism. In contrast, bullying duration reflecting the lasting of victimization was associated with psychotic experiences partially mediated by the personality trait of neuroticism and interpretation bias. Our findings enhance our knowledge of mechanisms underpinning the psychosis spectrum development and have implications for school-based intervention programs targeting bullying victims.
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Affiliation(s)
- Lu Hua Chen
- Department of Rehabilitation Sciences (Neuroscience and Neurological Rehabilitation), Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.,Mental Health Research Centre, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China.,Department of Psychology, Faculty of Social Sciences, The University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Timothea Toulopoulou
- Department of Psychology, Faculty of Social Sciences, The University of Hong Kong, Kowloon, Hong Kong SAR, China.,Department of Psychology, Bilkent University, Ankara, Turkey.,Department of Basic and Clinical Neuroscience, Institute of Psychiatry Psychology and Neuroscience at King's College London, London, United Kingdom
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7
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Sorenson RP, Rossell SL, Sumner PJ. Exploring the associations between dimensions of schizotypy and social defeat. PSYCHOSIS 2021. [DOI: 10.1080/17522439.2021.2014943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Rory P. Sorenson
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Susan L. Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
- Department of Psychiatry, St Vincent’s Hospital, Melbourne, Australia
| | - Philip J. Sumner
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
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8
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Betz LT, Penzel N, Rosen M, Kambeitz J. Relationships between childhood trauma and perceived stress in the general population: a network perspective. Psychol Med 2021; 51:2696-2706. [PMID: 32404227 DOI: 10.1017/s003329172000135x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Experiences of childhood trauma (CT) are associated with increased psychological vulnerability. Past research suggests that CT might alter stress processing with a subsequent negative impact on mental health. However, it is currently unclear how different domains of CT exert effects on specific subjective experiences of stress during adulthood. METHODS In the present study, we used network analysis to explore the complex interplay between distinct domains of CT and perceived stress in a large, general-population sample of middle-aged adults (N = 1252). We used a data-driven community-detection algorithm to identify strongly connected subgroups of items within the network. To assess the replicability of the findings, we repeated the analyses in a second sample (N = 862). Combining data from both samples, we evaluated network differences between men (n = 955) and women (n = 1159). RESULTS Results indicate specific associations between distinct domains of CT and perceived stress. CT domains reflecting a dimension of deprivation, i.e. experiences of neglect, were associated exclusively to a stress network community representing low perceived self-efficacy. By contrast, CT associated with threat, i.e. experiences of abuse, was specifically related to a stress community reflecting perceived helplessness. Our results replicated with high accordance in the second sample. We found no difference in network structure between men and women, but overall a stronger connected network in women. CONCLUSIONS Our findings emphasize the unique role of distinct domains of CT in psychological stress processes in adulthood, implying opportunities for targeted interventions following distinct domains of CT.
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Affiliation(s)
- Linda T Betz
- Department of Psychiatry and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Nora Penzel
- Department of Psychiatry and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Marlene Rosen
- Department of Psychiatry and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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9
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Tang W, Xu D, Yang Y, Xu J. Psychotic-like experiences in Chinese children and adolescents: The effect of earthquake exposure, maltreatment and negative life events. Early Interv Psychiatry 2021; 15:536-546. [PMID: 32500658 DOI: 10.1111/eip.12976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/02/2020] [Accepted: 04/28/2020] [Indexed: 02/05/2023]
Abstract
AIM Psychotic-like experiences (PLEs) are common in adolescents who have experienced or are experiencing trauma. However, the potential relationships between exposure to a major earthquake, negative life events or maltreatment and PLEs in Chinese adolescents are poorly understood. Therefore, this study explored the prevalence of PLEs and the psychosocial correlates in adolescent earthquake survivors. METHODS A total of 6132 adolescents from 11 primary and high schools in the areas most severely affected by the Ya'an earthquake completed questionnaires on earthquake exposure, maltreatment, negative life events and PLEs, which included paranoid ideation and psychoticism. RESULTS It was found that earthquake exposure significantly contributed to the PLEs, child maltreatment explained a significant amount of the PLE variances, emotional abuse had the most important PLE role and negative life events also explained a large amount of the PLE variances, of which interpersonal difficulties and academic pressure had the greatest effects. CONCLUSIONS Interventions should seek to reduce parental emotional abuse, reduce academic performance pressure, improve interpersonal skills and resolve interpersonal difficulties, and specific interventions should target children and adolescents exposed to the earthquake to prevent PLEs, schizophrenia or other mental illnesses arising from multiple traumas.
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Affiliation(s)
- Wanjie Tang
- Centre for Educational and Health Psychology, Sichuan University, Chengdu, China.,Institute of Emergency Management and Post-Disaster Reconstruction, Sichuan University, Chengdu, China
| | - Dun Xu
- Institute of Emergency Management and Post-Disaster Reconstruction, Sichuan University, Chengdu, China
| | - Yanchun Yang
- Mental Health Center, State Key Lab of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Jiuping Xu
- Institute of Emergency Management and Post-Disaster Reconstruction, Sichuan University, Chengdu, China
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Stress reactivity as a putative mechanism linking childhood trauma with clinical outcomes in individuals at ultra-high-risk for psychosis: Findings from the EU-GEI High Risk Study. Epidemiol Psychiatr Sci 2021; 30:e40. [PMID: 34044905 PMCID: PMC8193966 DOI: 10.1017/s2045796021000251] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
AIMS Childhood trauma is associated with an elevated risk for psychosis, but the psychological mechanisms involved remain largely unclear. This study aimed to investigate emotional and psychotic stress reactivity in daily life as a putative mechanism linking childhood trauma and clinical outcomes in individuals at ultra-high-risk (UHR) for psychosis. METHODS Experience sampling methodology was used to measure momentary stress, affect and psychotic experiences in the daily life of N = 79 UHR individuals in the EU-GEI High Risk Study. The Childhood Trauma Questionnaire was used to assess self-reported childhood trauma. Clinical outcomes were assessed at baseline, 1- and 2-year follow-up. RESULTS The association of stress with positive (β = -0.14, p = 0.010) and negative affect (β = 0.11, p = 0.020) was modified by transition status such that stress reactivity was greater in individuals who transitioned to psychosis. Moreover, the association of stress with negative affect (β = 0.06, p = 0.019) and psychotic experiences (β = 0.05, p = 0.037) was greater in individuals exposed to high v. low levels of childhood trauma. We also found evidence that decreased positive affect in response to stress was associated with reduced functioning at 1-year follow-up (B = 6.29, p = 0.034). In addition, there was evidence that the association of childhood trauma with poor functional outcomes was mediated by stress reactivity (e.g. indirect effect: B = -2.13, p = 0.026), but no evidence that stress reactivity mediated the association between childhood trauma and transition (e.g. indirect effect: B = 0.14, p = 0.506). CONCLUSIONS Emotional and psychotic stress reactivity may be potential mechanisms linking childhood trauma with clinical outcomes in UHR individuals.
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Smigielski L, Wotruba D, Treyer V, Rössler J, Papiol S, Falkai P, Grünblatt E, Walitza S, Rössler W. The Interplay Between Postsynaptic Striatal D2/3 Receptor Availability, Adversity Exposure and Odd Beliefs: A [11C]-Raclopride PET Study. Schizophr Bull 2021; 47:1495-1508. [PMID: 33876249 PMCID: PMC8379534 DOI: 10.1093/schbul/sbab034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Between unaffected mental health and diagnosable psychiatric disorders, there is a vast continuum of functioning. The hypothesized link between striatal dopamine signaling and psychosis has guided a prolific body of research. However, it has been understudied in the context of multiple interacting factors, subclinical phenotypes, and pre-postsynaptic dynamics. METHOD This work investigated psychotic-like experiences and D2/3 dopamine postsynaptic receptor availability in the dorsal striatum, quantified by in vivo [11C]-raclopride positron emission tomography, in a sample of 24 healthy male individuals. Additional mediation and moderation effects with childhood trauma and key dopamine-regulating genes were examined. RESULTS An inverse relationship between nondisplaceable binding potential and subclinical symptoms was identified. D2/3 receptor availability in the left putamen fully mediated the association between traumatic childhood experiences and odd beliefs, that is, inclinations to see meaning in randomness and unfounded interpretations. Moreover, the effect of early adversity was moderated by a DRD2 functional variant (rs1076560). The results link environmental and neurobiological influences in the striatum to the origination of psychosis spectrum symptomology, consistent with the social defeat and diathesis-stress models. CONCLUSIONS Adversity exposure may affect the dopamine system as in association with biases in probabilistic reasoning, attributional style, and salience processing. The inverse relationship between D2/3 availability and symptomology may be explained by endogenous dopamine occupying the receptor, postsynaptic compensatory mechanisms, and/or altered receptor sensitivity. This may also reflect a cognitively stabilizing mechanism in non-help-seeking individuals. Future research should comprehensively characterize molecular parameters of dopamine neurotransmission along the psychosis spectrum and according to subtype profiling.
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Affiliation(s)
- Lukasz Smigielski
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland,To whom correspondence should be addressed; Psychiatric University Hospital Zurich, Militärstrasse 8, 8004 Zurich, Switzerland; tel: +044-296-73-94, fax: +044-296-74-69, e-mail:
| | - Diana Wotruba
- Collegium Helveticum, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Valerie Treyer
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland,Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
| | - Julian Rössler
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Sergi Papiol
- Institute of Psychiatric Phenomics and Genomics, University Hospital, Ludwig Maximilian University, Munich, Germany,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Edna Grünblatt
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland,Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland,Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland,Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland,Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Campus Charité Mitte, Berlin, Germany,Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
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12
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Pena-Garijo J, Monfort-Escrig C. The centrality of secure attachment within an interacting network of symptoms, cognition, and attachment dimensions in persons with schizophrenia-spectrum disorders: A preliminary study. J Psychiatr Res 2021; 135:60-67. [PMID: 33450466 DOI: 10.1016/j.jpsychires.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Research in the field of psychosis broadly suggests that symptoms, neurocognitive deficits, social cognition, cognitive biases, and attachment experiences influence each other. However, little is known if any of these constructions play a more central role than others as they interact. METHOD To clarify this issue, we conducted a "network" analysis to explore the interplay among a set of variables related to attachment, cognition domains, and psychotic symptoms in a small sample of outpatients with stabilised schizophrenia-spectrum disorders (n = 25). Eighteen participants (72%) were first-episode patients. We assessed psychotic symptoms, attachment dimensions, neurocognitive performance, "theory of mind", emotion recognition, and "jumping to conclusions" bias using standardised instruments. RESULTS The study provides preliminary evidence about a network structure in which the secure attachment (SA) is the most central "node" within the interacting network considering all centrality measures, followed by general psychopathology. SA was closely connected to self-sufficiency (avoidant attachment) and child traumatism, as well as with neurocognition. Emotion recognition impairment was the most robust connection to positive symptoms and mediated the influence of SA on psychotic symptoms. CONCLUSIONS Beyond the importance of symptoms, our results, although preliminary, suggest the need to assess attachment experiences and cognition domains to improve specific interventions that can promote recovery in outpatients with psychosis.
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Affiliation(s)
- Josep Pena-Garijo
- Jaume I University. Castellon de la Plana, Spain; Mental Health Service. University Hospital Doctor Peset. Valencia, Spain.
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13
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Gawęda Ł, Pionke R, Hartmann J, Nelson B, Cechnicki A, Frydecka D. Toward a Complex Network of Risks for Psychosis: Combining Trauma, Cognitive Biases, Depression, and Psychotic-like Experiences on a Large Sample of Young Adults. Schizophr Bull 2020; 47:395-404. [PMID: 33728467 PMCID: PMC7965064 DOI: 10.1093/schbul/sbaa125] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although the linkage between traumatic life events and psychotic-like experiences (PLEs) is well established, the knowledge of potential mechanisms of this relationship is scarce. The aim of the present study was to better understand the structure of connections between traumatic life events and PLEs by considering at the same time the role of cognitive biases and depressive symptoms in the population of young adults (18-35 years of age, M = 26.52, SD = 4.74, n = 6772). Our study was conducted within a framework of network analysis. PLEs were measured with the Prodromal Questionnaire (PQ-16), cognitive biases were measured with nine items from the Davos Assessment of Cognitive Biases Scale-18 (DACOBS-18), depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression Scale (CESD-R) and exposure to traumatic life events was measured with a combination of Childhood Experience of Care and Abuse Questionnaire (CECA.Q) and Traumatic Experience Checklist (TEC). The results present a network of all nodes being interconnected within and between domains, with no isolated factors. Exposures to sexual trauma were the most central node in the network. Pathways were identified from trauma to PLEs via cognitive biases and depressive symptoms. However, the shortest pathway between the most central traumatic life event and PLEs was through other traumatic life events, without cognitive biases or depressive symptoms along the way. Our findings suggest the importance of environmental adversities as well as dysfunctional information processing and depression in the network of psychosis risks.
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Affiliation(s)
- Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland,To whom correspondence should be addressed; Institute of Psychology, Polish Academy of Sciences, Jaracza 1, 00-378 Warsaw, Poland; tel: +48 (22) 583-13-80, fax: +48 (22) 583-13-81, e-mail:
| | - Renata Pionke
- Psychopathology and Early Interventions Lab, II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Jessica Hartmann
- Orygen, Parkville, Victoria, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Barnaby Nelson
- Orygen, Parkville, Victoria, Australia,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Andrzej Cechnicki
- Department of Community Psychiatry, Chair of Psychiatry, Medical College Jagiellonian University, Krakow, Poland
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
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14
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Alameda L, Rodriguez V, Carr E, Aas M, Trotta G, Marino P, Vorontsova N, Herane-Vives A, Gadelrab R, Spinazzola E, Di Forti M, Morgan C, Murray RM. A systematic review on mediators between adversity and psychosis: potential targets for treatment. Psychol Med 2020; 50:1966-1976. [PMID: 32744193 DOI: 10.1017/s0033291720002421] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Various psychological and biological pathways have been proposed as mediators between childhood adversity (CA) and psychosis. A systematic review of the evidence in this domain is needed. Our aim is to systematically review the evidence on psychological and biological mediators between CA and psychosis across the psychosis spectrum. This review followed PRISMA guidelines. Articles published between 1979 and July 2019 were identified through a literature search in OVID (PsychINFO, Medline and Embase) and Cochrane Libraries. The evidence by each analysis and each study is presented by group of mediator categories found. The percentage of total effect mediated was calculated. Forty-eight studies were included, 21 in clinical samples and 27 in the general population (GP) with a total of 82 352 subjects from GP and 3189 from clinical studies. The quality of studies was judged as 'fair'. Our results showed (i) solid evidence of mediation between CA and psychosis by negative cognitive schemas about the self, the world and others (NS); by dissociation and other post-traumatic stress disorder symptoms; and through an affective pathway in GP but not in subjects with disorder; (iii) lack of studies exploring biological mediators. We found evidence suggesting that various overlapping and not competing pathways involving post-traumatic and mood symptoms, as well as negative cognitions contribute partially to the link between CA and psychosis. Experiences of CA, along with relevant mediators should be routinely assessed in patients with psychosis. Evidence testing efficacy of interventions targeting such mediators through cognitive behavioural approaches and/or pharmacological means is needed in future.
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Affiliation(s)
- Luis Alameda
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program, Lausanne University Hospital (CHUV), CH-1008Lausanne, Switzerland
- Department of Psychiatry, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Spain
- Instituto de Investigacion Sanitaria de Sevilla, IBiS, Spain
| | - Victoria Rodriguez
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ewan Carr
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Monica Aas
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Giulia Trotta
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paolo Marino
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Natasha Vorontsova
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Andrés Herane-Vives
- Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Departamento de Clínicas, Facultad de Medicina, Universidad Católica del Norte, Coquimbo, Chile
| | - Romayne Gadelrab
- Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Edoardo Spinazzola
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Marta Di Forti
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Craig Morgan
- ESRC Centre for Society and Mental Health, King's College London, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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15
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Stress perception following childhood adversity: Unique associations with adversity type and sex. Dev Psychopathol 2020; 32:343-356. [PMID: 30846020 DOI: 10.1017/s0954579419000130] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Childhood adversity is associated with poor mental and physical health outcomes across the life span. Alterations in the hypothalamic-pituitary-adrenal axis are considered a key mechanism underlying these associations, although findings have been mixed. These inconsistencies suggest that other aspects of stress processing may underlie variations in this these associations, and that differences in adversity type, sex, and age may be relevant. The current study investigated the relationship between childhood adversity, stress perception, and morning cortisol, and examined whether differences in adversity type (generalized vs. threat and deprivation), sex, and age had distinct effects on these associations. Salivary cortisol samples, daily hassle stress ratings, and retrospective measures of childhood adversity were collected from a large sample of youth at risk for serious mental illness including psychoses (n = 605, mean age = 19.3). Results indicated that childhood adversity was associated with increased stress perception, which subsequently predicted higher morning cortisol levels; however, these associations were specific to threat exposures in females. These findings highlight the role of stress perception in stress vulnerability following childhood adversity and highlight potential sex differences in the impact of threat exposures.
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16
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van der Linden K, Simons C, van Amelsvoort T, Marcelis M. Lifetime and Momentary Psychotic Experiences in Adult Males and Females With an Autism Spectrum Disorder. Front Psychiatry 2020; 11:766. [PMID: 32848936 PMCID: PMC7416642 DOI: 10.3389/fpsyt.2020.00766] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 07/20/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Existing research shows that adults with an autism spectrum disorder (ASD) are more vulnerable to develop overt psychosis. However, studies investigating (subclinical) psychotic experiences (PE) in ASD are scarce, and it is unknown if PE are accompanied with more distress in adults with ASD compared to the general population. This study examined lifetime PE and accompanying distress, momentary PE levels, and the impact of daily life stress and negative affect (NA) on momentary PE in males and females with ASD compared to controls. METHODS In 50 adults with ASD (males N= 26, females N= 24) and 51 adults without ASD (males N= 26, females N= 25), the Community Assessment of Psychic Experiences (CAPE) was used to analyze group differences in frequency and distress of lifetime subclinical positive, negative, and depressive symptoms. The Experience Sampling Method (ESM) was used to measure momentary PE, NA, and stress (activity-related, event-related, and social stress) for 10 days. Multilevel analyses were conducted to test whether stress and NA were associated with momentary PE and whether these associations were modified by group or sex. RESULTS Adults with ASD reported more lifetime CAPE negative and depressive symptoms, but similar levels of PE, than controls. Higher levels of accompanying distress were found in participants with ASD for each subscale. With respect to ESM momentary PE, higher levels were reported by adults with ASD and a stronger association between event-related stress and momentary PE was found compared to controls. This was not the case for NA, activity-related, and social stress. Overall, no significant differences between male and female outcomes were found. CONCLUSION Adults with ASD are more prone to encounter lifetime subclinical negative and depressive symptoms and accompanying distress compared to adults without ASD. Similar levels of lifetime PE in both groups were still accompanied with more distress in the ASD group. Furthermore, higher levels of ESM momentary PE were found in participants with ASD. Additionally, event-related stress may act as a risk factor for PE in both females and males with ASD, with a stronger risk-increasing effect than in their control counterparts.
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Affiliation(s)
- Kim van der Linden
- GGzE, Mental Healthcare Institution Eindhoven, Eindhoven, Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
| | - Claudia Simons
- GGzE, Mental Healthcare Institution Eindhoven, Eindhoven, Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
| | - Thérèse van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
| | - Machteld Marcelis
- GGzE, Mental Healthcare Institution Eindhoven, Eindhoven, Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, Netherlands
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17
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Chatziioannidis S, Andreou C, Agorastos A, Kaprinis S, Malliaris Y, Garyfallos G, Bozikas VP. The role of attachment anxiety in the relationship between childhood trauma and schizophrenia-spectrum psychosis. Psychiatry Res 2019; 276:223-231. [PMID: 31112856 DOI: 10.1016/j.psychres.2019.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 05/10/2019] [Accepted: 05/10/2019] [Indexed: 01/21/2023]
Abstract
Childhood trauma (CT) is a comprehensive concept encompassing experiences of sexual, physical, and emotional abuse, and neglect during childhood and adolescence. Patients with schizophrenia-spectrum psychosis (SSP) display higher rates of CT than healthy controls. Among the potential mediators of this association, insecure attachment has gained attention and empirical validation. The present study aimed to extend existing knowledge on this field by exploring the role of the two attachment dimensions, attachment anxiety and attachment avoidance, in the CT-SSP association. A clinical sample of 63 SSP inpatients was compared to a healthy control group on CT and attachment style measures. Correlations between CT, attachment dimensions and psychopathology were sought. Mediation analyses were also performed to examine whether attachment anxiety and/or attachment avoidance mediated the CT-SSP association. Patients displayed higher rates of CT and insecure attachment than controls. Attachment anxiety and severity of Mother Antipathy were linked to severity of hallucinations. Attachment anxiety was recognized as the sole mediator of the CT-SSP association. Our findings suggest that individuals with severe CT and increased attachment anxiety represent a risk population warranting early clinical attention, regular monitoring and tailored therapeutic interventions aimed at reducing the psychological impact of trauma.
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Affiliation(s)
- Stylianos Chatziioannidis
- 2nd Department of Psychiatry, Aristotle University of Thessaloniki, Lagada Street 196, 56430 Stavroupoli, Greece.
| | - Christina Andreou
- University Psychiatric Clinics Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland
| | - Agorastos Agorastos
- 2nd Department of Psychiatry, Aristotle University of Thessaloniki, Lagada Street 196, 56430 Stavroupoli, Greece
| | - Stergios Kaprinis
- 2nd Department of Psychiatry, Aristotle University of Thessaloniki, Lagada Street 196, 56430 Stavroupoli, Greece
| | - Yanni Malliaris
- EDO the Hellenic Bipolar Organization and BipolarLab.com, Asimaki Fotila Street 3, 11473, Pedion Areos, Athens, Greece
| | - George Garyfallos
- 2nd Department of Psychiatry, Aristotle University of Thessaloniki, Lagada Street 196, 56430 Stavroupoli, Greece
| | - Vasilios P Bozikas
- 2nd Department of Psychiatry, Aristotle University of Thessaloniki, Lagada Street 196, 56430 Stavroupoli, Greece
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18
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Hatzimanolis A, Avramopoulos D, Arking DE, Moes A, Bhatnagar P, Lencz T, Malhotra AK, Giakoumaki SG, Roussos P, Smyrnis N, Bitsios P, Stefanis NC. Stress-Dependent Association Between Polygenic Risk for Schizophrenia and Schizotypal Traits in Young Army Recruits. Schizophr Bull 2018; 44:338-347. [PMID: 29036523 PMCID: PMC5814832 DOI: 10.1093/schbul/sbx074] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Schizotypal personality traits may increase proneness to psychosis and likely index familial vulnerability to schizophrenia (SZ), implying shared genetic determinants with SZ. Here, we sought to investigate the contribution of common genetic risk variation for SZ on self-reported schizotypy in 2 ethnically homogeneous cohorts of healthy young males during compulsory military service, enrolled in the Athens Study of Proneness and Incidence of Schizophrenia (ASPIS, N = 875) and the Learning on Genetics of Schizophrenia Spectrum study (LOGOS, N = 690). A follow-up psychometric assessment was performed in a sub-sample of the ASPIS (N = 121), 18 months later at military service completion. Polygenic risk scores (PRS) for SZ were derived based on genome-wide association meta-analysis results from the Psychiatric Genomics Consortium. In the ASPIS, higher PRSSZ significantly associated with lower levels of positive (ie, perceptual distortions), disorganization and paranoid facets of schizotypy, whereas no association with negative (ie, interpersonal) facets was noted. Importantly, longitudinal data analysis in the ASPIS subsample revealed that PRSSZ was inversely associated with positive schizotypy at military induction (stressed condition) but not at follow-up (nonstressed condition), providing evidence for environmental rather than SZ-implicated genetic influences. Moreover, consistent with prior reports, PRSSZ was positively correlated with trait anxiety in the LOGOS and additionally the recruits with higher PRSSZ and trait anxiety exhibited attenuated paranoid ideation. Together, these findings do not support an etiological link between increased polygenic liability for SZ and schizotypy, suggesting that psychosocial stress or trait anxiety may impact schizotypal phenotypic expressions among healthy young adults not genetically predisposed to SZ.
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Affiliation(s)
- Alex Hatzimanolis
- Department of Psychiatry, National and Kapodistrian University of Athens School of Medicine, Eginition Hospital, Athens, Greece,Neurobiology Research Institute, Theodor-Theohari Cozzika Foundation, Athens, Greece
| | - Dimitrios Avramopoulos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD,McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Dan E Arking
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anna Moes
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Pallav Bhatnagar
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Todd Lencz
- Division of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY,Departments of Psychiatry and Molecular Medicine, Hofstra University School of Medicine, Hempstead, NY
| | - Anil K Malhotra
- Division of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY,Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY,Departments of Psychiatry and Molecular Medicine, Hofstra University School of Medicine, Hempstead, NY
| | | | - Panos Roussos
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY,Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY,Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY,James J. Peters Veterans Affairs Medical Center, Mental Illness Research Education and Clinical Center, Bronx, NY
| | - Nikolaos Smyrnis
- Department of Psychiatry, National and Kapodistrian University of Athens School of Medicine, Eginition Hospital, Athens, Greece
| | - Panos Bitsios
- Department of Psychiatry and Behavioral Sciences, University of Crete School of Medicine, Heraklion, Greece
| | - Nicholas C Stefanis
- Department of Psychiatry, National and Kapodistrian University of Athens School of Medicine, Eginition Hospital, Athens, Greece,Neurobiology Research Institute, Theodor-Theohari Cozzika Foundation, Athens, Greece,University Mental Health Research Institute, Athens, Greece,To whom correspondence should be addressed; Department of Psychiatry, National and Kapodistrian University of Athens School of Medicine, Eginition Hospital, 72 Vas. Sophias Avenue, 11528 Athens, Greece; tel: +30-210-7289128; fax: +30-210-7242020, e-mail:
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19
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Mansueto G, van Nierop M, Schruers K, Alizadeh BZ, Bartels-Velthuis AA, van Beveren NJ, Bruggeman R, Cahn W, de Haan L, Delespaul P, Meijer CJ, Myin-Germeys I, Kahn RS, Schirmbeck F, Simons CJP, van Haren NEM, van Os J, van Winkel R. The role of cognitive functioning in the relationship between childhood trauma and a mixed phenotype of affective-anxious-psychotic symptoms in psychotic disorders. Schizophr Res 2018; 192:262-268. [PMID: 28416093 DOI: 10.1016/j.schres.2017.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 03/17/2017] [Accepted: 04/01/2017] [Indexed: 12/11/2022]
Abstract
Cognitive impairments in patients with psychotic disorder have been associated with poor functioning and increased symptom severity. Furthermore, childhood trauma (CT) exposure has been associated with worse cognitive functioning as well as co-occurrence of affective-anxious-psychosis symptoms or a 'mixed phenotype of psychopathology' (MP), which in turn is associated with greater symptom severity, and poor functioning. This study aims to evaluate if cognition could be associated with CT/MP. 532 patients with non-affective psychotic patients were assessed on CT, symptom profile, cognition, functioning, and symptom severity at baseline and 3 and 6-year follow-up. Four subgroups were made according to trauma exposure (CT- or CT+) and presence of a mixed phenotype (MP- or MP+): CT-/MP (n=272), CT-/MP+ (n=157), CT+/MP- (n=49), and CT+/MP+ (n=54). Mixed-effects multilevel regression, linear regression, and Tobit analyses were performed. Patients with both CT and MP showed lower verbal learning and memory than CT-/MP+ individuals (p<0.001). No other significant differences were found among the 4 subgroups. No cognitive decline was found at follow-up, neither in the CT+/MP- nor in CT-/MP- group. Lower cognition was not associated with increased symptom severity or poor functioning at follow-up, neither in the CT+/MP- nor in CT-/MP- group. Although cognitive impairments and CT may be related to clinical or functional features of psychotic disorder, and cognitive functioning could be affected by CT exposure, cognition does not discriminate subgroups of patients stratified by CT exposure and MP.
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Affiliation(s)
- Giovanni Mansueto
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Martine van Nierop
- KU Leuven, Department of Neuroscience, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium
| | - Koen Schruers
- Maastricht University Medical Center, Dept. of Psychiatry & Psychology, School for Mental Health & Neuroscience, Maastricht, The Netherlands
| | | | - Berhooz Z Alizadeh
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands
| | - Agna A Bartels-Velthuis
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands
| | - Nico J van Beveren
- Antes Center for Mental Health Care, Rotterdam, The Netherlands; Erasmus MC, Dept of Psychiatry, Dept. of Neuroscience, Rotterdam, The Netherlands
| | - Richard Bruggeman
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Groningen, The Netherlands
| | - Wiepke Cahn
- University Medical Centre Utrecht, Dept. of Psychiatry, Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - Lieuwe de Haan
- Academic Medical Centre, University of Amsterdam, Dept. of Psychiatry, Amsterdam, The Netherlands
| | - Philippe Delespaul
- Maastricht University Medical Center, Dept. of Psychiatry & Psychology, School for Mental Health & Neuroscience, Maastricht, The Netherlands
| | - Carin J Meijer
- Academic Medical Centre, University of Amsterdam, Dept. of Psychiatry, Amsterdam, The Netherlands
| | - Inez Myin-Germeys
- KU Leuven, Department of Neuroscience, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium
| | - Rene S Kahn
- University Medical Centre Utrecht, Dept. of Psychiatry, Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - Frederike Schirmbeck
- Academic Medical Centre, University of Amsterdam, Dept. of Psychiatry, Amsterdam, The Netherlands
| | - Claudia J P Simons
- Maastricht University Medical Center, Dept. of Psychiatry & Psychology, School for Mental Health & Neuroscience, Maastricht, The Netherlands; GGzE, Institute for Mental Health Care Eindhoven and De Kempen, Eindhoven, The Netherlands
| | - Neeltje E M van Haren
- University Medical Centre Utrecht, Dept. of Psychiatry, Brain Centre Rudolf Magnus, Utrecht, The Netherlands
| | - Jim van Os
- Maastricht University Medical Center, Dept. of Psychiatry & Psychology, School for Mental Health & Neuroscience, Maastricht, The Netherlands; King's College London, King's Health Partners, Dept. of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
| | - Ruud van Winkel
- KU Leuven, Department of Neuroscience, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuvensesteenweg 517, 3070 Kortenberg, Belgium.
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20
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Benz T, Nüssle A, Lehmann S, Gantenbein AR, Sándor PS, Elfering A, Aeschlimann AG, Angst F. Health and quality of life in patients with medication overuse headache syndrome after standardized inpatient rehabilitation: A cross-sectional pilot study. Medicine (Baltimore) 2017; 96:e8493. [PMID: 29381924 PMCID: PMC5708923 DOI: 10.1097/md.0000000000008493] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The aim of this pilot study was to determine health-related quality of life (HRQoL) in patients with history of medication overuse headache (MOH) after detoxification and a headache-specific inpatient rehabilitation program and to receive necessary information for future prospective studies.HRQoL and headache-related disability were cross-sectionally measured by Short Form 36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Migraine Disability Score (MIDAS), Coping Strategies Questionnaire (CSQ), and Symptom Checklist 90 revised (SCL-90-R). SF-36, HADS, and SCL-90-R data were compared to German population norms, stratified by age, sex, and comorbidities.Fifty-one patients (72.5% females, mean age 47.3 years) were included with an average headache duration of 25.3 years. Moderate to high levels of headache were reported on the MIDAS VAS at 6.51 (range 0-10); SF-36 bodily pain was 40.3 (norm = 59.0, P < .001, 100 = best). Impaired functioning averaged at 78.4 (100 = no impairment) on the MIDAS. In contrast, SF-36 physical functioning was comparable to the norm (mean: 78.4, norm = 81.8, P = .63). All other SF-36 scales were significantly lower than expected from the norm (all P < .001). The scales depression, anxiety, obsessive-compulsive, and interpersonal sensitivity were significantly affected, whereas the levels of SCL-90-R schizophrenia nuclear and schizotypia were not lower than the norm. Coping with pain was moderate.This pilot study is the first that presents a comprehensive and simultaneously specific assessment of health and quality of life of MOH patients after detoxification and inpatient rehabilitation. Moderate to high levels of pain and self-reported disability owing to headache were observed, whereas physical function on the SF-36 was not different from the expected level of the norm. Mental health was substantially affected in several dimensions, which had been described to reduce the ability to cope with pain. MOH patients seem to have high expectations of functionality, low symptomatology, and intact well-being.
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Affiliation(s)
- Thomas Benz
- Rehabilitation Clinic “RehaClinic”, Bad Zurzach
- Institute of Psychology, University of Bern, Bern, Switzerland
| | | | | | | | - Peter S. Sándor
- Rehabilitation Clinic “RehaClinic”, Bad Zurzach
- University of Zurich, Zurich
| | - Achim Elfering
- Institute of Psychology, University of Bern, Bern, Switzerland
| | | | - Felix Angst
- Rehabilitation Clinic “RehaClinic”, Bad Zurzach
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21
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Rössler W, AjdacicGross V, Glozier N, Rodgers S, Haker H, Müller M. Sleep disturbances in young and middle-aged adults - Empirical patterns and related factors from an epidemiological survey. Compr Psychiatry 2017; 78:83-90. [PMID: 28806609 DOI: 10.1016/j.comppsych.2017.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/26/2017] [Accepted: 07/16/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Previous research suggests that sleep disorders are highly associated with other mental health problems. However, sleep problems even below the diagnostic threshold of sleep disorders are very common in the general population, which highly affects wellbeing and functioning. In order to broaden the focus beyond those severe cases we explored empirical patterns across the whole spectrum of sleep problems as well as associated clinical and other factors. METHOD A representative community sample of N=1274 residents from the canton of Zurich was interviewed for sleep problems and diagnostic criteria for mental disorders as well as was given a number of mental health-related psychometrical checklists. Based on a broader spectrum of sleep problems we conducted a latent class analysis (LCA) to derive distinct classes of such disturbances. Classes were compared regarding their associations to mental health-relevant and other risk factors. RESULTS The LCA revealed four classes - no sleep disturbances (72.6%), difficulties initiating and maintaining sleep (15.8%), delayed sleep (5.3%), and severe sleep problems (6.4%). Severe sleep problems were related to female gender and generalized anxiety disorder, while depression was linked to all sleep problem classes. Persons with difficulties initiating and maintaining sleep and severe sleep problems reported higher levels of psychopathology, burnout and neuroticism, while all sleep problem types were tied to stress-related variables, but not alcohol use disorder. DISCUSSION Sleep problems are highly prevalent among the young and middle-aged adults in our representative sample of young and middle-aged adults and as such represent a serious public mental health problem. Our findings indicate sleep problems to have a multi-dimensional structure with some differential associations. While all subtypes were associated with poorer mental health and particularly more depression, severe sleep problems appeared to be the sleep subtype seen in agoraphobia and GAD, while delayed sleep had no specific associations. The variety of associations assessed leads one to assume that likewise a variety of sleep interventions is required.
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Affiliation(s)
- Wulf Rössler
- Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Brazil; Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - University Medicine, Berlin, Germany.
| | - Vladeta AjdacicGross
- Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Nick Glozier
- Brain and Mind Research Institute, University of Sydney, NSW 2006, Australia
| | - Stephanie Rodgers
- Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Helene Haker
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich & ETH Zurich, Switzerland
| | - Mario Müller
- Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
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Strangio AM, Rinaldi L, Monniello G, Sisti LG, de Waure C, Janiri L. The Effect of Abuse History on Adolescent Patients with Feeding and Eating Disorders Treated through Psychodynamic Therapy: Comorbidities and Outcome. Front Psychiatry 2017; 8:31. [PMID: 28303109 PMCID: PMC5332355 DOI: 10.3389/fpsyt.2017.00031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 02/08/2017] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The first aim of our study was to compare the characteristics and comorbidities of patients with eating disorders between those who suffered from a childhood abuse and those who did not. Our second aim was to analyze the differences in the outcome of the psychodynamic therapy between abused and not abused patients. METHODS Twenty-six adolescent patients with eating disorders were assessed. Adolescent were evaluated by a single expert psychiatrist by checklists and questionnaires: EDI 3, SCL 90, BIS11, Dissociative Experiences Scale, Global Assessment of Functioning, SCID II, and CTQ-Self control (SF). According to the results of CTQ-SF (cut-off ≥ 8), patients were divided into two groups: those who had experienced a history of abuse and those who had not. They underwent a psychodynamic psychotherapy and were assessed again after 12 months. RESULTS Eleven patients (42.3%) had a history of abuse according to CTQ score. No significant differences were found in abused and not abused patients in their demographic, clinical, and comorbid characteristics (sex, age, type of eating disorder, comorbid impulse control, personality, and addictive disorders). Abused patients showed a significantly higher score in many scale. The psychotherapeutic intervention in patients with a history of abuse resulted only in a significant decrease in symptom checklist-90 (SCL-90) psychoticism dimension (p < 0.05), whereas in patients with no history of abuse a significant decrease was found for SCL-90 somatization, obsessive-compulsive and phobic anxiety dimensions, the SCL-90 Global Severity Index, the Eating Disorder Inventory-3 interceptive deficits, and the dissociative experience scale. CONCLUSION Regarding the first aim of our study, we proved that history of abuse is not significantly related to patient comorbidities. Regarding our second aim, history of abuse was related to patient improvement only for psychotic symptoms; whereas patients who had not experienced an abuse improved in a variety of symptoms. Thus, abuse history can be considered as a negative prognostic factor for patients with eating disorders undergoing dynamic psychotherapy. However, this psychotherapy may have a role in preventing early psychotic disorders in patients with and without an history of abuse.
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Affiliation(s)
| | - Lucio Rinaldi
- Institute of Psychiatry and Psychology, Catholic University, Rome, Italy
| | - Gianluigi Monniello
- Department of Pediatrics and Child and Adolescent Neurology and Psychiatry, “Sapienza” University of Rome, Rome, Italy
| | | | - Chiara de Waure
- Institute of Public Health, Catholic University, Rome, Italy
| | - Luigi Janiri
- Institute of Psychiatry and Psychology, Catholic University, Rome, Italy
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