Stress in schizophrenics and normals

Prevalence of Catatonia and Its Moderators in Clinical Samples: Results from a Meta-analysis and Meta-regression Analysis

Catatonia is an independent syndrome that co-occurs with several mental and medical conditions. We performed a systematic literature review in PubMed/Scopus until February 2017 and meta-analyzed studies reporting catatonia prevalence. Across 74 studies (cross-sectional = 32, longitudinal = 26, retrospective = 16) providing data collected from 1935 to 2017 across all continents, mean catatonia prevalence was 9.0% (k = 80, n = 110764; 95% CI = 6.9-11.7, I2 = 98%, publication bias P < .01), decreasing to 7.8% (k = 19, n = 7612, 95% CI = 7-8.7, I2 = 38.9%) in a subgroup with low heterogeneity. Catatonia prevalence was 23.9% (k = 8, n = 1168, 95% CI = 10-46.9, I2 = 96%) in patients undergoing ECT/having elevated creatinine phosphokinase. Excluding ECT samples, the catatonia prevalence was 8.1% (k = 72, n = 109606, 95% CI = 6.1-10.5, I2 = 98%, publication bias P < .01), with sensitivity analyses demonstrating that country of study origin (P < .001), treatment setting (P = .003), main underlying condition (P < .001), and sample size (P < .001)moderated catatonia prevalence, being highest in Uganda (48.5%, k = 1) and lowest in Mexico (1.9%, 95% CI = 0.4-8.8, I2 = 67%, k = 2), highest in nonpsychiatric out- or inpatient services (15.8%, 95% CI = 8.1-28.4, I2 = 97%, k = 15)and lowest in psychiatric outpatients services (3.2%, 95% CI = 1.7-6.1, I2 = 50%, k = 3), highest in presence of medical or neurological illness with no comorbid psychiatric condition (20.6%, 95% CI = 11.5-34.2, I2 = 95%, k = 10)and lowest in mixed psychiatric samples (5.7%, 95% CI = 4.2-7.7, I2 =98%, k = 43), highest in studies with sample sizes <100 (20.7%, 95% CI = 12.8-31.6, I2 = 90%, k = 17) and lowest in studies with sample sizes >1000 (2.3%, 95% CI = 1.3-3.9, I2 = 99%, k = 16). Meta-regression showed that smaller sample size (P < .01) and less major depressive disorder (P = .02) moderated higher catatonia prevalence. Year of data collection did not significantly moderate the results. Results from this first meta-analysis of catatonia frequencies across time and disorders suggest that catatonia is an epidemiologically and clinically relevant condition that occurs throughout several mental and medical conditions, whose prevalence has not decreased over time and does not seem to depend on different rating scales/criteria. However, results were highly heterogeneous, calling for a cautious interpretation.

Patterns of stress in schizophrenia

Although it is widely recognized that stress plays a key role in the pathophysiology of schizophrenia, little is known regarding the particular types of stress patients experience. Less is known about the interplay among stressful events, personality mediators, and emotional responses. In this study, we investigated 10 stress dimensions in 29 patients with schizophrenia and 36 healthy volunteers using the Derogatis Stress Profile (DSP), and the relationship between these dimensions and symptoms in patients. Overall, patients had an approximate 0.75 standard deviation increase in stress compared with healthy volunteers. Significant increases in stress among patients compared with healthy volunteers were observed specifically in areas related to domestic environment, driven behavior, and depression, but not in health, attitude posture, time pressure, relaxation potential, role definition, hostility, or anxiety. More DSP-rated depression among patients correlated significantly with greater negative symptom severity. Patients with a shorter duration of antipsychotic drug exposure had significantly greater hostility than did patients with a longer duration of exposure, but did not differ in any other dimension. Continued investigation of domestic environmental stressors, driven behavior, and depression may be useful in identifying high-risk groups, and understanding symptom exacerbation and precipitants of relapse in patients already diagnosed with schizophrenia.

Stress, coping, and social support in hypothetically psychosis-prone subjects

This paper examined stress processes in hypothetically psychosis-prone individuals. Subjects scoring high on Perceptual Aberration/Magical Ideation (Per-Mag subjects), Anhedonia, and low-scoring control subjects were compared for scores on Hassles and Uplifts, cognitive appraisal, coping strategies, emotions in two stressful situations, and on perceived social support. The groups differed in their experiences of minor life events and Secondary Appraisal but not in Primary Appraisal or emotions. There were notable differences in coping patterns and perceptions of social support. Per-Mag subjects contrasted with controls in using more coping by Escape-avoidance and Accepting responsibility, and reported less social support. Anhedonic subjects differed in their experience of minor life events and coped less through Positive reappraisal and Seeking social support. Per-Mag subjects are mainly distinguished by their coping processes. Anhedonic subjects are also sensitive to the incidence of minor life events. The results indicate that risk factors, stress, and coping interact in the absence of mental disorder.

A thirty-year retrospective study of hospitalization among severely mentally ill patients

This study examines the effects of deinstitutionalization policies on psychiatric hospitalization rates over a thirty-year period. It is based on a retrospective study of successive hospitalizations in severely disabled patients. The data indicate that in any five-year period these patients still spend over 20% of their time in hospital. For patients who have stayed for a total of more than one year every five years in hospital, the average length of stay has been decreasing far less rapidly in the last fifteen years than it had previously. Patients who were first admitted after 1971 spent proportionally as much time in hospital as those whose first stay was earlier. These results show that the groups primarily affected by deinstitutionalization are those who were first hospitalized prior to the 1970s and those who are the heaviest hospital users. However, the data from the patients admitted since the seventies seem to reveal that the process of change may have reached its limits.

Stressful life events and schizophrenia. II: Conceptual and methodological issues

Research on the relationship between stress and schizophrenia is fraught with conceptual and methodological problems. These problems include issues related to the nature and measurement of stress, the likelihood of reciprocal influences between stress and symptoms, and the adequate assessment of symptoms. Several recommendations are made regarding future research in this area. These include using multiple and broadly based measures of different types of stressors and symptoms, greater use of truly prospective research designs, and the evaluation of the effects of interventions specifically designed to reduce stress in patients who suffer from schizophrenia.

Hyperactivity of associations in psychosis

Disordered associative processes have long been regarded as central to the psychological description of psychotic states such as acute schizophrenia. Previous work is briefly summarised concerning the idea that hyperactive associative processes of thought underlie many of the symptoms of psychosis. The idea is developed further, with respect to several features of the psychotic state. Schneiderian symptoms are seen as a consequence of hyperactive associations of thought, combined with perceptual hypersensitivity characteristic of many psychotic individuals. Anxiety in psychotic states is seen as arising from the great ambiguity of mental images when associations are loosened. A vicious circle between high anxiety and hyperactive associations is postulated. The slow and variable response to neuroleptic treatment is seen as being determined in part by the dynamics of change of the memories acquired during a period of hyperactive associations.

Anxiety management with schizophrenic outpatients

Current theoretical speculation and research evidence suggest that elevated anxiety levels and poor anxiety coping skills may be important aspects of the schizophrenic process. Despite the success of various behaviorally oriented stress management techniques with nonpsychotic individuals, research on the effects of these programs as applied to schizophrenics has been scarce. The present study examined the effects of two such techniques, Anxiety Management Training (AMT) and Applied Relaxation Training (R), on schizophrenic outpatients. After 6 weeks of training, both the AMT and R Ss (N = 27) reported significantly lower levels of generalized anxiety on a standard measure, as contrasted to non-treated Wait-List (WL) group Ss (N = 12). In addition, significant positive changes were reported by the Ss' regular outpatient therapists on a number of related, non-targeted behaviors. The results of this study support the idea that short-term anxiety management interventions may be useful in the treatment of schizophrenic patients.

Relationship between cognitive defect, affect response and community adjustment in chronic schizophrenics

The relationship between mental status and community adjustment has been examined in 100 outpatient chronic schizophrenics. Sixty-six per cent presented at least one of the signs of Schneiderian First Rank Symptoms, which, however, failed to discriminate the diagnostic subgroups. Total adjustment correlated with total mental status and appeared to differentiate the diagnostic subclassifications of schizophrenia. From the major components of mental status, anxiety and depression appear to be significantly correlated with the functioning and stress of the individual in community adjustment while primary symptoms are only peripherally correlated with adjustment.

The effects of social changes in chronic schizophrenia: a study of forty patients transferred from hospital to residential home

Various clinical and social measures were applied to forty long-stay schizophrenic patients before and after transfer from hospital to a residential home and similarly to twenty-five patients retained in hospital. The results are used to test specific hypotheses concerning the relationship between social changes and clinical state in chronic schizophrenia.