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Jia L, Wei Z, Wang J, Zhang X, Wang H, Chen R, Zhang X. Children's early signs and developmental trajectories of psychotic-like experiences. Brain Res 2024; 1832:148853. [PMID: 38458308 DOI: 10.1016/j.brainres.2024.148853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/24/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION Children who experience persistent psychotic-like experiences (PLEs) are at a higher risk of developing psychotic disorder later in life. The developmental trajectories of PLEs are influenced by various factors. Therefore, it is important to identify early characteristics that can distinguish and predict between different developmental trajectories of PLEs. METHODS Using PLEs scores from the Adolescent Brain Cognitive Development (ABCD) data across three waves, we categorized participants into five distinct PLEs trajectories groups: persistent group (n = 47), remitting group (n = 185), increasing group (n = 117), remittent group (n = 21), and no PLEs group (n = 4,476). We utilized linear mixed-effect models and generalized linear mixed-effect models to examine the differences in baseline characteristics, including psychological and behavioral problems, suicidality, trauma experiences, developmental milestones, cognitive function, physical health, family income, family history of mental illness, and brain structureamong these PLEs trajectory groups. RESULTS We found that psychological and behavioral problems (such as DSM-oriented scales/externalizing/ADHD/social/attention/thought problems) assessed by the Child Behavior Checklist (CBCL) were associated with all PLEs groups. The persistent PLEs group had greater ADHD/social/thought problems and suicidal behavior compared to the remitting PLEs group. Comparing with the no PLEs group, poor cognitive function, abnormal brain structure (such as temporal lobe and supramarginal gyrus), more trauma experiences, and lower family income were found in only one of the PLEs groups, but not all PLEs groups. CONCLUSION The development of PLEs is accompanied by changes in many domains, implying a dynamic and complex developmental process. Given that psychological and behavioral problems can predict the emergence of PLEs at any time and can be regarded as risk factors for persistent PLEs, thereby enabling early precisely interventions, it is important to place greater emphasis on assessing psychological and behavioral problems.
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Affiliation(s)
- Luxia Jia
- School of Education, Guangzhou University, Guangzhou, China; Vanke School of Public Health, Tsinghua University, Beijing, China; Institute of Healthy China, Tsinghua University, Beijing, China
| | - Ziqian Wei
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute of Healthy China, Tsinghua University, Beijing, China
| | - Juan Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute of Healthy China, Tsinghua University, Beijing, China
| | - Xuan Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute of Healthy China, Tsinghua University, Beijing, China
| | - Huagen Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute of Healthy China, Tsinghua University, Beijing, China
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China; Institute of Healthy China, Tsinghua University, Beijing, China.
| | - Xiaoqian Zhang
- Wulituo Hospital of Beijing Shijingshan District, Beijing, China.
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Rimvall MK, Simonsen E, Zhang J, Andersen ZJ, Hastrup LH, Jeppesen P, Austin SF, Koch SV. Examining psychotic experiences in two generations - findings from a rural household-based cohort study; the Lolland-Falster Health Study. Psychol Med 2024; 54:1382-1390. [PMID: 37997748 DOI: 10.1017/s0033291723003276] [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: 11/25/2023]
Abstract
BACKGROUND Psychotic disorders are highly heritable, yet the evidence is less clear for subclinical psychosis expression, such as psychotic experiences (PEs). We examined if PEs in parents were associated with PEs in offspring. METHODS As part of the Danish general population Lolland-Falster Health Study, families with youths aged 11-17 years were included. Both children and parents reported PEs according to the Psychotic Like Experiences Questionnaire, counting only 'definite' PEs. Parents additionally reported depressive symptoms, anxiety, and mental wellbeing. The associations between parental and child PEs were estimated using generalized estimating equations with an exchangeable correlation structure to account for the clustering of observations within families, adjusting for sociodemographic characteristics. RESULTS Altogether, 984 youths (mean age 14.3 years [s.d. 2.0]), 700 mothers, and 496 fathers from 766 households completed PEs-questionnaires. Offspring of parents with PEs were at an increased risk of reporting PEs themselves (mothers: adjusted risk ratio (aRR) 2.42, 95% CI 1.73-3.38; fathers: aRR 2.25, 95% CI 1.42-3.59). Other maternal problems (depression, anxiety, and poor mental well-being), but not paternal problems, were also associated with offspring PEs. In multivariate models adjusting for parental problems, PEs, but not other parental problems, were robustly associated with offspring PEs (mothers: aRR 2.25, 95% CI 1.60-3.19; fathers: aRR 2.44, 95% CI 1.50-3.96). CONCLUSIONS The current findings add novel evidence suggesting that specific psychosis vulnerability in families is expressed at the lower end of the psychosis continuum, underlining the importance of assessing youths' needs based on psychosis vulnerability broadly within the family systems.
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Affiliation(s)
- Martin Køster Rimvall
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
- Child and Adolescent Mental Health Center, Mental Health Services - Capital Region of Denmark, Copenhagen, Denmark
| | - Erik Simonsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Mental Health Services East, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
| | - Jiawei Zhang
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Zorana Jovanovic Andersen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lene Halling Hastrup
- Mental Health Services East, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
- Danish Centre for Health Economics, DaCHE, University of Southern Denmark, Odense, Denmark
| | - Pia Jeppesen
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
- Child and Adolescent Mental Health Center, Mental Health Services - Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stephen F Austin
- Mental Health Services East, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
- Institute of Psychology, University of Southern Denmark, Odense, Denmark
| | - Susanne Vinkel Koch
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Deng W, Addington J, Bearden CE, Cadenhead KS, Cornblatt BA, Mathalon DH, Perkins DO, Seidman LJ, Tsuang MT, Woods SW, Walker EF, Cannon TD. Characterizing sustained social anxiety in individuals at clinical high risk for psychosis: trajectory, risk factors, and functional outcomes. Psychol Med 2023; 53:3644-3651. [PMID: 35144716 PMCID: PMC10277760 DOI: 10.1017/s0033291722000277] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/07/2022] [Accepted: 01/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND While comorbidity of clinical high-risk for psychosis (CHR-P) status and social anxiety is well-established, it remains unclear how social anxiety and positive symptoms covary over time in this population. The present study aimed to determine whether there are more than one covariant trajectory of social anxiety and positive symptoms in the North American Prodrome Longitudinal Study cohort (NAPLS 2) and, if so, to test whether the different trajectory subgroups differ in terms of genetic and environmental risk factors for psychotic disorders and general functional outcome. METHODS In total, 764 CHR individuals were evaluated at baseline for social anxiety and psychosis risk symptom severity and followed up every 6 months for 2 years. Application of group-based multi-trajectory modeling discerned three subgroups based on the covariant trajectories of social anxiety and positive symptoms over 2 years. RESULTS One of the subgroups showed sustained social anxiety over time despite moderate recovery in positive symptoms, while the other two showed recovery of social anxiety below clinically significant thresholds, along with modest to moderate recovery in positive symptom severity. The trajectory group with sustained social anxiety had poorer long-term global functional outcomes than the other trajectory groups. In addition, compared with the other two trajectory groups, membership in the group with sustained social anxiety was predicted by higher levels of polygenic risk for schizophrenia and environmental stress exposures. CONCLUSIONS Together, these analyses indicate differential relevance of sustained v. remitting social anxiety symptoms in the CHR-P population, which in turn may carry implications for differential intervention strategies.
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Affiliation(s)
- Wisteria Deng
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, Calgary, Canada
| | - Carrie E. Bearden
- Department of Psychiatry and Biobehavioral Sciences and Psychology, UCLA, Los Angeles, USA
| | | | | | | | - Diana O. Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, USA
| | - Larry J. Seidman
- Department of Psychiatry, Harvard Medical School, Boston, USA
- Massachusetts General Hospital, Boston, USA
| | | | - Scott W. Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Elaine F. Walker
- Department of Psychology and Psychiatry, Emory University, Atlanta, USA
| | - Tyrone D. Cannon
- Department of Psychology, Yale University, New Haven, CT, USA
- Department of Psychiatry, Yale University, New Haven, CT, USA
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Brandt JM, Gregersen M, Søndergaard A, Krantz MF, Knudsen CB, Andreassen AK, Veddum L, Ohland J, Hjorthøj C, Wilms M, Rohd SB, Greve A, Burton BK, Bliksted V, Mors O, Nordentoft M, Thorup AAE, Hemager N. Associations between exposure to early childhood adversities and middle childhood psychotic experiences in children at familial high risk of schizophrenia, bipolar disorder, and population-based controls: The Danish high risk and resilience study - VIA 7 and VIA 11. Psychol Med 2023; 53:1-11. [PMID: 36727506 DOI: 10.1017/s0033291722004020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Exposure to adversities in early childhood is associated with psychotic experiences and disorders in adulthood. We aimed to examine whether early childhood adversities are associated with middle childhood psychotic experiences in a cohort of children at familial high risk of schizophrenia (FHR-SZ), bipolar disorder (FHR-BP) and population-based controls (controls). METHODS Four hundred and forty-six children from The Danish High Risk and Resilience Study - VIA7 and VIA11 participated in this study (FHR-SZ = 170; FHR-BP = 103; controls = 173). Exposure to early childhood adversities and psychotic experiences were assessed using face-to-face interviews. Having childhood adversities assessed at baseline (age 7) was used as predictor. Psychotic experiences assessed at follow-up (age 11) were used as outcome. RESULTS Across the sample, exposure to early childhood interpersonal adversities was associated with an increased risk for any middle childhood psychotic experiences and subclinical delusions when adjusting for relevant confounders (OR 1.8, 95% CI 1.0-3.1, p = 0.05; OR 3.0, 95% CI 1.6-5.6, p < 0.001). There was no significant dose-response effect of exposure to multiple types of childhood adversities on any psychotic experiences. There were no interaction effects between early childhood adversities and FHR on middle childhood psychotic experiences. Exploratory analyses revealed that experiencing domestic violence in early childhood was associated with any middle childhood psychotic experiences (OR 2.8, 95% CI 1.5-5.1, p = 0.001). CONCLUSIONS Exposure to interpersonal adversities during early childhood is associated with an increased risk for middle childhood psychotic experiences including specifically subclinical delusions. Future studies should examine associations between exposure to childhood adversities and conversion to psychosis within this cohort.
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Affiliation(s)
- Julie Marie Brandt
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maja Gregersen
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
| | - Anne Søndergaard
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Falkenberg Krantz
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen, Denmark
| | - Christina Bruun Knudsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Aarhus, Denmark
| | - Anna Krogh Andreassen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Aarhus, Denmark
| | - Lotte Veddum
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Aarhus, Denmark
| | - Jessica Ohland
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
| | - Carsten Hjorthøj
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Martin Wilms
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
| | - Sinnika Birkehøj Rohd
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
| | - Aja Greve
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Aarhus, Denmark
| | - Birgitte Klee Burton
- Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen, Denmark
- Department of Child and Adolescent Psychiatry, Zealand University Hospital, Region Zealand, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Bliksted
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Aarhus, Denmark
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark
- Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Aarhus, Denmark
| | - Merete Nordentoft
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Amalie Elgaard Thorup
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen, Denmark
| | - Nicoline Hemager
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Copenhagen, Denmark
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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5
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Gregersen M, Møllegaard Jepsen JR, Rohd SB, Søndergaard A, Brandt JM, Ellersgaard D, Hjorthøj C, Ohland J, Krantz MF, Wilms M, Andreassen AK, Veddum L, Knudsen CB, Greve AN, Bliksted V, Mors O, Clemmensen L, Nordentoft M, Hemager N, Elgaard Thorup AA. Developmental Pathways and Clinical Outcomes of Early Childhood Psychotic Experiences in Preadolescent Children at Familial High Risk of Schizophrenia or Bipolar Disorder: A Prospective, Longitudinal Cohort Study - The Danish High Risk and Resilience Study, VIA 11. Am J Psychiatry 2022; 179:628-639. [PMID: 36048497 DOI: 10.1176/appi.ajp.21101076] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Psychotic experiences are common in children and adolescents and are associated with concurrent and subsequent psychopathology. Most findings originate from general population studies, whereas little is known of the clinical outcomes of psychotic experiences in children and adolescents at familial high risk of psychosis. We examined the prevalence of psychotic experiences in middle childhood and whether early childhood psychotic experiences and developmental pathways of psychotic experiences predicted mental disorders in middle childhood in children at familial high risk of schizophrenia (FHR-SZ), bipolar disorder (FHR-BP), and a population-based control group. METHODS In a longitudinal population-based cohort study children at FHR-SZ (N=170), FHR-BP (N=103), and the control group (N=174) were assessed for psychotic experiences and axis I disorders with face-to-face interviews in early and middle childhood (at 7 and 11 years of age). RESULTS Psychotic experiences were more prevalent in children at FHR-SZ (31.8%, odds ratio 2.1, 95% CI 1.3-3.4) than in the control group (18.4%) in middle childhood. Early childhood psychotic experiences predicted mental disorders in middle childhood after adjusting for early childhood disorders and familial risk (odds ratio 2.0, 95% CI 1.2-3.1). Having three or more psychotic experiences increased odds the most (odds ratio 2.5, 95% CI 1.1-5.7). Persistent psychotic experiences were associated with increased odds of middle childhood disorders (odds ratio 4.1, 95% CI 2.1-8.4). Psychotic experiences were nondifferentially associated with mental disorders across the three familial risk groups. CONCLUSIONS Early childhood psychotic experiences predict mental disorders in middle childhood. Psychotic experiences index vulnerability for psychopathology nondifferentially in children at familial high risk and the control group. Psychotic experiences should be included in mental health screenings including children at familial high risk.
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Affiliation(s)
- Maja Gregersen
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Gregersen, Møllegaard, Jepsen, Rohd, Søndergaard, Brandt, Ellersgaard, Hjorthøj, Ohland, Krantz, Wilms, Clemmensen, Nordentoft, Hemager); The Lundbeck Foundation Initiative for Integrative Psychiatric Research-iPSYCH, Aarhus, Denmark (Gregersen, Møllegaard Jepsen, Rohd, Søndergaard, Brandt, Hjorthøj, Ohland, Krantz, Wilms, Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors, Nordentoft, Hemager, Thorup); Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (Gregersen, Søndergaard, Brandt, Nordentoft, Hemager, Thorup); Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen (Møllegaard, Jepsen, Clemmensen, Thorup); Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen (Møllegaard, Jepsen); Department of Public Health, Section of Epidemiology, University of Copenhagen (Hjorthøj); Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Andreassen, Veddum, Knudsen, Bliksted, Mors); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark (Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors)
| | - Jens Richardt Møllegaard Jepsen
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Gregersen, Møllegaard, Jepsen, Rohd, Søndergaard, Brandt, Ellersgaard, Hjorthøj, Ohland, Krantz, Wilms, Clemmensen, Nordentoft, Hemager); The Lundbeck Foundation Initiative for Integrative Psychiatric Research-iPSYCH, Aarhus, Denmark (Gregersen, Møllegaard Jepsen, Rohd, Søndergaard, Brandt, Hjorthøj, Ohland, Krantz, Wilms, Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors, Nordentoft, Hemager, Thorup); Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (Gregersen, Søndergaard, Brandt, Nordentoft, Hemager, Thorup); Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen (Møllegaard, Jepsen, Clemmensen, Thorup); Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen (Møllegaard, Jepsen); Department of Public Health, Section of Epidemiology, University of Copenhagen (Hjorthøj); Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Andreassen, Veddum, Knudsen, Bliksted, Mors); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark (Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors)
| | - Sinnika Birkehøj Rohd
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Gregersen, Møllegaard, Jepsen, Rohd, Søndergaard, Brandt, Ellersgaard, Hjorthøj, Ohland, Krantz, Wilms, Clemmensen, Nordentoft, Hemager); The Lundbeck Foundation Initiative for Integrative Psychiatric Research-iPSYCH, Aarhus, Denmark (Gregersen, Møllegaard Jepsen, Rohd, Søndergaard, Brandt, Hjorthøj, Ohland, Krantz, Wilms, Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors, Nordentoft, Hemager, Thorup); Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (Gregersen, Søndergaard, Brandt, Nordentoft, Hemager, Thorup); Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen (Møllegaard, Jepsen, Clemmensen, Thorup); Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen (Møllegaard, Jepsen); Department of Public Health, Section of Epidemiology, University of Copenhagen (Hjorthøj); Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Andreassen, Veddum, Knudsen, Bliksted, Mors); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark (Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors)
| | - Anne Søndergaard
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Gregersen, Møllegaard, Jepsen, Rohd, Søndergaard, Brandt, Ellersgaard, Hjorthøj, Ohland, Krantz, Wilms, Clemmensen, Nordentoft, Hemager); The Lundbeck Foundation Initiative for Integrative Psychiatric Research-iPSYCH, Aarhus, Denmark (Gregersen, Møllegaard Jepsen, Rohd, Søndergaard, Brandt, Hjorthøj, Ohland, Krantz, Wilms, Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors, Nordentoft, Hemager, Thorup); Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (Gregersen, Søndergaard, Brandt, Nordentoft, Hemager, Thorup); Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen (Møllegaard, Jepsen, Clemmensen, Thorup); Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen (Møllegaard, Jepsen); Department of Public Health, Section of Epidemiology, University of Copenhagen (Hjorthøj); Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Andreassen, Veddum, Knudsen, Bliksted, Mors); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark (Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors)
| | - Julie Marie Brandt
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Gregersen, Møllegaard, Jepsen, Rohd, Søndergaard, Brandt, Ellersgaard, Hjorthøj, Ohland, Krantz, Wilms, Clemmensen, Nordentoft, Hemager); The Lundbeck Foundation Initiative for Integrative Psychiatric Research-iPSYCH, Aarhus, Denmark (Gregersen, Møllegaard Jepsen, Rohd, Søndergaard, Brandt, Hjorthøj, Ohland, Krantz, Wilms, Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors, Nordentoft, Hemager, Thorup); Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (Gregersen, Søndergaard, Brandt, Nordentoft, Hemager, Thorup); Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen (Møllegaard, Jepsen, Clemmensen, Thorup); Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen (Møllegaard, Jepsen); Department of Public Health, Section of Epidemiology, University of Copenhagen (Hjorthøj); Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Andreassen, Veddum, Knudsen, Bliksted, Mors); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark (Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors)
| | - Ditte Ellersgaard
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Gregersen, Møllegaard, Jepsen, Rohd, Søndergaard, Brandt, Ellersgaard, Hjorthøj, Ohland, Krantz, Wilms, Clemmensen, Nordentoft, Hemager); The Lundbeck Foundation Initiative for Integrative Psychiatric Research-iPSYCH, Aarhus, Denmark (Gregersen, Møllegaard Jepsen, Rohd, Søndergaard, Brandt, Hjorthøj, Ohland, Krantz, Wilms, Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors, Nordentoft, Hemager, Thorup); Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (Gregersen, Søndergaard, Brandt, Nordentoft, Hemager, Thorup); Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen (Møllegaard, Jepsen, Clemmensen, Thorup); Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen (Møllegaard, Jepsen); Department of Public Health, Section of Epidemiology, University of Copenhagen (Hjorthøj); Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Andreassen, Veddum, Knudsen, Bliksted, Mors); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark (Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors)
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Gregersen, Møllegaard, Jepsen, Rohd, Søndergaard, Brandt, Ellersgaard, Hjorthøj, Ohland, Krantz, Wilms, Clemmensen, Nordentoft, Hemager); The Lundbeck Foundation Initiative for Integrative Psychiatric Research-iPSYCH, Aarhus, Denmark (Gregersen, Møllegaard Jepsen, Rohd, Søndergaard, Brandt, Hjorthøj, Ohland, Krantz, Wilms, Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors, Nordentoft, Hemager, Thorup); Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (Gregersen, Søndergaard, Brandt, Nordentoft, Hemager, Thorup); Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen (Møllegaard, Jepsen, Clemmensen, Thorup); Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen (Møllegaard, Jepsen); Department of Public Health, Section of Epidemiology, University of Copenhagen (Hjorthøj); Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Andreassen, Veddum, Knudsen, Bliksted, Mors); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark (Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors)
| | - Jessica Ohland
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Gregersen, Møllegaard, Jepsen, Rohd, Søndergaard, Brandt, Ellersgaard, Hjorthøj, Ohland, Krantz, Wilms, Clemmensen, Nordentoft, Hemager); The Lundbeck Foundation Initiative for Integrative Psychiatric Research-iPSYCH, Aarhus, Denmark (Gregersen, Møllegaard Jepsen, Rohd, Søndergaard, Brandt, Hjorthøj, Ohland, Krantz, Wilms, Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors, Nordentoft, Hemager, Thorup); Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (Gregersen, Søndergaard, Brandt, Nordentoft, Hemager, Thorup); Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen (Møllegaard, Jepsen, Clemmensen, Thorup); Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen (Møllegaard, Jepsen); Department of Public Health, Section of Epidemiology, University of Copenhagen (Hjorthøj); Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Andreassen, Veddum, Knudsen, Bliksted, Mors); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark (Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors)
| | - Mette Falkenberg Krantz
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Gregersen, Møllegaard, Jepsen, Rohd, Søndergaard, Brandt, Ellersgaard, Hjorthøj, Ohland, Krantz, Wilms, Clemmensen, Nordentoft, Hemager); The Lundbeck Foundation Initiative for Integrative Psychiatric Research-iPSYCH, Aarhus, Denmark (Gregersen, Møllegaard Jepsen, Rohd, Søndergaard, Brandt, Hjorthøj, Ohland, Krantz, Wilms, Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors, Nordentoft, Hemager, Thorup); Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (Gregersen, Søndergaard, Brandt, Nordentoft, Hemager, Thorup); Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen (Møllegaard, Jepsen, Clemmensen, Thorup); Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen (Møllegaard, Jepsen); Department of Public Health, Section of Epidemiology, University of Copenhagen (Hjorthøj); Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Andreassen, Veddum, Knudsen, Bliksted, Mors); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark (Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors)
| | - Martin Wilms
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Gregersen, Møllegaard, Jepsen, Rohd, Søndergaard, Brandt, Ellersgaard, Hjorthøj, Ohland, Krantz, Wilms, Clemmensen, Nordentoft, Hemager); The Lundbeck Foundation Initiative for Integrative Psychiatric Research-iPSYCH, Aarhus, Denmark (Gregersen, Møllegaard Jepsen, Rohd, Søndergaard, Brandt, Hjorthøj, Ohland, Krantz, Wilms, Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors, Nordentoft, Hemager, Thorup); Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (Gregersen, Søndergaard, Brandt, Nordentoft, Hemager, Thorup); Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen (Møllegaard, Jepsen, Clemmensen, Thorup); Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen (Møllegaard, Jepsen); Department of Public Health, Section of Epidemiology, University of Copenhagen (Hjorthøj); Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Andreassen, Veddum, Knudsen, Bliksted, Mors); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark (Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors)
| | - Anna Krogh Andreassen
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Gregersen, Møllegaard, Jepsen, Rohd, Søndergaard, Brandt, Ellersgaard, Hjorthøj, Ohland, Krantz, Wilms, Clemmensen, Nordentoft, Hemager); The Lundbeck Foundation Initiative for Integrative Psychiatric Research-iPSYCH, Aarhus, Denmark (Gregersen, Møllegaard Jepsen, Rohd, Søndergaard, Brandt, Hjorthøj, Ohland, Krantz, Wilms, Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors, Nordentoft, Hemager, Thorup); Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (Gregersen, Søndergaard, Brandt, Nordentoft, Hemager, Thorup); Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen (Møllegaard, Jepsen, Clemmensen, Thorup); Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen (Møllegaard, Jepsen); Department of Public Health, Section of Epidemiology, University of Copenhagen (Hjorthøj); Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Andreassen, Veddum, Knudsen, Bliksted, Mors); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark (Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors)
| | - Lotte Veddum
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Gregersen, Møllegaard, Jepsen, Rohd, Søndergaard, Brandt, Ellersgaard, Hjorthøj, Ohland, Krantz, Wilms, Clemmensen, Nordentoft, Hemager); The Lundbeck Foundation Initiative for Integrative Psychiatric Research-iPSYCH, Aarhus, Denmark (Gregersen, Møllegaard Jepsen, Rohd, Søndergaard, Brandt, Hjorthøj, Ohland, Krantz, Wilms, Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors, Nordentoft, Hemager, Thorup); Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (Gregersen, Søndergaard, Brandt, Nordentoft, Hemager, Thorup); Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen (Møllegaard, Jepsen, Clemmensen, Thorup); Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen (Møllegaard, Jepsen); Department of Public Health, Section of Epidemiology, University of Copenhagen (Hjorthøj); Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Andreassen, Veddum, Knudsen, Bliksted, Mors); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark (Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors)
| | - Christina Bruun Knudsen
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Gregersen, Møllegaard, Jepsen, Rohd, Søndergaard, Brandt, Ellersgaard, Hjorthøj, Ohland, Krantz, Wilms, Clemmensen, Nordentoft, Hemager); The Lundbeck Foundation Initiative for Integrative Psychiatric Research-iPSYCH, Aarhus, Denmark (Gregersen, Møllegaard Jepsen, Rohd, Søndergaard, Brandt, Hjorthøj, Ohland, Krantz, Wilms, Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors, Nordentoft, Hemager, Thorup); Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (Gregersen, Søndergaard, Brandt, Nordentoft, Hemager, Thorup); Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen (Møllegaard, Jepsen, Clemmensen, Thorup); Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen (Møllegaard, Jepsen); Department of Public Health, Section of Epidemiology, University of Copenhagen (Hjorthøj); Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Andreassen, Veddum, Knudsen, Bliksted, Mors); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark (Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors)
| | - Aja Neergaard Greve
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Gregersen, Møllegaard, Jepsen, Rohd, Søndergaard, Brandt, Ellersgaard, Hjorthøj, Ohland, Krantz, Wilms, Clemmensen, Nordentoft, Hemager); The Lundbeck Foundation Initiative for Integrative Psychiatric Research-iPSYCH, Aarhus, Denmark (Gregersen, Møllegaard Jepsen, Rohd, Søndergaard, Brandt, Hjorthøj, Ohland, Krantz, Wilms, Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors, Nordentoft, Hemager, Thorup); Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (Gregersen, Søndergaard, Brandt, Nordentoft, Hemager, Thorup); Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen (Møllegaard, Jepsen, Clemmensen, Thorup); Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen (Møllegaard, Jepsen); Department of Public Health, Section of Epidemiology, University of Copenhagen (Hjorthøj); Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Andreassen, Veddum, Knudsen, Bliksted, Mors); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark (Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors)
| | - Vibeke Bliksted
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Gregersen, Møllegaard, Jepsen, Rohd, Søndergaard, Brandt, Ellersgaard, Hjorthøj, Ohland, Krantz, Wilms, Clemmensen, Nordentoft, Hemager); The Lundbeck Foundation Initiative for Integrative Psychiatric Research-iPSYCH, Aarhus, Denmark (Gregersen, Møllegaard Jepsen, Rohd, Søndergaard, Brandt, Hjorthøj, Ohland, Krantz, Wilms, Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors, Nordentoft, Hemager, Thorup); Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (Gregersen, Søndergaard, Brandt, Nordentoft, Hemager, Thorup); Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen (Møllegaard, Jepsen, Clemmensen, Thorup); Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen (Møllegaard, Jepsen); Department of Public Health, Section of Epidemiology, University of Copenhagen (Hjorthøj); Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Andreassen, Veddum, Knudsen, Bliksted, Mors); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark (Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors)
| | - Ole Mors
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Gregersen, Møllegaard, Jepsen, Rohd, Søndergaard, Brandt, Ellersgaard, Hjorthøj, Ohland, Krantz, Wilms, Clemmensen, Nordentoft, Hemager); The Lundbeck Foundation Initiative for Integrative Psychiatric Research-iPSYCH, Aarhus, Denmark (Gregersen, Møllegaard Jepsen, Rohd, Søndergaard, Brandt, Hjorthøj, Ohland, Krantz, Wilms, Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors, Nordentoft, Hemager, Thorup); Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (Gregersen, Søndergaard, Brandt, Nordentoft, Hemager, Thorup); Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen (Møllegaard, Jepsen, Clemmensen, Thorup); Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen (Møllegaard, Jepsen); Department of Public Health, Section of Epidemiology, University of Copenhagen (Hjorthøj); Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Andreassen, Veddum, Knudsen, Bliksted, Mors); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark (Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors)
| | - Lars Clemmensen
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Gregersen, Møllegaard, Jepsen, Rohd, Søndergaard, Brandt, Ellersgaard, Hjorthøj, Ohland, Krantz, Wilms, Clemmensen, Nordentoft, Hemager); The Lundbeck Foundation Initiative for Integrative Psychiatric Research-iPSYCH, Aarhus, Denmark (Gregersen, Møllegaard Jepsen, Rohd, Søndergaard, Brandt, Hjorthøj, Ohland, Krantz, Wilms, Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors, Nordentoft, Hemager, Thorup); Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (Gregersen, Søndergaard, Brandt, Nordentoft, Hemager, Thorup); Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen (Møllegaard, Jepsen, Clemmensen, Thorup); Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen (Møllegaard, Jepsen); Department of Public Health, Section of Epidemiology, University of Copenhagen (Hjorthøj); Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Andreassen, Veddum, Knudsen, Bliksted, Mors); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark (Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors)
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Gregersen, Møllegaard, Jepsen, Rohd, Søndergaard, Brandt, Ellersgaard, Hjorthøj, Ohland, Krantz, Wilms, Clemmensen, Nordentoft, Hemager); The Lundbeck Foundation Initiative for Integrative Psychiatric Research-iPSYCH, Aarhus, Denmark (Gregersen, Møllegaard Jepsen, Rohd, Søndergaard, Brandt, Hjorthøj, Ohland, Krantz, Wilms, Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors, Nordentoft, Hemager, Thorup); Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (Gregersen, Søndergaard, Brandt, Nordentoft, Hemager, Thorup); Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen (Møllegaard, Jepsen, Clemmensen, Thorup); Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen (Møllegaard, Jepsen); Department of Public Health, Section of Epidemiology, University of Copenhagen (Hjorthøj); Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Andreassen, Veddum, Knudsen, Bliksted, Mors); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark (Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors)
| | - Nicoline Hemager
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Gregersen, Møllegaard, Jepsen, Rohd, Søndergaard, Brandt, Ellersgaard, Hjorthøj, Ohland, Krantz, Wilms, Clemmensen, Nordentoft, Hemager); The Lundbeck Foundation Initiative for Integrative Psychiatric Research-iPSYCH, Aarhus, Denmark (Gregersen, Møllegaard Jepsen, Rohd, Søndergaard, Brandt, Hjorthøj, Ohland, Krantz, Wilms, Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors, Nordentoft, Hemager, Thorup); Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (Gregersen, Søndergaard, Brandt, Nordentoft, Hemager, Thorup); Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen (Møllegaard, Jepsen, Clemmensen, Thorup); Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen (Møllegaard, Jepsen); Department of Public Health, Section of Epidemiology, University of Copenhagen (Hjorthøj); Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Andreassen, Veddum, Knudsen, Bliksted, Mors); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark (Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors)
| | - Anne Amalie Elgaard Thorup
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen (Gregersen, Møllegaard, Jepsen, Rohd, Søndergaard, Brandt, Ellersgaard, Hjorthøj, Ohland, Krantz, Wilms, Clemmensen, Nordentoft, Hemager); The Lundbeck Foundation Initiative for Integrative Psychiatric Research-iPSYCH, Aarhus, Denmark (Gregersen, Møllegaard Jepsen, Rohd, Søndergaard, Brandt, Hjorthøj, Ohland, Krantz, Wilms, Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors, Nordentoft, Hemager, Thorup); Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (Gregersen, Søndergaard, Brandt, Nordentoft, Hemager, Thorup); Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen (Møllegaard, Jepsen, Clemmensen, Thorup); Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Copenhagen (Møllegaard, Jepsen); Department of Public Health, Section of Epidemiology, University of Copenhagen (Hjorthøj); Faculty of Health and Medical Sciences, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark (Andreassen, Veddum, Knudsen, Bliksted, Mors); Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Denmark (Andreassen, Veddum, Knudsen, Greve, Bliksted, Mors)
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6
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Taylor MJ, Freeman D, Lundström S, Larsson H, Ronald A. Heritability of Psychotic Experiences in Adolescents and Interaction With Environmental Risk. JAMA Psychiatry 2022; 79:889-897. [PMID: 35921098 PMCID: PMC9350848 DOI: 10.1001/jamapsychiatry.2022.1947] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Genetic risk factors are known to play a role in the etiology of psychotic experiences in the general population. Little is known about whether these risk factors interact with environmental risks for psychotic experiences. OBJECTIVE To assess etiological heterogeneity and exposure to environmental risks associated with psychotic experiences in adolescence using the twin design. DESIGN, SETTING, AND PARTICIPANTS This twin study, conducted from December 1, 2014, to August 31, 2020, included a UK-based sample of twin pairs aged 16 years. This investigation evaluated the extent to which the genetic variance underlying psychotic experiences and the magnitude of the heritability of psychotic experiences was moderated by exposure to 5 environmental risk factors (bullying, dependent life events, cannabis use, tobacco use, and low birth weight). Psychotic experiences were assessed by 5 self-reported measures and 1 parent-reported measure. Participants' exposure to environmental risks was assessed at birth and age 12 to 16 years. Structural equation models were used to assess differences in the variance in and heritability of psychotic experiences across these exposures, while controlling for gene-environment correlation effects. Analyses were repeated in an independent Swedish sample. Data analyses were performed from September 1, 2018, to August 31, 2020. MAIN OUTCOMES AND MEASURES Primary outcome measures were exposure to environmental factors, as measured by a composite score, and psychotic experiences. RESULTS A total of 4855 twin pairs (1926 female same-sex pairs, 1397 male same-sex pairs, and 1532 opposite-sex pairs) were included from the Twins Early Development Study (TEDS), and 6435 twin pairs (2358 female same-sex pairs, 1861 male same-sex pairs, and 2216 opposite-sex pairs) were included from the Child and Adolescent Twin Study in Sweden (CATSS). Mean age of twins from TEDS was 16.5 years. Mean age of twins from CATSS was 18.6 years. More exposure to environmental risk factors was associated with having more psychotic experiences. The relative contribution of genetic influences to psychotic experiences was lower with increasing environmental exposure for paranoia (44%; 95% CI, 33%-53% to 38%; 95% CI, 14%-58%), cognitive disorganization (47%; 95% CI, 38%-51% to 32%; 95% CI, 11%-45%), grandiosity (41%; 95% CI, 29%-52% to 32%; 95% CI, 9%-48%), and anhedonia (49%; 95% CI, 42%-53% to 37%; 95% CI, 15%-54%). This pattern was replicated for the measure of psychotic experiences in the independent Swedish replication sample. The heritability of hallucinations and parent-rated negative symptoms remained relatively constant. CONCLUSIONS AND RELEVANCE Findings of this twin study suggest that environmental factors play a greater role in the etiology of psychotic experiences than genetic factors. The relative importance of environmental factors is even higher among individuals exposed to environmental risks for psychotic experiences, highlighting the importance of a diathesis-stress or bioecological framework for understanding adolescent psychotic experiences.
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Affiliation(s)
- Mark J. Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Centre for Ethics, Law and Mental Health, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Angelica Ronald
- Genes Environment Lifespan Laboratory, Centre for Brain and Cognitive Development, Department of Psychological Sciences, Birkbeck University of London, London, United Kingdom
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7
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Brandt JM, Hemager N, Gregersen M, Søndergaard A, Falkenberg Krantz M, Ohland J, Wilms M, Birkehøj Rohd S, Hjorthøj C, Veddum L, Bruun Knudsen C, Krogh Andreassen A, Greve A, Spang KS, Christiani CA, Ellersgaard D, Klee Burton B, Gantriis DL, Bliksted V, Mors O, Plessen KJ, Møllegaard Jepsen JR, Nordentoft M, Elgaard Thorup AA. Childhood trauma in children at familial high risk of schizophrenia or bipolar disorder: A longitudinal study. The Danish High Risk and Resilience Study - VIA 7 and VIA 11. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:875-894. [PMID: 35332530 DOI: 10.1111/bjc.12364] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/24/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Childhood trauma increases the risk of developing mental illness as does being born to parents with schizophrenia or bipolar disorder. We aimed to compare prevalence of lifetime childhood trauma among 11-year-old children at familial high risk of schizophrenia (FHR-SZ) or bipolar disorder (FHR-BP) compared with population-based controls (PBCs). DESIGN The study is a longitudinal, prospective cohort study of children at FHR-SZ, FHR-BP, and PBCs. METHODS A cohort of 512 children at FHR-SZ (N = 199), FHR-BP (N = 118), and PBCs (N = 195) were examined at baseline (mean age 7.8, SD 0.2) and 451 children at FHR-SZ (N = 172), FHR-BP (N = 104), and PBCs (N = 175) were examined at four-year follow-up (mean age 11.9, SD 0.2, retention rate 87.3%). Childhood trauma was measured with a semi-structured interview. RESULTS Children at FHR-BP had an elevated risk of exposure to any lifetime trauma (age 0-11 years) compared with PBCs (OR 2.082, 95%CI 1.223-3.545, p = .007) measured with binary logistic regression. One-way ANOVA revealed that both FHR-groups had a higher lifetime prevalence of exposure to a greater number of types of trauma compared with PBCs (FHR-SZ: observed mean: 1.53, 95%CI 1.29-1.77; FHR-BP: observed mean: 1.56, 95%CI 1.26-1.85; PBCs: observed mean: 0.99, 95%CI 0.82-1.17; p < .001). Binary logistic regression showed that the lifetime risk of exposure to interpersonal trauma (age 0-11 years) was elevated for both FHR-groups (FHR-SZ: OR 3.773, 95%CI 2.122-6.710, p < .001; FHR-BP: OR 3.602, 95%CI 1.913-6.783, p < .001). CONCLUSIONS Children at FHR-SZ and FHR-BP are at increased risk for being exposed to childhood trauma compared with PBCs. This study underscores the need for early detection, support, and prevention of childhood trauma in children at FHR-SZ and FHR-BP.
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Affiliation(s)
- Julie Marie Brandt
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicoline Hemager
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maja Gregersen
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Søndergaard
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Falkenberg Krantz
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
| | - Jessica Ohland
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
| | - Martin Wilms
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
| | - Sinnika Birkehøj Rohd
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
| | - Carsten Hjorthøj
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Lotte Veddum
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Aarhus, Denmark
| | - Christina Bruun Knudsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Aarhus, Denmark
| | - Anna Krogh Andreassen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Aarhus, Denmark
| | - Aja Greve
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Aarhus, Denmark
| | - Katrine Søborg Spang
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
| | - Camilla Austa Christiani
- Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen, Denmark
| | - Ditte Ellersgaard
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
| | - Birgitte Klee Burton
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen, Denmark
| | - Ditte Lou Gantriis
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Aarhus, Denmark
| | - Vibeke Bliksted
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Aarhus, Denmark
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Aarhus, Denmark
| | - Kerstin Jessica Plessen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen, Denmark.,Division of Child and Adolescent Psychiatry, Department of Psychiatry, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Jens Richardt Møllegaard Jepsen
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen, Denmark.,Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Hellerup, Denmark
| | - Merete Nordentoft
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Amalie Elgaard Thorup
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen, Denmark
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8
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Pastore A, de Girolamo G, Tafuri S, Tomasicchio A, Margari F. Traumatic experiences in childhood and adolescence: a meta-analysis of prospective studies assessing risk for psychosis. Eur Child Adolesc Psychiatry 2022; 31:215-228. [PMID: 32577908 DOI: 10.1007/s00787-020-01574-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 06/10/2020] [Indexed: 12/13/2022]
Abstract
Evidence of the association between traumatic experiences and psychosis are uncertain with respect to temporal order, clinical outcomes and the role of the age and genetic liability. The aim of the present meta-analysis was to explore the temporal relationship between the development of psychosis and traumatic exposure using prospective studies and to examine the role of moderation factors on overall effect sizes. Studies were identified by searching Embase-Ovid, PsycINFO (EBSCO), Pubmed, Scopus, Web of Science databases, and yielded an initial total of 9016 papers, leaving finally 23 after the screening process. Three sets of meta-analyses estimated the risk of developing psychotic experiences or full clinical psychosis by having experienced maltreatment by an adult or bullying by peers or parental death, using the random-effects model. Bullying by peers (OR = 2.28 [1.64, 4.34]), maltreatment by an adult (OR = 2.20 [1.72, 2.81]) and parental death (OR = 1.24 [1.06, 1.44]) all increased the risk of psychosis. Moderator analysis showed that negative effects of bullying were detected especially in those with genetic liability for psychosis and exposure to multiple trauma types; studies with higher prevalence of males showed a stronger risk for those exposed to parental death. No significant meta-regression was found between the risk of developing a full clinical psychosis or a psychotic experience. Lack of studies hampered the results about the age of trauma occurrence. The cumulative effect of being bullied from peers and experiencing other adversities during childhood and/or adolescence, together with genetic liability for psychosis, appears to confer the highest risk for developing psychotic symptoms later in life.
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Affiliation(s)
- Adriana Pastore
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Giulio Cesare Square, 11, Bari, Italy.
| | | | - Silvio Tafuri
- Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Aldo Tomasicchio
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Giulio Cesare Square, 11, Bari, Italy
| | - Francesco Margari
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Giulio Cesare Square, 11, Bari, Italy
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9
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Smigielski L, Papiol S, Theodoridou A, Heekeren K, Gerstenberg M, Wotruba D, Buechler R, Hoffmann P, Herms S, Adorjan K, Anderson-Schmidt H, Budde M, Comes AL, Gade K, Heilbronner M, Heilbronner U, Kalman JL, Klöhn-Saghatolislam F, Reich-Erkelenz D, Schaupp SK, Schulte EC, Senner F, Anghelescu IG, Arolt V, Baune BT, Dannlowski U, Dietrich DE, Fallgatter AJ, Figge C, Jäger M, Juckel G, Konrad C, Nieratschker V, Reimer J, Reininghaus E, Schmauß M, Spitzer C, von Hagen M, Wiltfang J, Zimmermann J, Gryaznova A, Flatau-Nagel L, Reitt M, Meyers M, Emons B, Haußleiter IS, Lang FU, Becker T, Wigand ME, Witt SH, Degenhardt F, Forstner AJ, Rietschel M, Nöthen MM, Andlauer TFM, Rössler W, Walitza S, Falkai P, Schulze TG, Grünblatt E. Polygenic risk scores across the extended psychosis spectrum. Transl Psychiatry 2021; 11:600. [PMID: 34836939 PMCID: PMC8626446 DOI: 10.1038/s41398-021-01720-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/24/2021] [Accepted: 10/29/2021] [Indexed: 12/23/2022] Open
Abstract
As early detection of symptoms in the subclinical to clinical psychosis spectrum may improve health outcomes, knowing the probabilistic susceptibility of developing a disorder could guide mitigation measures and clinical intervention. In this context, polygenic risk scores (PRSs) quantifying the additive effects of multiple common genetic variants hold the potential to predict complex diseases and index severity gradients. PRSs for schizophrenia (SZ) and bipolar disorder (BD) were computed using Bayesian regression and continuous shrinkage priors based on the latest SZ and BD genome-wide association studies (Psychiatric Genomics Consortium, third release). Eight well-phenotyped groups (n = 1580; 56% males) were assessed: control (n = 305), lower (n = 117) and higher (n = 113) schizotypy (both groups of healthy individuals), at-risk for psychosis (n = 120), BD type-I (n = 359), BD type-II (n = 96), schizoaffective disorder (n = 86), and SZ groups (n = 384). PRS differences were investigated for binary traits and the quantitative Positive and Negative Syndrome Scale. Both BD-PRS and SZ-PRS significantly differentiated controls from at-risk and clinical groups (Nagelkerke's pseudo-R2: 1.3-7.7%), except for BD type-II for SZ-PRS. Out of 28 pairwise comparisons for SZ-PRS and BD-PRS, 9 and 12, respectively, reached the Bonferroni-corrected significance. BD-PRS differed between control and at-risk groups, but not between at-risk and BD type-I groups. There was no difference between controls and schizotypy. SZ-PRSs, but not BD-PRSs, were positively associated with transdiagnostic symptomology. Overall, PRSs support the continuum model across the psychosis spectrum at the genomic level with possible irregularities for schizotypy. The at-risk state demands heightened clinical attention and research addressing symptom course specifiers. Continued efforts are needed to refine the diagnostic and prognostic accuracy of PRSs in mental healthcare.
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Affiliation(s)
- Lukasz Smigielski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Psychiatric University Hospital Zurich, Zurich, Switzerland.
| | - Sergi Papiol
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Anastasia Theodoridou
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Psychiatric University Hospital Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Karsten Heekeren
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Psychiatric University Hospital Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Psychiatry and Psychotherapy I, LVR-Hospital, Cologne, Germany
| | - Miriam Gerstenberg
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Diana Wotruba
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Roman Buechler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Psychiatric University Hospital Zurich, Zurich, Switzerland
- Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Per Hoffmann
- Department of Biomedicine, Human Genomics Research Group, University Hospital and University of Basel, Basel, Switzerland
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Stefan Herms
- Department of Biomedicine, Human Genomics Research Group, University Hospital and University of Basel, Basel, Switzerland
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Kristina Adorjan
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Heike Anderson-Schmidt
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Monika Budde
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Ashley L Comes
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- International Max Planck Research School for Translational Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Katrin Gade
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Maria Heilbronner
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Urs Heilbronner
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Janos L Kalman
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- International Max Planck Research School for Translational Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | | | - Daniela Reich-Erkelenz
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Sabrina K Schaupp
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Eva C Schulte
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Fanny Senner
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Ion-George Anghelescu
- Department of Psychiatry and Psychotherapy, Mental Health Institute, Berlin, Germany
| | - Volker Arolt
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Münster, Germany
- Department of Psychiatry, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Detlef E Dietrich
- AMEOS Clinical Center Hildesheim, Hildesheim, Germany
- Center for Systems Neuroscience (ZSN), Hannover, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tübingen, Tübingen, Germany
| | - Christian Figge
- Karl-Jaspers Clinic, European Medical School Oldenburg-Groningen, Oldenburg, Germany
| | - Markus Jäger
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Georg Juckel
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Carsten Konrad
- Department of Psychiatry and Psychotherapy, Agaplesion Diakonieklinikum, Rotenburg, Germany
| | - Vanessa Nieratschker
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tübingen, Tübingen, Germany
| | - Jens Reimer
- Department of Psychiatry, Klinikum Bremen-Ost, Bremen, Germany
- Department of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eva Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Research Unit for Bipolar Affective Disorder, Medical University of Graz, Graz, Austria
| | - Max Schmauß
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, Augsburg University, Medical Faculty, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Carsten Spitzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Martin von Hagen
- Clinic for Psychiatry and Psychotherapy, Clinical Center Werra-Meißner, Eschwege, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- iBiMED, Medical Sciences Department, University of Aveiro, Aveiro, Portugal
| | - Jörg Zimmermann
- Psychiatrieverbund Oldenburger Land gGmbH, Karl-Jaspers-Klinik, Bad Zwischenahn, Germany
| | - Anna Gryaznova
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Laura Flatau-Nagel
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Markus Reitt
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Milena Meyers
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Barbara Emons
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Ida Sybille Haußleiter
- Department of Psychiatry, Ruhr University Bochum, LWL University Hospital, Bochum, Germany
| | - Fabian U Lang
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Thomas Becker
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Moritz E Wigand
- Department of Psychiatry II, Ulm University, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Stephanie H Witt
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Franziska Degenhardt
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Andreas J Forstner
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
- Centre for Human Genetics, University of Marburg, Marburg, Germany
- Institute of Neuroscience and Medicine (INM-1), Research Center Jülich, Jülich, Germany
| | - Marcella Rietschel
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn, School of Medicine & University Hospital Bonn, Bonn, Germany
| | - Till F M Andlauer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Wulf Rössler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), Psychiatric University Hospital Zurich, Zurich, Switzerland
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin, Berlin, Germany
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, Universidade de São Paulo, São Paulo, Brazil
| | - 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
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - 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
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10
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Cowan HR, Mittal VA, McAdams DP. Narrative identity in the psychosis spectrum: A systematic review and developmental model. Clin Psychol Rev 2021; 88:102067. [PMID: 34274799 DOI: 10.1016/j.cpr.2021.102067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/31/2021] [Accepted: 07/06/2021] [Indexed: 01/19/2023]
Abstract
Individuals with schizophrenia-spectrum disorders face profound challenges as they attempt to maintain identity through the course of illness. Narrative identity-the study of internalized, evolving life stories-provides a rich theoretical and empirical perspective on these challenges. Based on evidence from a systematic review of narrative identity in the psychosis spectrum (30 studies, combined N = 3859), we argue that the narrative identities of individuals with schizophrenia-spectrum disorders are distinguished by three features: disjointed structure, a focus on suffering, and detached narration. Psychotic disorders typically begin to emerge during adolescence and emerging adulthood, which are formative developmental stages for narrative identity, so it is particularly informative to understand identity disturbances from a developmental perspective. We propose a developmental model in which a focus on suffering emerges in childhood; disjointed structure emerges in middle and late adolescence; and detached narration emerges before or around the time of a first psychotic episode. Further research with imminent risk and early course psychosis populations would be needed to test these predictions. The disrupted life stories of individuals on the psychosis spectrum provide multiple rich avenues for further research to understand narrative self-disturbances.
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Affiliation(s)
| | - Vijay A Mittal
- Psychology, Psychiatry, Medical and Social Sciences, Institute for Policy Research, Northwestern University, United States
| | - Dan P McAdams
- Psychology, School of Education and Social Policy, Northwestern University, United States
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11
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Ellersgaard D, Gregersen M, Spang KS, Christiani C, Burton BK, Hemager N, Søndergaard A, Greve A, Gantriis D, Jepsen JRM, Mors O, Plessen KJ, Thorup AAE, Nordentoft M. Psychotic experiences in seven-year-old children with familial high risk of schizophrenia or bipolar disorder in: The Danish High Risk and Resilience Study - VIA 7; A population-based cohort study. Schizophr Res 2021; 228:510-518. [PMID: 33308959 DOI: 10.1016/j.schres.2020.11.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 10/09/2020] [Accepted: 11/23/2020] [Indexed: 01/06/2023]
Abstract
We aimed to examine the prevalence of psychotic experiences (PEs) in children with familial high risk of schizophrenia (FHR-SZ) or bipolar disorder (FHR-BP) and, in exploratory analyses, to examine the possible associations between PEs and mental disorders as well as level of functioning. A cohort of seven-year-old children with FHR-SZ (N = 199), FHR-BP (N = 118) and controls (N = 196) was recruited through Danish nationwide registers. Lifetime PEs were assessed through interviews using the psychosis section of the 'Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version' (K-SADS-PL). Lifetime DSM-IV diagnoses were ascertained through K-SADS-PL and the level of functioning of the children through 'Children's Global Assessment Scale'. Both children with FHR-SZ (OR = 2.9, 95% CI = 1.4-6.2, p = 0.005) and FHR-BP (OR = 2.9, 95% CI = 1.3-6.7, p = 0.011) had an increased risk of having experienced "severe" PEs compared with controls. In the overall cohort PEs were associated with any lifetime mental disorder, Attention-Deficit/Hyperactivity Disorder, anxiety disorders and a lower level of functioning. The findings of a higher proportion of high risk children reporting PEs could represent an early manifestation of later more severe psychopathology or simply an unspecific transitory symptom. Future follow-up studies of this cohort will explore the predictive value of the occurrence of PEs at age seven.
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Affiliation(s)
- Ditte Ellersgaard
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 15, 4th floor, DK-2900 Hellerup, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark
| | - Maja Gregersen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 15, 4th floor, DK-2900 Hellerup, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark.
| | - Katrine Soeborg Spang
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark; Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 3A, 1th floor, DK-2900 Hellerup, Denmark.
| | - Camilla Christiani
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 15, 4th floor, DK-2900 Hellerup, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark.
| | - Birgitte Klee Burton
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 3A, 1th floor, DK-2900 Hellerup, Denmark.
| | - Nicoline Hemager
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 15, 4th floor, DK-2900 Hellerup, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark.
| | - Anne Søndergaard
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 15, 4th floor, DK-2900 Hellerup, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark.
| | - Aja Greve
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark; Psychosis Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, DK-8200 Aarhus, Denmark.
| | - Ditte Gantriis
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark; Psychosis Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, DK-8200 Aarhus, Denmark.
| | - Jens Richardt Møllegaard Jepsen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 15, 4th floor, DK-2900 Hellerup, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark; Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 3A, 1th floor, DK-2900 Hellerup, Denmark.
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark; Psychosis Research Unit, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, DK-8200 Aarhus, Denmark.
| | - Kerstin Jessica Plessen
- Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 3A, 1th floor, DK-2900 Hellerup, Denmark; Division of Child and Adolescent Psychiatry, Department of Psychiatry, Lausanne University Hospital, Avenue d'Echallens 9, CH-1004 Lausanne, Switzerland.
| | - Anne Amalie Elgaard Thorup
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark; Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 3A, 1th floor, DK-2900 Hellerup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen N, Denmark.
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Gentofte Hospitalsvej 15, 4th floor, DK-2900 Hellerup, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Fuglesangs Allé 26, DK-8210 Aarhus, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen N, Denmark.
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12
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Aloba O, Opakunle T. The Brief 10-Item Community Assessment of Psychic Experiences-Positive Scale (Brief CAPE-P10): Initial psychometric properties, gender measurement invariance and mean differences among Nigerian adolescents. Early Interv Psychiatry 2020; 14:723-733. [PMID: 31749283 DOI: 10.1111/eip.12903] [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: 11/20/2018] [Revised: 10/08/2019] [Accepted: 10/31/2019] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to evaluate the Community Assessment of Psychic Experiences-Positive Scale (CAPE-P) for its psychometric properties in terms of its reliability and validity, in addition to its factor structure and gender measurement invariance among Nigerian adolescents (n = 1336, Mage = 15.15). METHODS The sample consisted of 606 (45.4%) males, who completed the 20-items CAPE-P in addition to the Positive and Negative Suicide Ideation Inventory (PANSI), the Hospital Anxiety and Depression Scale (HADS) and the Rosenberg Self-Esteem Scale (RSES). We compared 11 a priori models of the CAPE-P with the aim of identifying the one with the best fit indices applying Confirmatory Factor Analysis (CFA). Gender measurement invariance was examined with nested multiple-group confirmatory factor analysis (MGCFA). RESULTS All the 11 a priori models had poor fit indices. An examination of the scale's 20 items revealed that 10 items had poor correlation with the overall scale. The remaining 10 items which we labelled as the Brief CAPE-P10 were subjected to CFA which yielded a 3-factor model (Bizarre Experiences-5 items, Delusional Ideation-3 items and Perceptual Anomalies-2 items) with satisfactory fit indices (CFI = 0.961, SRMR = 0.0376, RMSEA = 0.062/90% CI = 0.052-0.069). The validity and reliability of the Brief CAPE-P10 and its subscales were modestly satisfactory. MGCFA affirmed the configural, metric and scalar gender invariance of the 3-factor Brief CAPE-P10. CONCLUSIONS The Brief CAPE-P10 is a promising instrument for the evaluation of PLEs among Nigerian adolescents.
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Affiliation(s)
- Olutayo Aloba
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Tolulope Opakunle
- Department of Mental Health, State Specialist Hospital, Osogbo, Nigeria
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13
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Seiler N, Nguyen T, Yung A, O'Donoghue B. Terminology and assessment tools of psychosis: A systematic narrative review. Psychiatry Clin Neurosci 2020; 74:226-246. [PMID: 31846133 DOI: 10.1111/pcn.12966] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022]
Abstract
AIM Phenomena within the psychosis continuum that varies in frequency/duration/intensity have been increasingly identified. Different terms describe these phenomena, however there is no standardization within the terminology. This review evaluated the definitions and assessment tools of seven terms - (i) 'psychotic experiences'; (ii) 'psychotic-like experiences'; (iii) 'psychotic-like symptoms'; (iv) 'attenuated psychotic symptoms'; (v) 'prodromal psychotic symptoms'; (vi) 'psychotic symptomatology'; and (vii) 'psychotic symptoms'. METHODS EMBASE, MEDLINE, and CINAHL were searched during February-March 2019. Inclusion criteria included 1989-2019, full text, human, and English. Papers with no explicit definition or assessment tool, duplicates, conference abstracts, systematic reviews, meta-analyses, or no access were excluded. RESULTS A total of 2238 papers were identified and of these, 627 were included. Definitions and assessment tools varied, but some trends were found. Psychotic experiences and psychotic-like experiences were transient and mild, found in the general population and those at-risk. Psychotic-like symptoms were subthreshold and among at-risk populations and non-psychotic mental disorders. Attenuated psychotic symptoms were subthreshold but associated with distress, risk, and help-seeking. Prodromal psychotic symptoms referred to the prodrome of psychotic disorders. Psychotic symptomatology included delusions and hallucinations within psychotic disorders. Psychotic symptoms was the broadest term, encompassing a range of populations but most commonly involving hallucinations, delusions, thought disorder, and disorganization. DISCUSSION A model for conceptualizing the required terms is proposed and future directions needed to advance this field of research are discussed.
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Affiliation(s)
- Natalie Seiler
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,The University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Tony Nguyen
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,The University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Alison Yung
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, the National Centre of Excellence in Youth Mental Health, Parkville, Melbourne, Australia.,Centre for Youth Mental Health, University of Melbourne, Parkville, Melbourne, Australia.,Orygen Youth Health, Parkville, Melbourne, Australia
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14
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Söder E, Clamor A, Lincoln TM. Hair cortisol concentrations as an indicator of potential HPA axis hyperactivation in risk for psychosis. Schizophr Res 2019; 212:54-61. [PMID: 31455519 DOI: 10.1016/j.schres.2019.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 07/10/2019] [Accepted: 08/05/2019] [Indexed: 12/24/2022]
Abstract
A chronic hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis is assumed to be an important indicator of vulnerability for psychosis. Despite the considerable research on this topic, putative social origins of HPA axis hyperactivation have received little attention in the literature so far. Also, the inconsistency of previous findings calls for new and reliable methods in the assessment of HPA axis activation. To address these issues, we used hair cortisol concentrations as an indicator of chronic HPA axis activation in participants at elevated risk for psychosis (clinical risk: n = 43, familial risk: n = 32) and low-risk controls (n = 35), and assessed its relation with a variety of social stressors. We also tested the interaction effect between social stressors and familial risk status on hair cortisol concentrations (moderation analysis). Participants at elevated risk for psychosis did not show significantly higher hair cortisol concentrations than low-risk controls. However, severe social stressors (child abuse experiences, traumatic events) predicted hair cortisol concentrations in the total sample. This relationship was not significantly moderated by familial risk status (as a marker of genetic risk). The results challenge the assumption that HPA axis hyperactivation is an early vulnerability indicator for psychosis but leave the possibility that it manifests only at more severe risk stages. Furthermore, the findings suggest that acquired experiences contribute to the emergence of HPA axis hyperactivation, which might occur via a gene-environment correlation rather than via a gene-environment interaction.
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Affiliation(s)
- Eveline Söder
- Universität Hamburg, Clinical Psychology and Psychotherapy, Institute of Psychology, Von-Melle-Park 5, 20146 Hamburg, Germany.
| | - Annika Clamor
- Universität Hamburg, Clinical Psychology and Psychotherapy, Institute of Psychology, Von-Melle-Park 5, 20146 Hamburg, Germany
| | - Tania M Lincoln
- Universität Hamburg, Clinical Psychology and Psychotherapy, Institute of Psychology, Von-Melle-Park 5, 20146 Hamburg, Germany
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15
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Evidence for interaction between genetic liability and childhood trauma in the development of psychotic symptoms. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1045-1054. [PMID: 31209522 DOI: 10.1007/s00127-019-01711-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 04/08/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Whilst childhood trauma (CT) is a known risk factor across the spectrum of psychosis expression, little is known about possible interplay with genetic liability. METHODS The TwinssCan Study collected data in general population twins, focussing on expression of psychosis at the level of subthreshold psychotic experiences. A multilevel mixed-effects linear regression analysis was performed including 745 subjects to assess the interaction between genetic liability and CT. The Symptom Checklist-90 (SCL-90-R) score of the co-twin was used as an indirect measure of genetic liability to psychopathology, while the Childhood Trauma Questionnaire Short-Form (CTQ-SF) was used to assess CT in the domains of physical, emotional and sexual abuse, as well as physical and emotional neglect. The Community Assessment of Psychic Experience (CAPE) questionnaire was used to phenotypically characterize psychosis expression. RESULTS In the model using the CAPE total score, the interaction between CT and genetic liability was close to statistical significance (χ2 = 5.6, df = 2, p = 0.06). Analyses of CAPE subscales revealed a significant interaction between CT and genetic liability (χ2 = 8.8, df = 2, p = 0.012) for the CAPE-negative symptoms subscale, but not for the other two subscales (i.e. positive and depressive). CONCLUSION The results suggest that the impact of CT on subthreshold expression of psychosis, particularly in the negative subdomain, may be larger in the co-presence of significant genetic liability for psychopathology.
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16
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Kalman JL, Bresnahan M, Schulze TG, Susser E. Predictors of persisting psychotic like experiences in children and adolescents: A scoping review. Schizophr Res 2019; 209:32-39. [PMID: 31109737 DOI: 10.1016/j.schres.2019.05.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/22/2019] [Accepted: 05/05/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Subclinical psychotic experiences (PLEs) are among the frequently reported mental health problems in children/adolescents. PLEs identified in cross sectional studies of children/adolescents are associated with current and future mental health problems. These associations are stronger for PLEs that persist over time. Hence, it could be useful to examine which children/adolescents with PLEs at a first assessment (baseline) are more likely to have PLEs at subsequent assessments. METHODS We conducted a scoping review of studies that examined whether characteristics of children/adolescents (≤18 years) with PLEs at baseline predict whether PLEs are likely to be persistent or remittent at subsequent assessments. We included studies published between January 2002 and December 2017, conducted on general child/adolescent populations of ≥300 individuals, that provided data on PLEs for at least 2 time points, had available follow-up data for ≥50% of those assessed for PLEs at baseline and targeted for follow-up examination, and reported the differences between individuals with PLEs that persisted or remitted during the study period. RESULTS Six studies met our criteria. Each of them investigated a wide range of baseline characteristics but no predictor of persistence was replicated. CONCLUSIONS Our knowledge about which children/adolescents with PLEs at an initial assessment are likely to have persistent PLEs at subsequent assessments is sparse. A handful of predictors of persistent PLEs have been investigated so far, and none replicated. A better understanding of these predictors would be an important complement to investigations examining the evolution of PLEs and of mental health problems in children/adolescents.
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Affiliation(s)
- Janos L Kalman
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany; International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany.
| | - Michaeline Bresnahan
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Thomas G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, United States; Department of Psychiatry and Psychotherapy, University Medical Center, Georg-August University Göttingen, Göttingen, Germany; Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Ezra Susser
- Mailman School of Public Health, Columbia University, New York, NY, United States; New York State Psychiatric Institute, New York, New York, United States
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17
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Pan PM, Gadelha A, Argolo FC, Hoffmann MS, Arcadepani FB, Miguel EC, Rohde LA, McGuire P, Salum GA, Bressan RA. Childhood trauma and adolescent psychotic experiences in a community-based cohort: The potential role of positive attributes as a protective factor. Schizophr Res 2019; 205:23-29. [PMID: 30879477 DOI: 10.1016/j.schres.2018.06.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/11/2018] [Accepted: 06/14/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate how a set of positive social and personality characteristics called 'positive attributes' affects the emergence and persistence of Psychotic Experiences (PE) in adolescence. METHOD We used data from a community-based Brazilian High-Risk Cohort (HRC). 2511 6-12 year-old children were evaluated at baseline, and 80.05% completed a 3-year follow-up interview. At baseline, childhood trauma was assessed using parent- and self-report, and positive attributes were assessed by parent-report. Trained psychologists rated self-reported PE at both time points. Linear models evaluated the effect of childhood trauma and positive attributes on PE at follow-up. Mediation models tested i.) the indirect effect of positive attributes on the association between childhood trauma and follow-up PE and, ii.) the indirect effect of childhood trauma and positive attributes on the relationship between PE at baseline and follow-up. RESULTS Higher levels of baseline PE (B = 0.157, p < .001) and higher childhood trauma (B = 0.110, p < .001) were associated with increased follow-up PE. Higher positive attributes predicted lower PE after 3 years, adjusting for the prevalence of baseline PE and childhood trauma (B = -0.042, p < .022). Positive attributes partially mediated the relationship between childhood trauma and follow-up PE. The indirect pathway of childhood trauma and positive attributes mediated the association between baseline and follow-up PE. CONCLUSIONS Higher levels of positive social and behavioral traits in childhood may diminish the subsequent emergence of PE. As these attributes can be promoted, our findings suggest that positive attributes may represent a novel target for preventive interventions in children at risk of developing PE.
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Affiliation(s)
- Pedro M Pan
- Department of Psychiatry, Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Universidade Federal de São Paulo, São Paulo, Brazil; National Institute of Developmental Psychiatry, São Paulo, Brazil.
| | - Ary Gadelha
- Department of Psychiatry, Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Universidade Federal de São Paulo, São Paulo, Brazil; National Institute of Developmental Psychiatry, São Paulo, Brazil
| | - Felipe C Argolo
- Department of Psychiatry, Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mauricio S Hoffmann
- National Institute of Developmental Psychiatry, São Paulo, Brazil; Departament of Neuropsychiatry, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
| | - Felipe B Arcadepani
- Department of Psychiatry, Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Universidade Federal de São Paulo, São Paulo, Brazil
| | - Euripedes C Miguel
- National Institute of Developmental Psychiatry, São Paulo, Brazil; Department & Institute of Psychiatry, Universidade de São Paulo, São Paulo, Brazil
| | - Luis A Rohde
- National Institute of Developmental Psychiatry, São Paulo, Brazil; Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Giovanni A Salum
- National Institute of Developmental Psychiatry, São Paulo, Brazil; Department of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rodrigo A Bressan
- Department of Psychiatry, Laboratório Interdisciplinar de Neurociências Clínicas (LiNC), Universidade Federal de São Paulo, São Paulo, Brazil; National Institute of Developmental Psychiatry, São Paulo, Brazil; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
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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: 24] [Impact Index Per Article: 4.0] [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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Hasmi L, Drukker M, Guloksuz S, Viechtbauer W, Thiery E, Derom C, van Os J. Genetic and Environmental Influences on the Affective Regulation Network: A Prospective Experience Sampling Analysis. Front Psychiatry 2018; 9:602. [PMID: 30546324 PMCID: PMC6279878 DOI: 10.3389/fpsyt.2018.00602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 10/29/2018] [Indexed: 12/18/2022] Open
Abstract
Background: The study of networks of affective mental states that play a role in psychopathology may help model the influence of genetic and environmental risks. The aim of the present paper was to examine networks of affective mental states (AMS: "cheerful," "insecure," "relaxed," "anxious," "irritated," and "down") over time, stratified by genetic liability for psychopathology and exposure to environmental risk, using momentary assessment technology. Methods: Momentary AMS, collected using the experience sampling method (ESM) as well as childhood trauma and genetic liability (based on the level of shared genes and psychopathology in the co-twin) were collected in a population-based sample of female-female twin pairs and sisters (585 individuals). Networks were generated using multilevel time-lagged regression analysis, and regression coefficients were compared across three strata of childhood trauma severity and three strata of genetic liability using permutation testing. Regression coefficients were presented as network connections. Results: Visual inspection of network graphs revealed some suggestive changes in the networks with more exposure to either childhood trauma or genetic liability (i.e., stronger reinforcing loops between the three negative AMS anxious, insecure, and down both under higher early environmental, and under higher genetic liability exposure, stronger negative association between AMS of different valences: i.e., between "anxious" at t-1 and "relaxed" at t, "relaxed" at t-1 and "down" at t, under intermediate genetic liability exposure when compared to both networks under low and high genetic liability). Yet, statistical evaluation of differences across exposure strata was inconclusive. Conclusions: Although suggestive of a difference in the emotional dynamic, there was no conclusive evidence that genetic and environmental factors may impact ESM network models of individual AMS.
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Affiliation(s)
- Laila Hasmi
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Marjan Drukker
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Sinan Guloksuz
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, Netherlands.,Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, CT, United States
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Evert Thiery
- Department of Neurology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Catherine Derom
- Centre of Human Genetics, University Hospitals Leuven, Leuven, Belgium.,Department of Obstetrics and Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Jim van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, Netherlands.,Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, King's Health Partners, London, United Kingdom
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20
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Childhood trauma is not a confounder of the overlap between autistic and schizotypal traits: A study in a non-clinical adult sample. Psychiatry Res 2017; 257:111-117. [PMID: 28750214 DOI: 10.1016/j.psychres.2017.07.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 07/05/2017] [Accepted: 07/16/2017] [Indexed: 01/03/2023]
Abstract
Childhood trauma has been shown to be a robust risk factor for mental disorders, and may exacerbate schizotypal traits or contribute to autistic trait severity. However, little is known whether childhood trauma confounds the overlap between schizotypal traits and autistic traits. This study examined whether childhood trauma acts as a confounding variable in the overlap between autistic and schizotypal traits in a large non-clinical adult sample. A total of 2469 participants completed the Autism Spectrum Quotient (AQ), the Schizotypal Personality Questionnaire (SPQ), and the Childhood Trauma Questionnaire-Short Form. Correlation analysis showed that the majority of associations between AQ variables and SPQ variables were significant (p < 0.05). In the multiple regression models predicting scores on the AQ total, scores on the three SPQ subscales were significant predictors(Ps < 0.05). Scores on the Positive schizotypy and Negative schizotypy subscales were significant predictors in the multiple regression model predicting scores on the AQ Social Skill, AQ Attention Switching, AQ Attention to Detail, AQ Communication, and AQ Imagination subscales. The association between autistic and schizotypal traits could not be explained by shared variance in terms of exposure to childhood trauma. The findings point to important overlaps in the conceptualization of ASD and SSD, independent of childhood trauma.
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Abstract
SummaryCoughlan & Cannon have provided an extremely useful review, highlighting the evidence for the association between childhood trauma and psychosis. This is relevant to those working with individuals with psychosis across all age ranges. This commentary discusses further some of the points raised, the complexity of the association and developmental aspects.
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Hodgins S, Klein S. New Clinically Relevant Findings about Violence by People with Schizophrenia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:86-93. [PMID: 27605579 PMCID: PMC5298520 DOI: 10.1177/0706743716648300] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To review findings with clinical relevance that add to knowledge about antisocial and aggressive behaviour among persons with schizophrenia. METHOD Nonsystematic literature review. RESULTS Recent evidence shows that individuals who develop schizophrenia present cognitive deficits, psychotic-like experiences, and internalizing and externalizing problems from childhood onwards. Many of their relatives present not only schizophrenia-related disorders but also antisocial behaviour. While the increased risk of aggressive behaviour among persons with schizophrenia has been robustly established, recent findings show that by first contact with clinical services for psychosis, most people with schizophrenia who will engage in aggressive behaviour may be identified. At first episode, 2 distinct types are distinguishable: those who present a history of antisocial and aggressive behaviour since childhood and those who began engaging in aggressive behaviour as illness onsets. Antipsychotic medications and other treatments shown to be effective for schizophrenia are needed by both types of patients. Additionally, those with a history of antisocial and aggressive behaviour since childhood require cognitive-behavioural programs aimed at reducing these behaviours and promoting prosocial behaviour. Reducing physical victimisation and cannabis use will likely reduce aggressive behaviour. Evidence suggests that threats to hurt others often precede assaults. CONCLUSIONS At first contact with services, patients with schizophrenia who have engaged in aggressive behaviour should be identified and treated for schizophrenia and for aggression. Research is needed to identify interactions between genotypes and environmental factors, from conception onwards, that promote and that protect against the development of aggressive behaviour among persons with schizophrenia.
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Affiliation(s)
- Sheilagh Hodgins
- 1 Département de Psychiatrie, Institut Universitaire de Santé Mentale de Montréal, Université de Montréal, Montreal, Quebec.,2 Karolinska Institutet, Solna, Sweden
| | - Sanja Klein
- 3 Department of Psychology, University of Giessen, Gießen, Germany.,4 Vitos Klinik für forensische Psychiatrie Haina, Haina, Germany
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Interplay between Schizophrenia Polygenic Risk Score and Childhood Adversity in First-Presentation Psychotic Disorder: A Pilot Study. PLoS One 2016; 11:e0163319. [PMID: 27648571 PMCID: PMC5029892 DOI: 10.1371/journal.pone.0163319] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/07/2016] [Indexed: 11/19/2022] Open
Abstract
A history of childhood adversity is associated with psychotic disorder, with an increase in risk according to number or severity of exposures. However, it is not known why only some exposed individuals go on to develop psychosis. One possibility is pre-existing genetic vulnerability. Research on gene-environment interaction in psychosis has primarily focused on candidate genes, although the genetic effects are now known to be polygenic. This pilot study investigated whether the effect of childhood adversity on psychosis is moderated by the polygenic risk score for schizophrenia (PRS). Data were utilised from the Genes and Psychosis (GAP) study set in South London, UK. The GAP sample comprises 285 first-presentation psychosis cases and 256 unaffected controls with information on childhood adversity. We studied only white subjects (80 cases and 110 controls) with PRS data, as the PRS has limited predictive ability in patients of African ancestry. The occurrence of childhood adversity was assessed with the Childhood Experience of Care and Abuse Questionnaire (CECA.Q) and the PRS was based on genome-wide meta-analysis results for schizophrenia from the Psychiatric Genomics Consortium. Higher schizophrenia PRS and childhood adversities each predicted psychosis status. Nevertheless, no evidence was found for interaction as departure from additivity, indicating that the effect of polygenic risk scores on psychosis was not increased in the presence of a history of childhood adversity. These findings are compatible with a multifactorial threshold model in which both genetic liability and exposure to environmental risk contribute independently to the etiology of psychosis.
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Mansur RB, Cunha GR, Asevedo E, Zugman A, Rizzo LB, Grassi-Oliveira R, Levandowski ML, Gadelha A, Pan PM, Teixeira AL, McIntyre RS, Mari JJ, Rohde LA, Miguel EC, Bressan RA, Brietzke E. Association of serum interleukin-6 with mental health problems in children exposed to perinatal complications and social disadvantage. Psychoneuroendocrinology 2016; 71:94-101. [PMID: 27258821 DOI: 10.1016/j.psyneuen.2016.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/18/2016] [Accepted: 05/16/2016] [Indexed: 11/28/2022]
Abstract
There is consistent evidence that inflammation is involved in mental disorders pathogenesis. Herein, using data from the High Risk Cohort Study for Psychiatric Disorders, we investigated the relationship between parental mood disorders (PMD), environmental factors, serum interleukin-6 (IL6) and mental health problems in children aged 6-12. We measured the serum levels of IL6 in 567 children. Information related to socio-demographic characteristics, mental health problems and multiple risk factors, as well as parent's psychiatric diagnosis, was captured. We evaluated two groups of environmental risk factors (i.e. perinatal complications and social disadvantage) using a cumulative risk model. Results showed that higher serum levels of IL6 were associated with PMD (RR=1.072, p=0.001), perinatal complications (RR=1.022, p=0.013) and social disadvantage (RR=1.024, p=0.021). There was an interaction between PMD and social disadvantage (RR=1.141, p=0.021), as the effect of PMD on IL6 was significantly higher in children exposed to higher levels of social disadvantage. Moreover, there was a positive correlation between IL6 and mental health problems (RR=1.099, p=0.026), which was moderated by exposure to perinatal complications or social disadvantage (RR=1.273, p=0.015 and RR=1.179, p=0.048, respectively). In conclusions, there is evidence of a differential inflammatory activation in children with PMD and exposure to environmental risk factors, when compared to matched peers. Systemic inflammation may be involved in the pathway linking familial risk and mental health problems.
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Affiliation(s)
- Rodrigo B Mansur
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental State, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada.
| | - Graccielle R Cunha
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental State, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Elson Asevedo
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental State, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - André Zugman
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental State, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Lucas B Rizzo
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental State, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Department of Psychiatry, University of Tuebingen, Tuebingen, Germany
| | - Rodrigo Grassi-Oliveira
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mateus L Levandowski
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; Institute of Biomedical Research, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ary Gadelha
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental State, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Pedro M Pan
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental State, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Antônio L Teixeira
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; Interdisciplinary Laboratory of Medical Investigation, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, Toronto, Canada
| | - Jair J Mari
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental State, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Luís A Rohde
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Eurípedes C Miguel
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; Department of Psychiatry, Universidade de São Paulo, São Paulo, Brazil
| | - Rodrigo A Bressan
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental State, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Elisa Brietzke
- National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, São Paulo, Brazil; PRISMA-Program for Recognition and Intervention in Individuals in At-Risk Mental State, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Siebald C, Khandaker GM, Zammit S, Lewis G, Jones PB. Association between childhood psychiatric disorders and psychotic experiences in adolescence: A population-based longitudinal study. Compr Psychiatry 2016; 69:45-52. [PMID: 27423344 PMCID: PMC4959416 DOI: 10.1016/j.comppsych.2016.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Adolescent psychotic experiences (PEs) are common, and are associated with both psychotic and non-psychotic illnesses. In order to examine psychopathological and cognitive antecedents of adolescent PEs, we have conducted a longitudinal study of common childhood psychiatric disorders and subsequent adolescent PEs in the population-based prospective ALSPAC birth cohort. METHOD Depression, anxiety, attention deficit hyperactivity disorder, oppositional defiant or conduct disorder, and pervasive developmental disorder were diagnosed according to DSM-IV criteria in 8253 participants at age 8years. IQ was assessed by WISC-III also at 8years. PEs, depressive and anxiety symptoms were assessed at 13years. Logistic regression calculated odds ratio (OR) for PEs at 13years associated with psychiatric disorders at 8years. Linear regression calculated mean difference in IQ between groups with and without psychiatric disorder. Mediating effects of IQ, mood and anxiety symptoms on the psychiatric disorder-PEs relationship were examined. RESULTS In total, 599 children were assessed to have a DSM-IV psychiatric disorder at 8years (7.2%). These children compared with those without any psychiatric disorder performed worse on all measures of IQ; adjusted mean difference in total IQ -6.17 (95% CI, -7.86, -4.48). Childhood psychiatric disorders were associated with PEs subsequently in adolescence; adjusted OR 1.96 (95% CI, 1.47-2.68). The association between psychiatric disorder and subsequent PEs was partly mediated by, independently, IQ deficit at 8years and depressive and anxiety symptoms at 13years. CONCLUSIONS The findings indicate that adolescent PEs are associated with general cognitive ability and past and present psychopathological factors.
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Affiliation(s)
| | - Golam M. Khandaker
- Department of Psychiatry, University of Cambridge, UK,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK,Corresponding author at: Department of Psychiatry, Box 189, Cambridge Biomedical Campus, Cambridge CB2 2QQ, UK.Department of PsychiatryCambridge Biomedical CampusBox 189CambridgeCB2 2QQUK
| | - Stanley Zammit
- Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, UK,Institute of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, UK,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Sex differences in the effect of childhood trauma on the clinical expression of early psychosis. Compr Psychiatry 2016; 68:86-96. [PMID: 27234188 DOI: 10.1016/j.comppsych.2016.04.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 04/01/2016] [Accepted: 04/02/2016] [Indexed: 12/19/2022] Open
Abstract
Childhood trauma, a risk factor of psychosis, is associated the clinical expression of the illness (greater severity of psychotic symptoms; poorer cognitive performance). We aimed to explore whether there are sex differences in this relationship. We studied 79 individuals with a psychotic disorder (PD) with <3years of illness and 59 healthy subjects (HS). All participants were administered the MATRICS Cognitive Consensus Cognitive Battery (MCCB) to assess cognition. Depressive, positive and negative psychotic symptoms, and global functioning were also assessed. History of childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ). Patients reported a greater history of childhood trauma on all CTQ domains (emotional, physical and sexual abuse, and physical and emotional neglect). A poorer cognitive performance was also observed in PD when compared to HS. No sex differences were found in the CTQ scores. In the relationship between childhood trauma and psychopathological symptoms, significant correlations were found between CTQ scores and positive and negative psychotic symptoms, depressive symptoms and poorer functionality, but only in women. Childhood trauma was associated with poorer social cognition in both men and women. Of all CTQ dimensions, emotional neglect and physical neglect were more clearly associated with a more severe psychopathological and cognitive profile. Our results suggest that childhood trauma, particularly emotional and physical neglect, is associated with the clinical expression of psychosis and that there are sex differences in this relationship.
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Morgan C, Gayer‐Anderson C. Childhood adversities and psychosis: evidence, challenges, implications. World Psychiatry 2016; 15:93-102. [PMID: 27265690 PMCID: PMC4911761 DOI: 10.1002/wps.20330] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
There is a substantial body of research reporting evidence of associations between various forms of childhood adversity and psychosis, across the spectrum from experiences to disorder. This has been extended, more recently, to include studies of cumulative effects, of interactions with other factors, of specific effects, and of putative biological and psychological mechanisms. In this paper we evaluate this research and highlight the remaining methodological issues and gaps that temper, but do not dismiss, conclusions about the causal role of childhood adversity. We also consider the emerging work on cumulative, synergistic, and specific effects and on mechanisms; and discuss the broader implications of this line of research for our understanding of psychosis. We conclude that the current balance of evidence is that childhood adversities - particularly exposure to multiple adversities involving hostility and threat - do, in some people, contribute to the onset of psychotic experiences and psychotic disorders.
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Affiliation(s)
- Craig Morgan
- Society and Mental Health Research Group, Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College LondonLondonUK
| | - Charlotte Gayer‐Anderson
- Society and Mental Health Research Group, Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College LondonLondonUK
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28
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Affiliation(s)
- Stephanie Thornton
- Chartered psychologist and former lecturer in psychology and child development
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29
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Rössler W, Ajdacic-Gross V, Rodgers S, Haker H, Müller M. Childhood trauma as a risk factor for the onset of subclinical psychotic experiences: Exploring the mediating effect of stress sensitivity in a cross-sectional epidemiological community study. Schizophr Res 2016; 172:46-53. [PMID: 26874870 DOI: 10.1016/j.schres.2016.02.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 01/31/2016] [Accepted: 02/03/2016] [Indexed: 02/06/2023]
Abstract
Childhood trauma is a risk factor for the onset of schizophrenic psychosis. Because the psychosis phenotype can be described as a continuum with varying levels of severity and persistence, childhood trauma might likewise increase the risk for psychotic experiences below the diagnostic threshold. But the impact of stressful experiences depends upon its subjective appraisal. Therefore, varying degrees of stress sensitivity possibly mediate how childhood trauma impacts in the end upon the occurrence of subclinical psychotic experiences. We investigated this research question in a representative community cohort of 1500 participants. A questionnaire, comprising five domains of physical and emotional neglect, as well as physical, emotional, and sexual abuse, was used to assess childhood trauma. Based on different symptoms of subclinical psychotic experiences, we conducted a latent profile analysis (LPA) to derive distinct profiles for such experiences. Path modeling was performed to identify the direct and indirect (via stress sensitivity) pathways from childhood trauma to subclinical psychotic experiences. The LPA revealed four classes - unaffected, anomalous perceptions, odd beliefs and behavior, and combined anomalous perceptions/odd beliefs and behavior, that - except for sexual abuse - were all linked to childhood trauma. Moreover, except for physical abuse, childhood trauma was significantly associated with stress sensitivity. Thus, our results revealed that the pathways from emotional neglect/abuse and physical neglect to subclinical psychotic experiences were mediated by stress sensitivity. In conclusion, we can state that subclinical psychotic experiences are affected by childhood traumatic experiences in particular through the pathway of a heightened subjective stress appraisal.
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Affiliation(s)
- Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Brazil; Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland.
| | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland
| | - Stephanie Rodgers
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland
| | - Helene Haker
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich & ETH Zurich, Switzerland
| | - Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland; Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland
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Mark W, Toulopoulou T. Psychometric Properties of "Community Assessment of Psychic Experiences": Review and Meta-analyses. Schizophr Bull 2016; 42:34-44. [PMID: 26150674 PMCID: PMC4681550 DOI: 10.1093/schbul/sbv088] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The Community Assessment of Psychic Experiences (CAPE) has been used extensively as a measurement for psychosis proneness in clinical and research settings. However, no prior review and meta-analysis have comprehensively examined psychometric properties (reliability and validity) of CAPE scores across different studies. To study CAPE's internal reliability--ie, how well scale items correlate with one another--111 studies were reviewed. Of these, 18 reported unique internal reliability coefficients using data at hand, which were aggregated in a meta-analysis. Furthermore, to confirm the number and nature of factors tapped by CAPE, 17 factor analytic studies were reviewed and subjected to meta-analysis in cases of discrepancy. Results suggested that CAPE scores were psychometrically reliable--ie, scores obtained could be attributed to true score variance. Our review of factor analytic studies supported a 3-factor model for CAPE consisting of "Positive", "Negative", and "Depressive" subscales; and a tripartite structure for the Negative dimension consisting of "Social withdrawal", "Affective flattening", and "Avolition" subdimensions. Meta-analysis of factor analytic studies of the Positive dimension revealed a tridimensional structure consisting of "Bizarre experiences", "Delusional ideations", and "Perceptual anomalies". Information on reliability and validity of CAPE scores is important for ensuring accurate measurement of the psychosis proneness phenotype, which in turn facilitates early detection and intervention for psychotic disorders. Apart from enhancing the understanding of psychometric properties of CAPE scores, our review revealed questionable reporting practices possibly reflecting insufficient understanding regarding the significance of psychometric properties. We recommend increased focus on psychometrics in psychology programmes and clinical journals.
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Jeppesen P, Larsen JT, Clemmensen L, Munkholm A, Rimvall MK, Rask CU, van Os J, Petersen L, Skovgaard AM. The CCC2000 Birth Cohort Study of Register-Based Family History of Mental Disorders and Psychotic Experiences in Offspring. Schizophr Bull 2015; 41:1084-94. [PMID: 25452427 PMCID: PMC4535626 DOI: 10.1093/schbul/sbu167] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Psychotic experiences (PE) in individuals of the general population are hypothesized to mark the early expression of the pathology underlying psychosis. This notion of PE as an intermediate phenotype is based on the premise that PE share genetic liability with psychosis. We examined whether PE in childhood was predicted by a family history of mental disorder with psychosis rather than a family history of nonpsychotic mental disorder and whether this association differed by severity of PE. The study examined data on 1632 children from a general population birth cohort assessed at age 11-12 years by use of a semistructured interview covering 22 psychotic symptoms. The Danish national registers were linked to describe the complete family history of hospital-based psychiatric diagnoses. Uni- and multivariable logistic regressions were used to test whether a family history of any mental disorder with psychosis, or of nonpsychotic mental disorder, vs no diagnoses was associated with increased risk of PE in offspring (hierarchical exposure variable). The occurrence of PE in offspring was significantly associated with a history of psychosis among the first-degree relatives (adjusted relative risk [RR] = 3.29, 95% CI: 1.82-5.93). The risk increased for combined hallucinations and delusions (adjusted RR = 5.90, 95% CI: 2.64-13.16). A history of nonpsychotic mental disorders in first-degree relatives did not contribute to the risk of PE in offspring nor did any mental disorder among second-degree relatives. Our findings support the notion of PE as a vulnerability marker of transdiagnostic psychosis. The effect of psychosis in first-degree relatives may operate through shared genetic and environmental factors.
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Affiliation(s)
- Pia Jeppesen
- Child and Adolescent Mental Health Center, Mental Health Services, The Capital Region of Denmark, Glostrup, Denmark; Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark;
| | - Janne Tidselbak Larsen
- The National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark;,Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus University, Aarhus, Denmark
| | - Lars Clemmensen
- Child and Adolescent Mental Health Center, Mental Health Services, The Capital Region of Denmark, Glostrup, Denmark;,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anja Munkholm
- Child and Adolescent Mental Health Center, Mental Health Services, The Capital Region of Denmark, Glostrup, Denmark;,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Martin Kristian Rimvall
- Child and Adolescent Mental Health Center, Mental Health Services, The Capital Region of Denmark, Glostrup, Denmark;,Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Ulrikka Rask
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark;,Child and Adolescent Psychiatric Centre Risskov, Aarhus University Hospital, Aarhus, Denmark
| | - Jim van Os
- Department of Psychosis Studies, King’s College London, King’s Health Partners, Institute of Psychiatry, London, UK;,Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Liselotte Petersen
- The National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark;,Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus University, Aarhus, Denmark
| | - Anne Mette Skovgaard
- Child and Adolescent Mental Health Center, Mental Health Services, The Capital Region of Denmark, Glostrup, Denmark;,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Psychotic experiences in the population: Association with functioning and mental distress. Schizophr Res 2015; 165:9-14. [PMID: 25868930 DOI: 10.1016/j.schres.2015.03.020] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 03/03/2015] [Accepted: 03/22/2015] [Indexed: 11/23/2022]
Abstract
Psychotic experiences are far more common in the population than psychotic disorder. They are associated with a number of adverse outcomes but there has been little research on associations with functioning and distress. We wished to investigate functioning and distress in a community sample of adolescents with psychotic experiences. Two hundred and twelve school-going adolescents were assessed for psychotic experiences, mental distress associated with these experiences, global (social/occupational) functioning on the Children's Global Assessment Scale, and a number of candidate mediator variables, including psychopathology, suicidality, trauma (physical and sexual abuse and exposure to domestic violence) and neurocognitive functioning. Seventy five percent of participants who reported psychotic experiences reported that they found these experiences distressing (mean score for severity of distress was 6.9 out of maximum 10). Participants who reported psychotic experiences had poorer functioning than participants who did not report psychotic experiences (respective means: 68.6, 81.9; OR=0.25, 95% CI=0.14-0.44). Similarly, participants with an Axis-1 psychiatric disorder who reported psychotic experiences had poorer functioning than participants with a disorder who did not report psychotic experiences (respective means: 61.8, 74.5; OR=0.28, 95% CI=0.12-0.63). Candidate mediator variables explained some but not all of the relationship between psychotic experiences and functioning (OR=0.48, 95% CI=0.22-1.05, P<0.07). Young people with psychotic experiences have poorer global functioning than those who do not, even when compared with other young people with psychopathology (but who do not report psychotic experiences). A disclosure of psychotic experiences should alert treating clinicians that the individual may have significantly more functional disability than suggested by the psychopathological diagnosis alone.
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Trotta A, Di Forti M, Iyegbe C, Green P, Dazzan P, Mondelli V, Morgan C, Murray RM, Fisher HL. Familial risk and childhood adversity interplay in the onset of psychosis. BJPsych Open 2015; 1:6-13. [PMID: 27703716 PMCID: PMC4995579 DOI: 10.1192/bjpo.bp.115.000158] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 01/29/2015] [Accepted: 03/20/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The association between childhood adversity and psychosis in adulthood is well established. However, genetic factors might confound or moderate this association. AIMS Using a catchment-based case-control sample, we explored the main effects of, and interplay between, childhood adversity and family psychiatric history on the onset of psychosis. METHOD Childhood adversity (parental separation and death, physical and sexual abuse) was assessed retrospectively in 224 individuals with a first presentation of psychosis and 256 community controls from South London, UK. Occurrence of psychotic and affective disorders in first-degree relatives was ascertained with the Family Interview for Genetic Studies (FIGS). RESULTS Parental history of psychosis did not confound the association between childhood adversity and psychotic disorder. There was no evidence that childhood adversity and familial liability combined synergistically to increase odds of psychosis beyond the effect of each individually. CONCLUSIONS Our results do not support the hypothesis that family psychiatric history amplifies the effect of childhood adversity on odds of psychosis. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) licence.
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Affiliation(s)
- Antonella Trotta
- , PhD, , PhD, , PhD, , PhD, , MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Marta Di Forti
- , PhD, , PhD, , PhD, , PhD, , MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Conrad Iyegbe
- , PhD, , PhD, , PhD, , PhD, , MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Priscilla Green
- , PhD, , PhD, , PhD, , PhD, , MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Paola Dazzan
- , PhD, , PhD, , PhD, , PhD, , MRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Valeria Mondelli
- , PhD, Section of Stress, Psychiatry and Immunology and Perinatal Psychiatry, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Craig Morgan
- , PhD, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Robin M Murray
- , FRCPsych, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Helen L Fisher
- , PhD, MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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van Nierop M, Viechtbauer W, Gunther N, van Zelst C, de Graaf R, Ten Have M, van Dorsselaer S, Bak M, van Winkel R. Childhood trauma is associated with a specific admixture of affective, anxiety, and psychosis symptoms cutting across traditional diagnostic boundaries. Psychol Med 2015; 45:1277-1288. [PMID: 25273550 DOI: 10.1017/s0033291714002372] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Meta-analyses link childhood trauma to depression, mania, anxiety disorders, and psychosis. It is unclear, however, whether these outcomes truly represent distinct disorders following childhood trauma, or that childhood trauma is associated with admixtures of affective, psychotic, anxiety and manic psychopathology throughout life. METHOD We used data from a representative general population sample (NEMESIS-2, n = 6646), of whom respectively 1577 and 1120 had a lifetime diagnosis of mood or anxiety disorder, as well as from a sample of patients with a diagnosis of schizophrenia (GROUP, n = 825). Multinomial logistic regression was used to assess whether childhood trauma was more strongly associated with isolated affective/psychotic/anxiety/manic symptoms than with their admixture. RESULTS In NEMESIS-2, largely comparable associations were found between childhood trauma and depression, mania, anxiety and psychosis. However, childhood trauma was considerably more strongly associated with their lifetime admixture. These results were confirmed in the patient samples, in which it was consistently found that patients with a history of childhood trauma were more likely to have a combination of multiple symptom domains compared to their non-traumatized counterparts. This pattern was also found in exposed individuals who did not meet criteria for a psychotic, affective or anxiety disorder and who did not seek help for subclinical psychopathology. CONCLUSIONS Childhood trauma increases the likelihood of a specific admixture of affective, anxiety and psychotic symptoms cutting across traditional diagnostic boundaries, and this admixture may already be present in the earliest stages of psychopathology. These findings may have significant aetiological, pathophysiological, diagnostic and clinical repercussions.
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Affiliation(s)
- M van Nierop
- Department of Psychiatry and Psychology,School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre,Maastricht,The Netherlands
| | - W Viechtbauer
- Department of Psychiatry and Psychology,School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre,Maastricht,The Netherlands
| | - N Gunther
- Faculty of Psychology and Educational Sciences,Open University,The Netherlands
| | - C van Zelst
- Department of Psychiatry and Psychology,School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre,Maastricht,The Netherlands
| | - R de Graaf
- Netherlands Institute of Mental Health and Addiction,Da Costakade,Utrecht,The Netherlands
| | - M Ten Have
- Netherlands Institute of Mental Health and Addiction,Da Costakade,Utrecht,The Netherlands
| | - S van Dorsselaer
- Netherlands Institute of Mental Health and Addiction,Da Costakade,Utrecht,The Netherlands
| | - M Bak
- Department of Psychiatry and Psychology,School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre,Maastricht,The Netherlands
| | - R van Winkel
- Department of Psychiatry and Psychology,School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre,Maastricht,The Netherlands
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35
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Ronald A. Recent quantitative genetic research on psychotic experiences: new approaches to old questions. Curr Opin Behav Sci 2015. [DOI: 10.1016/j.cobeha.2014.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Trauma history characteristics associated with mental states at clinical high risk for psychosis. Psychiatry Res 2014; 220:237-44. [PMID: 25200190 PMCID: PMC4218920 DOI: 10.1016/j.psychres.2014.08.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/14/2014] [Accepted: 08/17/2014] [Indexed: 11/23/2022]
Abstract
Traumatic experiences have been positively associated with both severity of attenuated psychotic symptoms in individuals at high risk (HR) for psychosis and transitions into psychotic disorders. Our aim was to determine what characteristics of the trauma history are more likely to be associated with individuals at HR. The Trauma History Screen (THS) was used to enable emphasis on number and perceived intensity of adverse life events and age at trauma exposure. Sixty help-seeking individuals who met HR criteria were compared to a random sample of 60 healthy volunteers. Both groups were aged 16-35 and resided in the same geographical location. HR participants experienced their first trauma at an earlier age, continued to experience trauma at younger developmental stages, especially during early/mid adolescence and were exposed to a high number of traumas. They were more depressed and anxious, but did not experience more distress in relation to trauma. Both incidences of trauma and age at which trauma occurred were the most likely predictors of becoming HR. This work emphasises the importance of assessing trauma characteristics in HR individuals to enable differentiation between psychotic-like experiences that may reflect dissociative responses to trauma and genuine prodromal psychotic presentations.
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Fisher HL, McGuffin P, Boydell J, Fearon P, Craig TK, Dazzan P, Morgan K, Doody GA, Jones PB, Leff J, Murray RM, Morgan C. Interplay between childhood physical abuse and familial risk in the onset of psychotic disorders. Schizophr Bull 2014; 40:1443-51. [PMID: 24399191 PMCID: PMC4193698 DOI: 10.1093/schbul/sbt201] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Childhood abuse is considered one of the main environmental risk factors for the development of psychotic symptoms and disorders. However, this association could be due to genetic factors influencing exposure to such risky environments or increasing sensitivity to the detrimental impact of abuse. Therefore, using a large epidemiological case-control sample, we explored the interplay between a specific form of childhood abuse and family psychiatric history (a proxy for genetic risk) in the onset of psychosis. METHODS Data were available on 172 first presentation psychosis cases and 246 geographically matched controls from the Aetiology and Ethnicity of Schizophrenia and Other Psychoses study. Information on childhood abuse was obtained retrospectively using the Childhood Experience of Care and Abuse Questionnaire and occurrence of psychotic and affective disorders in first degree relatives with the Family Interview for Genetic Studies. RESULTS Parental psychosis was more common among psychosis cases than unaffected controls (adjusted OR = 5.96, 95% CI: 2.09-17.01, P = .001). Parental psychosis was also associated with physical abuse from mothers in both cases (OR = 3.64, 95% CI: 1.06-12.51, P = .040) and controls (OR = 10.93, 95% CI: 1.03-115.90, P = .047), indicative of a gene-environment correlation. Nevertheless, adjusting for parental psychosis did not measurably impact on the abuse-psychosis association (adjusted OR = 3.31, 95% CI: 1.22-8.95, P = .018). No interactions were found between familial liability and maternal physical abuse in determining psychosis caseness. CONCLUSIONS This study found no evidence that familial risk accounts for associations between childhood physical abuse and psychotic disorder nor that it substantially increases the odds of psychosis among individuals reporting abuse.
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Affiliation(s)
- Helen L. Fisher
- MRC Social Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK;,*To whom correspondence should be addressed; MRC Social, Genetic & Developmental Psychiatry Centre, PO80, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK; tel: +44 (0)207-848-5430, fax +44 (0)207-848-0866, e-mail:
| | - Peter McGuffin
- MRC Social Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK
| | - Jane Boydell
- Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Paul Fearon
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - Thomas K. Craig
- Health Services & Population Research, Institute of Psychiatry, King’s College London, London, UK
| | - Paola Dazzan
- Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK;,National Institute of Health Research Biomedical Research Centre for Mental Health, London, UK
| | - Kevin Morgan
- Department of Psychology, University of Westminster, London, UK
| | - Gillian A. Doody
- Division of Psychiatry, University of Nottingham, Nottingham, UK
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Julian Leff
- Mental Health Sciences, University College London, London, UK
| | - Robin M. Murray
- Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK;,National Institute of Health Research Biomedical Research Centre for Mental Health, London, UK
| | - Craig Morgan
- Health Services & Population Research, Institute of Psychiatry, King’s College London, London, UK;,National Institute of Health Research Biomedical Research Centre for Mental Health, London, UK
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van Nierop M, van Os J, Gunther N, van Zelst C, de Graaf R, ten Have M, van Dorsselaer S, Bak M, Myin-Germeys I, van Winkel R. Does social defeat mediate the association between childhood trauma and psychosis? Evidence from the NEMESIS-2 Study. Acta Psychiatr Scand 2014; 129:467-76. [PMID: 24571736 DOI: 10.1111/acps.12212] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Based on theoretical considerations and animal studies, mediation of 'social defeat' (SD) in the association between childhood trauma (CT) and psychosis was investigated. METHOD Trained interviewers administered a structured interview assessing CT, psychotic experiences and other psychopathology in 6646 participants in the second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2). RESULTS Childhood trauma was associated with psychotic experiences making up the extended psychosis phenotype (EPP), as well as with a diagnosis of psychotic disorder (PD). Similarly, CT was associated with a priori selected items indexing SD (discouraged, hopeless, worthless, loss of self-confidence, low self-esteem, better off dead, suicidal thoughts) and with a measure of affective dysregulation (AD), which in turn were also associated with psychosis. While SD and AD individually acted as mediators in the association between CT and EPP, only SD acted as a mediator in the association between CT and PD. Cannabis use did not mediate the association between CT and EPP or PD. CONCLUSION The present results suggest a developmental model implicating SD as an important mediator in the link between childhood adverse experiences and later development of psychotic experiences. The combined mediation by SD and AD is compatible with an 'affective pathway' to early psychosis.
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Affiliation(s)
- M van Nierop
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, the Netherlands
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Coelho R, Viola TW, Walss-Bass C, Brietzke E, Grassi-Oliveira R. Childhood maltreatment and inflammatory markers: a systematic review. Acta Psychiatr Scand 2014; 129:180-92. [PMID: 24205846 DOI: 10.1111/acps.12217] [Citation(s) in RCA: 256] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Childhood maltreatment (CM) has been associated with several diseases in adult life, including diabetes, obesity and mental disorders. Inflammatory conditions have been postulated as possible mediators of this relationship. The aim was to conduct a systematic review regarding the association between CM and inflammatory markers in adulthood. METHOD A literature search of the PubMed, ISI, EMBASE and PsychINFO databases was conducted. The key terms used were as follows: 'Child Maltreatment', 'Childhood Trauma', 'Early Life Stress', 'Psychological Stress', 'Emotional Stress', 'Child Abuse' and 'Child Neglect'. They were cross-referenced separately with the terms: 'C-reactive Protein (CRP)', 'Tumor Necrosis Factor', 'Cytokine', 'Interleukin', 'Inflammatory' and 'Inflammation'. RESULTS Twenty articles remained in the review after exclusion criteria were applied. Studies showed that a history of CM was associated with increased levels of CRP, fibrinogen and proinflammatory cytokines. Increased levels of circulating CRP in individuals with a history of CM were the most robust finding among the studies. Data about anti-inflammatory mediators are still few and inconsistent. CONCLUSION Childhood maltreatment is associated with a chronic inflammatory state independent of clinical comorbidities. However, studies are heterogeneous regarding CM assessment and definition. Important methodological improvements are needed to better understand the potential impact of CM on inflammatory response.
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Affiliation(s)
- R Coelho
- Centre of Studies and Research in Traumatic Stress (NEPTE), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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Lataster T, Verweij K, Viechtbauer W. Effect of illness expression and liability on familial associations of clinical and subclinical psychosis phenotypes. Acta Psychiatr Scand 2014; 129:44-53. [PMID: 23465170 DOI: 10.1111/acps.12102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Given the familial influences on schizophrenia, it may be hypothesized that specific symptom domains also cluster within families, and that this applies to both clinical and subclinical levels of expression. This hypothesis was put to the test in a group of patients with a DSM-IV diagnosis of psychotic disorder together with their unaffected siblings, and a group of healthy sib-pairs. METHOD Subclinical positive, negative and depressive symptoms in relatives and healthy controls were assessed with the Community Assessment of Psychic Experiences (CAPE). Positive and negative schizotypy in relatives and controls was measured with the Structured Interview for Schizotypy-Revised. Multilevel linear regression analyses were conducted to investigate clustering of symptom dimensions within patient-relative sib-pairs (N = 811 pairs), healthy sib-pairs of affected families (N = 136 pairs) and healthy control sib-pairs (N = 58 pairs). RESULTS Familial clustering of symptoms was found in all three groups. Effect sizes were largest in healthy control sib-pairs, smallest in patient-relative sib-pairs and intermediate in healthy sib-pairs of affected families. CONCLUSION Studies of sibling associations in genetic studies of psychometric expression of psychosis liability need to take into account the fact that the higher levels of background genetic risk and presence of diagnosed illness are inversely associated with sibling associations.
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Affiliation(s)
- T Lataster
- South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, Maastricht, the Netherlands
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41
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Ramsay H, Kelleher I, Flannery P, Clarke MC, Lynch F, Harley M, Connor D, Fitzpatrick C, Morris DW, Cannon M. Relationship between the COMT-Val158Met and BDNF-Val66Met polymorphisms, childhood trauma and psychotic experiences in an adolescent general population sample. PLoS One 2013; 8:e79741. [PMID: 24224001 PMCID: PMC3818212 DOI: 10.1371/journal.pone.0079741] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 09/23/2013] [Indexed: 01/24/2023] Open
Abstract
Objective Psychotic experiences occur at a much greater prevalence in the population than psychotic disorders. There has been little research to date, however, on genetic risk for this extended psychosis phenotype. We examined whether COMT or BDNF genotypes were associated with psychotic experiences or interacted with childhood trauma in predicting psychotic experiences. Method Psychiatric interviews and genotyping for COMT-Val158Met and BDNF-Val66Met were carried out on two population-based samples of 237 individuals aged 11-15 years. Logistic regression was used to examine for main effects by genotype and childhood trauma, controlling for important covariates. This was then compared to a model with a term for interaction between genotype and childhood trauma. Where a possible interaction was detected, this was further explored in stratified analyses. Results While childhood trauma showed a borderline association with psychotic experiences, COMT-Val158Met and BDNF-Val66Met genotypes were not directly associated with psychotic experiences in the population. Testing for gene x environment interaction was borderline significant in the case of COMT-Val158Met with individuals with the COMT-Val158Met Val-Val genotype, who had been exposed to childhood trauma borderline significantly more likely to report psychotic experiences than those with Val-Met or Met-Met genotypes. There was no similar interaction by BDNF-Val66Met genotype. Conclusion The COMT-Val158Met Val-Val genotype may be a genetic moderator of risk for psychotic experiences in individuals exposed to childhood traumatic experiences.
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Affiliation(s)
- Hugh Ramsay
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
- * E-mail:
| | - Ian Kelleher
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Padraig Flannery
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Mary C. Clarke
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | | | - Michelle Harley
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
- Department of Child and Adolescent Psychiatry, St Vincent’s Hospital, Fairview, Dublin, Ireland
| | - Dearbhla Connor
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Carol Fitzpatrick
- School of Medicine & Medical Science, University College Dublin, Dublin, Ireland
| | - Derek W. Morris
- Neuropsychiatric Genetics Research Group, Department of Psychiatry and Institute of Molecular Medicine, Trinity College Dublin, Dublin, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
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Abstract
Childhood trauma is a common occurrence and has been associated with psychosis and suggested as a risk factor leading to psychosis and schizophrenia in adulthood. This article introduces the scope of the problem and discusses the evidence for causal relationships between childhood adversities and increased risk for psychosis. The relationship between specific types of trauma and their association with specific psychotic symptoms is described, as well as the manifestations of co-occurring trauma effects and psychosis in adolescents. Clinical presentations and the use of diagnostic instruments, diagnostic comorbidities, and evidence-based psychotherapeutic interventions to treat effects of trauma in youth with psychotic illnesses are discussed.
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Affiliation(s)
- Yael Dvir
- Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
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McGrath JJ, Mortensen PB, Visscher PM, Wray NR. Where GWAS and epidemiology meet: opportunities for the simultaneous study of genetic and environmental risk factors in schizophrenia. Schizophr Bull 2013; 39:955-9. [PMID: 23907349 PMCID: PMC3756798 DOI: 10.1093/schbul/sbt108] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- John J McGrath
- University of Queensland, St Lucia, Queensland, Australia.
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Nuevo R, Van Os J, Arango C, Chatterji S, Ayuso-Mateos JL. Evidence for the early clinical relevance of hallucinatory-delusional states in the general population. Acta Psychiatr Scand 2013; 127:482-93. [PMID: 22943634 DOI: 10.1111/acps.12010] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To analyze, in a general population sample, clustering of delusional and hallucinatory experiences in relation to environmental exposures and clinical parameters. METHOD General population-based household surveys of randomly selected adults between 18 and 65 years of age were carried out. SETTING 52 countries participating in the World Health Organization's World Health Survey were included. PARTICIPANTS 225 842 subjects (55.6% women), from nationally representative samples, with an individual response rate of 98.5% within households participated. RESULTS Compared with isolated delusions and hallucinations, co-occurrence of the two phenomena was associated with poorer outcome including worse general health and functioning status (OR = 0.93; 95% CI: 0.92-0.93), greater severity of symptoms (OR = 2.5 95% CI: 2.0-3.0), higher probability of lifetime diagnosis of psychotic disorder (OR = 12.9; 95% CI: 11.5-14.4), lifetime treatment for psychotic disorder (OR = 19.7; 95% CI: 17.3-22.5), and depression during the last 12 months (OR = 11.6; 95% CI: 10.9-12.4). Co-occurrence was also associated with adversity and hearing problems (OR = 2.0; 95% CI: 1.8-2.3). CONCLUSION The results suggest that the co-occurrence of hallucinations and delusions in populations is not random but instead can be seen, compared with either phenomenon in isolation, as the result of more etiologic loading leading to a more severe clinical state.
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Affiliation(s)
- R Nuevo
- Department of Psychiatry, Universidad Autonoma de Madrid, Hospital Universitario de la Princesa, Madrid, Spain
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45
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Genes and environments in schizophrenia: The different pieces of a manifold puzzle. Neurosci Biobehav Rev 2013; 37:2424-37. [PMID: 23628741 DOI: 10.1016/j.neubiorev.2013.04.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 04/17/2013] [Indexed: 01/12/2023]
Abstract
Genetic research targeting schizophrenia has undergone tremendous development during recent years. Supported by recently developed high-throughput genotyping technologies, both rare and common genetic variants have been identified that show consistent association with schizophrenia. These results have been replicated by independent studies and refined in meta-analyses. The genetic variation uncovered consists of common alleles, i.e. single nucleotide polymorphisms (SNPs) conveying small effects (odds ratios below 1.1) on disease risk. The source of rare variants is copy number variations (CNVs), only detectable in a small proportion of patients (3-5% for all known CNVs) with schizophrenia, furthermore extremely rare de novo mutations captured by next generation sequencing, the most recent technological advancement in the field. Despite these findings, the search for the genetic architecture underlying schizophrenia continues since these variants explain only a small proportion of the overall phenotypic variance. Gene-environment interactions provide a compelling model for resolving this paradox and interpreting the risk factors of schizophrenia. Epidemiologically proven risk factors, such as prenatal infection, obstetric complications, urbanicity, cannabis, and trauma have been demonstrated to interact with genetic risk, giving rise to higher prevalence rates or more severe symptomatology in individuals with direct or indirect genetic predisposition for schizophrenia. Further research will have to explain how the different forms of genetic variation interact and how environmental factors modulate their effects. Moreover, the challenging question lying ahead of us is how genetic and environmental factors translate to molecular disease pathways. New approaches, including animal studies and in vitro disease modeling, as well as innovative real-world environment assessment methods, will help to understand the complex etiology of schizophrenia.
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van Winkel R, van Nierop M, Myin-Germeys I, van Os J. Childhood trauma as a cause of psychosis: linking genes, psychology, and biology. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:44-51. [PMID: 23327756 DOI: 10.1177/070674371305800109] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent studies have provided robust evidence for an association between childhood trauma (CT) and psychosis. Meta-analyses have quantified the association, pointing to odds ratios in the order of around 3, and prospective studies have shown that reverse causation is unlikely to explain the association. However, more work is needed to address the possibility of a gene-environment correlation, that is, whether genetic risk for psychosis predicts exposure to CT. Nevertheless, multiple studies have convincingly shown that the association between CT and psychosis remains strong and significant when controlling for genetic risk, in agreement with a possible causal association. In addition, several studies have shown plausible psychological and neurobiological mechanisms linking adverse experiences to psychosis, including induction of social defeat and reduced self-value, sensitization of the mesolimbic dopamine system, changes in the stress and immune system, and concomitant changes in stress-related brain structures, such as the hippocampus and the amygdala, findings that should be integrated, however, in more complex models of vulnerability. It is currently unclear whether genetic vulnerability plays a role in conferring the mental consequences of adversity, and which genes are likely to be involved. The current, limited evidence points to genes that are not specifically involved in psychosis but more generally in regulating mood (serotonin transporter gene), neuroplasticity (brain-derived neurotrophic factor), and the stress-response system (FKBP5), in line with a general effect of CT on a range of mental disorders, rather than suggesting specificity for psychosis.
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Affiliation(s)
- Ruud van Winkel
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, the Netherlands.
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