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Defayette AB, Silverstein SM, Pisani AR. Social network structure as a biopsychosocial suicide prevention target for young people at clinical high-risk for psychosis. Schizophr Res 2024; 270:63-67. [PMID: 38865807 DOI: 10.1016/j.schres.2024.06.006] [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: 12/26/2023] [Revised: 05/28/2024] [Accepted: 06/08/2024] [Indexed: 06/14/2024]
Abstract
Young people who are at clinical high-risk for psychosis experience suicidal thoughts and behaviors at a greater rate than young people in the general population. However, no suicide prevention interventions have been specifically designed for or tested with this group of young people. To address this gap, we need to identify and leverage malleable potential intervention targets that can be measured at multiple levels of analysis. Here, we argue that social network structure, or the pattern of relationships in which a person is embedded, offers one potential target for intervention. We first provide a select review of what is currently known about social network structure and suicide risk, social network disruption among people at clinical high-risk for psychosis, and inflammatory processes as a potential underlying metric of social bond disruption. We then propose opportunities to advance suicide prevention research focused on young people at clinical high-risk for psychosis, with an eye toward establishing a foundation for future interventions that can account for biological, psychological, and social domains.
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Affiliation(s)
- Annamarie B Defayette
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States of America.
| | - Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Anthony R Pisani
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States of America; Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States of America
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2
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Ellett L, Kingston J, Tarant E, Kouimtsidis C, Vivarelli L, Chadwick P. Self-Structure in Persecutory Delusions. Behav Ther 2023; 54:132-140. [PMID: 36608970 DOI: 10.1016/j.beth.2022.07.011] [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] [Received: 12/06/2021] [Revised: 07/15/2022] [Accepted: 07/26/2022] [Indexed: 01/14/2023]
Abstract
There is currently limited research examining self-structure in clinical groups and no current data on the extent to which self-structure is amendable to change following psychological therapy. We address this important gap by examining self-structure in individuals with persecutory delusions using the card sort task, an established paradigm measuring key self-structure indices, including the degree to which self-structure is compartmentalized (characterized by primarily positive or negative attributes, as opposed to a mix of both), and the proportion and importance of negative attributes. In Study 1, individuals with a schizophrenia spectrum diagnosis with current persecutory delusions (clinical group, n = 27) and a healthy control group (n = 47) were compared on self-structure indices. In Study 2 (n = 27), the clinical group also completed the card sort task before and after randomization to either a 12-week mindfulness-based psychological therapy or treatment-as-usual control. In Study 1, self-structure differed significantly between the clinical and control groups. The clinical group had a greater proportion of negative attributes, assigned more importance to negative self-aspects, and had more compartmentalized self-structures compared with controls. In Study 2 there were no associations between delusion severity and self-structure. Large effect sizes for reductions in compartmentalization and proportion of negative attributes across self-aspects were found following mindfulness therapy. The findings highlight key differences in self-structure between individuals with persecutory delusions and healthy controls, and suggest that it might be possible to change self-structure following psychological therapy. These data support the central role of the self in theoretical models of paranoid thinking.
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Affiliation(s)
| | | | - Eryna Tarant
- Surrey and Borders Partnership NHS Foundation Trust
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3
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Crowter L, Banerjee R, Berry C, Fowler D. Schematic beliefs, negative affect and paranoia in at-risk youth. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:1038-1051. [PMID: 35762490 DOI: 10.1111/bjc.12373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/08/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Attenuated symptoms of psychosis are a core feature of At-Risk Mental States. However, subthreshold levels of paranoia are also common among nonpsychosis populations. At present, little is known about whether the processes underpinning the experience of paranoid ideation in high-risk youth differ as a consequence of meeting At-Risk Mental States (ARMS) for psychosis criteria. METHODS This study utilized path analysis techniques to examine the relationships between schematic beliefs, negative affect and the experience of paranoia for two groups: a group meeting criteria for ARMS (n = 133) and a group presenting with emerging complex mental health difficulties who did not meet the criteria for ARMS (n = 137). RESULTS While the ARMS group displayed significantly greater maladaptive schematic beliefs and more severe symptomatology, the associations between schematic beliefs, symptoms of negative affect and paranoia did not differ as a consequence of ARMS status. CONCLUSIONS While meeting the ARMS criteria is associated with experiencing more maladaptive cognitions and more negative symptomatology among at-risk youth, the associations between these cognitive beliefs and symptoms may be similar for youth who do not meet ARMS. These findings have implications for broadening the scope of at-risk/high-risk and for developing effective interventions for young people presenting with emerging difficulties.
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Affiliation(s)
| | | | - Clio Berry
- Brighton and Sussex Medical School, Sussex, UK
| | - David Fowler
- University of Sussex, Sussex, UK.,Sussex Partnership NHS Foundation Trust, Sussex, UK
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Humphrey C, Berry K, Degnan A, Bucci S. Childhood interpersonal trauma and paranoia in psychosis: The role of disorganised attachment and negative schema. Schizophr Res 2022; 241:142-148. [PMID: 35123337 DOI: 10.1016/j.schres.2022.01.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 12/19/2021] [Accepted: 01/21/2022] [Indexed: 10/19/2022]
Abstract
Paranoia is associated with significant distress and is associated with childhood trauma. Understanding the mechanisms responsible for this association is important for informing psychological interventions. Theoretical proposals suggest that negative schema and insecure attachment may be important mechanisms in the development of paranoia. Disorganised attachment may be particularly relevant. The current study is the first to examine whether the relationship between childhood interpersonal trauma and paranoia is mediated by disorganised attachment, and the impact of disorganised attachment on negative self and negative other schema. A large online sample of 242 people with self-reported psychosis completed measures of childhood trauma, attachment, self and other schema, paranoia and psychosis symptomatology. Path analysis indicated that childhood interpersonal trauma was associated with disorganised attachment, which in turn was associated with negative self-schema, negative other schema, and paranoia. Negative schema about others, but not self, was associated with paranoia. Disorganised attachment and negative other schema fully mediated the relationship between trauma and paranoia. Negative other schema partially mediated the association between disorganised attachment and paranoia. Results were found when controlling for depression, hallucinations and age. Results suggest that interventions that aim to modify disorganised attachment patterns and negative schema about others can potentially alleviate the impact of trauma on paranoia. Findings provide justification for longitudinal studies to confirm the direction of effects, and intervention studies that aim to manipulate disorganised attachment and negative schema about others and observe the impact of this on paranoia.
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Affiliation(s)
- Charlotte Humphrey
- University of Manchester, Division of Psychology and Mental Health, Manchester Academic Health Science, 2nd Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, United Kingdom
| | - Katherine Berry
- University of Manchester, Division of Psychology and Mental Health, Manchester Academic Health Science, 2nd Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, United Kingdom; Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester, Greater Manchester M25 3BL, United Kingdom
| | - Amy Degnan
- University of Manchester, Division of Psychology and Mental Health, Manchester Academic Health Science, 2nd Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, United Kingdom
| | - Sandra Bucci
- University of Manchester, Division of Psychology and Mental Health, Manchester Academic Health Science, 2nd Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, United Kingdom; Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester, Greater Manchester M25 3BL, United Kingdom.
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5
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Andreu-Bernabeu Á, Díaz-Caneja CM, Costas J, De Hoyos L, Stella C, Gurriarán X, Alloza C, Fañanás L, Bobes J, González-Pinto A, Crespo-Facorro B, Martorell L, Vilella E, Muntané G, Nacher J, Molto MD, Aguilar EJ, Parellada M, Arango C, González-Peñas J. Polygenic contribution to the relationship of loneliness and social isolation with schizophrenia. Nat Commun 2022; 13:51. [PMID: 35013163 PMCID: PMC8748758 DOI: 10.1038/s41467-021-27598-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 11/26/2021] [Indexed: 12/24/2022] Open
Abstract
Previous research suggests an association of loneliness and social isolation (LNL-ISO) with schizophrenia. Here, we demonstrate a LNL-ISO polygenic score contribution to schizophrenia risk in an independent case-control sample (N = 3,488). We then subset schizophrenia predisposing variation based on its effect on LNL-ISO. We find that genetic variation with concordant effects in both phenotypes shows significant SNP-based heritability enrichment, higher polygenic contribution in females, and positive covariance with mental disorders such as depression, anxiety, attention-deficit hyperactivity disorder, alcohol dependence, and autism. Conversely, genetic variation with discordant effects only contributes to schizophrenia risk in males and is negatively correlated with those disorders. Mendelian randomization analyses demonstrate a plausible bi-directional causal relationship between LNL-ISO and schizophrenia, with a greater effect of LNL-ISO liability on schizophrenia than vice versa. These results illustrate the genetic footprint of LNL-ISO on schizophrenia.
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Affiliation(s)
- Álvaro Andreu-Bernabeu
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Covadonga M Díaz-Caneja
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
| | - Javier Costas
- Instituto de Investigación Sanitaria (IDIS) de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Galicia, Spain
| | - Lucía De Hoyos
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Carol Stella
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Xaquín Gurriarán
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Instituto de Investigación Sanitaria (IDIS) de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Galicia, Spain
| | - Clara Alloza
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Lourdes Fañanás
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
- Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Julio Bobes
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
- Faculty of Medicine and Health Sciences-Psychiatry, Universidad de Oviedo, ISPA, INEUROPA, Oviedo, Spain
| | - Ana González-Pinto
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
- BIOARABA Health Research Institute, OSI Araba, University Hospital, University of the Basque Country, Vitoria, Spain
| | - Benedicto Crespo-Facorro
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
- Hospital Universitario Virgen del Rocío, Department of Psychiatry, Universidad de Sevilla, Sevilla, Spain
| | - Lourdes Martorell
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - Elisabet Vilella
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - Gerard Muntané
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
- Hospital Universitari Institut Pere Mata, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - Juan Nacher
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
- Neurobiology Unit, Department of Cell Biology, Interdisciplinary Research Structure for Biotechnology and Biomedicine (BIOTECMED), University of Valencia, Valencia, 46100, Spain
| | - María Dolores Molto
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
- Department of Genetics, University of Valencia, Campus of Burjassot, Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Eduardo Jesús Aguilar
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
- Fundación Investigación Hospital Clínico de Valencia, INCLIVA, 46010, Valencia, Spain
| | - Mara Parellada
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
| | - Javier González-Peñas
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
- CIBERSAM, Centro Investigación Biomédica en Red Salud Mental, Madrid, Spain.
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Humphrey C, Bucci S, Varese F, Degnan A, Berry K. Paranoia and negative schema about the self and others: A systematic review and meta-analysis. Clin Psychol Rev 2021; 90:102081. [PMID: 34564019 DOI: 10.1016/j.cpr.2021.102081] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 04/26/2021] [Accepted: 08/24/2021] [Indexed: 01/20/2023]
Abstract
Negative self and negative other schema have been implicated in the development of paranoia. The current study provides a meta-analysis, narrative review and quality appraisal of quantitative studies investigating the relationship between negative self and negative other schema and paranoia across the paranoia continuum. A systematic search identified 43 eligible studies; 25 were included in the meta-analysis. Meta-analytic findings demonstrated a medium to large relationship between paranoia and negative self-schema (r = 0.46, 95% CI 0.39 to 0.53) and negative other schema (r = 0.48, 95% CI 0.38 to 0.56). The magnitude of associations was similar across people with and without psychosis. Findings demonstrated that associations between negative self-schema and paranoia were not always statistically significant when controlling for confounding variables, particularly depression. The association between negative other schema and paranoia tended to remain significant when controlling for confounding variables. Findings also demonstrated that negative schema may mediate relationships between adverse experiences in childhood and paranoia. Overall, findings support theoretical proposals that both negative self and negative other schema are associated with paranoia. Longitudinal studies are required to confirm the direction of effects. Findings provide support for incorporating and targeting negative self and negative other schema in psychological formulations and therapeutic work.
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Affiliation(s)
- Charlotte Humphrey
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Science Centre; Manchester, United Kingdom (UK)
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Science Centre; Manchester, United Kingdom (UK)
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Science Centre; Manchester, United Kingdom (UK)
| | - Amy Degnan
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Science Centre; Manchester, United Kingdom (UK)
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester Academic Health Science Centre; Manchester, United Kingdom (UK).
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