A time-lagged study of predictors of paranoia and psychotic-like experiences in daily life across the schizotypy continuum

The daily association between positive affect and psychotic experiences in individuals along the early stages of the psychosis continuum

Introduction

Psychosis often develops gradually along a continuum of severity. Little is known about the role of protective factors such as positive affect (PA) in the development of psychotic experiences (PEs). This study investigated i) the temporal (between-day) and contemporaneous (within-day) daily associations between PA and PEs in individuals at different early clinical stages for psychosis and ii) whether these associations differed per clinical stage.

Methods

Daily diary data for 90 days came from 96 individuals at risk for psychosis, distributed over four subgroups defined according to the clinical staging model (stages 0-1b). We constructed multilevel models with PA as a predictor of PEs and vice versa. We investigated within- and between-person temporal and contemporaneous associations and tested whether these associations differed among early stages with multilevel moderation analyses.

Results

We found no within-person temporal effects between PA and PEs in either direction. Contemporaneously, current-day PA predicted current-day PEs (B = -0.14, p < 0.001) and vice versa (B = -0.61, p < 0.001). Between persons, more 90-day PA predicted fewer PEs in the temporal model (B = -0.14, p = 0.03). In addition, more 90-day PEs predicted PA in the temporal (B = -0.26, p < 0.001) and contemporaneous (B = -0.36, p < 0.001) models. The contemporaneous association between PA and PEs was stronger in individuals at ultra-high risk (UHR) for psychosis than in earlier stages.

Discussion

Our study supported a significant within-day, bidirectional relationship between PA and PEs. This suggests that a focus on PA and methods to improve PA may be an important addition to early intervention practices, particularly in those at UHR for psychosis.

A Systematic Review of Momentary Social Predictors of Positive Psychosis Experiences

BACKGROUND

Social factors can play an important role in the development and maintenance of psychosis. Clarifying this relationship is vital for advancing theoretical understanding and development of targeted interventions. Psychosis is increasingly researched with an experience sampling methodology (ESM), which provides an ecologically valid approach, that reduces recall biases. Studies examining momentary associations between social factors and psychosis have not yet been summarised.

METHOD

We identified 29 ESM studies investigating associations between social factors and positive psychotic experiences through a pre-registered systematic search of the published literature.

RESULTS

Being alone did not predict increase in psychosis; however, appraisals and feelings associated with being alone such as feeling socially disconnected, lonely and unwanted did. Being with familiar company was found to reduce psychosis experiences but feeling stressed by the current company increased psychosis.

CONCLUSIONS

While issues with sample size and generalisability mean these results should be interpreted with caution, some putative conclusions can be made. Individuals with psychosis or emerging symptoms should be offered interventions that improve social networks such as peer support, community participation and engagement skills training. These individuals may also benefit from virtual reality or compassion-based interventions which aim to dampen perceived social threat. Moreover, digital interventions which monitor changes in social variables that predict relapse in symptoms would allow early intervention to prevent mental health crises.

The experience sampling methodology in psychosis risk states: A systematic review

The experience sampling method (ESM) is a structured diary technique, which is used to assess thoughts, mood and appraise subjective experiences in daily life. It has been recognized as a useful tool for understanding the characteristics, dynamics, and underlying mechanisms of prodromal symptoms of psychosis. The present systematic review aimed to provide a qualitative synthesis of findings provided by the ESM studies conducted in people with psychosis risk states. A systematic review of the MEDLINE, ERIC, Academic Search Ultimate, and Health Source: Nursing/Academic Edition databases, utilizing search terms related to the ESM and the risk of psychosis was conducted. Out of 1069 publication records identified, 77 studies met the inclusion criteria for the review. Data were synthesized around the following topics: 1) assessment of symptoms dynamics and social functioning; 2) assessment of the mechanisms contributing to the emergence of psychotic experiences and 3) assessment of stress sensitivity. The studies have shown that negative emotions are associated with subsequent development of paranoia. The tendency to draw hasty conclusions, aberrant salience, self-esteem, and emotion regulation were the most frequently reported mechanisms associated with the emergence of psychotic experiences. Studies using the ESM also provided evidence for the role of stress sensitivity, in the development of psychotic symptoms. The ESM has widely been applied to studies investigating psychosis risk states, using a variety of protocols. Findings from this systematic review might inform future studies and indicate potential targets for interventions.

The temporal association between social isolation, distress, and psychotic experiences in individuals at clinical high-risk for psychosis

BACKGROUND

Psychotic experiences (PEs) and social isolation (SI) seem related during early stages of psychosis, but the temporal dynamics between the two are not clear. Literature so far suggests a self-perpetuating cycle wherein momentary increases in PEs lead to social withdrawal, which, subsequently, triggers PEs at a next point in time, especially when SI is associated with increased distress. The current study investigated the daily-life temporal associations between SI and PEs, as well as the role of SI-related and general affective distress in individuals at clinical high risk (CHR) for psychosis.

METHODS

We used experience sampling methodology in a sample of 137 CHR participants. We analyzed the association between SI, PEs, and distress using time-lagged linear mixed-effects models.

RESULTS

SI did not predict next-moment fluctuations in PEs, or vice versa. Furthermore, although SI-related distress was not predictive of subsequent PEs, general affective distress during SI was a robust predictor of next-moment PEs.

CONCLUSIONS

Our results suggest that SI and PEs are not directly related on a moment-to-moment level, but a negative emotional state when alone does contribute to the risk of PEs. These findings highlight the role of affective wellbeing during early-stage psychosis development.

Do loneliness and social exclusion breed paranoia? An experience sampling investigation across the psychosis continuum

Background

The role of loneliness and social exclusion in the development of paranoia is largely unexplored. Negative affect may mediate potential associations between these factors. We investigated the temporal relationships of daily-life loneliness, felt social exclusion, negative affect, and paranoia across the psychosis continuum.

Method

Seventy-five participants, including 29 individuals with a diagnosis of non-affective psychosis, 20 first-degree relatives, and 26 controls used an Experience Sampling Method (ESM) app to capture the fluctuations in loneliness, feelings of social exclusion, paranoia, and negative affect across a 1-week period. Data were analysed with multilevel regression analyses.

Results

In all groups, loneliness and feelings of social exclusion were independent predictors of paranoia over time (b = 0.05, p < .001 and b = 0.04, p < .05, respectively). Negative affect predicted paranoia (b = 0.17, p < .001) and partially mediated the associations between loneliness, social exclusion, and paranoia. It also predicted loneliness (b = 0.15, p < .0001), but not social exclusion (b = 0.04, p = .21) over time. Paranoia predicted social exclusion over time, with more pronounced effects in controls (b = 0.43) than patients (b = 0.19; relatives: b = 0.17); but not loneliness (b = 0.08, p = .16).

Conclusion

Paranoia and negative affect worsen in all groups following feelings of loneliness and social exclusion. This highlights the importance of a sense of belonging and being included for mental well-being. Loneliness, feeling socially excluded, and negative affect were independent predictors of paranoid thinking, suggesting they represent useful targets in its treatment.

A psychosocial pathway to paranoia: The interplay between social connectedness and self-esteem

The quantity and quality of social contacts have been related to self-esteem, and both social relationships and self-esteem have been implicated in the pathways to paranoia. However, how social relationships interplay with self-esteem to trigger paranoia is not well understood. This study aims to investigate whether different measures of social connectedness (social support, loneliness, and desired friendship), as well as the frequency of social contact, impact paranoia and other positive and negative psychotic-like experiences (PLE) through the indirect effect of self-esteem. Data from a sample of 169 nonclinically ascertained participants oversampled for schizotypy scores were analyzed using two different approaches: retrospective trait-like and ecological momentary measures of social connectedness. Results showed that self-esteem mediates the pathways from poor social support and social longing, but not from loneliness, to paranoia and other cognitive PLE. In contrast, pathways from social connectedness to perceptual PLE and negative PLE were not mediated by self-esteem. Results were consistent across trait-like and momentary measures. Finally, self-esteem was not implicated in the pathways from the frequency of social contact and paranoia or other forms of PLE. These results provide a comprehensive picture of how social connectedness drives specific symptoms of psychosis through self-esteem. Findings underscore the need to explore separately the quality and quantity of social relationships and suggest that the subjective experience of meaningful social bonds is key social determinants of mental health. Therefore, addressing inadequacies of social connectedness could substantially improve symptomatic and functional outcomes of psychosis.