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Perry BI, Zammit S, Jones PB, Khandaker GM. Childhood inflammatory markers and risks for psychosis and depression at age 24: Examination of temporality and specificity of association in a population-based prospective birth cohort. Schizophr Res 2021; 230:69-76. [PMID: 33684738 PMCID: PMC8224182 DOI: 10.1016/j.schres.2021.02.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Cross-sectional studies have reported elevated concentrations of inflammatory markers in psychosis and depression. However, questions regarding temporality and specificity of association, crucial for understanding the potential role of inflammation, remain. METHODS Based on 2224 ALSPAC birth cohort participants, we used regression analyses to test associations of interleukin-6 (IL-6) and C-reactive protein (CRP) levels at age 9 with risks for psychosis (psychotic experiences; negative symptoms; psychotic disorder), and depression (depressive episode; symptom score) at age 24. Regression models were adjusted for sex, ethnicity, social class and body mass index. We tested for linearity (using quadratic terms) and specificity (using bi-variate probit regression) of association, and used multiple imputation to explore the impact of missing data. RESULTS After adjustments, higher IL-6 levels at age 9 were associated with increased risk of psychotic disorder (OR = 1.56; 95% C.I., 1.09-2.21 per SD increase in IL-6; OR=2.60; 95% C.I., 1.04-6.53 for the top compared with bottom third of IL-6) and depressive episode (OR = 1.14; 95% C.I., 0.99-1.32 per SD increase in IL-6; OR = 1.49; 95% C.I., 1.02-2.18 for the top compared with bottom third of IL-6). IL-6 was associated with negative symptoms after adjusting for depression (β = 0.09; 95% C.I., 0.01-0.22). There was no evidence for outcome-specific associations of IL-6. Childhood CRP was not associated with adult psychosis or depression. CONCLUSIONS Evidence for similar, longitudinal, dose-response associations suggest that elevated childhood IL-6 could be a shared risk factor for adult psychosis and depression. The IL-6 pathway may represent a novel target for treatment and prevention of these disorders.
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Affiliation(s)
- Benjamin I Perry
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
| | - Stanley Zammit
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Golam M Khandaker
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK; Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Avon and Wiltshire Mental Health Partnership NHS Trust, UK
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Abstract
Psychiatry's most recent foray into the area of risk and prevention has been spear-headed by work on at-risk mental states for psychotic disorders. Twenty-five years' research and clinical application have led us to reformulate the clinical evolution of these syndromes, blurred unhelpful conceptual boundaries between childhood and adult life by adopting a developmental view and has changed the shape of many mental health services as part of a global movement to increase quality. But there are problems: fragmentary psychotic experiences are common in young people but transition from risk-state to full syndrome is uncommon away from specialist clinics with rarefied referrals and can, anyway, be subtle; diagnostic over-shadowing by the prospect of schizophrenia and other psychotic disorders may divert clinical attention from the kaleidoscopic and disabling range of probably treatable psychopathology with which people with risk syndromes present. We use a 19th Century lyric poem, The Lady of Shallot, as an allegory for Psychiatry warning us against regarding these mental states only as pointers towards diagnoses that probably will not occur. Viewed from the fresh perspective of common mental disorders they tell us a great deal about the psychopathological crucible of the second and third decades, the nature of diagnosis, and point towards new treatment paradigms.
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Affiliation(s)
- Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
- CAMEO, Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn, CB21 5EF, UK
- Norwich Medical School, University of East Anglia (UEA), Norwich, NR4 7TJ, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
- CAMEO, Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn, CB21 5EF, UK
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Effects of the COVID-19 pandemic and lockdown in Spain: comparison between community controls and patients with a psychiatric disorder. Preliminary results from the BRIS-MHC STUDY. J Affect Disord 2021; 281:13-23. [PMID: 33279864 PMCID: PMC7683299 DOI: 10.1016/j.jad.2020.11.099] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/07/2020] [Accepted: 11/11/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The aim of this study was to evaluate potential differences about the effects of the COVID-19 pandemic and lockdown between community controls (CC) and patients with a mental illness (MI) in a Spanish population during the state of emergency. METHODS Individuals with a psychiatric condition and the general population were invited to complete an anonymous online survey. Bivariate analyses were used to compare them in a broad range of measures: sociodemographic, clinical variables, behavioral changes related to the lockdown and coping strategies to face it. Two groups of different psychiatric disorders were compared: depression or anxiety disorders (D+A) versus bipolar disorder and schizophrenia related disorders (BD+SCZ). RESULTS 413 CC and 206 MI were included in the study. CC reported to use more adaptive coping strategies as following a routine, talking to friends/relatives, practicing physical exercise and maintaining a balanced diet. MI reported significantly more anxiety and depression symptoms during the lockdown when compared to CC. Gaining weight, sleep changes, and tobacco consumption were more prevalent in the MI group. The D+A group showed significantly more psychological distress and negative expectations about the future, suffered more sleep disturbances when compared to BD+SCZ, whilst reported to practice more exercise. LIMITATIONS psychiatric disorders were self-reported. CONCLUSIONS Imposed restrictions and uncertainty during confinement had a higher psychological impact in individuals with a psychiatric illness, with less healthy behavior strategies to face the situation. Developing interventions to mitigate negative mental health outcomes among this vulnerable population will be essential in the coming months.
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Coughlan H, Walton-Ball E, Carey E, Healy C, O’Regan-Murphy G, Uidhir AN, Clarke MC, Cannon M. Self-reported interpersonal and educational/vocational difficulties in young adults with a history of transient psychotic experiences: findings from a population-based study. BMC Psychiatry 2021; 21:30. [PMID: 33430829 PMCID: PMC7802220 DOI: 10.1186/s12888-020-03022-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 12/22/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Psychotic experiences (PEs) are not uncommon in young people and are associated with both psychopathology and compromised global functioning. Although psychotic experiences are transient (short-lived, self-resolving and non-recurring) for most people who report them, few studies have examined the association between early transient PEs and later functioning in population samples. Additionally, studies using self-report measures of interpersonal and educational/ vocational difficulties are lacking. The aim of this study was to examine the relationship between transient psychotic experiences and self-reported interpersonal and educational/vocational difficulties in adolescence and young adulthood. METHODS Participants were 103 young people from a longitudinal population-based study cohort of mental health in Ireland. They attended for baseline clinical interviews in childhood (age 11-13) and were followed up in young adulthood (age 19-25). Participants who reported psychotic experiences at baseline but not at follow-up were classified as having transient psychotic experiences. Data from both time-points were used to examine the association between transient psychotic experiences and self-reported interpersonal and educational/ vocational difficulties in young adulthood using poisson regression modelling. RESULTS Young people with a history of transient psychotic experiences reported significantly higher interpersonal (adj IRR: 1.83, 95%ileCI: 1.10-3.02, p = .02) and educational/vocational (adj IRR: 2.28, 95%ileCI: 1.43-3.64, p = .001) difficulties during adolescence. However, no significant differences in interpersonal (adj IRR: 0.49, 95%ileCI: 0.10-2.30, p = .37) or educational/vocational (adj IRR: 0.88, 95%ileCI: 0.37-2.08, p = .77) difficulties were found in young adulthood. Self-reported interpersonal and educational/vocational difficulties in young people both with and without a history of transient psychotic experiences decreased between adolescence and young adulthood. CONCLUSIONS Young people with transient psychotic experiences have increased interpersonal and educational/vocational difficulties in adolescence but these may not persist into the young adult years. This finding indicates that early psychotic experiences may not confer high risk for long-term interpersonal or educational/vocational deficits among young people who experience these phenomena transiently.
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Affiliation(s)
- Helen Coughlan
- grid.414315.60000 0004 0617 6058Department of Psychiatry, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Erin Walton-Ball
- grid.414315.60000 0004 0617 6058Department of Psychiatry, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Eleanor Carey
- grid.414315.60000 0004 0617 6058Department of Psychiatry, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Colm Healy
- grid.414315.60000 0004 0617 6058Department of Psychiatry, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Grace O’Regan-Murphy
- grid.414315.60000 0004 0617 6058Department of Psychiatry, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Aoife Nic Uidhir
- grid.414315.60000 0004 0617 6058Department of Psychiatry, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Mary C. Clarke
- grid.414315.60000 0004 0617 6058Department of Psychiatry, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland. .,Department of Psychiatry, Beaumont Hospital Dublin, Dublin, Ireland.
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Cupo L, McIlwaine SV, Daneault JG, Malla AK, Iyer SN, Joober R, Shah JL. Timing, Distribution, and Relationship Between Nonpsychotic and Subthreshold Psychotic Symptoms Prior to Emergence of a First Episode of Psychosis. Schizophr Bull 2021; 47:604-614. [PMID: 33410487 PMCID: PMC8759816 DOI: 10.1093/schbul/sbaa183] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Prospective population studies suggest that psychotic syndromes may be an emergent phenomenon-a function of severity and complexity of more common mental health presentations and their nonpsychotic symptoms. Examining the relationship between nonpsychotic and subthreshold psychotic symptoms in individuals who later developed the ultimate outcome of interest, a first episode of psychosis (FEP), could provide valuable data to support or refute this conceptualization of how psychosis develops. We therefore conducted a detailed follow-back study consisting of semistructured interviews with 430 patients and families supplemented by chart reviews in a catchment-based sample of affective and nonaffective FEP. The onset and sequence of 27 pre-onset nonpsychotic (NPS) or subthreshold psychotic (STPS) symptoms was systematically characterized. Differences in proportions were analyzed with z-tests, and correlations were assessed with negative binomial regressions. Both the first psychiatric symptom (86.24% NPS) and the first prodromal symptom (66.51% NPS) were more likely to be NPS than STPS. Patients reporting pre-onset STPS had proportionally more of each NPS than did those without pre-onset STPS. Finally, there was a strong positive correlation between NPS counts (reflecting complexity) and STPS counts (β = 0.34, 95% CI [0.31, 0.38], P < 2 e-16). Prior to a FEP, NPS precede STPS, and greater complexity of NPS is associated with the presence and frequency of STPS. These findings complement recent arguments that the emergence of psychotic illness is better conceptualized as part of a continuum-with implications for understanding pluripotential developmental trajectories and strengthening early intervention paradigms.
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Affiliation(s)
- Lani Cupo
- Integrated Program in Neuroscience, McGill University, Montréal, QC, Canada,Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Sarah V McIlwaine
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Jean-Gabriel Daneault
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada,Département de Psychiatrie, Université de Montréal, Montréal, QC, Canada,Clinique J.-P. Mottard, Hôpital en santé mentale Albert-Prévost, Montréal, QC, Canada
| | - Ashok K Malla
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Srividya N Iyer
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Jai L Shah
- Integrated Program in Neuroscience, McGill University, Montréal, QC, Canada,Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada,Department of Psychiatry, McGill University, Montréal, QC, Canada,To whom correspondence should be addressed; Department of Psychiatry, McGill University, Montréal, QC, Canada; tel: (514) 761-6131x2465, fax: (514) 888-4458, e-mail:
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56
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Jacob L, Smith L, McDermott D, Haro JM, Stickley A, Koyanagi A. Relationship between sexual orientation and psychotic experiences in the general population in England. Psychol Med 2021; 51:138-146. [PMID: 31694728 DOI: 10.1017/s003329171900309x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Non-heterosexual individuals are at high risk for a variety of factors associated with the emergence of psychotic experiences (PEs) (e.g. common mental disorders, substance use, and stress). However, there is a scarcity of data on the association between sexual orientation and PEs. Therefore, the aim of this study was to examine the sexual orientation-PE relationship, and to identify potential mediators in this relationship. METHODS This study used nationally representative cross-sectional data from the 2007 Adult Psychiatric Morbidity Survey. Sexual orientation was dichotomized into heterosexual and non-heterosexual. Past 12-month PE was assessed with the Psychosis Screening Questionnaire. Regression and mediation analyses were conducted to analyze the association between sexual orientation and PEs, and to identify potential mediators involved in this relationship. RESULTS The final sample consisted of 7275 individuals aged ⩾16 years. The prevalence of non-heterosexual orientation and any PE was 7.1% and 5.5%, respectively. After adjusting for sex, age, and ethnicity, non-heterosexual orientation was positively associated with any PE (odds ratio 1.99, 95% confidence interval 1.34-2.93). The strongest mediators involved in this relationship were borderline personality disorder (BPD) traits (mediated percentage = 33.5%), loneliness (29.1%), and stressful life events (25.4%). CONCLUSIONS These findings suggest that there is a positive relationship between sexual orientation and PEs in the general population in England, and that underlying mechanisms may involve BPD traits, loneliness, and stressful life events. Future studies with a longitudinal design are warranted to shed more light on how these factors are implicated in the association between sexual orientation and PEs.
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Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux78180, France
- Research and development unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona08830, Spain
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Daragh McDermott
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK
| | - Josep Maria Haro
- Research and development unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona08830, Spain
| | - Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Ai Koyanagi
- Research and development unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona08830, Spain
- ICREA, Pg. Lluis Companys 23, Barcelona, Spain
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57
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Rodrigues M, Wiener JC, Stranges S, Ryan BL, Anderson KK. The risk of physical multimorbidity in people with psychotic disorders: A systematic review and meta-analysis. J Psychosom Res 2021; 140:110315. [PMID: 33307516 DOI: 10.1016/j.jpsychores.2020.110315] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/17/2020] [Accepted: 11/22/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The occurrence of multiple co-occurring chronic health conditions, known as multimorbidity, is associated with decreases in quality of life for patients and poses unique challenges for healthcare systems. Since people with psychotic disorders have an excess of physical health conditions compared to the general population, they may also be at a higher risk for multimorbidity. We conducted a systematic review and meta-analysis to quantify the prevalence and excess risk of multimorbidity among people with psychotic disorders, relative to those without psychosis. METHODS We searched the MEDLINE, EMBASE, and PsycINFO databases, and conducted forward and backward citation tracing of included studies. Studies published after 1990 were included if they reported the prevalence of multiple chronic physical health conditions among people with psychotic disorders. Data on the prevalence and relative risk of multimorbidity were meta-analyzed using random effects models. RESULTS Fourteen studies met the inclusion criteria, and eight were included in the meta-analysis. Each study used a different operational definition of multimorbidity, both for the number and types of chronic conditions, which resulted in a wide range in prevalence estimates (16% to 91%). People with psychotic disorders had an increased risk of multimorbidity (RR = 1.69, 95%CI = 1.37,2.08), relative to those without psychosis. CONCLUSIONS People with psychotic disorders are more likely to experience multimorbidity than those without psychotic disorders. Clinicians treating people with psychosis should closely monitor for a range of physical health conditions. Future research examining multimorbidity among people with psychiatric illness should employ consistent definitions to better enable cross-study comparisons.
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Affiliation(s)
- Myanca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Joshua C Wiener
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, Canada; Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, Canada; Department of Population Health, Luxembourg, Institute of Health, Strassen, Luxembourg
| | - Bridget L Ryan
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, Canada; Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, Canada; Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, Canada.
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58
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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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Bahlinger K, Lincoln TM, Krkovic K, Clamor A. Linking psychophysiological adaptation, emotion regulation, and subjective stress to the occurrence of paranoia in daily life. J Psychiatr Res 2020; 130:152-159. [PMID: 32823048 DOI: 10.1016/j.jpsychires.2020.07.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/12/2020] [Accepted: 07/17/2020] [Indexed: 12/22/2022]
Abstract
As stress is relevant to the formation of paranoia, maladaptive behavioral and physiological stress regulation is discussed as a crucial indicator of vulnerability. This is supported by research linking psychosis to the tendency to make less use of functional and more use of dysfunctional emotion regulation strategies (ER) and with a lower vagally-mediated heart rate variability (HRV). However, it remains unclear whether ER serves as a mediator between resting-state HRV on the one hand and subjective stress levels and paranoia on the other and whether this is specific to paranoia as compared to depression. We used an experience sampling method during seven days to repeatedly assess the experience of stress, usage of ER strategies, paranoia und depression (9/day) in a sample with subclinical positive symptoms (N = 32). Resting-state HRV was measured during a 5min interval in the laboratory. Data was analyzed by multi-level models. Higher resting-state HRV was predictive of lower stress-levels and of using more functional ER strategies (reappraisal, acceptance) in daily life, but did not predict the use of dysfunctional strategies (rumination, suppression) or paranoia. The association between resting-state HRV and stress was mediated by the usage of functional ER. Less functional and more dysfunctional ER were linked to higher levels of stress, paranoia and depression. Our study highlights that deficits in ER represent a link between psychophysiological and phenomenological aspects of paranoia but also of depression. This encourages to further investigate transdiagnostic prevention and therapy programs aiming to improve ER and to increase HRV.
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Affiliation(s)
- Katrin Bahlinger
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Sciences, Universität Hamburg, Germany.
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Sciences, Universität Hamburg, Germany
| | - Katarina Krkovic
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Sciences, Universität Hamburg, Germany
| | - Annika Clamor
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Sciences, Universität Hamburg, Germany
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60
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Schürhoff F, Pignon B, Lajnef M, Denis R, Rutten B, Morgan C, Murray RM, Leboyer M, van Os J, Szöke A. Psychotic Experiences Are Associated With Paternal Age But Not With Delayed Fatherhood in a Large, Multinational, Community Sample. Schizophr Bull 2020; 46:1327-1334. [PMID: 32049353 PMCID: PMC7505204 DOI: 10.1093/schbul/sbz142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Advanced paternal age has been consistently associated with an increased risk of schizophrenia. It is less known if such an association also exists with subclinical/attenuated forms of psychosis. Additionally, it has been suggested that it is not paternal age per se, but rather delayed fatherhood, as a marker of a genetic liability of psychosis, that is the cause of the association. The aim of the current study was to examine whether paternal age and/or delayed fatherhood (paternity age) predict self-reported positive, negative, and/or depressive dimensions of psychosis in a large sample from the general population. The sample (N = 1465) was composed of control subjects from the 6 countries participating in the European Union Gene-Environment Interaction study. The CAPE, a self-report questionnaire, was used to measure dimensions of subclinical psychosis. Paternal age at the time of respondents' birth and age of paternity were assessed by self-report. We assessed the influence of the variables of interest (paternal age or paternity age) on CAPE scores after adjusting for potential confounders (age, gender, and ethnicity). Paternal age was positively associated with the positive dimension of the CAPE. By contrast, paternity age was not associated with any of the psychosis dimensions assessed by the CAPE. Thus, our results do not support the idea that delayed fatherhood explains the association between age of paternity and psychosis risk. Furthermore, our results provide arguments for the hypothesis of an etiologic continuum of psychosis.
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Affiliation(s)
- Franck Schürhoff
- INSERM, U955, Translational Neuropsychiatry lab, Créteil, France
- AP-HP, DMU IMPACT, Psychiatry and Addictology Department, Mondor University Hospital, Créteil, France
- Fondation FondaMental, Créteil, France
- Univ Paris-Est Créteil, Faculté de médecine, Créteil, France
| | - Baptiste Pignon
- INSERM, U955, Translational Neuropsychiatry lab, Créteil, France
- AP-HP, DMU IMPACT, Psychiatry and Addictology Department, Mondor University Hospital, Créteil, France
- Fondation FondaMental, Créteil, France
- Univ Paris-Est Créteil, Faculté de médecine, Créteil, France
| | - Mohamed Lajnef
- INSERM, U955, Translational Neuropsychiatry lab, Créteil, France
| | - Romain Denis
- INSERM, U955, Translational Neuropsychiatry lab, Créteil, France
- AP-HP, DMU IMPACT, Psychiatry and Addictology Department, Mondor University Hospital, Créteil, France
- Fondation FondaMental, Créteil, France
- Univ Paris-Est Créteil, Faculté de médecine, Créteil, France
| | - Bart Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Marion Leboyer
- INSERM, U955, Translational Neuropsychiatry lab, Créteil, France
- AP-HP, DMU IMPACT, Psychiatry and Addictology Department, Mondor University Hospital, Créteil, France
- Fondation FondaMental, Créteil, France
- Univ Paris-Est Créteil, Faculté de médecine, Créteil, France
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Andrei Szöke
- INSERM, U955, Translational Neuropsychiatry lab, Créteil, France
- AP-HP, DMU IMPACT, Psychiatry and Addictology Department, Mondor University Hospital, Créteil, France
- Fondation FondaMental, Créteil, France
- Univ Paris-Est Créteil, Faculté de médecine, Créteil, France
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Taylor JH, Calkins ME, Gur RE. Markers of Psychosis Risk in the General Population. Biol Psychiatry 2020; 88:337-348. [PMID: 32220500 DOI: 10.1016/j.biopsych.2020.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 12/17/2019] [Accepted: 02/05/2020] [Indexed: 12/17/2022]
Abstract
The categorical approach to defining schizophrenia spectrum disorders requires meeting established criteria. To advance early identification and intervention in young people, the field has progressed to studying help-seeking individuals who are at clinical high risk based on subthreshold psychosis spectrum symptoms, and criteria have been articulated for qualifying individuals as at risk. A broader dimensional examination of psychosis has been applied to population-based studies on non-help seekers. This review highlights the ascertainment and assessment approaches to such population-based studies. Most studies are cross-sectional and rely on questionnaires with limited overlap of tools. However, several consistent findings emerge on symptoms, neurocognitive deficits, and neuroimaging parameters and other biomarkers associated with emergence and persistence of psychotic features. The findings are consistent with the literature on abnormalities associated with schizophrenia, including the presence of neurocognitive deficits; abnormalities in brain structure, function, and connectivity that are related to distress; impairment; and functional outcome. These findings support the validity of studying psychosis experiences during development in a way that can chart the emergence of psychosis in the context of general psychopathology. Such studies are necessary for establishing developmental trajectories that characterize this emergence and for identifying risk and resilience biomarkers moderating or modulating the full range of schizophrenia-related manifestations. More community-based studies are needed, with better standardization and harmonization of measures and incorporating longitudinal follow-up, to establish mechanistic links between cellular-molecular aberrations and specific manifestations of psychosis as envisioned by the precision medicine agenda.
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Affiliation(s)
- Jerome H Taylor
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, and Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Monica E Calkins
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, and Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Raquel E Gur
- Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, and Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
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Hides L, Baker A, Norberg M, Copeland J, Quinn C, Walter Z, Leung J, Stoyanov SR, Kavanagh D. A Web-Based Program for Cannabis Use and Psychotic Experiences in Young People (Keep It Real): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e15803. [PMID: 32723727 PMCID: PMC7424487 DOI: 10.2196/15803] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/20/2019] [Accepted: 11/27/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Young Australians (16-25 years) have the highest rates of past-month cannabis use in the world. Cannabis use increases the risk of alcohol and other drug disorders and depressive disorders, and has a robust dose-response association with psychotic experiences (PEs) and disorders. PEs are subthreshold positive psychotic symptoms, including delusions and hallucinations, which increase the risk of substance use, depressive or anxiety disorders, and psychotic disorders. Access to effective web-based early interventions targeting both cannabis use and PEs could reduce such risk in young people. OBJECTIVE The objective of this study is to determine the efficacy and cost-effectiveness of the Keep it Real web-based program compared to an information-only control website among young cannabis users (16-25 years) with PEs. METHODS Participants are recruited online, and consenting individuals meeting inclusion criteria (aged 16-25 years, who have used cannabis in the past month and experienced PEs in the past 3 months) are automatically randomized to either the Keep it Real web-based program (n=249) or an information-only control website (n=249). Both websites are self-guided (fully automated). The baseline and follow-up assessments at 3, 6, 9, and 12 months are self-completed online. Primary outcome measures are weekly cannabis use, PEs, and the relative cost-effectiveness for quality-adjusted life years. Secondary outcomes include other substance use and related problems, PE-related distress, cannabis intoxication experiences, severity of cannabis dependence, depression/anxiety symptoms, suicidality, and mental well-being and functioning. RESULTS Recruitment commenced in February 2019, and the results are expected to be submitted for publication in mid-2021. CONCLUSIONS This study protocol describes a large randomized controlled trial of a new web-based program for young cannabis users experiencing PEs. If effective, the accessibility and scalability of Keep it Real could help reduce growing public health concerns about the significant social, economic, and health impacts of cannabis use. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12618001107213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374800. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/15803.
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Affiliation(s)
- Leanne Hides
- Lives Lived Well Group, National Centre for Youth Substance Use Research, School of Psychology, The University of Queensland, Brisbane, Australia
| | - Amanda Baker
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Melissa Norberg
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Jan Copeland
- Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya, Australia
| | - Catherine Quinn
- Lives Lived Well Group, National Centre for Youth Substance Use Research, School of Psychology, The University of Queensland, Brisbane, Australia
| | - Zoe Walter
- Lives Lived Well Group, National Centre for Youth Substance Use Research, School of Psychology, The University of Queensland, Brisbane, Australia
| | - Janni Leung
- Lives Lived Well Group, National Centre for Youth Substance Use Research, School of Psychology, The University of Queensland, Brisbane, Australia
| | - Stoyan R Stoyanov
- Lives Lived Well Group, National Centre for Youth Substance Use Research, School of Psychology, The University of Queensland, Brisbane, Australia
| | - David Kavanagh
- Centre for Youth Substance Abuse Research, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Australia
- School of Psychology & Counselling, Queensland University of Technology, Brisbane, Australia
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63
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Knight C, Russo D, Stochl J, Croudace T, Fowler D, Grey N, Reeve N, Jones PB, Perez J. Prevalence of and recovery from common mental disorder including psychotic experiences in the UK Primary Care Improving Access to Psychological Therapies (IAPT) Programme. J Affect Disord 2020; 272:84-90. [PMID: 32379625 DOI: 10.1016/j.jad.2020.04.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/13/2020] [Accepted: 04/18/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Psychotic experiences (PE) may co-occur with common mental disorders (CMD), such as depression and anxiety. However, we know very little about the prevalence of and recovery from PE in primary mental health care settings, such as the Improving Access to Psychological Therapies (IAPT) services in the UK National Health Service (NHS), where most CMD are treated. METHODS We used the Community Assessment of Psychic Experiences - Positive 15-item Scale (CAPE-P15) to determine the prevalence of PE in patients receiving treatment from IAPT services. Patient-reported measures of depression (PHQ-9) and anxiety (GAD-7) are routinely collected and establish recovery in IAPT services. We studied recovery rates according to the absence and presence of PE. Multi-group growth models estimated improvement trajectories for each group. RESULTS A total of 2,042 patients with CMD completed the CAPE-P15. The mean age was 39.8. The overall prevalence of PE was 29.68%. The recovery rate was 27.43% compared to 62.08% for those without PE. Although patients with or without PE shared similar improvement trajectories, the initial severity of patients with PE impeded their likelihood of recovery. LIMITATIONS We mirrored routine data collection in IAPT services, including self-report questionnaires that may affect valid reporting of symptoms. Missing data in the calculation of improvement trajectories may reduce generalisability. CONCLUSIONS At least one in four patients receiving treatment from IAPT services in primary care experience CMD and PE. This significant group of people experience a lower recovery rate, with adverse implications not only for them but also for efficiency of services.
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Affiliation(s)
- Clare Knight
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK.
| | - Debra Russo
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK.
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK; National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England, Douglas House, Trumpinton Road, Cambridge, CB2 8AH, UK.
| | - Tim Croudace
- School of Nursing and Health Sciences, University of Dundee, Dundee, DD1 4HJ, UK.
| | - David Fowler
- School of Psychology, Pevensey Building, University of Sussex, Brighton, BN1 9QH, UK.
| | - Nick Grey
- Sussex Partnership NHS Foundation Trust, Aldrington House, 35 New Church Road, Hove, BN3 4AG, UK.
| | - Nesta Reeve
- Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Drayton High Road, Norwich, NR6 5BE, UK.
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK; National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England, Douglas House, Trumpinton Road, Cambridge, CB2 8AH, UK; Cambrigeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn Hospital, Cambridge, CB21 5EF, UK.
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK; National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England, Douglas House, Trumpinton Road, Cambridge, CB2 8AH, UK; Cambrigeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn Hospital, Cambridge, CB21 5EF, UK; Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ.
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64
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Coughlan H, Healy C, Ní Sheaghdha Á, Murray G, Humphries N, Clarke M, Cannon M. Early risk and protective factors and young adult outcomes in a longitudinal sample of young people with a history of psychotic-like experiences. Early Interv Psychiatry 2020; 14:307-320. [PMID: 31310453 DOI: 10.1111/eip.12855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 04/28/2019] [Accepted: 06/09/2019] [Indexed: 12/13/2022]
Abstract
AIM Psychotic-like experiences (PEs) have been associated with childhood adversity and psychopathology. However, few studies have examined the dynamic interplay between risk and protective factors and later life outcomes in people with PEs. This study aimed to explore and compare patterns of early adverse and protective experiences and young adult outcomes in a sample of young people with a history of PEs. METHOD Longitudinal qualitative data spanning nine years were collected from a general population sample of seventeen young adults who had reported PEs in early adolescence. A qualitative comparative case study design was used to explore patterns of early life experiences and young adult outcomes. RESULTS Four archetypal profiles of early life experiences and later outcomes were identified. Qualitative differences between types of early adverse experiences and the quality of attachment relationships were dominant discriminating factors between low-risk and at-risk archetypes for poor young adult outcomes. Experiences of multiple adversities, which included childhood trauma and occurred in the absence of secure attachment relationships was associated with the poorest young adult outcomes. The presence of secure attachment relationships was protective, even among individuals who had experienced adversity. CONCLUSIONS Not all young people who report PEs have high levels of adversity. Those who experience multiple early adversities, childhood trauma and insecure attachment relationships are at highest risk for reoccurring PEs and poor young adult outcomes. Developing trusted attachment relationships and engaging in corrective experiences may be protective and could promote positive outcomes in youth with PEs.
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Affiliation(s)
- Helen Coughlan
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Áine Ní Sheaghdha
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gareth Murray
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh Humphries
- Research Department, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Mary Clarke
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Psychiatry, Beaumont Hospital Dublin, Dublin, Ireland
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65
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O'Brien KJ, Barch DM, Kandala S, Karcher NR. Examining Specificity of Neural Correlates of Childhood Psychotic-like Experiences During an Emotional n-Back Task. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 5:580-590. [PMID: 32354687 DOI: 10.1016/j.bpsc.2020.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Psychotic-like experiences (PLEs) during childhood are associated with greater risk of developing a psychotic disorder in adulthood, highlighting the importance of identifying neural correlates of childhood PLEs. Furthermore, impairment of cognitive functions, such as working memory and emotion regulation, has also been linked to psychosis risk as well as to disruptions in several brain regions. However, impairments in these domains have also been linked to other disorders, including depression. Therefore, the aim of the current study was to examine whether neural impairments in regions associated with working memory and implicit emotion regulation impairments are specific to PLEs versus depression. METHODS The current study used an emotional n-back task to examine the relationship between childhood PLEs and neural activation of regions involved in both working memory and implicit emotion regulation using data from 8805 9- to 11-year-olds in the Adolescent Brain Cognitive Development (ABCD) Study 2.0 release. To examine specificity, we also analyzed associations with depressive symptoms. RESULTS Our results indicated that increased PLEs during middle childhood were associated with decreased activation of the dorsolateral prefrontal cortex, striatum, and pallidum during trials requiring working memory. In contrast, increased activation of the parahippocampus, caudate, nucleus accumbens, and rostral anterior cingulate during face-viewing trials was associated with increased depressive symptoms. CONCLUSIONS These results support the dimensional view of psychosis across the lifespan, providing evidence that neural correlates of PLEs, such as decreased activation during working memory, are present during middle childhood. Furthermore, these correlates are specific to psychotic-like symptoms as compared with depressive symptoms.
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Affiliation(s)
- Kathleen J O'Brien
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.
| | - Deanna M Barch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; Department of Psychology, Washington University, St. Louis, Missouri
| | - Sridhar Kandala
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Nicole R Karcher
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
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Ma Q, Tang Y, Wang F, Liao X, Jiang X, Wei S, Mechelli A, He Y, Xia M. Transdiagnostic Dysfunctions in Brain Modules Across Patients with Schizophrenia, Bipolar Disorder, and Major Depressive Disorder: A Connectome-Based Study. Schizophr Bull 2020; 46:699-712. [PMID: 31755957 PMCID: PMC7147584 DOI: 10.1093/schbul/sbz111] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Psychiatric disorders, including schizophrenia (SCZ), bipolar disorder (BD), and major depressive disorder (MDD), share clinical and neurobiological features. Because previous investigations of functional dysconnectivity have mainly focused on single disorders, the transdiagnostic alterations in the functional connectome architecture of the brain remain poorly understood. We collected resting-state functional magnetic resonance imaging data from 512 participants, including 121 with SCZ, 100 with BD, 108 with MDD, and 183 healthy controls. Individual functional brain connectomes were constructed in a voxelwise manner, and the modular architectures were examined at different scales, including (1) global modularity, (2) module-specific segregation and intra- and intermodular connections, and (3) nodal participation coefficients. The correlation of these modular measures with clinical scores was also examined. We reliably identify common alterations in modular organization in patients compared to controls, including (1) lower global modularity; (2) lower modular segregation in the frontoparietal, subcortical, visual, and sensorimotor modules driven by more intermodular connections; and (3) higher participation coefficients in several network connectors (the dorsolateral prefrontal cortex and angular gyrus) and the thalamus. Furthermore, the alterations in the SCZ group are more widespread than those of the BD and MDD groups and involve more intermodular connections, lower modular segregation and higher connector integrity. These alterations in modular organization significantly correlate with clinical scores in patients. This study demonstrates common hyper-integrated modular architectures of functional brain networks among patients with SCZ, BD, and MDD. These findings reveal a transdiagnostic mechanism of network dysfunction across psychiatric disorders from a connectomic perspective.
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Affiliation(s)
- Qing Ma
- National Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Yanqing Tang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Fei Wang
- Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China
- Brain Function Research Section, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xuhong Liao
- National Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Xiaowei Jiang
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Shengnan Wei
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Andrea Mechelli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Yong He
- National Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Mingrui Xia
- National Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
- Beijing Key Laboratory of Brain Imaging and Connectomics, Beijing Normal University, Beijing, China
- IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
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Wigman J, Wardenaar K, Wanders R, Booij S, Jeronimus B, van der Krieke L, Wichers M, de Jonge P. Dimensional and discrete variations on the psychosis continuum in a Dutch crowd-sourcing population sample. Eur Psychiatry 2020; 42:55-62. [DOI: 10.1016/j.eurpsy.2016.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/24/2016] [Accepted: 11/27/2016] [Indexed: 12/18/2022] Open
Abstract
AbstractBackgroundMild psychotic experiences are common in the general population. Although transient and benign in most cases, these experiences are predictive of later mental health problems for a significant minority. The goal of the present study was to perform examinations of the dimensional and discrete variations in individuals’ reporting of subclinical positive and negative psychotic experiences in a unique Dutch internet-based sample from the general population.MethodsPositive and negative subclinical psychotic experiences were measured with the Community Assessment of Psychic Experiences in 2870 individuals. First, the prevalence of these experiences and their associations with demographics, affect, psychopathology and quality of life were investigated. Next, latent class analysis was used to identify data-driven subgroups with different symptom patterns, which were subsequently compared on aforementioned variables.ResultsSubclinical psychotic experiences were commonly reported. Both positive and negative psychotic experiences were associated with younger age, more negative affect, anxiety and depression as well as less positive affect and poorer quality of life. Seven latent classes (‘Low psychotic experiences’, ‘Lethargic’, ‘Blunted’, ‘Distressed’, ‘Paranormal’, ‘Distressed_grandiose’ and ‘Distressed/positive psychotic experiences’) were identified that demonstrated both dimensional differences in the number/severity of psychotic experiences and discrete differences in the patterns of reported experiences.ConclusionSubclinical psychotic experiences show both dimensional severity variations and discrete symptom-pattern variations across individuals. To understand and capture all interindividual variations in subclinical psychotic experiences, their number, nature and context (co-occurrence patterns) should be considered at the same time. Only some psychotic experiences may lay on a true psychopathological psychosis continuum.
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Prochwicz K, Kłosowska J. Attentional focus moderates the relationship between attention to threat bias and delusion-like experiences in healthy adults. Eur Psychiatry 2020; 39:27-32. [DOI: 10.1016/j.eurpsy.2016.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 06/23/2016] [Accepted: 06/29/2016] [Indexed: 10/20/2022] Open
Abstract
AbstractBackgroundThe role of cognitive biases in delusion and delusion-like experiences has been widely investigated in recent years. However, little is known about individual differences, which may influence association between cognitive biases and formation of delusional beliefs. The aim of this study was to examine the moderating effect of self-reported attentional control on the relationship between attention to threat bias (ATB) and delusion-like experiences (DLEs) in healthy adults.MethodsParticipants (n = 138) completed the Davos Assessment of the Cognitive Biases Scale (DACOBS), the Attentional Control Scale (ACS) and the Peters et al. Delusions Inventory (PDI). The moderation analysis was performed to check the influence of different components of attentional control (i.e. general ability to allocate attention, focusing, shifting and divide attention) on the interplay between ATB and DLEs.ResultsThe results supported the moderation model. Specifically, we found that a higher level of ability to focus attention is associated with a stronger effect of attention to threat bias on the overall frequency of DLEs. Our results indicate that ATB contributes to the number of DLEs only in individuals with high and moderate capacity to focus attention, whereas in those who scored low on the ACS focusing attention subscale, the presence of attentional bias does not influence the frequency of DLEs.ConclusionsOur findings show that the individual difference variable, such as ability to voluntarily focus attention, may moderate the relationship between attention to threat bias and delusion-like experiences in healthy adults.
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Checking the predictive accuracy of basic symptoms against ultra high-risk criteria and testing of a multivariable prediction model: Evidence from a prospective three-year observational study of persons at clinical high-risk for psychosis. Eur Psychiatry 2020; 45:27-35. [DOI: 10.1016/j.eurpsy.2017.05.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 05/22/2017] [Accepted: 05/23/2017] [Indexed: 12/25/2022] Open
Abstract
AbstractBackground:The aim of this study was to critically examine the prognostic validity of various clinical high-risk (CHR) criteria alone and in combination with additional clinical characteristics.Methods:A total of 188 CHR positive persons from the region of Zurich, Switzerland (mean age 20.5 years; 60.2% male), meeting ultra high-risk (UHR) and/or basic symptoms (BS) criteria, were followed over three years. The test battery included the Structured Interview for Prodromal Syndromes (SIPS), verbal IQ and many other screening tools. Conversion to psychosis was defined according to ICD-10 criteria for schizophrenia (F20) or brief psychotic disorder (F23).Results:Altogether n = 24 persons developed manifest psychosis within three years and according to Kaplan–Meier survival analysis, the projected conversion rate was 17.5%. The predictive accuracy of UHR was statistically significant but poor (area under the curve [AUC] = 0.65, P < .05), whereas BS did not predict psychosis beyond mere chance (AUC = 0.52, P = .730). Sensitivity and specificity were 0.83 and 0.47 for UHR, and 0.96 and 0.09 for BS. UHR plus BS achieved an AUC = 0.66, with sensitivity and specificity of 0.75 and 0.56. In comparison, baseline antipsychotic medication yielded a predictive accuracy of AUC = 0.62 (sensitivity = 0.42; specificity = 0.82). A multivariable prediction model comprising continuous measures of positive symptoms and verbal IQ achieved a substantially improved prognostic accuracy (AUC = 0.85; sensitivity = 0.86; specificity = 0.85; positive predictive value = 0.54; negative predictive value = 0.97).Conclusions:We showed that BS have no predictive accuracy beyond chance, while UHR criteria poorly predict conversion to psychosis. Combining BS with UHR criteria did not improve the predictive accuracy of UHR alone. In contrast, dimensional measures of both positive symptoms and verbal IQ showed excellent prognostic validity. A critical re-thinking of binary at-risk criteria is necessary in order to improve the prognosis of psychotic disorders.
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Pionke R, Gidzgier P, Nelson B, Gawęda Ł. Prevalence, dimensionality and clinical relevance of self-disturbances and psychotic-like experiences in Polish young adults: a latent class analysis approach. Int J Methods Psychiatr Res 2020; 29:e1809. [PMID: 31808220 PMCID: PMC7051838 DOI: 10.1002/mpr.1809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 08/23/2019] [Accepted: 09/20/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES We aimed to investigate latent classes of psychotic-like experiences (PLEs) and self-disturbances (SD) and to explore mutual overlapping between derived subgroups. Further, our goal was to investigate class membership relationship with an exposure to childhood trauma and different psychopathological factors such as cognitive biases, depression, insomnia, psychiatric diagnosis and lifetime suicidality. METHODS Participants consist of 3167 non-clinical adults. We performed two latent class analyses (LCA), for PLEs and SD separately, to identify subgroups of individuals with different profiles on PLEs and SD. Associations between psychopathological factors and latent class membership were examined using multinomial logistic regression analysis. RESULTS LCA produced 5 classes within SD and 3 classes within PLEs. Class of the highest endorsement of SD showed 53% overlap with class of the highest endorsement of PLEs. The highest risk of belonging to High Class for both SD and PLEs was associated in particular with depression, cognitive biases and insomnia. Trauma emerged as a significant predictor only for PLEs classes. CONCLUSIONS Our findings confirm that high PLEs and SD co-occur and are concentrated in a relatively small number of individuals, at least in the general population. Their combination may capture the highest risk of psychosis in the general population.
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Affiliation(s)
- Renata Pionke
- Psychopathology and Early Intervention Lab, II Department of Psychiatry, The Medical University of Warsaw, Poland
| | - Piotr Gidzgier
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Łukasz Gawęda
- Clinical Neuroscience Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
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Comorbidity rates of depression and anxiety in first episode psychosis: A systematic review and meta-analysis. Schizophr Res 2020; 216:322-329. [PMID: 31791816 DOI: 10.1016/j.schres.2019.11.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/09/2019] [Accepted: 11/22/2019] [Indexed: 01/09/2023]
Abstract
Anxiety and depression symptoms are frequently experienced by individuals with psychosis, although prevalence rates have not been reviewed in first-episode psychosis (FEP). The aim of this systematic review was to focus on the prevalence rates for both anxiety and depression, comparing the rates within the same study population. A systematic review and meta-analysis was completed for all studies measuring both anxiety and depression in FEP at baseline. The search identified 6040 citations, of which n = 10 met inclusion criteria. These reported 1265 patients (age 28.3 ± 9.1, females: 39.9%) with diagnosed FEP. Studies which used diagnosis to define comorbidity count were included in separate meta-analyses for anxiety and depression, although the heterogeneity was high limiting interpretation of separate prevalence rates. A random-effects meta-analysis also compared the mean difference between anxiety and depression within the same studies. We show that anxiety and depression co-occur at a similar rate within FEP, although the exact rates are not reliable due to the heterogeneity between the small number of studies. Future research in FEP should consider routinely measuring anxiety and depression using continuous self-report measures of symptoms. Clinically we recommend that both anxiety and depression are equally targeted during psychological intervention in FEP, together with the psychotic symptoms.
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Isaksson J, Vadlin S, Olofsdotter S, Åslund C, Nilsson KW. Psychotic-like experiences during early adolescence predict symptoms of depression, anxiety, and conduct problems three years later: A community-based study. Schizophr Res 2020; 215:190-196. [PMID: 31677809 DOI: 10.1016/j.schres.2019.10.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 08/23/2019] [Accepted: 10/12/2019] [Indexed: 12/28/2022]
Abstract
Psychotic-like experiences (PLEs), such as delusions and hallucinations, are risk markers for psychiatric symptoms and functional impairment. However, the unique contribution of PLEs to psychiatric symptoms remains unclear. Thus, the aim of this study was to investigate the effect of PLEs on psychiatric symptoms, adjusting for the baseline of such symptoms. We assessed a community-based cohort of young adolescents (N = 1445; mean age = 14.38 years, SD = 1.04) to establish a baseline and reassessed them three years later (mean age = 17.31 years, SD = 1.04). Participants reported PLEs they had experienced in the last year and any internalizing (depression and anxiety) or externalizing (attention-deficit/hyperactivity disorder and conduct problems) psychiatric symptoms. The experience of more PLEs predicted more internalizing symptoms three years later, and to a lesser extent, more conduct problems as well, even when adjusting for the baseline occurrence of these symptoms. The association was not sex-specific, although girls reported more PLEs than did boys. The strongest predictor of internalizing/externalizing symptoms was the occurrence of those same symptoms at baseline. These findings highlight the importance of PLEs as markers for a wide range of psychiatric symptoms, emphasizing the importance of assessing PLEs in early adolescence.
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Affiliation(s)
- Johan Isaksson
- Department of Neuroscience, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden.
| | - Sofia Vadlin
- Centre for Clinical Research, Västmanland County Hospital Västerås, Uppsala University, Sweden
| | - Susanne Olofsdotter
- Centre for Clinical Research, Västmanland County Hospital Västerås, Uppsala University, Sweden
| | - Cecilia Åslund
- Centre for Clinical Research, Västmanland County Hospital Västerås, Uppsala University, Sweden
| | - Kent W Nilsson
- Centre for Clinical Research, Västmanland County Hospital Västerås, Uppsala University, Sweden
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Bourgin J, Tebeka S, Mallet J, Mazer N, Dubertret C, Le Strat Y. Prevalence and correlates of psychotic-like experiences in the general population. Schizophr Res 2020; 215:371-377. [PMID: 31477372 DOI: 10.1016/j.schres.2019.08.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 06/16/2019] [Accepted: 08/19/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND To what extent Psychotic Like Experiences (PLEs) are associated with nonpsychotic psychiatric disorders and whether the number of PLEs is associated with higher rates of psychiatric disorders remains unclear. METHODS The sample was composed of 34,653 civilian participants, aged 18 years and older from wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). This was a representative sample of the non-institutionalized U.S. POPULATION Twenty-two PLEs were assessed. Lifetime prevalence of psychiatric disorders (any mood, anxiety, substance use and personality disorders, PTSD, ADHD, and suicide attempts) according to the number of PLEs were calculated. RESULTS Almost a third (26.69%) of respondents reported experiencing at least one type of PLEs. There was a gradual association between the number of PLEs and the presence of a nonpsychotic psychiatric disorder (ranging from 5.68%in participants with no PLEs up to 99.53% in those with five or more PLEs). This association with PLE was significant for each of the 25 psychiatric disorders examined regardless of the number of PLEs. Lifetime prevalence of PLEs were significantly higher among the younger respondents, women, non-married, unemployed, high educational level and those with low family income. CONCLUSION There is a gradual increase in the magnitude of the association of the numbers of PLEs for each of the 25 nonpsychotic psychiatric disorders examined. Having at least one PLE is strongly associated with the presence of a psychiatric disorder.
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Affiliation(s)
- Julie Bourgin
- Department of Psychiatry, Louis-Mourier Hospital, AP-HP, 92700 Colombes, France; Faculty of Medicine, Paris Diderot University, 75013 Paris, France; INSERM U894, Centre for Psychiatry and Neurosciences, 102 rue de la Santé, 75014 Paris, France
| | - Sarah Tebeka
- Department of Psychiatry, Louis-Mourier Hospital, AP-HP, 92700 Colombes, France; Faculty of Medicine, Paris Diderot University, 75013 Paris, France; INSERM U894, Centre for Psychiatry and Neurosciences, 102 rue de la Santé, 75014 Paris, France.
| | - Jasmina Mallet
- Department of Psychiatry, Louis-Mourier Hospital, AP-HP, 92700 Colombes, France; Faculty of Medicine, Paris Diderot University, 75013 Paris, France; INSERM U894, Centre for Psychiatry and Neurosciences, 102 rue de la Santé, 75014 Paris, France
| | - Nicolas Mazer
- Department of Psychiatry, Louis-Mourier Hospital, AP-HP, 92700 Colombes, France; Faculty of Medicine, Paris Diderot University, 75013 Paris, France; INSERM U894, Centre for Psychiatry and Neurosciences, 102 rue de la Santé, 75014 Paris, France
| | - Caroline Dubertret
- Department of Psychiatry, Louis-Mourier Hospital, AP-HP, 92700 Colombes, France; Faculty of Medicine, Paris Diderot University, 75013 Paris, France; INSERM U894, Centre for Psychiatry and Neurosciences, 102 rue de la Santé, 75014 Paris, France
| | - Yann Le Strat
- Department of Psychiatry, Louis-Mourier Hospital, AP-HP, 92700 Colombes, France; Faculty of Medicine, Paris Diderot University, 75013 Paris, France; INSERM U894, Centre for Psychiatry and Neurosciences, 102 rue de la Santé, 75014 Paris, France
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Moritz S, Gawęda Ł, Heinz A, Gallinat J. Four reasons why early detection centers for psychosis should be renamed and their treatment targets reconsidered: we should not catastrophize a future we can neither reliably predict nor change. Psychol Med 2019; 49:2134-2140. [PMID: 31337458 DOI: 10.1017/s0033291719001740] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Since the 1990s, facilities for individuals at putative risk for psychosis have mushroomed and within a very short time have become part of the standard psychiatric infrastructure in many countries. The idea of preventing a severe mental disorder before its exacerbation is laudable, and early data indeed strongly suggested that the sooner the intervention, the better the outcome. In this paper, the authors provide four reasons why they think that early detection or prodromal facilities should be renamed and their treatment targets reconsidered. First, the association between the duration of untreated psychosis and outcome is empirically established but has become increasingly weak over the years. Moreover, its applicability to those who are considered at risk remains elusive. Second, instruments designed to identify future psychosis are prone to many biases that are not yet sufficiently controlled. None of these instruments allows an even remotely precise prognosis. Third, the rate of transition to psychosis in at-risk patients is likely lower than initially thought, and evidence for the success of early intervention in preventing future psychosis is promising but still equivocal. Perhaps most importantly, the treatment is not hope-oriented. Patients are more or less told that schizophrenia is looming over them, which may stigmatize individuals who will never, in fact, develop psychosis. In addition self-stigma has been associated with suicidality and depression. The authors recommend that treatment of help-seeking individuals with mental problems but no established diagnosis should be need-based, and the risk of psychosis should be de-emphasized as it is only one of many possible outcomes, including full remission. Prodromal clinics should not be abolished but should be renamed and restructured. Such clinics exist, but the transformation process needs to be facilitated.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Łukasz Gawęda
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Psychopathology and Early Intervention Lab, II Department of Psychiatry, The Medical University of Warsaw, Warsaw, Poland
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Charitéplatz, Berlin, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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'False-positive' self-reported psychotic experiences in the general population: an investigation of outcome, predictive factors and clinical relevance. Epidemiol Psychiatr Sci 2019; 28:532-543. [PMID: 29656729 PMCID: PMC6998918 DOI: 10.1017/s2045796018000197] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIMS. Self-reported psychotic experiences (SRPE) by individuals from the general population are often unconfirmed by clinical interview and referred to as 'false-positive' (FP) SRPE. FP SRPE have been suggested to represent the mildest form of risk along the extended psychosis continuum. However, little is known about their (clinical) outcome and evolution over time. Aims of this study were to prospectively examine, in individuals with FP SRPE, (1) the prevalence of remission, persistence and transition to validated PE at 3-year follow-up; (2) potential baseline psychopathological and psychosocial predictors of persistence of FP SRPE and transition to validated PE; and (3) whether those with persistent FP SRPE and validated PE already differed on psychopathology and psychosocial factors at baseline. We tested the hypotheses that (i) individuals with FP SRPE would be more likely to have SRPE and validated PE at follow-up; and (ii) that FP SRPE would be predictive of lower functioning and more psychopathology and help-seeking behaviour at follow-up. METHODS. Baseline (n = 6646) and 3-year follow-up (n = 5303) data of the second the Netherlands Mental Health Survey and Incidence Study (NEMESIS-2), a general population research project on prevalence, incidence, course and consequences of psychiatric disorders was used. Self-report of PE was followed by clinical interview to determine clinical validity. The presence of mood, anxiety and substance use disorders, childhood adversity, help-seeking and functioning as well as PE characteristics (number, frequency, distress and impact) were used in the analyses which included only individuals with complete data for both assessments waves (n = 4683). RESULTS. At baseline, 454 participants had any FP SRPE; of these 372 participants had complete follow-up data available. Those with baseline FP SRPE were significantly more likely to report SRPE (OR = 3.58; 95% CI 2.38-5.40, p < 0.001) and validated PE (OR = 6.26; 95% CI 3.91-10.02, p < 0.001) at follow-up. Baseline FP SRPE also predicted the presence of mood and anxiety disorders, reduced functioning and help-seeking at follow-up. Several baseline psychopathological, psychosocial and PE characteristics were predictive for the persistence of SRPE. These factors also differentiated groups with FP SRPE or validated PE from those with remitted FP SRPE at follow-up. CONCLUSIONS. 'FP SRPE' are not truly 'false' as they index risk for the development of clinically relevant psychotic symptoms, development of mood and anxiety disorders and reduced functioning. Self-reported PE, even unconfirmed, warrant 'watchful waiting' and follow-up over time, especially when they are reported by individuals with reduced psychosocial functioning and general psychiatric problems.
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Healy C, Gordon AA, Coughlan H, Clarke M, Kelleher I, Cannon M. Do childhood psychotic experiences improve the prediction of adolescent psychopathology? A longitudinal population-based study. Early Interv Psychiatry 2019; 13:1245-1251. [PMID: 30488567 DOI: 10.1111/eip.12762] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 09/14/2018] [Accepted: 11/04/2018] [Indexed: 12/19/2022]
Abstract
AIMS (a) To investigate the utility of childhood PE as a predictor of adolescent psychopathology while accounting for three known risk factors: childhood mental disorder; traumatic experiences and poor childhood functioning, and (b) to investigate the additive effects of including childhood PE in predictive clinical model of adolescent psychopathology. METHOD The study sample comprised of 86 Irish youths who completed two waves of the "Adolescent Brain Development" study (baseline age: 11.7 and follow-up age: 15.7). At baseline, participants completed a clinical interview assessing for PE, mental disorders, traumatic experiences and global functioning in childhood. The internalizing and externalizing problems sub-scales from the Youth Self Report questionnaire were used as follow-up outcomes variables in adolescence. RESULTS Logistic regression analyses revealed that childhood PE was the only predictor significantly associated with both internalizing (univariate OR: 7.58, CI: 2.59-22.15; multivariate OR: 5.43, CI: 1.53-19.29) and externalizing (univariate OR: 11.76, CI: 3.70-37.41; multivariate OR: 30.39, CI: 5.28-174.80) problems in adolescence. All predictive models with PE significantly predicted adolescent outcomes (area under the curve range: 0.70-0.81; all P < 0.05) and adding PE to the models improved the predictive value for externalizing problems (P = 0.02). CONCLUSION Childhood PE is a powerful predictor of adolescent psychopathology, particularly for externalizing problems. Routine assessment of PE and targeted support for children who report PE may reduce the incidence of mental disorder in adolescence.
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Affiliation(s)
- Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Aoife A Gordon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Helen Coughlan
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Mary Clarke
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland.,Department of Psychology, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Ian Kelleher
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland.,Department of Psychiatry, Beaumont Hospital, Dublin 9, Ireland
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Reininghaus U, Rauschenberg C, Ten Have M, de Graaf R, van Dorsselaer S, Simons CJP, Gunther N, Pries LK, Guloksuz S, Radhakrishnan R, Bak M, van Os J. Reasoning bias, working memory performance and a transdiagnostic phenotype of affective disturbances and psychotic experiences in the general population. Psychol Med 2019; 49:1799-1809. [PMID: 30160228 DOI: 10.1017/s0033291718002209] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The jumping to conclusions (JTC) reasoning bias and decreased working memory performance (WMP) are associated with psychosis, but associations with affective disturbances (i.e. depression, anxiety, mania) remain inconclusive. Recent findings also suggest a transdiagnostic phenotype of co-occurring affective disturbances and psychotic experiences (PEs). This study investigated whether JTC bias and decreased WMP are associated with co-occurring affective disturbances and PEs. METHODS Data were derived from the second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2). Trained interviewers administered the Composite International Diagnostic Interview (CIDI) at three time points in a general population sample (N = 4618). The beads and digit-span task were completed to assess JTC bias and WMP, respectively. CIDI was used to measure affective disturbances and an add-on instrument to measure PEs. RESULTS Compared to individuals with neither affective disturbances nor PEs, the JTC bias was more likely to occur in individuals with co-occurring affective disturbances and PEs [moderate psychosis (1-2 PEs): adjusted relative risk ratio (RRR) 1.17, 95% CI 0.98-1.41; and high psychosis (3 or more PEs or psychosis-related help-seeking behaviour): adjusted RRR 1.57, 95% CI 1.19-2.08], but not with affective disturbances and PEs alone, whereas decreased WMP was more likely in all groups. There was some evidence of a dose-response relationship, as JTC bias and decreased WMP were more likely in individuals with affective disturbances as the level of PEs increased or help-seeking behaviour was reported. CONCLUSION The findings suggest that JTC bias and decreased WMP may contribute to a transdiagnostic phenotype of co-occurring affective disturbances and PEs.
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Affiliation(s)
- Ulrich Reininghaus
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Christian Rauschenberg
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Margreet Ten Have
- Department of Epidemiology,Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands
| | - Ron de Graaf
- Department of Epidemiology,Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands
| | - Saskia van Dorsselaer
- Department of Epidemiology,Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands
| | - Claudia J P Simons
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Nicole Gunther
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Lotta-Katrin Pries
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Sinan Guloksuz
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Rajiv Radhakrishnan
- Department of Psychiatry,Yale University School of Medicine,New Haven, CT,USA
| | - Maarten Bak
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
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Wang C, Wang Q, Li X, Zhang Y, Wei W, Deng W, Guo W, He L, Tang W, Chen T, Li T. Rural birth/upbringing and childhood adversities are associated with psychotic experiences in university students in China. Schizophr Res 2019; 209:105-112. [PMID: 31101515 DOI: 10.1016/j.schres.2019.05.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 03/28/2019] [Accepted: 05/05/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Urbanicity has been reported to associate with an increased risk of psychotic experiences (PEs) in developed countries but less is known about the situation in developing countries. The present study aimed to investigate the effects of birth/upbringing place and other environmental factors on PEs in Chinese university students. METHODS A computer-assisted cross-sectional survey was conducted on 4620 second-year undergraduates, using a stratified cluster sampling. Birth places and residential mobility before 16 years old were recorded. PEs were measured using the subscales of psychoticism and paranoid ideation in the Symptom Checklist-90-R (SCL-90-R). Six questions extracted from the childhood section of the World Mental Health Composite International Diagnostic Interview (WMH-CIDI) were used to assess childhood trauma. RESULTS Generalized ordered logit model of multiple regression analysis revealed that participants with rural birth/upbringing (e.g. rural upbringing, on graded factor score of psychoticism and paranoid ideation [GFSPPI], 0 versus 1 & 2, odds ratio [OR] 1.409, 95% CI 1.219-1.628, p < 0.00001; 0 & 1 versus 2, OR 1.584, 95% CI 1.179-2.128, p < 0.00001) and those who reported childhood trauma (e.g. on GFSPPI, 0 versus 1 & 2, OR 1.737, 95% CI 1.498-2.014, p < 0.00001; 0 & 1 versus 2, OR 1.618, 95% CI 1.224-2.140, p < 0.00001) were apt to present more severe PEs. While upbringing places and childhood trauma affected both the presence and the severity of PEs, gender affected the presence or absence of PEs only (e.g. females, on GFSPPI, 0 versus 1 & 2, OR 1.887, 95% CI 1.631-2.183, p < 0.00001; 0 & 1 versus 2, OR 0.927, 95% CI 0.702-1.223, p = 0.593). Besides, the number of risk factors was associated with the severity of PEs in the cumulative odds logistic regression analysis (e.g. 3 risk factors versus 0 risk factor, on GFSPPI, OR 4.126, 95% CI 3.075-5.537, p < 0.00001). CONCLUSIONS Female, rural birth/upbringing and childhood trauma are risk factors of PEs in university students in China. The discrepancy in the findings between developed countries and China has important implications for urbanicity as a risk factor for PEs.
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Affiliation(s)
- Chengyu Wang
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China; The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, Guangdong, China; Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Qiang Wang
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| | - Xiaojing Li
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yamin Zhang
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wei Wei
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wei Deng
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wanjun Guo
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Lingshuang He
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wanjie Tang
- Centre for Educational and Health Psychology, Sichuan University, Chengdu, Sichuan, China
| | - Ting Chen
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Tao Li
- Mental Health Center and Psychiatric Laboratory, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China; West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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Soneson E, Russo D, Knight C, Lafortune L, Heslin M, Stochl J, Georgiadis A, Galante J, Duschinsky R, Grey N, Gonzalez-Blanco L, Couche J, Griffiths M, Murray H, Reeve N, Hodgekins J, French P, Fowler D, Byford S, Dixon-Woods M, Jones PB, Perez J. Psychological interventions for people with psychotic experiences: protocol for a systematic review and meta-analysis. Syst Rev 2019; 8:124. [PMID: 31122287 PMCID: PMC6533690 DOI: 10.1186/s13643-019-1041-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/10/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Many people who have common mental disorders, such as depression and anxiety, also have some psychotic experiences. These experiences are associated with higher clinical complexity, poor treatment response, and negative clinical outcomes. Psychological interventions have the potential to improve outcomes for people with psychotic experiences. The aims of this systematic review are to (1) synthesise the evidence on the effectiveness and cost-effectiveness of psychological interventions to reduce psychotic experiences and their associated distress and (2) identify key components of effective interventions. METHODS Our search strategy will combine terms for (1) psychological interventions, (2) psychotic experiences, and (3) symptoms associated with psychotic experiences. We will search the following online databases: MEDLINE, Embase, PsycINFO, all Cochrane databases, British Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Management Information Consortium (HMIC), Education Resources Information Center (ERIC), and EconLit. Our primary outcome is the proportion of people who recovered or remitted from psychotic experiences after the intervention. Our secondary outcomes are changes in positive psychotic symptoms, negative psychotic symptoms, depression, anxiety, functioning (including social, occupational, and academic), quality of life, and cost-effectiveness. Two independent reviewers will judge each study against pre-specified inclusion and exclusion criteria and will extract study characteristics, outcome data, and intervention components. Risk of bias and methodological quality will be assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies and the Drummond Checklist. Results will be synthesised using random-effects meta-analysis and narrative synthesis. DISCUSSION The identification of effective psychological interventions and of specific components associated with intervention effectiveness will augment existing evidence that can inform the development of a new, tailored intervention to improve outcomes related to psychotic symptoms, anxiety and depression, distress, functioning, and quality of life. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016033869.
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Affiliation(s)
- Emma Soneson
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK.
| | - Debra Russo
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK.
| | - Clare Knight
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Louise Lafortune
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Margaret Heslin
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Alex Georgiadis
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, CB2 0AH, UK
| | - Julieta Galante
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Robbie Duschinsky
- The Primary Care Unit, Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Box 113, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | | | - Leticia Gonzalez-Blanco
- Department of Psychiatry, University of Oviedo - CIBERSAM - Servicio de Salud del Principado de Asturias, Oviedo, Spain
| | - Juliet Couche
- Health in Mind, Sussex Partnership NHS Foundation Trust, Woodside, The Drive, Hellingly, East Sussex, BN27 4ER, UK
| | | | - Hannah Murray
- Oxford Centre for Anxiety Disorders and Trauma, Paradise Square, Oxford, OX1 1TW, UK
| | - Nesta Reeve
- Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Drayton High Road, Norwich, NR6 5BE, UK
| | - Joanne Hodgekins
- Department of Clinical Psychology, Elizabeth Fry Building, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
| | - David Fowler
- School of Psychology, Pevensey Building, University of Sussex, Brighton, BN1 9QH, UK
| | - Sarah Byford
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, CB2 0AH, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
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80
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Rimvall MK, Jespersen CP, Clemmensen L, Munkholm A, Skovgaard AM, Verhulst F, van Os J, Rask CU, Jeppesen P. Psychotic experiences are associated with health anxiety and functional somatic symptoms in preadolescence. J Child Psychol Psychiatry 2019; 60:524-532. [PMID: 30289180 DOI: 10.1111/jcpp.12986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Health anxiety (HA) is an increasing public health problem related to increased health service costs, and associated with functional somatic symptoms (FSS) and considerable personal suffering. Abnormal bodily experiences which may resemble HA and FSS are common in psychotic disorders, but a potential link between HA and psychosis vulnerability in childhood is largely unexplored. The current study estimates the association between subclinical psychotic experiences (PE) and HA and FSS in a general population cohort of preadolescents. METHODS The study population consisted of 1,572 11-12-year-old children from the Copenhagen Child Cohort 2000. PE were comprehensibly assessed as either present or not present using the Kiddie Schedule of Affective Disorders and Schizophrenia psychosis section. HA and FSS were assessed by self-report on validated questionnaires. Additional variables on general psychopathology, puberty, and chronic somatic illness were also obtained. RESULTS Psychotic experiences were associated with the top 10% high scores of HA (Odds Ratio (OR) 3.2; 95% CI: 2.1-4.8) and FSS (OR 4.6; 95% CI: 3.1-6.9) in univariate analyses. After mutual adjustment, the association was reduced to (HA: OR 2.3; 95% CI: 1.5-3.5; FSS: OR 3.7; 95% CI: 2.4-4.7), suggesting interdependence. Further adjustment for potential confounders and general psychopathology only reduced the associations slightly: HA OR 2.2 (95% CI: 1.4-3.4); FSS OR 3.3 (95% CI: 2.1-5.2). Secondary analyses of subdimensions of HA showed that PE were associated with fears (OR 3.0; 95% CI: 2.0-4.6) and daily impact of HA symptoms (OR 5.0; 95% CI: 3.4-7.5), but not help seeking (OR 1.2; 95% CI: 0.7-2.1). CONCLUSIONS This is the first study to investigate the associations between PE and HA and FSS, respectively. PE were significantly associated with HA and FSS over and above general psychopathology in preadolescence. Individuals with PE expressed high levels of health-related fears and daily impact, but no corresponding help-seeking behavior.
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Affiliation(s)
- Martin K Rimvall
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cecilia Pihl Jespersen
- Department of Child and Adolescent Psychiatry, Research Unit, Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Clemmensen
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark
| | - Anja Munkholm
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark
| | - Anne Mette Skovgaard
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Frank Verhulst
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jim van Os
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Psychosis Studies, King's College London, King's Health Partners, Institute of Psychiatry, London, UK
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Research Unit, Psychiatry, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Pia Jeppesen
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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81
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Rice S, Polari A, Thompson A, Hartmann J, McGorry P, Nelson B. Does reason for referral to an ultra-high risk clinic predict transition to psychosis? Early Interv Psychiatry 2019; 13:318-321. [PMID: 29873447 DOI: 10.1111/eip.12679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 04/02/2018] [Accepted: 04/26/2018] [Indexed: 01/27/2023]
Abstract
AIM To examine reasons for referral to a specialist ultra-high risk (UHR) for psychosis clinic and whether these reasons are associated with risk for subsequent transition to psychosis. METHODS Data for 127 patients referred to the Personal Assessment and Crisis Evaluation clinic were collected by medical record audit. Time to transition to psychosis was calculated from date of referral to time at which the young person was judged by their treating team to be experiencing onset of first episode psychosis. RESULTS Patients were primarily referred due to attenuated psychotic symptoms and depression (40.2%). There was an association with transition, with those in the attenuated psychotic-symptom-only category being more likely to transition. CONCLUSION As well as attenuated psychotic symptoms, depression and anxiety were also important reasons for referral indicating that there is a broad clinical phenotype of young people presenting to UHR clinics. Clinical reason for referral may index level of risk for subsequent transition to psychosis.
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Affiliation(s)
- Simon Rice
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,Youth Mood Clinic, Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
| | - Andrea Polari
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,Personal Assessment and Crisis Evaluation (PACE) Clinic, Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
| | - Andrew Thompson
- Division of Mental Health and Wellbeing, The University of Warwick, Coventry, UK
| | - Jessica Hartmann
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,Personal Assessment and Crisis Evaluation (PACE) Clinic, Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,Personal Assessment and Crisis Evaluation (PACE) Clinic, Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
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82
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Kırlı U, Binbay T, Drukker M, van Os J, Alptekin K, Kayahan B, Elbi H. Psychotic experiences and mood episodes predict each other bidirectionally: a 6-year follow-up study in a community-based population. Soc Psychiatry Psychiatr Epidemiol 2019; 54:331-341. [PMID: 30671600 DOI: 10.1007/s00127-018-1641-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 12/03/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Psychotic experiences (PEs) are not exclusive to psychotic disorders and highly correlated with mood episodes. In this representative general population-based study, longitudinal bidirectional associations between the extended psychosis phenotype and mood episodes were investigated, accounting for other possible causes. METHODS Households were contacted in a multistage clustered probability sampling frame covering 11 districts and 302 neighbourhoods at baseline (n = 4011) and at 6-year follow-up (n = 2185). Participants were interviewed with the relevant sections of the composite international diagnostic interview both at baseline and at follow-up. Sociodemographic, familial and environmental risk factors associated with the extended psychosis phenotype and mood episodes were assessed. Logistic regression and cross-lagged panel correlation models were used for the associations between the extended psychosis phenotype and mood episodes. RESULTS PEs were associated with subsequent depressive and manic episodes. There was bidirectionality in that mood episodes were associated with subsequent PEs, and PEs were associated with subsequent mood episodes. The associations occurred in a sub-additive pattern. There were substantial synchronous and cross-lagged correlations between these psychopathology domains, with reciprocally similar cross-lagged correlations. Familial risk and adverse life events were associated with both psychopathology domains, whereas some sociodemographic risk factors and alcohol/cannabis use were associated with only one domain. CONCLUSION The sub-additive bidirectional associations between PEs and mood episodes over time and the similarity of cross-lagged correlations are suggestive of mutually causal connections between affective and psychotic domains of psychopathology.
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Affiliation(s)
- Umut Kırlı
- Psychiatry Unit, Van Education and Research Hospital, Van, Turkey.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tolga Binbay
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, 35340, Izmir, Turkey.
| | - Marjan Drukker
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, UK.,Department of Psychiatry, Brain Center Rudolf Magnus Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Köksal Alptekin
- Department of Psychiatry, Faculty of Medicine, Dokuz Eylul University, 35340, Izmir, Turkey
| | - Bülent Kayahan
- Department of Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Hayriye Elbi
- Department of Psychiatry, Faculty of Medicine, Ege University, Izmir, Turkey
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83
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Bell CJ, Foulds JA, Horwood LJ, Mulder RT, Boden JM. Childhood abuse and psychotic experiences in adulthood: findings from a 35-year longitudinal study. Br J Psychiatry 2019; 214:153-158. [PMID: 30774061 DOI: 10.1192/bjp.2018.264] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The extent to which exposure to childhood sexual and physical abuse increases the risk of psychotic experiences in adulthood is currently unclear.AimsTo examine the relationship between childhood sexual and physical abuse and psychotic experiences in adulthood taking into account potential confounding and time-dynamic covariate factors. METHOD Data were from a cohort of 1265 participants studied from birth to 35 years. At ages 18 and 21, cohort members were questioned about childhood sexual and physical abuse. At ages 30 and 35, they were questioned about psychotic experiences (symptoms of abnormal thought and perception). Generalised estimating equation models investigated covariation of the association between abuse exposure and psychotic experiences including potential confounding factors in childhood (socioeconomic disadvantage, adverse family functioning) and time-dynamic covariate factors (mental health, substance use and life stress). RESULTS Data were available for 962 participants; 6.3% had been exposed to severe sexual abuse and 6.4% to severe physical abuse in childhood. After adjustment for confounding and time-dynamic covariate factors, those exposed to severe sexual abuse had rates of abnormal thought and abnormal perception symptoms that were 2.25 and 4.08 times higher, respectively than the 'no exposure' group. There were no significant associations between exposure to severe physical abuse and psychotic experiences. CONCLUSIONS Findings indicate that exposure to severe childhood sexual (but not physical) abuse is independently associated with an increased risk of psychotic experiences in adulthood (particularly symptoms of abnormal perception) and this association could not be fully accounted for by confounding or time-dynamic covariate factors.Declaration of interestNone.
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Affiliation(s)
- Caroline J Bell
- Associate Professor,Department of Psychological Medicine,University of Otago,New Zealand
| | - James A Foulds
- Senior Lecturer,Department of Psychological Medicine,University of Otago,New Zealand
| | - L John Horwood
- Professor,Department of Psychological Medicine and Director, Christchurch Health and Development Study,University of Otago,New Zealand
| | - Roger T Mulder
- Professor,Department of Psychological Medicine,University of Otago,New Zealand
| | - Joseph M Boden
- Associate Professor,Department of Psychological Medicine,University of Otago and Deputy Director, Christchurch Health and Development Study,New Zealand
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Dobler VB, Neufeld SA, Fletcher PF, Perez J, Subramaniam N, Teufel C, Goodyer IM. Disaggregating physiological components of cortisol output: A novel approach to cortisol analysis in a clinical sample - A proof-of-principle study. Neurobiol Stress 2019; 10:100153. [PMID: 31193494 PMCID: PMC6535687 DOI: 10.1016/j.ynstr.2019.100153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 01/17/2019] [Accepted: 03/04/2019] [Indexed: 12/12/2022] Open
Abstract
Although childhood adversity (CA) increases risk for subsequent mental illnesses, developmental mechanisms underpinning this association remain unclear. The hypothalamic-pituitary-adrenal axis (HPAA) is one candidate system potentially linking CA with psychopathology. However, determining developmental effects of CA on HPAA output and differentiating these from effects of current illness has proven difficult. Different aspects of HPAA output are governed by differentiable physiological mechanisms. Disaggregating HPAA output according to its biological components (baseline tonic cortisol, background diurnal variation, phasic stress response) may improve precision of associations with CA and/or psychopathology. In a novel proof-of-principle investigation we test whether different predictors, CA (distal risk factor) and current depressive symptoms, show distinct associations with dissociable HPAA components. A clinical group (aged 16-25) at high-risk for developing severe psychopathology (n = 20) were compared to age and sex matched healthy controls (n = 21). Cortisol was measured at waking (x4), following stress induction (x8), and during a time-environment-matched non-stress condition. Using piecewise multilevel modeling, stress responses were disaggregated into increase and decrease, while controlling for waking cortisol, background diurnal output and confounding variables. Elevated waking cortisol was specifically associated with higher CA scores. Higher non-stress cortisol was specifically associated with higher depressive scores. Following stress induction, depressive symptoms attenuated cortisol increase, whilst CA attenuated cortisol decrease. The results support a differential HPAA dysregulation hypothesis where physiologically dissociable components of HPAA output are differentially associated with distal (CA) or proximal (depressive symptoms) predictors. This proof-of-principle study demonstrates that future cortisol analyses need to disaggregate biologically independent mechanisms of HPAA output.
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Affiliation(s)
- Veronika B. Dobler
- Department of Psychiatry, Developmental Psychiatry, University of Cambridge, 18b Trumpington Rd, Cambridge, CB2 8AH, UK
| | - Sharon A.S. Neufeld
- Department of Psychiatry, Developmental Psychiatry, University of Cambridge, 18b Trumpington Rd, Cambridge, CB2 8AH, UK
| | - Paul F. Fletcher
- Department of Psychiatry, Developmental Psychiatry, University of Cambridge, 18b Trumpington Rd, Cambridge, CB2 8AH, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Elisabeth House, Cambridge, CB21 5EF, UK
| | - Jesus Perez
- Department of Psychiatry, Developmental Psychiatry, University of Cambridge, 18b Trumpington Rd, Cambridge, CB2 8AH, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Elisabeth House, Cambridge, CB21 5EF, UK
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
- Department of Neuroscience, Instituto de Investigacion Biomedica de Salamanca (IBSAL), University of Salamanca, Spain
| | - Naresh Subramaniam
- Department of Psychiatry, Developmental Psychiatry, University of Cambridge, 18b Trumpington Rd, Cambridge, CB2 8AH, UK
| | - Christoph Teufel
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Maindy Road, Cardiff, CF24 4HQ, UK
| | - Ian M. Goodyer
- Department of Psychiatry, Developmental Psychiatry, University of Cambridge, 18b Trumpington Rd, Cambridge, CB2 8AH, UK
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85
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Fonville L, Drakesmith M, Zammit S, Lewis G, Jones DK, David AS. MRI Indices of Cortical Development in Young People With Psychotic Experiences: Influence of Genetic Risk and Persistence of Symptoms. Schizophr Bull 2019; 45:169-179. [PMID: 29385604 PMCID: PMC6293214 DOI: 10.1093/schbul/sbx195] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Psychotic experiences (PEs) are considered part of an extended psychosis phenotype and are associated with an elevated risk of developing a psychotic disorder. Risk of transition increases with persistence of PEs, and this is thought to be modulated by genetic and environmental factors. However, it is unclear if persistence is associated with progressive schizophrenia-like changes in neuroanatomy. Methods We examined cortical morphometry using MRI in 247 young adults, from a population-based cohort, assessed for the presence of PEs at ages 18 and 20. We then incorporated a polygenic risk score for schizophrenia (PRS) to elucidate the effects of high genetic risk. Finally, we used atlas-based tractography data to examine the underlying white matter. Results Individuals with persisting PEs showed reductions in gyrification (local gyrification index: lGI) in the left temporal gyrus as well as atypical associations with brain volume (TBV) in the left occipital and right prefrontal gyri. No main effect was found for the PRS, but interaction effects with PEs were identified in the orbitofrontal, parietal, and temporal regions. Examination of underlying white matter did not provide strong evidence of further disturbances. Conclusions Disturbances in lGI were similar to schizophrenia but findings were mostly limited to those with persistent PEs. These could reflect subtle changes that worsen with impending psychosis or reflect an early vulnerability associated with the persistence of PEs. The lack of clear differences in underlying white matter suggests our findings reflect early disturbances in cortical expansion rather than progressive changes in brain structure.
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Affiliation(s)
- Leon Fonville
- Section of Cognitive Neuropsychiatry (Box 68), Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King ’s College London, UK
| | - Mark Drakesmith
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK
- Institute of Psychological Medicine and Clinical Neuroscience, School of Medicine, Cardiff University, Cardiff, UK
| | - Stanley Zammit
- Institute of Psychological Medicine and Clinical Neuroscience, School of Medicine, Cardiff University, Cardiff, UK
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Glyn Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Derek K Jones
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK
- Institute of Psychological Medicine and Clinical Neuroscience, School of Medicine, Cardiff University, Cardiff, UK
| | - Anthony S David
- Section of Cognitive Neuropsychiatry (Box 68), Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King ’s College London, UK
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86
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Burke AS, Shapero BG, Pelletier-Baldelli A, Deng WY, Nyer MB, Leathem L, Namey L, Landa C, Cather C, Holt DJ. Rationale, Methods, Feasibility, and Preliminary Outcomes of a Transdiagnostic Prevention Program for At-Risk College Students. Front Psychiatry 2019; 10:1030. [PMID: 32158406 PMCID: PMC7051934 DOI: 10.3389/fpsyt.2019.01030] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 12/30/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Early adulthood represents one period of increased risk for the emergence of a serious mental illness. The college campus provides a unique opportunity to assess and monitor individuals in this at-risk age group. However, there are no validated early detection programs that are widely implemented on college campuses. In an effort to address this gap, we designed and tested an early detection and prevention program tailored to college students. A transdiagnostic approach was employed because of evidence for shared risk factors across major mental illnesses. DESIGN Single arm, prospective study evaluating outcomes following a 4-week intervention. METHOD Three in-person mental health screenings were conducted on the campus of one university. Undergraduate students with at least mildly elevated, self-reported levels of depressive or subclinical psychotic symptoms, who were not receiving treatment for these symptoms, were invited to participate in a 4-session workshop focused on increasing self- and other- awareness and emotion regulation using established mindfulness, self-compassion, and mentalization principles and experiential exercises. Symptoms, resilience-promoting capacities, and aspects of social functioning were assessed pre- and post- intervention. RESULTS 416 students were screened and a total of 63 students participated in the workshop. 91% attended at least 3 of the 4 sessions. The majority of participants found the workshop interesting and useful and would recommend it to a friend. Significant pre-to-post reductions in symptoms (depression, anxiety, and subclinical psychotic symptoms, ps < 0.004) and improvements in resilience-promoting capacities (self-compassion and self-efficacy, ps < 0.006) and indices of social functioning (social motivation, activity, and a measure of comfort with the physical presence of others, ps < 0.04) were observed. Moreover, the significant increases in resilience-promoting capacities correlated with the reductions in affective symptoms (ps < 0.03). CONCLUSIONS These findings suggest that an on-campus mental health screening and early intervention program is feasible, acceptable, and may be associated with improvements in resilience-related capacities and symptom reductions in young adults with non-impairing, subclinical symptoms of psychopathology. Follow-up work will determine whether this program can improve both shorter and longer-term mental health and functional outcomes in this at-risk population.
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Affiliation(s)
- Anne S Burke
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Benjamin G Shapero
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | | | - Wisteria Y Deng
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Maren B Nyer
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Logan Leathem
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Leah Namey
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Carrie Landa
- Behavioral Medicine, Boston University, Boston, MA, United States
| | - Corinne Cather
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Daphne J Holt
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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Abstract
Current diagnostic criteria delineate schizophrenia as a discrete entity essentially defined by positive symptoms. However, the role of positive symptoms in psychiatry is being questioned. There is compelling evidence that psychotic manifestations are expressed in the population in a continuum of varying degrees of severity, ranging from normality to full-blown psychosis. In most cases, these phenomena do not persist, but they constitute risk factors for psychiatric disorders in general. Psychotic symptoms are also present in most non-psychotic psychiatric diagnoses, being a marker of severity. Research revealed that hallucinations and delusions appear to have distinct, independent biological underpinnings-in the general population, in psychotic, and in non-psychotic disorders as well. On the other hand, negative symptoms were seen to be far more restricted to schizophrenia, have other underlying pathophysiology than positive symptoms, predict outcome and treatment response in schizophrenia, and start before the first psychotic outbreak. The current work discusses the concept of schizophrenia, suggesting that a greater emphasis should be put on cases where psychotic symptoms emerge in a premorbid subtly increasing negative/cognitive symptoms background. In those cases, psychosis would have a different course and outcome while psychosis occurring in the absence of such background deterioration would be more benign-probably having no, or a milder, underlying degenerative process. This reformulation should better drive psychopathological classification, face positive symptoms as epiphenomenon of the schizophrenia process, and dishevel stigma from schizophrenia and from delusions and hallucinations.
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Affiliation(s)
- Alexandre Andrade Loch
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, São Paulo, Brazil
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88
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Sengutta M, Gawęda Ł, Moritz S, Karow A. The mediating role of borderline personality features in the relationship between childhood trauma and psychotic-like experiences in a sample of help-seeking non-psychotic adolescents and young adults. Eur Psychiatry 2018; 56:84-90. [DOI: 10.1016/j.eurpsy.2018.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/27/2018] [Accepted: 11/26/2018] [Indexed: 01/18/2023] Open
Abstract
AbstractObjective:Psychotic-like experiences (PLEs) often occur across different non-psychotic disorders in adolescent and young adult population and are related to early trauma. However, the mechanisms of how exposure to early trauma shapes the risk of PLEs are unclear. In our study, we investigated whether borderline personality features and further non-psychotic symptoms, i.e. factors related to both PLEs and childhood trauma, may mediate the relationship between childhood trauma and PLEs.Methods:Two hundred inpatients aged 16–21 years who were treated due to non-psychotic disorders were included. PLEs were assessed with the Prodromal Questionnaire (PQ-16). Childhood Trauma was assessed with the Adverse Childhood Experience Questionnaire (ACE). Borderline personality features were assessed by using the Borderline-Symptom Checklist (BSL-23). Presence and frequency of depressive symptoms and anxiety were assessed by Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Questionnaire (GAD-7).Table 1Clinical characteristics (n = 200).Mean (SD)Male/female67/133Age18.72 (1.85)Clinical diagnosisDepressive disorder (F32.1, F32.2, F33.0, F33.1, F33.2)167 (83.5%)Anxiety disorder (F40.1, F41.0, F41.1, F41.2)51 (25.5%)ComorbiditiesPTSD26 (13.0%)Personality disorders (F60.30, F60.31, F60.4, F60.6, F60.7, F60.8, F61)124 (66.5%)Eating disorder (F50.0, F50.1, F50.2)19 (9.5%)Others (F42.1, F42.2, F45.1, F44.5, F90.0)33 (16.5%)Measures: The Structured Clinical Interview for the Diagnostic and statistical manual of mental disorders, 4th edition (DSM-IV) (SCID-I) and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders II (SCID-II) were used to identify the clinical diagnoses.Results:A significant relationship between childhood trauma (ACE total score) and PLEs was found (ß = 0.30, 95% CI 0.247--0.659). In particular, emotional neglect (r = 0.298, p < 0.001) and sexual abuse (r = 0.264, p < 0.001) were significantly associated with PLEs. Borderline personality features fully mediated the relationship of childhood trauma and PLEs (ß = 0.12, 95% CI: -0.019--0.370). Anxiety and Depression showed a significant, but partial mediation of the relationship.Conclusion:Borderline personality features seem to be an important mediator of the relationship between childhood trauma and PLEs in adolescent patients with different non-psychotic psychiatric disorders. Theoretical and clinical implications are discussed.
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89
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Georgiadis A, Duschinsky R, Perez J, Jones PB, Russo D, Knight C, Soneson E, Dixon-Woods M. Coproducing healthcare service improvement for people with common mental health disorders including psychotic experiences: a study protocol of a multiperspective qualitative study. BMJ Open 2018; 8:e026064. [PMID: 30413522 PMCID: PMC6231599 DOI: 10.1136/bmjopen-2018-026064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Some people, who have common mental health disorders such as depression and anxiety, also have some psychotic experiences. These individuals may experience a treatment gap: their symptoms neither reach the increasingly high threshold for secondary care, nor do they receive full benefit from current interventions offered by the Improving Access to Psychological Therapies (IAPT) programme. The result may be poorer clinical and functional outcomes. A new talking therapy could potentially benefit this group. Informed by principles of coproduction, this study will seek the views of service users and staff to inform the design and development of such a therapy. METHODS AND ANALYSIS Semistructured interviews will be conducted with IAPT service users, therapists and managers based in three different geographical areas in England. Our sample will include (1) approximately 15 service users who will be receiving therapy or will have completed therapy at the time of recruitment, (2) approximately 15 service users who initiated treatment but withdrew, (3) approximately 15 therapists each with at least 4-month experience in a step-3 IAPT setting and (4) three IAPT managers. Data analysis will be based on the constant comparative method. ETHICS AND DISSEMINATION The study has been approved by the London Harrow Research Ethics Committee (reference: 18/LO/0642), and all National Health Service Trusts have granted permissions to conduct the study. Findings will be published in peer-reviewed academic journals, and presented at academic conferences. We will also produce a 'digest' summary of the findings, which will be accessible, visual and freely available.
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Affiliation(s)
- Alexandros Georgiadis
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Robbie Duschinsky
- Applied Social Science Group, University of Cambridge, Cambridge, UK
| | - Jesus Perez
- CAMEO Early Intervention Services, Cambridgeshire andPeterborough NHS FoundationTrust, Cambridge, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Debra Russo
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Clare Knight
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Emma Soneson
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
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90
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Jacob L, Haro JM, Koyanagi A. The association between problem gambling and psychotic experiences: Findings from the Adult Psychiatric Morbidity Survey 2007. Schizophr Res 2018; 201:79-84. [PMID: 29804926 DOI: 10.1016/j.schres.2018.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/13/2018] [Accepted: 05/13/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Studies on the association between psychotic experiences (PEs) and problem gambling are lacking. Thus, we examined the association between PEs and problem gambling in the general UK population. METHODS This study used community-based, cross-sectional data from the 2007 Adult Psychiatric Morbidity Survey (APMS) (n = 7403). Ten items from the DSM-IV criteria and the British Gambling Prevalence Survey studies were used to ascertain problem gambling among individuals who gambled in the past 12 months. Respondents were classified as no problem (0 criteria), at-risk (1 or 2 criteria) and problem gambling (≥3 criteria). Past 12-month PE was assessed with the Psychosis Screening Questionnaire. Multivariable logistic regression models were constructed to assess the association between gambling status (exposure variable) and PE (outcome variable). RESULTS The final sample consisted of 7363 people aged ≥16 years with no definite or probable psychosis [mean (SD) age 46.4 (18.6) years; 51.2% females]. The prevalence of PE in those with no problem, at-risk, and problem gambling were 5.1%, 11.1%, and 29.7%, respectively. In the model adjusted for sociodemographics, common mental disorders and risky health behaviors, at-risk (OR = 1.88; 95% CI: 1.11-3.19) and problem gambling (OR = 4.64; 95% CI: 1.78-12.13) were associated with an increased odds for PE. CONCLUSION Problem gambling and PE tend to co-exist. Further research is needed to gain a better understanding of the mechanisms that underlie the association observed.
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Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Paris 5, Paris 75006, France.
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
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91
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Hielscher E, Connell M, Lawrence D, Zubrick SR, Hafekost J, Scott JG. Prevalence and correlates of psychotic experiences in a nationally representative sample of Australian adolescents. Aust N Z J Psychiatry 2018; 52:768-781. [PMID: 29992826 DOI: 10.1177/0004867418785036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Despite growing literature on psychotic experiences, no nationally representative study has reported on the prevalence of both hallucinatory experiences and delusional experiences in Australian adolescents. Also, while many studies have examined the association between psychotic experiences and certain demographic and clinical correlates, there are more variables of interest to be investigated, including disordered eating behaviour and hours of sleep. The aims of this study were to examine (1) the prevalence of hallucinatory experiences and delusional experiences in Australian adolescents, and (2) the associations between different types of psychotic experiences with a broad range of demographic, clinical, and psychosocial variables. METHODS A random sample of Australian adolescents aged 14- to 17-year-olds were recruited in 2013-2014 as part of the Young Minds Matter Survey. Participants completed self-report questions regarding five different psychotic experience types (auditory and visual hallucinatory experiences, and thoughts read, special messages, spied upon) experienced in the past 12 months. Using logistic regression analyses, we investigated associations between psychotic experiences and demographic, clinical, and psychosocial factors. RESULTS The 12-month prevalence ranged from 3.3% (95% confidence interval = [2.6, 4.3]) for special messages to 14.0% (95% confidence interval = [12.3, 15.8]) for auditory hallucinatory experiences. At the bivariate level, each psychotic experience subtype was associated with increased likelihood of major depression, being bullied, psychological distress, low self-esteem, mental health service use and insufficient sleep (<8 hours per night). Multivariate analyses revealed both auditory and visual hallucinatory experiences were associated with an increased likelihood of four of these variables (depression, being bullied, service use, insufficient sleep), whereas associations with delusional experiences were inconsistent. CONCLUSION Hallucinatory and delusional experiences are common in Australian adolescents. Hallucinatory experiences, rather than delusional experiences, may be more clinically relevant in this demographic. When psychotic experiences are endorsed by adolescents, further assessment is indicated so as to ascertain more detail on the phenomenology of the experiences to better understand their clinical relevance.
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Affiliation(s)
- Emily Hielscher
- 1 Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,2 Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, QLD, Australia.,3 School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Melissa Connell
- 1 Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,4 Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - David Lawrence
- 5 Graduate School of Education, The University of Western Australia, Perth, WA, Australia
| | - Stephen R Zubrick
- 6 Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia.,7 Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Jennifer Hafekost
- 5 Graduate School of Education, The University of Western Australia, Perth, WA, Australia
| | - James G Scott
- 1 Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,2 Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, QLD, Australia.,4 Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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92
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Prochwicz K, Kłosowska J. The moderating role of cognitive biases on the relationship between negative affective states and psychotic-like experiences in non-clinical adults. Psychiatry Res 2018; 265:118-127. [PMID: 29702303 DOI: 10.1016/j.psychres.2018.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 11/29/2022]
Abstract
Negative emotions and cognitive biases are important factors underlying psychotic symptoms and psychotic-like experiences (PLEs); however, it is not clear whether these factors interact when they influence psychotic phenomena. The aim of our study was to investigate whether psychosis-related cognitive biases moderate the relationship between negative affective states, i.e. anxiety and depression, and psychotic-like experiences. The study sample contains 251 participants who have never been diagnosed with psychiatric disorders. Anxiety, depression, cognitive biases, and psychotic-like experiences were assessed with self-report questionnaires. A moderation analysis was performed to examine the relationship between the study variables. The analyses revealed that the link between anxiety and positive PLEs is moderated by External Attribution bias, whereas the relationship between depression and positive PLEs is moderated by Attention to Threat bias. Attributional bias was also found to moderate the association between depression and negative subclinical symptoms; Jumping to Conclusions bias served as a moderator in the link between anxiety and depression and negative PLEs. Further studies in clinical samples are required to verify the moderating role of individual cognitive biases on the relationship between negative emotional states and full-blown psychotic symptoms.
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Affiliation(s)
| | - Joanna Kłosowska
- Jagiellonian University, Institute of Psychology, Krakow, Poland
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93
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Heinze K, Lin A, Nelson B, Reniers RLEP, Upthegrove R, Clarke L, Roche A, Lowrie A, Wood SJ. The impact of psychotic experiences in the early stages of mental health problems in young people. BMC Psychiatry 2018; 18:214. [PMID: 29954377 PMCID: PMC6025824 DOI: 10.1186/s12888-018-1767-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/23/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Anxiety and depressive symptoms and psychotic experiences constitute common features of emerging mental disorders in young people. Psychotic experiences and the ultra-high risk (UHR) state for psychosis appear to have a particular importance for clinical presentation, progression of symptomatology, quality of life and functioning, but the impact of psychotic experiences in individuals seeking help at non-UHR services, compared to UHR services, is under-researched. METHODS Sixty-nine young people (Mage ± SD at baseline = 20.8 ± 2.6, range 16-26 years, 48 females) presenting to mental health services were grouped according to UHR and non-UHR status. They were assessed at baseline for anxiety and depressive symptoms, psychological distress, psychosocial functioning and quality of life. They were followed up at three, six, and 12 months. Data were analysed using mixed linear modelling. RESULTS UHR individuals reported higher levels of depressive symptoms and psychological distress, and lower levels of role functioning and quality of life compared to non-UHR individuals. No differences were reported for anxiety symptoms or social functioning. Decline in psychosocial functioning was not associated with clinical deterioration or reduction of quality of life. CONCLUSIONS Psychotic experiences appear to be particularly associated with depressive symptoms and psychological distress, impaired role functioning and quality of life in help-seeking young people in the medium-term. It is therefore important to pay special attention to psychotic experiences in the early stages of mental health problems even if psychotic symptoms are not the main motivation for help-seeking.
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Affiliation(s)
- Kareen Heinze
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK. .,Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, UK.
| | - Ashleigh Lin
- 0000 0000 8828 1230grid.414659.bTelethon Kids Institute, Perth, Australia
| | - Barnaby Nelson
- grid.488501.0Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia ,0000 0001 2179 088Xgrid.1008.9Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Renate L. E. P. Reniers
- 0000 0004 1936 7486grid.6572.6Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, UK ,0000 0004 1936 7486grid.6572.6Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Rachel Upthegrove
- 0000 0004 1936 7486grid.6572.6School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK ,0000 0004 1936 7486grid.6572.6Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, UK ,0000 0004 1936 7486grid.6572.6Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Latoya Clarke
- 0000 0000 8809 1613grid.7372.1Warwick Medical School, University of Warwick, Coventry, UK
| | - Ayesha Roche
- 0000 0004 1936 9262grid.11835.3eDepartment of Psychology, University of Sheffield, Sheffield, UK
| | - Angelique Lowrie
- 0000 0004 1936 7486grid.6572.6School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - Stephen J. Wood
- 0000 0004 1936 7486grid.6572.6School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK ,0000 0004 1936 7486grid.6572.6Institute for Mental Health, University of Birmingham, Edgbaston, Birmingham, UK ,grid.488501.0Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia ,0000 0001 2179 088Xgrid.1008.9Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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Perez J, Russo DA, Stochl J, Clarke J, Martin Z, Jassi C, French P, Fowler D, Jones PB. Common mental disorder including psychotic experiences: Trailblazing a new recovery pathway within the Improving Access to Psychological Therapies programme in England. Early Interv Psychiatry 2018; 12:497-504. [PMID: 28509391 DOI: 10.1111/eip.12434] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 01/05/2017] [Accepted: 01/19/2017] [Indexed: 12/12/2022]
Abstract
Psychotic experiences, depressive and anxiety symptoms may be manifestations of a latent continuum of common mental distress. The Improving Access to Psychological Therapies (IAPT) programme has increased the reach of psychological treatments to people with common mental disorders in England. However, psychotic experiences are neither measured nor considered in therapy. We aimed to confirm the presence of psychotic experiences among IAPT service-users and determine whether these experiences are associated with higher depression/anxiety levels and poorer recovery. All service-users that attended the Fenland and Peterborough IAPT teams in Cambridgeshire between November 16, 2015 and January 29, 2016 participated in a service evaluation. In addition to routine mesures, such as the Generalized Anxiety Disorder-7 questionnaire (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), we introduced a shortened version of the Community Assessment of Psychic Experiences (CAPE-P15) to measure psychotic experiences. Classes of individuals were identified with latent class analysis. Associations were reported using Pearson correlation coefficient. One hundred and seventy-three services-users were included, mostly females (N = 133; 76.9%). The mean age was 36.6 (SD = 13.3). Around 30% likely belonged to a class with psychotic experiences. CAPE-P15 frequency was significantly correlated to PHQ-9 (r = 0.44; P < .001) and GAD-7 (r = 0.32; P < .001). Similarly, CAPE-P15 distress and both PHQ-9 (r = 0.43; P < .001) and GAD-7 (r = 0.38; P < .001) were highly correlated. These associations were replicated after the initial period of the therapy, indicating poor recovery. Some IAPT service-users suffer psychotic experiences. Tailoring available evidence-based psychological therapies for these people in IAPT settings might trailblaze a new care pathway to improve recovery in this group.
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Affiliation(s)
- Jesus Perez
- CAMEO Early Intervention in Psychosis Service, Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK.,Department of Psychiatry, University of Cambridge, Cambridge, UK.,Norwich Medical School, University of East Anglia, Norwich, UK.,NIHR Collaboration for Leadership in Applied Health Research & Care East of England, Cambridge, UK
| | - Debra A Russo
- CAMEO Early Intervention in Psychosis Service, Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK.,Department of Psychiatry, University of Cambridge, Cambridge, UK.,NIHR Collaboration for Leadership in Applied Health Research & Care East of England, Cambridge, UK
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,NIHR Collaboration for Leadership in Applied Health Research & Care East of England, Cambridge, UK
| | - James Clarke
- Psychological Wellbeing Services (IAPT Services), Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Zoe Martin
- Psychological Wellbeing Services (IAPT Services), Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Christina Jassi
- Psychological Wellbeing Services (IAPT Services), Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Prestwich, UK
| | - David Fowler
- Department of Psychology, University of Sussex, Sussex, UK
| | - Peter B Jones
- CAMEO Early Intervention in Psychosis Service, Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK.,Department of Psychiatry, University of Cambridge, Cambridge, UK.,NIHR Collaboration for Leadership in Applied Health Research & Care East of England, Cambridge, UK
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95
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Yamasaki S, Usami S, Sasaki R, Koike S, Ando S, Kitagawa Y, Matamura M, Fukushima M, Yonehara H, Foo JC, Nishida A, Sasaki T. The association between changes in depression/anxiety and trajectories of psychotic-like experiences over a year in adolescence. Schizophr Res 2018; 195:149-153. [PMID: 29055569 DOI: 10.1016/j.schres.2017.10.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 08/03/2017] [Accepted: 10/09/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent cross-sectional studies suggest that psychotic-like experiences (PLEs) are associated with depression and anxiety in adolescents. While longitudinal studies have observed that adolescents suffer more severe symptoms of depression/anxiety when PLEs persist, it remains unclear whether depression/anxiety worsens or improves with PLE emergence or remission, respectively. In this prospective school-based study, we investigated the association between longitudinal changes in depression/anxiety and one-year PLE trajectories in adolescence. METHODS Nine hundred and twelve adolescents participated in the baseline assessment of PLEs and depression/anxiety; 887 (97.3%) adolescents completed the follow-up assessment one year later. Multilevel analysis was conducted to evaluate the change in depression/anxiety, evaluated using the General Health Questionnaire-12 (GHQ-12), during the year according to PLE trajectory, adjusting for baseline depression/anxiety, gender, age, substance use and victimization. RESULTS Sixteen percent of adolescents reported PLEs at baseline, with 56% of them remitting at follow-up. At follow-up, PLEs were experienced by 6.6% of adolescents not experiencing PLEs at baseline (incident PLE group). After adjusting for covariates, GHQ-12 score worsened significantly during the year in students with incident trajectories (regression coefficient for time, α1=1.91, 95% CI: 1.04-2.77), but in those showing remission, GHQ-12 score did not significantly improve (α1=-0.20, 95% CI: -0.97-0.56). CONCLUSIONS Greater awareness about PLEs and their trajectories in school health care settings may be a key towards the prevention and treatment of adolescent depression and anxiety.
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Affiliation(s)
- Syudo Yamasaki
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan
| | - Satoshi Usami
- Department of Psychology, University of Tsukuba, Tennodai, Tsukuba, Ibaraki 305-8572, Japan
| | - Ryo Sasaki
- School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Shinsuke Koike
- University of Tokyo Institute for Diversity & Adaptation of Human Mind (UTIDAHM), The University of Tokyo, 3-8-1 Komaba, Meguro-ku, Tokyo 153-8902, Japan
| | - Shuntaro Ando
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan; Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yuko Kitagawa
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Misato Matamura
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Masako Fukushima
- The University of Tokyo Secondary School attached to the Faculty of Education, Minamidai, Nakano-ku, Tokyo 164-8654, Japan
| | - Hiromi Yonehara
- The University of Tokyo Secondary School attached to the Faculty of Education, Minamidai, Nakano-ku, Tokyo 164-8654, Japan
| | - Jerome Clifford Foo
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, 68159 Mannheim, Germany
| | - Atsushi Nishida
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo 156-8506, Japan
| | - Tsukasa Sasaki
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
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96
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Couvy-Duchesne B, O’Callaghan V, Parker R, Mills N, Kirk KM, Scott J, Vinkhuyzen A, Hermens DF, Lind PA, Davenport TA, Burns JM, Connell M, Zietsch BP, Scott J, Wright MJ, Medland SE, McGrath J, Martin NG, Hickie IB, Gillespie NA. Nineteen and Up study (19Up): understanding pathways to mental health disorders in young Australian twins. BMJ Open 2018; 8:e018959. [PMID: 29550775 PMCID: PMC5875659 DOI: 10.1136/bmjopen-2017-018959] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The Nineteen and Up study (19Up) assessed a range of mental health and behavioural problems and associated risk factors in a genetically informative Australian cohort of young adult twins and their non-twin siblings. As such, 19Up enables detailed investigation of genetic and environmental pathways to mental illness and substance misuse within the Brisbane Longitudinal Twin Sample (BLTS). PARTICIPANTS Twins and their non-twin siblings from Queensland, Australia; mostly from European ancestry. Data were collected between 2009 and 2016 on 2773 participants (age range 18-38, 57.8% female, 372 complete monozygotic pairs, 493 dizygotic pairs, 640 non-twin siblings, 403 singleton twins). FINDINGS TO DATE A structured clinical assessment (Composite International Diagnostic Interview) was used to collect lifetime prevalence of diagnostic statistical manual (4th edition) (DSM-IV) diagnoses of major depressive disorder, (hypo)mania, social anxiety, cannabis use disorder, alcohol use disorder, panic disorder and psychotic symptoms. Here, we further describe the comorbidities and ages of onset for these mental disorders. Notably, two-thirds of the sample reported one or more lifetime mental disorder.In addition, the 19Up study assessed general health, drug use, work activity, education level, personality, migraine/headaches, suicidal thoughts, attention deficit hyperactivity disorder (ADHD) symptomatology, sleep-wake patterns, romantic preferences, friendships, familial environment, stress, anorexia and bulimia as well as baldness, acne, asthma, endometriosis, joint flexibility and internet use.The overlap with previous waves of the BLTS means that 84% of the 19Up participants are genotyped, 36% imaged using multimodal MRI and most have been assessed for psychological symptoms at up to four time points. Furthermore, IQ is available for 57%, parental report of ADHD symptomatology for 100% and electroencephalography for 30%. FUTURE PLANS The 19Up study complements a phenotypically rich, longitudinal collection of environmental and psychological risk factors. Future publications will explore hypotheses related to disease onset and development across the waves of the cohort. A follow-up study at 25+years is ongoing.
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Affiliation(s)
- Baptiste Couvy-Duchesne
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Victoria O’Callaghan
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Richard Parker
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Natalie Mills
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Katherine M Kirk
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Jan Scott
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Anna Vinkhuyzen
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
- Institute of Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Daniel F Hermens
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Penelope A Lind
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Tracey A Davenport
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Jane M Burns
- Young and Well CRC, University of Melbourne, Melbourne, Victoria, Australia
| | - Melissa Connell
- UQCCR, The University of Queensland, Brisbane, Queensland, Australia
| | - Brendan P Zietsch
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - James Scott
- UQCCR, The University of Queensland, Brisbane, Queensland, Australia
| | - Margaret J Wright
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Advanced Imaging, The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah E Medland
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - John McGrath
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia
| | - Nicholas G Martin
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Nathan A Gillespie
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia, USA
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97
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Catone G, Marotta R, Pisano S, Lennox B, Carotenuto M, Gritti A, Pascotto A, Broome MR. Psychotic-like experiences in help-seeking adolescents: Dimensional exploration and association with different forms of bullying victimization - A developmental social psychiatry perspective. Int J Soc Psychiatry 2017; 63:752-762. [PMID: 28990447 DOI: 10.1177/0020764017733765] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Psychotic-like experiences (PLEs) are common in the general population and increase the risk of psychotic disorders. Adolescents are a high-risk group of this condition. Stressful events, such as bullying, have a role in the onset of PLEs. This study has several aims: (1) to assess PLEs in adolescents seeking help from a Child and Adolescent Mental Health Service, (2) to assess the association of PLEs with specific bullying victimization and (3) to assess difference in PLEs and victimizations by sex and age. METHODS Participants were help-seeking (HS) adolescents initially screened for PLEs. They completed an assessment including characteristics of PLEs and bullying victimization. We paid particular attention to different kinds of PLEs and victimization. RESULTS In total, 50 PLE-positive adolescents screened from 324 HS adolescents (15.4%) constituted the sample. Paranoia and verbal bullying were the PLEs and form of victimization most represented, respectively. Verbal bullying was strongly associated with paranoia (odds ratio (OR): 4.40, confidence interval (CI): 2.8-5.9, p < .001). Results remained significant after controlling for confounder (socio-demographic, anxiety, depression and for the latter analysis also other forms of victimization). Furthermore, social manipulation showed a strong association of paranoia and physical bullying with grandiosity. Verbal bullying was also associated with psychotic negative symptoms, but controlling for emotional symptoms and other victimization led to a reduction in the effect. Men were more involved in physical victimization and experienced grandiosity; on the contrary, late adolescents were most involved in social victimization and negative psychotic symptoms Conclusion: PLEs are relevant in HS adolescents. Bullying victimization interacts with the onset of these phenomena. In particular, verbal bullying predicted paranoia onset significantly.
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Affiliation(s)
- Gennaro Catone
- 1 Department of Mental and Physical Health and Preventive Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy.,2 Faculty of Education Sciences, University of Suor Orsola Benincasa, Naples, Italy
| | - Roberta Marotta
- 1 Department of Mental and Physical Health and Preventive Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Simone Pisano
- 1 Department of Mental and Physical Health and Preventive Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Belinda Lennox
- 3 Department of Psychiatry, University of Oxford, Oxford, UK.,4 Oxford Health NHS Foundation Trust, Oxford, UK
| | - Marco Carotenuto
- 1 Department of Mental and Physical Health and Preventive Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Antonella Gritti
- 2 Faculty of Education Sciences, University of Suor Orsola Benincasa, Naples, Italy
| | - Antonio Pascotto
- 1 Department of Mental and Physical Health and Preventive Medicine, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Matthew R Broome
- 5 Institute for Mental Health, University of Birmingham, Birmingham, UK
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98
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Psychotic-like experiences and happiness in the English general population. J Affect Disord 2017; 222:211-217. [PMID: 28711798 DOI: 10.1016/j.jad.2017.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/29/2017] [Accepted: 07/06/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Psychotic-like experiences (PLEs) have been associated with a variety of adverse outcomes but how they affect happiness in individuals with PLE is unknown. Thus, the aim of the study was to assess the association between PLEs and happiness, and the factors that may influence this association. METHODS Nationally representative data from the 2007 Adult Psychiatric Morbidity Survey including adults aged ≥ 16 years was analyzed. The Psychosis Screening Questionnaire was used to assess past 12-month PLE. Individuals who endorsed at least one of the following were considered to have any PLE: thought control, paranoia, strange experiences, auditory hallucinations. Happiness (3-point scale) was assessed with a validated question with higher scores indicating lower levels of happiness. The association between PLE and happiness was assessed by multivariable ordinal logistic regression. Mediation analysis was also performed. RESULTS Among the 7363 individuals included in the analysis, the prevalence of any PLE increased with decreasing levels of happiness [very happy (2.3%), fairly happy (5.4%), not too happy (14.9%)]. This was also shown in the multivariable analysis adjusted for sociodemographic factors and stressful life events (from very happy to not too happy: OR = 2.41; 95%CI = 1.86-3.12). Mediation analysis showed that anxiety disorders explained the largest proportion of the association (38.8%) followed by depressive episode (28.5%), insomnia (21.9%), disability (16.5%), pain (12.5%), social support (10.0%), and physical health conditions (6.0%). LIMITATIONS The cross-sectional design limits causal inference. CONCLUSION Interventions to identify and address conditions that may have a negative impact on happiness in individuals with PLE may be important to improve their well-being.
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99
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van Os J, van der Steen Y, Islam MA, Gülöksüz S, Rutten BP, Simons CJ. Evidence that polygenic risk for psychotic disorder is expressed in the domain of neurodevelopment, emotion regulation and attribution of salience. Psychol Med 2017; 47:2421-2437. [PMID: 28436345 DOI: 10.1017/s0033291717000915] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The liability-threshold model of psychosis risk predicts stronger phenotypic manifestation of the polygenic risk score (PRS) in the healthy relatives of patients, as compared with healthy comparison subjects. METHODS First-degree relatives of patients with psychotic disorder (871 siblings and 812 parents) and healthy comparison subjects (n = 523) were interviewed three times in 6 years. Repeated measures of two psychosis phenotypes, the Community Assessment of Psychic Experiences (CAPE; self-report - subscales of positive, negative and depressive symptoms) and the Structured Interview for Schizotypy - Revised (SIS-R; clinical interview - subscales of positive and negative schizotypy), were examined for association with PRS. Interview-based lifetime rate of depressive and manic episodes were also examined, as was association with repeated measures of intelligence quotient (IQ). RESULTS In the relatives, PRS was associated with CAPE/SIS-R total score (respectively, B = 0.12, 95% CI 0.02-0.22 and B = 0.11, 95% CI 0.02-0.20), the SIS-R positive subscale (B = 0.16, 95% CI 0.04-0.28), the CAPE depression subscale (B = 0.21, 95% CI 0.07-0.34), any lifetime affective episode (OR 3.1, 95% CI 1.04-9.3), but not with IQ (B = -1.8, 95% CI -8.0 to 4.4). In the controls, similar associations were apparent between PRS on the one hand and SIS-R total score, SIS-R positive, SIS-R negative, any lifetime affective episode and, in contrast, lower IQ (B = -8.5, 95% CI -15.5 to -1.6). CONCLUSIONS In non-ill people, polygenic risk for psychotic disorder is expressed pleiotropically in the domain of neurodevelopment, emotion regulation and attribution of salience. In subjects at elevated genetic risk, emerging expression of neurodevelopmental alterations may create floor effects, obscuring genetic associations.
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Affiliation(s)
- J van Os
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Y van der Steen
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Md A Islam
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry,Groningen,The Netherlands
| | - S Gülöksüz
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - B P Rutten
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - C J Simons
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
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100
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Abstract
Many individuals in the general population experience psychotic-like experiences in the absence of a psychotic disorder. The degree of psychological distress associated with these experiences is a key predictor of clinical outcomes. One factor that may influence the degree of distress from psychotic-like experiences is emotion regulation. Although it has been demonstrated that emotion regulation deficits are present in psychotic disorders, the association between emotion regulation and subclinical psychotic-like experiences is not well understood. Here, we examined the associations between frequency of and distress from psychotic-like experiences and several key components of emotion regulation: difficulties with emotion regulation; emotion regulation self-efficacy; and emotion regulation strategy use. Difficulties with emotion regulation and maladaptive patterns of emotion regulation strategy use were associated with the frequency of both positive and negative psychotic-like experiences. In addition, results suggest that habitual acceptance use and reappraisal self-efficacy may serve as protective factors against the distress associated with psychotic-like experiences.
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