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He XY, Huang ZH, Wang F, Jia F, Hou CL. Individuals with genetic high-risk for psychosis experience impaired coping styles compared with healthy controls. Early Interv Psychiatry 2024. [PMID: 39048537 DOI: 10.1111/eip.13598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/04/2024] [Accepted: 07/10/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Individuals with schizophrenia tend to have negative coping styles and low levels of self-esteem, but it is unclear whether coping styles and self-esteem levels are altered in people in the prodromal phase of psychosis. AIMS The study was designed to assess the role of coping style and self-esteem in the context of different phases of schizophrenia. METHODS Recurrent Schizophrenia (ReSch), first-episode schizophrenia patients (FEP), genetic-high risk for psychosis (GHR) patients, and healthy controls (HC) (40 per group) were subjected to in-person clinical interviews. The results of these interviews were then used to gauge coping style and self-esteem using the Coping Styles Questionnaire (CSQ) and the Rosenberg's Self-Esteem Scale (RSES). Data were analyzed through ANCOVAs and logistic regression analyses. RESULTS The results found that positive coping style (CSQ problem-solving and CSQ seeking for help) generally decline with progression through the HC, GHR, and FEP groups, while negative coping style (CSQ fantasy, CSQ repression and CSQ self-blame) generally increase with progression through the HC, GHR, and FEP groups (except that GHR group was slightly lower than HC group in CSQ self-blame). Results for members of ReSch group were in line with those of members of the FEP group in coping style. At the level of self-esteem, the GHR group was similar to the HC group and significantly higher than the FEP group and the ReSch group. Logistic regression analyses indicated that GHR group patients exhibited increased negative coping styles (CSQ fantasy) relative to members of the HC group, but had greater Positive coping style (CSQ problem-solving) than did members of the FEP group. DISCUSSION These findings suggest that both GHR individuals experience impaired negative coping styles which expands the understanding of the psychological characteristics of the prodromal group. Further explorations are warranted to develop optimal psychosocial interventions.
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Affiliation(s)
- Xiao-Yang He
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
- The Affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, WuXi, Jiangsu, China
| | - Zhuo-Hui Huang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Fei Wang
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Fujun Jia
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Cai-Lan Hou
- Guangdong Mental Health Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
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Rinaldi G, Osman N, Kaess M, Schimmelmann BG, Kindler J, Schultze-Lutter F, Michel C. Exploring the complex relationships between coping strategies, locus of control and self-esteem with psychopathology: structural equation modeling with a special focus on clinical high-risk of psychosis. Eur Psychiatry 2023; 66:e88. [PMID: 37848406 PMCID: PMC10755569 DOI: 10.1192/j.eurpsy.2023.2457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Coping strategies, competence, and locus of control (LOC) beliefs are important predictors of mental health (MH). However, research into their complex interactions has produced mixed results. Our study investigated them further in the previously unexplored context of clinical high-risk (CHR) of psychosis. METHODS We tested six alternative structural equation models in a community sample (N = 523), hypothesizing a mediating role of coping and treating CHR symptoms as (i) an additional mediator or (ii) a specific outcome. Our measurement model included two latent factors of MH: (1) psychopathology (PP), consisting of presence of mental disorders, global and psychosocial functioning, and (2) self-rated health (SRH) status. RESULTS In the model with the best Akaike Information Criterion and the latent factors as outcome variables, maladaptive coping completely mediated the impact of maladaptive LOC on PP and SRH. Additionally, CHR symptoms partially mediated the effect of maladaptive coping on PP and SRH in the community sample, as long as sex was not entered into the model. In the clinical sample (N = 371), the model did not support a mediation by CHR symptoms, despite significant pathways with both coping and MH outcomes; further, competence beliefs directly impacted SRH. CONCLUSIONS Coping strategies are an important intervention target for MH promotion, especially in the community. In clinical populations, interventions focusing on coping strategies may improve CHR symptoms, thus potentially supporting better MH, especially SRH. Additionally, due to their mostly cascading effects on MH, improving competence and LOC beliefs may also promote psychological well-being.
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Affiliation(s)
- Giulia Rinaldi
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Naweed Osman
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Benno G. Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- University Hospital of Child and Adolescent Psychiatry, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Jochen Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Low goal-directed behavior in negative symptoms is explained by goal setting - Results of a diary study. J Behav Ther Exp Psychiatry 2022; 76:101740. [PMID: 35738687 DOI: 10.1016/j.jbtep.2022.101740] [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: 05/17/2021] [Revised: 11/09/2021] [Accepted: 03/16/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Engaging in goal-directed activities is a core difficulty of people with negative symptoms in schizophrenia. A previously developed goal pursuit model of negative symptoms (Schlier et al. 2017) postulates that negative symptom severity correlates with a tendency to set more avoidance- than approach-oriented goals. This shift in goal orientation correlates with low levels of goal expectancy, goal importance, and goal commitment. We explored whether these alterations translate into reduced goal-directed behavior (i.e., reduced goal striving and goal attainment). METHODS We conducted a one-week diary-study in a population sample (N=91). Participants were assessed for subclinical negative symptoms at baseline. Next, they set a daily goal and completed an online survey measuring goal orientation, goal characteristics, goal pursuit, and goal attainment once per day for one week. RESULTS Multilevel regression analyses and structural equation models showed that negative symptoms correlated with a tendency to set less approach-oriented goals with reduced goal expectancy and goal commitment. Goal orientation, expectancy, and commitment mediated the association between negative symptoms and reduced goal pursuit and attainment. LIMITATIONS We used a community sample, thus our results need to be replicated in a clinical sample of people with motivational negative symptoms. CONCLUSIONS Our results support the hypothesis that dysfunctional goal pursuit processes explain why negative symptoms lead to reduced goal-directed behavior. Interventions focusing on goal setting and goal expectations could be promising in improving goal-directed behavior in people with negative symptoms.
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Easden D, Gurvich C, Kaplan RA, Rossell SL. Exploring fear of death and psychosis proneness: positive schizotypy as a function of death anxiety and maladaptive coping. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2022.2070426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Dane Easden
- Research School of Psychology, Australian National University, Canberra. Australia
| | - Caroline Gurvich
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Monash University and The Alfred Hospital, Melbourne, Australia
| | - Ryan A. Kaplan
- Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, Australia
| | - Susan L. Rossell
- Centre for Mental Health, School of Health Sciences, Swinburne University, Melbourne, Australia
- Mental Health, St Vincent’s Hospital, Melbourne, Australia
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Feeling Capable in an Ubuntu Way: Kenyan Comprehensions of Control Beliefs Compared with the German Perspective. OPEN PSYCHOLOGY 2022. [DOI: 10.1515/psych-2022-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
In Western personnel psychology, control beliefs are a valued predictor for work-related outcomes. Yet, little is known about the culture-specific functioning of control in East Africa. Kenya, as an Ubuntu culture, is examined regarding control beliefs and contrasted with a German sample considered to represent an individualistic or Western culture. Responses to N=143 quantitative personality tests were attended with qualitative interviews on control beliefs (self-concept of ability, internality, powerful others, and chance). Content validity and factor structure of control beliefs were analyzed, followed by a Procrustean target rotation. Linear regression analyses were conducted to assess the predictability of job performance, achievement motivation, and well-being. Item comprehension, as well as factor structure of the four control aspects, differ between the two samples. In particular, the ‘powerful others’ control aspect diverges the most between the cultures. Linear regression analyses showed comparable, but not fully congruent predictability. Results indicate that an uncritical transfer of the control beliefs measure from one culture to another is inappropriate. Results fit in the picture of African Ubuntu philosophy, emphasizing social-relational aspects shaping control beliefs. More emic-etic based research is demanded concerning intra- and intercultural variability of control beliefs to depict a transcultural applicable and invariant model.
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Schönenberg A, Zipprich HM, Teschner U, Prell T. Impact of Depression, Resilience, and Locus of Control on Adjustment of Health-Related Expectations in Aging Individuals With Chronic Illness. Front Psychol 2022; 13:867785. [PMID: 35572337 PMCID: PMC9097897 DOI: 10.3389/fpsyg.2022.867785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Quality of Life (QoL) depends on the discrepancy between desired and current experiences (referred to as the Calman gap), thus in chronic illness, adjustment of expectations and interpretation of the current situation are crucial. Depression is known to influence this gap, and the present study aims to further assess the role of resilience and health locus of control (HLC). Methods A total of 94 patients (age M = 71.8, SD = 7.7 years) with neurological disorders were screened via telephone regarding depression, resilience and HLC. Current and desired state of several life domains were assessed, such as Fitness, General Health, Pain, Daily Activities, Finances, Leisure, and Family. Elastic net regularization and analyses of variance were used to disentangle the impact of depression, resilience, HLC, and sociodemographic factors on the perception of current and desired state, and the gap between both. Results A gap was present for all domains but largest for pain. Interpretation of the current state was linked to desired state, HLC, and age. All gaps were related to depression; certain domains were in addition influenced by resilience, HLC and sociodemographic factors. Of note, for most domains, patients did not select the highest possible desired state. Conclusion Older patients with neurological disorders report a gap between current and desired state for many aspects of life. Adjusting expectations is beneficial in the face of declining health, but a reasonably increased desired state may positively influence the perception of the current situation. Depression negatively influences the interpretation of the Calman gap.
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Affiliation(s)
- Aline Schönenberg
- Department of Geriatrics, Halle University Hospital, Halle (Saale), Germany
| | | | - Ulrike Teschner
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Tino Prell
- Department of Geriatrics, Halle University Hospital, Halle (Saale), Germany
- Department of Neurology, Jena University Hospital, Jena, Germany
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Devoe DJ, Cadenhead KS, Cornblatt B, Granholm E, Addington J. Negative symptoms: associations with defeatist beliefs, self-efficacy, and maladaptive schemas in youth and young adults at-risk for psychosis. Behav Cogn Psychother 2021; 50:1-14. [PMID: 34784991 DOI: 10.1017/s1352465821000461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Investigations into possible mechanisms that may contribute to the development, maintenance, and exacerbation of negative symptoms are needed. Defeatist beliefs, self-efficacy, and early maladaptive schemas have been shown to contribute to negative symptoms in schizophrenia. Likewise, negative symptoms occur in those at clinical high-risk (CHR) for psychosis. AIMS The aim of this study was to determine if negative symptoms were associated with defeatist beliefs, self-efficacy, and early maladaptive schemas in CHR participants of a group therapy intervention study. METHOD All CHR participants (n = 203; 99 males, 104 females) were recruited as part of a three-site randomized control trial: Recovery through Group Study (ReGroup). Negative symptoms, defeatist beliefs, self-efficacy and early maladaptive schemas were assessed by trained clinical raters. Mediation analyses were conducted to examine the relationship between defeatist beliefs, self-efficacy, functioning, and negative symptoms. RESULTS The majority of CHR youth (72.9%) had at least one negative symptom of moderate to above moderate severity at baseline. In multiple mediation analyses, both asocial beliefs and social self-efficacy mediated the effects of social functioning on negative symptoms. Finally, defeatist performance attitudes significantly mediated the effects of role functioning on negative symptoms. CONCLUSIONS These results highlight the importance of considering beliefs and attitudes in relation to functioning and severity of negative symptoms. Psychosocial interventions may wish to target beliefs and attitudes in effort to reduce negative symptoms and improve functioning in CHR youth.
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Affiliation(s)
- Daniel J Devoe
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - K S Cadenhead
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Barbara Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, USA
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
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Self-efficacy, Hope as Mediators Between Positive Coping and Resilience Among Patients With Gastric Cancer Before the First Chemotherapy. Cancer Nurs 2021; 44:79-85. [PMID: 31743154 DOI: 10.1097/ncc.0000000000000753] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with gastric cancer experience severe psychological distress as a result of their cancer diagnosis and chemotherapy. Resilience is a defense mechanism that enables one to thrive amid distress. However, little research has been done to explore the formation and development mechanism of resilience among patients with gastric cancer before their first chemotherapy treatment. OBJECTIVE The mediating roles of self-efficacy and hope on the relationship between positive coping and resilience among patients with gastric cancer before their first chemotherapy treatment were examined to inform the future resilience intervention. METHODS A total of 253 patients with gastric cancer before their first chemotherapy treatment were investigated using the Simplified Coping Style Questionnaire, the General Self-efficacy Scale, the Herth Hope Index, and the 14-Item Resilience Scale. Structural equation modeling was conducted using Mplus version 7.03 to test the hypothesized mediational model. RESULTS Structural equation modeling analysis showed self-efficacy and hope completely mediated the relationship between positive coping and resilience; the indirect effects were 0.242 (P < .01) and 0.258 (P < .01), respectively; indirect effects accounted for 81% of the total effect. CONCLUSIONS Positive coping is not the independent predictor that may contribute to resilience among patients with gastric cancer before their first chemotherapy treatment, but it can indirectly affect resilience through self-efficacy and hope. IMPLICATIONS Self-efficacy and hope may increase the positive influence of positive coping on resilience among patients with gastric cancer before their first chemotherapy treatment. Resilience intervention might be enhanced by addressing the impact of positive coping on self-efficacy and hope.
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The effects of intensive home treatment on self-efficacy in patients recovering from a psychiatric crisis. Int J Ment Health Syst 2021; 15:1. [PMID: 33407731 PMCID: PMC7789166 DOI: 10.1186/s13033-020-00426-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/29/2020] [Indexed: 02/02/2023] Open
Abstract
Background This study evaluated whether providing intensive home treatment (IHT) to patients experiencing a psychiatric crisis has more effect on self-efficacy when compared to care as usual (CAU). Self-efficacy is a psychological concept closely related to one of the aims of IHT. Additionally, differential effects on self-efficacy among patients with different mental disorders and associations between self-efficacy and symptomatic recovery or quality of life were examined. Methods Data stem from a Zelen double consent randomised controlled trial (RCT), which assesses the effects of IHT compared to CAU on patients who experienced a psychiatric crisis. Data were collected at baseline, 6 and 26 weeks follow-up. Self-efficacy was measured using the Mental Health Confidence Scale. The 5-dimensional EuroQol instrument and the Brief Psychiatric Rating Scale (BPRS) were used to measure quality of life and symptomatic recovery, respectively. We used linear mixed modelling to estimate the associations with self-efficacy. Results Data of 142 participants were used. Overall, no difference between IHT and CAU was found with respect to self-efficacy (B = − 0.08, SE = 0.15, p = 0.57), and self-efficacy did not change over the period of 26 weeks (B = − 0.01, SE = 0.12, t (103.95) = − 0.06, p = 0.95). However, differential effects on self-efficacy over time were found for patients with different mental disorders (F(8, 219.33) = 3.75, p < 0.001). Additionally, self-efficacy was strongly associated with symptomatic recovery (total BPRS B = − 0.10, SE = 0.02, p < 0.00) and quality of life (B = 0.14, SE = 0.01, p < 0.001). Conclusions Although self-efficacy was associated with symptomatic recovery and quality of life, IHT does not have a supplementary effect on self-efficacy when compared to CAU. This result raises the question whether, and how, crisis care could be adapted to enhance self-efficacy, keeping in mind the development of self-efficacy in depressive, bipolar, personality, and schizophrenia spectrum and other psychotic disorders. The findings should be considered with some caution. This study lacked sufficient power to test small changes in self-efficacy and some mental disorders had a small sample size. Trial registration This trial is registered at Trialregister.nl, number NL6020.
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Wang FG, Lou ML, Lu SH, Yen WJ, Tsai CL, Ma WF. A preliminary study on the effectiveness of a stress management program for healthcare-related undergraduates with at-risk mental state. Perspect Psychiatr Care 2021; 57:88-97. [PMID: 32394496 DOI: 10.1111/ppc.12528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/12/2020] [Accepted: 04/25/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This study aimed to examine the effects of a stress management program on stress perception and coping strategies for healthcare-related undergraduates with at-risk mental state (ARMS). DESIGN AND METHODS A randomized experimental design with pretest and posttest was used. Of the 2812 students screened, 65 were identified as having ARMS, 52 enrolled in the study, and 49 (75%) completed the study. FINDINGS Significance was found for subjects with schizotypal traits in emotion expression and problem-avoidance coping strategies. Subjects with trait anxiety improved significantly in interpersonal deficits after the program. PRACTICE IMPLICATIONS Students with different trait risks reported benefits in different stress-coping strategies from the program.
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Affiliation(s)
- Fong-Gang Wang
- Department of Forensic Psychiatry, Changhua Christian Hospital, Changhua City, Taiwan.,Department of Criminology, National Chung Cheng University, Chiayi County, Taiwan
| | - Mei-Ling Lou
- Department of Public Health (in Nursing), China Medical University, Taichung City, Taiwan.,Department of Nursing, Hungkuang University, Taichung City, Taiwan
| | - Siang-Han Lu
- School of Nursing, China Medical University, Taichung City, Taiwan
| | - Wen-Jiuan Yen
- School of Nursing, Chung-Shan Medical University, Taichung City, Taiwan
| | - Ching-Lun Tsai
- Department of Public Health (in Epidemiology and Preventive Medicine), China Medical University, Taichung City, Taiwan
| | - Wei-Fen Ma
- School of Nursing, China Medical University, Taichung City, Taiwan.,Department of Nursing, China Medical University Hospital, Taichung City, Taiwan
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Riera-López de Aguileta I, Vila-Badia R, Usall J, Butjosa A, Ochoa S. Coping strategies in first-episode psychosis: A systematic review. Early Interv Psychiatry 2020; 14:252-262. [PMID: 31318154 DOI: 10.1111/eip.12847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 06/09/2019] [Indexed: 12/12/2022]
Abstract
AIMS This paper reviews and discusses the published information on coping strategies in people with a first-episode psychosis (FEP). The objective is to update knowledge about coping strategies used by people with a FEP, to compare these strategies with those used by other mental disorders, and to examine the relationship between coping strategies and other variables in FEP. METHOD A search was conducted using PsycINFO, MEDLINE and PSICODOC between 1995 and 2018 using the following terms: coping strategies or Adaptation, Psychological and FEP. RESULTS A total of 167 studies were found, of which 14 were selected for review. The results suggest the need for a multiple and integrated approach, since there are several factors that are involved in the coping strategies (eg, socio-demographic, clinical and psychological variables) used in the different profiles of psychotic spectrum, specifically in FEP. CONCLUSIONS The role of coping skills is an important issue in psychopathological research in addition to clinical outcome, especially from the point of view of the patients, their social context and their recovery. Moreover, personalized therapies addressed to personal recovery should be considered to develop better coping specifically addressed to patients' needs.
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Affiliation(s)
| | | | - Judith Usall
- PARC SANITARI SANT JOAN DE DÉU. CIBERSAM, Barcelona, Spain
| | - Anna Butjosa
- PARC SANITARI SANT JOAN DE DÉU. CIBERSAM, Barcelona, Spain
| | - Susana Ochoa
- PARC SANITARI SANT JOAN DE DÉU. CIBERSAM, Barcelona, Spain
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Abstract
BACKGROUND Patients in every stage of the psychosis continuum can present with negative symptoms. While no treatment is currently available to address these symptoms, a more refined characterization of their course over the lifetime could help in elaborating interventions. Previous reports have separately investigated the prevalence of negative symptoms within each stage of the psychosis continuum. Our aim in this review is to compare those prevalences across stages, thereby disclosing the course of negative symptoms. METHODS We searched several databases for studies reporting prevalences of negative symptoms in each one of our predetermined stages of the psychosis continuum: clinical or ultra-high risk (UHR), first-episode of psychosis (FEP), and younger and older patients who have experienced multiple episodes of psychosis (MEP). We combined results using the definitions of negative symptoms detailed in the Brief Negative Symptom Scale, a recently developed tool. For each negative symptom, we averaged and weighted by the combined sample size the prevalences of each negative symptom at each stage. RESULTS We selected 47 studies totaling 1872 UHR, 2947 FEP, 5039 younger MEP, and 669 older MEP patients. For each negative symptom, the prevalences showed a comparable course. Each negative symptom decreased from the UHR to FEP stages and then increased from the FEP to MEP stages. CONCLUSIONS Certain psychological, environmental, and treatment-related factors may influence the cumulative impact of negative symptoms, presenting the possibility for early intervention to improve the long-term course.
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13
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Schmidt S, Schultze-Lutter F, Schimmelmann B, Maric N, Salokangas R, Riecher-Rössler A, van der Gaag M, Meneghelli A, Nordentoft M, Marshall M, Morrison A, Raballo A, Klosterkötter J, Ruhrmann S. EPA guidance on the early intervention in clinical high risk states of psychoses. Eur Psychiatry 2020; 30:388-404. [DOI: 10.1016/j.eurpsy.2015.01.013] [Citation(s) in RCA: 262] [Impact Index Per Article: 65.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/30/2015] [Accepted: 01/30/2015] [Indexed: 11/28/2022] Open
Abstract
AbstractThis guidance paper from the European Psychiatric Association (EPA) aims to provide evidence-based recommendations on early intervention in clinical high risk (CHR) states of psychosis, assessed according to the EPA guidance on early detection. The recommendations were derived from a meta-analysis of current empirical evidence on the efficacy of psychological and pharmacological interventions in CHR samples. Eligible studies had to investigate conversion rate and/or functioning as a treatment outcome in CHR patients defined by the ultra-high risk and/or basic symptom criteria. Besides analyses on treatment effects on conversion rate and functional outcome, age and type of intervention were examined as potential moderators. Based on data from 15 studies (n = 1394), early intervention generally produced significantly reduced conversion rates at 6- to 48-month follow-up compared to control conditions. However, early intervention failed to achieve significantly greater functional improvements because both early intervention and control conditions produced similar positive effects. With regard to the type of intervention, both psychological and pharmacological interventions produced significant effects on conversion rates, but not on functional outcome relative to the control conditions. Early intervention in youth samples was generally less effective than in predominantly adult samples. Seven evidence-based recommendations for early intervention in CHR samples could have been formulated, although more studies are needed to investigate the specificity of treatment effects and potential age effects in order to tailor interventions to the individual treatment needs and risk status.
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Yee CI, Gupta T, Mittal VA, Haase CM. Coping with family stress in individuals at clinical high-risk for psychosis. Schizophr Res 2020; 216:222-228. [PMID: 31839553 PMCID: PMC10484199 DOI: 10.1016/j.schres.2019.11.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/26/2019] [Accepted: 11/28/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Despite the long-emphasized role of the family environment in the schizophrenia literature, coping with family stress has been neglected in research on the psychosis risk period. METHODS The sample consisted of 75 youth at clinical high-risk (CHR) for psychosis and 79 matched healthy controls who reported on their use of engagement and disengagement coping strategies in response to stress with parents and perceived social support (i.e., advice availability, family support and strain). Participants were also assessed for clinical symptoms. RESULTS Individuals at CHR reported similar levels of engagement strategies (e.g., emotion regulation, positive thinking) and more frequent use of disengagement strategies (e.g., avoidance, denial) compared to healthy controls. In individuals at CHR (as well as healthy controls), greater use of engagement strategies predicted greater perceptions of availability of advice support, whereas greater employment of disengagement strategies predicted lower perceived social support from the family and greater family strain. In individuals at CHR (as well as healthy controls), engagement strategies were not linked to any clinical outcomes, whereas disengagement strategies were closely tied to anxiety and depression (but not psychosis symptoms in individuals at CHR). CONCLUSIONS Individuals at CHR appeared to engage the same amount as controls, but disengage more often when coping with family stress; this pattern was linked to perceptions of social support and tied to a putative family environment as well as clinical phenomenology. The findings have implications for targeting interventions for CHR populations during a vulnerable period for stress and social change.
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Affiliation(s)
- Claire I Yee
- Department of Psychology, Northwestern University, United States of America; School of Education and Social Policy, Northwestern University, United States of America.
| | - Tina Gupta
- Department of Psychology, Northwestern University, United States of America
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, United States of America
| | - Claudia M Haase
- School of Education and Social Policy, Northwestern University, United States of America
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Schmidt SJ, Hurlemann R, Schultz J, Wasserthal S, Kloss C, Maier W, Meyer-Lindenberg A, Hellmich M, Muthesius-Digón A, Pantel T, Wiesner PS, Klosterkötter J, Ruhrmann S. Multimodal prevention of first psychotic episode through N-acetyl-l-cysteine and integrated preventive psychological intervention in individuals clinically at high risk for psychosis: Protocol of a randomized, placebo-controlled, parallel-group trial. Early Interv Psychiatry 2019; 13:1404-1415. [PMID: 30784233 DOI: 10.1111/eip.12781] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/27/2018] [Accepted: 12/26/2018] [Indexed: 01/22/2023]
Abstract
AIM Meta-analyses indicate positive effects of both antipsychotic and cognitive-behavioural interventions in subjects clinically at high risk (CHR) for psychosis in terms of a delay or prevention of psychotic disorders. However, these effects have been limited regarding social functioning and the relative efficacy of both types of interventions remains unclear. Furthermore, neuroprotective substances seem to be a promising alternative agent in psychosis-prevention as they are associated with few and weak side-effects. METHODS In this multi-centre randomized controlled trial (RCT), we investigate the effects of two interventions on transition to psychosis and social functioning: (a) an integrated preventive psychological intervention (IPPI) including stress-/symptom-management and social-cognitive remediation; (b) N-acetyl-l-cysteine (NAC) as a pharmacological intervention with glutamatergic, neuroprotective and anti-inflammatory capabilities. RESULTS This is a double-blind, placebo-controlled RCT with regard to NAC and a single-blind RCT with regard to IPPI using a 2 × 2-factorial design to investigate the individual and combined preventive effects of both interventions. To this aim, a total of 200 CHR subjects will be randomized stratified by site to one of four conditions: (a) IPPI and NAC; (b) IPPI and Placebo; (c) NAC and psychological stress management; (d) Placebo and psychological stress management. Interventions are delivered over 26 weeks with a follow-up period of 12 months. CONCLUSION This paper reports on the rationale and protocol of an indicated prevention trial to detect the most effective and tolerable interventions with regard to transition to psychosis as well as improvements in social functioning, and to evaluate the synergistic effects of these interventions.
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Affiliation(s)
- Stefanie J Schmidt
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - René Hurlemann
- Department of Psychiatry, University Hospital Bonn, Bonn, Germany.,Division of Medical Psychology, University Hospital Bonn, Bonn, Germany
| | - Johannes Schultz
- Department of Psychiatry, University Hospital Bonn, Bonn, Germany.,Division of Medical Psychology, University Hospital Bonn, Bonn, Germany
| | - Sven Wasserthal
- Department of Psychiatry, University Hospital Bonn, Bonn, Germany.,Division of Medical Psychology, University Hospital Bonn, Bonn, Germany
| | - Christian Kloss
- Department of Psychiatry, University Hospital Bonn, Bonn, Germany.,Division of Medical Psychology, University Hospital Bonn, Bonn, Germany
| | - Wolfgang Maier
- Department of Psychiatry, University Hospital Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases, Bonn, Germany
| | | | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Ana Muthesius-Digón
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Tanja Pantel
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Pia-Sophie Wiesner
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | | | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
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16
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Løberg EM, Gjestad R, Posserud MB, Kompus K, Lundervold AJ. Psychosocial characteristics differentiate non-distressing and distressing voices in 10,346 adolescents. Eur Child Adolesc Psychiatry 2019; 28:1353-1363. [PMID: 30820670 PMCID: PMC6785583 DOI: 10.1007/s00787-019-01292-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 02/09/2019] [Indexed: 12/30/2022]
Abstract
Adolescents hearing non-existent voices may be at risk for psychosis, but the prevalence of voice-hearing (VH) in the general population complicates clinical interpretations. Differentiating between VH with and without distress may aid treatment decisions in psychosis services, but understanding the differences between these two phenomena as they present in the normal adolescent population is necessary to validate this differentiation. The present study compared VH with and without distress in 10,346 adolescents in relation to clinical characteristics, known risk factors, predictors and psychosocial moderators of psychosis. A population-based cohort of Norwegian 16-19 years old adolescents completed a comprehensive web-based questionnaire, including two questions from the extended Launay-Slade Hallucinations Scale: (1) I often hear a voice speaking my thoughts aloud and (2) I have been troubled by hearing voices in my head. Adolescents reporting no VH, non-distressing VH or distressing VH were compared on 14 psychosocial and clinical variables. A multinomial regression model showed that non-disturbing voices were predicted by better school grades, social dysfunction, distractibility, affective symptoms and experience of trauma, while the disturbing voices were predicted by the experience of bullying and trauma, perceived negative self-worth and self-efficacy, less family support, dysregulation of activation, distractibility, self-harm and anxiety. Hearing voices without distress versus being distressed by the voices is related to different constellations of psychosocial variables, suggesting that they represent two separate groups of adolescents. The findings validate the emphasis on distress in clinical practice.
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Affiliation(s)
- Else-Marie Løberg
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.
- NORMENT Center of Excellence, Haukeland University Hospital, Bergen, Norway.
| | - Rolf Gjestad
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Maj-Britt Posserud
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Gillberg Neuropsychiatry Centre (GNC), University of Gothenburg, Gothenburg, Sweden
| | - Kristiina Kompus
- NORMENT Center of Excellence, Haukeland University Hospital, Bergen, Norway
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia
| | - Astri J Lundervold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Gillberg Neuropsychiatry Centre (GNC), University of Gothenburg, Gothenburg, Sweden
- K. G. Jebsen Center for Neuropsychiatric Disorders, University of Bergen, Bergen, Norway
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17
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Romain K, Eriksson A, Onyon R, Kumar M. The psychosis risk timeline: can we improve our preventive strategies? Part 2: adolescence and adulthood. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2019.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYCurrent understanding of psychosis development is relevant to patients' clinical outcomes in mental health services as a whole, given that psychotic symptoms can be a feature of many different diagnoses at different stages of life. Understanding the risk factors helps clinicians to contemplate primary, secondary and tertiary preventive strategies that it may be possible to implement. In this second article of a three-part series, the psychosis risk timeline is again considered, here focusing on risk factors more likely to be encountered during later childhood, adolescence and adulthood. These include environmental factors, substance misuse, and social and psychopathological aspects.LEARNING OBJECTIVES:After reading this article you will be able to:
•understanding the range of risk factors for development of psychotic symptoms in young people and adults•understand in particular the association between trauma/abuse and subsequent psychosis•appreciate current evidence for the nature and strength of the link between substance misuse and psychosis.DECLARATION OF INTEREST:None.
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18
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Groth N, Schnyder N, Kaess M, Markovic A, Rietschel L, Moser S, Michel C, Schultze-Lutter F, Schmidt SJ. Coping as a mediator between locus of control, competence beliefs, and mental health: A systematic review and structural equation modelling meta-analysis. Behav Res Ther 2019; 121:103442. [PMID: 31430689 DOI: 10.1016/j.brat.2019.103442] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/18/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This systematic review and two-staged structural equation modelling meta-analysis (TSSEM) aimed to examine whether coping mediates the associations between locus of control, competence beliefs, and mental health in the general population and clinical samples. METHODS Eligible studies published until May 2017 were identified through systematic searches of PubMED and EMBASE. The review included 19 studies and the meta-analysis 15 studies. RESULTS The review supports the assumption that coping mediates the associations between locus of control and competence beliefs, and mental health. TSSEM using a pooled sample of 3986 respondents and 225 cross-sectional effect sizes indicated that maladaptive coping mediates the association between maladaptive locus of control and mental health problems. On the contrary, adaptive coping did not mediate this association and was only significantly associated with competence beliefs and adaptive locus of control but, unexpectedly, not with mental health. Both maladaptive and adaptive locus of control but not competence beliefs had direct links to mental health problems that were independent of coping. CONCLUSION Interventions should not only focus on enhancing adaptive coping as it might be more promising to diminish maladaptive locus of control, which may result in reduced maladaptive coping and, finally, improved mental health.
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Affiliation(s)
- Nicola Groth
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, Haus A, Bolligenstrasse 111, 3000 Bern 60, Switzerland.
| | - Nina Schnyder
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, Haus A, Bolligenstrasse 111, 3000 Bern 60, Switzerland.
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, Haus A, Bolligenstrasse 111, 3000 Bern 60, Switzerland; Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany, Blumenstraße 8, 69115 Heidelberg, Germany.
| | - Andjela Markovic
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, Haus A, Bolligenstrasse 111, 3000 Bern 60, Switzerland.
| | - Liz Rietschel
- SRH University Heidelberg, Academy for Psychotherapy, Heidelberg, Germany, Maaßstrasse 32/1, 69123 Heidelberg, Germany.
| | - Susann Moser
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, Haus A, Bolligenstrasse 111, 3000 Bern 60, Switzerland.
| | - Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, Haus A, Bolligenstrasse 111, 3000 Bern 60, Switzerland; Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland, 40, Boulevard du Pont-d'Arve, 1211 Genève 4, Switzerland.
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, Haus A, Bolligenstrasse 111, 3000 Bern 60, Switzerland; Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany, Bergische Landstraße 2, 40629 Düsseldorf, Germany.
| | - Stefanie J Schmidt
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, Haus A, Bolligenstrasse 111, 3000 Bern 60, Switzerland; Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland, Fabrikstrasse 8, 3012 Bern, Switzerland.
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19
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Traber-Walker N, Gerstenberg M, Metzler S, Joris MR, Karr M, Studer N, Zulauf Logoz M, Roth A, Rössler W, Walitza S, Franscini M. Evaluation of the Combined Treatment Approach "Robin" (Standardized Manual and Smartphone App) for Adolescents at Clinical High Risk for Psychosis. Front Psychiatry 2019; 10:384. [PMID: 31244692 PMCID: PMC6562244 DOI: 10.3389/fpsyt.2019.00384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/15/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: The prevention of schizophrenia and other psychotic disorders has led researchers to focus on early identification of individuals at clinical high risk (CHR) for psychosis and to treat the at-risk symptoms in the pre-psychotic period. Although at-risk symptoms such as attenuated hallucinations or delusions are common in adolescents and associated with a marked reduction in global functioning, the evidence base of effective interventions for adolescents at CHR state and even first-episode psychosis is limited. Thus, the present protocol describes a study design that combines therapy modules for CHR adolescents with a smartphone application supporting the young individuals between the therapy sessions. The treatment approach "Robin" is based on existing therapy strategies for adolescents with first episode of psychosis and the available recommendations for adults with at-risk symptoms. Methods: The evaluation aims firstly to compare the efficacy of Robin in 30 CHR adolescents aged 14-18 to an active control group (treatment as usual) from a previous study. Primary outcome measures will be at-risk symptomatology, comorbid diagnosis, functioning, self-efficacy, and quality of life. For the prospective intervention condition (16 weekly individual sessions + a minimum 4 family sessions), help-seeking adolescents with CHR for psychosis, aged 14-18, will be recruited over 3 years. At-risk and comorbid symptoms, functioning, self-efficacy, and quality of life are monitored at six time points (baseline, during the treatment period; immediately after intervention; and 6, 12, and 24 months later) and compared with the respective measures of the active control group. Discussion: To the best of our knowledge, this is the first controlled trial to test the efficacy of a specific early psychosis treatment in combination with a smartphone application for adolescents at CHR for developing psychosis. The results of the study are expected to add information that may substantially decrease the burden of CHR adolescents and increase their resilience. It may offer age-adapted and targeted strategies to guide clinicians in the treatment of these vulnerable individuals. Furthermore, research in the field of early intervention will be enriched by our findings. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03829527.
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Affiliation(s)
- Nina Traber-Walker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Miriam Gerstenberg
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Sibylle Metzler
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Maria Raquel Joris
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Markus Karr
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Nadja Studer
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Marina Zulauf Logoz
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Alexander Roth
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Zurich, Switzerland
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
- Laboratory of Neuroscience, LIM27, Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Maurizia Franscini
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland
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20
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van Dijk FA, Schirmbeck F, Boyette LL, de Haan L. Coping styles mediate the association between negative life events and subjective well-being in patients with non-affective psychotic disorders and their siblings. Psychiatry Res 2019; 272:296-303. [PMID: 30594763 DOI: 10.1016/j.psychres.2018.12.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
Coping styles are associated with levels of subjective well-being. Negative life events and reduced subjective well-being are more prevalent in patients with psychotic disorders. The aims of the current study were to test a mediation model, with coping styles as potential mediators of the relation between negative life events and subjective well-being in patients with psychotic disorders (N = 259), and aimed to repeat the potential mediation model in patients' non-affected siblings (N = 309). Data pertains to a subsample of GROUP, a Dutch naturalistic cohort study. The Subjective Well-being under Neuroleptics-20 (SWN-20) scale was used to assess well-being. Coping styles were assessed with the Utrechtse Coping Lijst (UCL). Life events were assessed using an adaptation of the Interview of the Recent Life Event Scale (IRLES). Siblings, but not patients, who experienced negative life events in the previous three year period were more likely to experience a lower well-being. For both groups passive coping styles mediated the relation between negative life events and subjective well-being. Severity of positive, negative or affective symptoms did not change this relationship. Our findings point to a better recognition of copings styles as a therapeutic target to promote well-being and recovery.
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Affiliation(s)
- Floor A van Dijk
- Department of Early Psychosis, Academic Medical Centre of the University of Amsterdam, Amsterdam, the Netherlands.
| | - Frederike Schirmbeck
- Department of Early Psychosis, Academic Medical Centre of the University of Amsterdam, Amsterdam, the Netherlands; Arkin Institute for Mental Health, Amsterdam, the Netherlands
| | - Lindy-Lou Boyette
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Lieuwe de Haan
- Department of Early Psychosis, Academic Medical Centre of the University of Amsterdam, Amsterdam, the Netherlands; Arkin Institute for Mental Health, Amsterdam, the Netherlands
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21
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Hofer A, Post F, Pardeller S, Frajo-Apor B, Hoertnagl CM, Kemmler G, Fleischhacker WW. Self-stigma versus stigma resistance in schizophrenia: Associations with resilience, premorbid adjustment, and clinical symptoms. Psychiatry Res 2019; 271:396-401. [PMID: 30530057 DOI: 10.1016/j.psychres.2018.12.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/05/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
Self-stigma is regarded as a barrier to recovery from schizophrenia and the identification of factors protecting from its development may help identify vulnerable patients and subsequently, implement effective preventive and therapeutic interventions. Hence, this study aimed to assess whether resilience, premorbid adjustment, and psychopathology might differently impact self-stigma and stigma resistance among 54 regular attendees of a specialized outpatient clinic. There was no significant association between sociodemographic variables and self-stigma/stigma resistance, while resilience was negatively correlated with self-stigma and positively correlated with stigma resistance. In addition, we detected a negative correlation between self-stigma and both academic and social functioning during late adolescence. Most residual symptoms correlated with self-stigma, while no association was found between stigma resistance and psychopathology, except for depressed symptoms. These data provide evidence that future self-stigma reduction interventions may consider to focus on the improvement of resilience in order to promote schizophrenia patients' stigma resistance. In addition, the improvement of depressive symptoms as well as interventions focusing on the strengthening of social adjustment during the prodromal phase may be effective in preventing self-stigma.
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Affiliation(s)
- Alex Hofer
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria.
| | - Fabienne Post
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Silvia Pardeller
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Beatrice Frajo-Apor
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Christine M Hoertnagl
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - Georg Kemmler
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
| | - W Wolfgang Fleischhacker
- Medical University Innsbruck, Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Innsbruck, Austria
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22
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Vancampfort D, De Hert M, Broderick J, Lederman O, Firth J, Rosenbaum S, Probst M. Is autonomous motivation the key to maintaining an active lifestyle in first-episode psychosis? Early Interv Psychiatry 2018; 12:821-827. [PMID: 27594592 DOI: 10.1111/eip.12373] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/15/2016] [Accepted: 06/12/2016] [Indexed: 11/28/2022]
Abstract
AIM Physical activity has the potential to improve the health of patients with first-episode psychosis (FEP), yet many patients with FEP remain inactive. Exploring the theoretical basis of the motivational processes linked to the adoption and maintenance of physical activity behaviours in FEP patients can assist with the design and delivery of physical activity interventions. Within the self-determination theory and the transtheoretical model (stages of change) frameworks, we investigated motives for physical activity adoption and maintenance in FEP. METHODS Overall 56 FEP patients (20♀) (24 ± 4 years) completed the Behavioural Regulation in Exercise Questionnaire 2 to assess exercise motives, and the Patient-Centred Assessment and Counselling for Exercise to determine stage of change. Gender and setting differences in motives for physical activity were compared with unpaired t-tests. The relationship between motives for physical activity and stage of change was investigated using anova with post-hoc Scheffe tests. RESULTS No significant differences were found according to gender and setting. Multivariate analyses found significantly higher levels of amotivation and lower levels of autonomous motivation in the earlier stages of change. CONCLUSIONS Our results suggest that in FEP patients, autonomous regulations may play an important role in the adoption and maintenance of physical activity behaviours. The study provides a platform for future research to investigate the importance of autonomous motivation within physical activity interventions for this population.
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Affiliation(s)
- Davy Vancampfort
- Department of Rehabilitation Sciences, University of Leuven - KU Leuven, Leuven, Belgium.,University Psychiatric Center, University of Leuven - KU Leuven, Kortenberg, Belgium
| | - Marc De Hert
- University Psychiatric Center, University of Leuven - KU Leuven, Kortenberg, Belgium
| | - Julie Broderick
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Oscar Lederman
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Joseph Firth
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Simon Rosenbaum
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Michel Probst
- Department of Rehabilitation Sciences, University of Leuven - KU Leuven, Leuven, Belgium
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23
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Mian L, Lattanzi GM, Tognin S. Coping strategies in individuals at ultra-high risk of psychosis: A systematic review. Early Interv Psychiatry 2018; 12:525-534. [PMID: 29761632 DOI: 10.1111/eip.12492] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/15/2017] [Accepted: 08/20/2017] [Indexed: 01/07/2023]
Abstract
AIM The impact of dysfunctional coping strategies during the prodromal phase of psychosis has recently been explored by several studies. What has yet to be clarified is whether maladaptive coping is evident in the prodromal phase and the impact that this might have on symptomatic and functional outcomes. The aim of this study was to review the findings on coping in individuals at ultra-high risk of psychosis (UHR) in relation to symptoms and level of functioning. METHODS Original articles were identified by searching 7 databases using the terms "prodrom*," "ultra high risk," "clinical high risk," "at-risk mental state," "coping style*," "coping strategies," "cope," "coping" and "psychosis". We included original articles that: (1) reported a measure of coping and (2) evaluated UHR individuals. RESULTS A total of 9 original articles of 335 that examined coping in individuals at high risk of psychosis were included. UHR subjects were more likely to use maladaptive coping strategies than healthy controls and were more likely to use emotion-focussed than task-oriented coping. Maladaptive coping was associated with higher levels of negative symptoms, whereas positive coping was associated with fewer negative symptoms. The coping style employed by UHR individuals was found to negatively influence their psychosocial functioning. CONCLUSIONS It is still unclear whether coping heightens or reduces the likelihood of transition to psychosis in relation to other factors, including environment. Longitudinal studies could clarify whether coping styles remain stable after the onset of psychosis or whether the emerging psychotic symptoms influence the coping strategies.
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Affiliation(s)
- Louise Mian
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Guido Maria Lattanzi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | - Stefania Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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24
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Kang M, Bang M, Lee SY, Lee E, Yoo SW, An SK. Coping styles in individuals at ultra-high risk for psychosis: Associations with cognitive appraisals. Psychiatry Res 2018; 264:162-168. [PMID: 29635143 DOI: 10.1016/j.psychres.2018.03.079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 01/15/2018] [Accepted: 03/29/2018] [Indexed: 11/18/2022]
Abstract
Maladaptive coping may play an important role in the manifestation of symptoms, functioning, and overt psychosis onset in individuals at ultra-high risk (UHR) for psychosis. To determine the factors associated with coping strategies, the relationships between cognitive appraisals and coping styles were investigated in UHR individuals. Sixty-five UHR individuals and 83 healthy controls were assessed for coping styles and cognitive appraisals of attribution bias as a primary appraisal and self-efficacy and perceived social support as a secondary appraisal. UHR participants relied more on a passive, tension-reduction coping style and less on an active, problem-focused coping style. These maladaptive coping styles in UHR individuals were significantly associated with their cognitive appraisals of stress. Aberrant attribution style of hostility perception and composite blaming bias were associated with problem-focused coping and tension-reduction, respectively. Perceived social support was related to problem-focused coping, seeking social support, and wishful thinking. General self-efficacy was associated with problem-focused coping. Our findings suggest that cognitive appraisals themselves may be the major determinants of coping styles in UHR individuals. The identified attribution styles, perceived social support, and self-efficacy may provide some clues regarding specialized interventions for the buildup of adaptive coping strategies in UHR individuals.
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Affiliation(s)
- MinJae Kang
- Section of Self, Affect and Neuroscience, Yonsei University College of Medicine, Seoul, South Korea; Yonsei University College of Medicine, Seoul, South Korea
| | - Minji Bang
- Section of Self, Affect and Neuroscience, Yonsei University College of Medicine, Seoul, South Korea; Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Su Young Lee
- Section of Self, Affect and Neuroscience, Yonsei University College of Medicine, Seoul, South Korea; Department of Psychiatry, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, South Korea
| | - Eun Lee
- Section of Self, Affect and Neuroscience, Yonsei University College of Medicine, Seoul, South Korea; Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea
| | - Sang Woo Yoo
- Yonsei Yoo & Kim Mental Health Clinic, Seoul, South Korea
| | - Suk Kyoon An
- Section of Self, Affect and Neuroscience, Yonsei University College of Medicine, Seoul, South Korea; Department of Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, South Korea; Graduate Program in Cognitive Science, Yonsei University, Seoul, South Korea.
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Determinants of self-esteem in early psychosis: The role of perceived social dominance. Psychiatry Res 2017; 258:583-586. [PMID: 27363724 DOI: 10.1016/j.psychres.2016.05.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 04/07/2016] [Accepted: 05/29/2016] [Indexed: 11/23/2022]
Abstract
Self-esteem plays a role in the formation and maintenance of symptoms and in the recovery from psychotic illness. This study examines the relative contribution of perceived social dominance and other known predictors in determining self-esteem in 102 individuals in an early intervention program for psychosis. Regression analysis demonstrated that scores on the Perceived Relational Evaluation Scale (PRES), depressed mood, social dominance, gender and positive symptoms significantly contributed to the prediction of scores on the Rosenberg Self-esteem Scale (RSES), whereas self-stigma and negative symptoms did not. Our study suggests that low self-esteem in early psychosis can be understood in part as a reflection of low levels of perceived social value and status.
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Surmann M, Gruchalla LV, Falke S, Maisch B, Uhlmann C, Bock E, Arolt V, Lencer R. The importance of strengthening competence and control beliefs in patients with psychosis to reduce treatment hindering self-stigmatization. Psychiatry Res 2017; 255:314-320. [PMID: 28601714 DOI: 10.1016/j.psychres.2017.05.053] [Citation(s) in RCA: 9] [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] [Received: 10/28/2016] [Revised: 05/31/2017] [Accepted: 05/31/2017] [Indexed: 11/19/2022]
Abstract
Different aspects of self-stigmatization represent barriers for recovery in patients with psychosis disorders. It is unclear whether addressing patient's competence and control beliefs could attenuate the extent of self-stigmatization. The major aim of this study was to identify predictors of self-stigmatization derived from competence and control beliefs in patients (N = 80). Sociodemographic characteristics, clinical variables, competence and control beliefs and self-stigmatization were assessed among 80 patients with psychosis disorders. The cross-sectional data was analyzed by correlation and regression analyses. Results indicate deficits in self-concept of own competences, i.e. the capability of acting in new, difficult or ambiguous situations, resulting in also impaired self-efficacy and relatively increased externality in patients compared to a general population sample. Subjective well-being under neuroleptics, trait-anxiety and defining oneself as religious were the most influential predictors of competence and control beliefs. A weaker self-concept of own competences was also revealed as the strongest predictor of overall high self-stigmatization. Our results stress the importance of orienting treatment strategies towards strengthening the self-concept of own competences in patients in order to reduce self-stigmatization and enhance resilience.
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Affiliation(s)
- Marian Surmann
- Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Geb. A9, 48149 Muenster, Germany
| | - Lara von Gruchalla
- Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Geb. A9, 48149 Muenster, Germany
| | - Sebastian Falke
- Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Geb. A9, 48149 Muenster, Germany
| | | | - Christina Uhlmann
- Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Geb. A9, 48149 Muenster, Germany
| | - Eva Bock
- Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Geb. A9, 48149 Muenster, Germany
| | - Volker Arolt
- Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Geb. A9, 48149 Muenster, Germany; Otto-Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Germany
| | - Rebekka Lencer
- Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Geb. A9, 48149 Muenster, Germany; Otto-Creutzfeldt Center for Cognitive and Behavioral Neuroscience, University of Muenster, Germany.
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27
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Millman ZB, Weintraub MJ, Bentley E, DeVylder JE, Mittal VA, Pitts SC, Thompson E, Demro C, Reeves GM, Schiffman J. Differential relations of locus of control to perceived social stress among help-seeking adolescents at low vs. high clinical risk of psychosis. Schizophr Res 2017; 184:39-44. [PMID: 27998649 DOI: 10.1016/j.schres.2016.12.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/01/2016] [Accepted: 12/05/2016] [Indexed: 12/19/2022]
Abstract
Research suggests that perceived social stress influences illness presentation and course among youth in the clinical high-risk (CHR) phase of psychosis. Little is known, however, about the social cognitive factors associated with social stress perception in this population, particularly relative to youth with non-CHR psychopathology. Individuals with psychosis tend to endorse an external locus of control (LOC), which is associated with the stress response in healthy individuals. LOC may therefore be related to perceived social stress in youth at CHR. We examined the differential relations of self-reported LOC and perceived social stress, as measured by the Behavior Assessment System for Children, Second Edition, across 45 CHR and 65 help-seeking control (HSC) participants. Youth at CHR reported more social stress (F[1, 107]=6.28, p=0.01) and a more external LOC (F[1, 107]=4.98, p=0.03) than HSCs. Further, external LOC was more strongly associated with feelings of social stress in the CHR group relative to the HSC group (interaction: b=0.35, t[105]=2.32, p<0.05, f2=0.05). Group differences in social stress, however, were nonsignificant at internal levels of LOC (b=-2.0, t[105]=-0.72, p=0.48; f2=0.00). Results suggest that perceptions of uncontrollability over one's social environment may more often induce or exacerbate feelings of stress and tension in CHR youth relative to HSCs. A better understanding of the social cognition-stress relation may improve understanding of CHR phenomenology, etiology, and treatment.
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Affiliation(s)
- Zachary B Millman
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Marc J Weintraub
- Department of Psychology, University of Miami, Coral Gables, 5665 Ponce De Leon Boulevard, Coral Gables, FL 33146, USA
| | - Eryn Bentley
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Jordan E DeVylder
- Department of Social Work, University of Maryland, School of Social Work, 535 West Redwood Street, Baltimore, MD 21201, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, 2029 Sheridan Road, Evanston, IL 60208, USA
| | - Steven C Pitts
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Elizabeth Thompson
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Caroline Demro
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA
| | - Gloria M Reeves
- Division of Child and Adolescent Psychiatry, University of Maryland, Baltimore, 701 W. Pratt Street, Baltimore, MD 21201, USA
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250, USA.
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Schlier B, Engel M, Fladung AK, Fritzsche A, Lincoln TM. The relevance of goal-orientation for motivation in high versus low proneness to negative symptoms. J Behav Ther Exp Psychiatry 2017; 55:113-120. [PMID: 28209215 DOI: 10.1016/j.jbtep.2017.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 01/08/2017] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The psychological mechanisms of why individuals with negative symptoms fail to initiate and perform goal-directed behavior are not well understood. Drawing on the reward-sensitivity and expectancy-value theories, we investigate whether negative symptom-like experiences (NSLE) are associated with generating less approach goals (aimed at reaching a positive outcome) and more avoidance goals (aimed at avoiding a negative outcome) and whether this type of goal-orientation explains motivational deficits (i.e., perceiving goals as less feasible and important and being less committed to them). METHODS Based on the continuum model of negative symptoms, we identified two parallelized extreme groups with high and low levels of NSLE (n = 37, respectively) in an ad-hoc online-sample of healthy individuals (N = 262) using the Community Assessment of Psychic Experiences. In an online study, these participants were instructed to generate approach and avoidance goals and to rate each goal in terms of feasibility, importance and goal-commitment. RESULTS Participants with low levels of NSLE generated more approach than avoidance goals. Participants with high levels of NSLE showed no such difference due to increased numbers of avoidance goals. Furthermore, avoidance goal-orientation predicted reduced subjective feasibility and importance of goals and less goal-commitment. LIMITATIONS Results are based on a healthy sample rather than people with psychosis. No longitudinal or behavioral data for goal-striving was collected. CONCLUSION People with NSLE generate more avoidance goals than controls. This is dysfunctional because it correlates with feeling less committed to reach one's goals. Optimizing goal-setting could be a promising starting-point for psychological interventions aimed at reducing negative symptoms.
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Affiliation(s)
- Björn Schlier
- University of Hamburg, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, D-20146 Hamburg, Germany.
| | - Maike Engel
- University of Hamburg, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, D-20146 Hamburg, Germany
| | - Anne-Katharina Fladung
- University of Hamburg, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, D-20146 Hamburg, Germany
| | - Anja Fritzsche
- University of Hamburg, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, D-20146 Hamburg, Germany
| | - Tania M Lincoln
- University of Hamburg, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, D-20146 Hamburg, Germany
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Kommescher M, Gross S, Pützfeld V, Klosterkötter J, Bechdolf A. Coping and the stages of psychosis: an investigation into the coping styles in people at risk of psychosis, in people with first-episode and multiple-episode psychoses. Early Interv Psychiatry 2017; 11:147-155. [PMID: 25726849 DOI: 10.1111/eip.12223] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/19/2014] [Indexed: 11/29/2022]
Abstract
AIM The concept of coping is central to recent models of psychosis. The aim of the present paper is to explore whether specific coping styles relate to certain stages of the disorder. METHODS Thirty-nine clients at clinical high risk (CHR) of first-episode psychosis, 19 clients with first-episode psychosis and 52 clients with multiple-episode psychosis completed a Stress Coping Questionnaire. This questionnaire consists of 114 items defining one overall positive coping scale (with three subscales) and one negative coping scale. Analyses of variance with group as between-subject factor and coping behaviour as within-subject factor were used to identify different coping patterns. RESULTS On the level of subscales no group differences could be detected, but analysis of variance revealed slightly different patterns: CHR clients used significantly more negative than positive coping styles (P = 0.001), followed by patients with multiple-episode psychosis (P = 0.074). First-episode patients were most likely to use negative as well as positive coping (P = 0.960). Across all stages of illness, stress control was significantly preferred compared to the other positive coping styles distraction and devaluation. Again, this pattern was especially pronounced for at-risk clients and patients with multiple-episode psychosis, whereas patients with first-episode psychosis were most likely to use devaluation as well as distraction. CONCLUSIONS The overall coping styles were similar across the different stages of psychosis. However, at-risk persons presented especially pronounced negative coping and a small range of strategies, indicating a specific need for psychosocial support in this stage of the disorder.
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Affiliation(s)
- Mareike Kommescher
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Sonja Gross
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Verena Pützfeld
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | | | - Andreas Bechdolf
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
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30
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Ebner K, Thiele L, Spurk D, Kauffeld S. Validation of the German Career Decision-Making Profile—An Updated 12-Factor Version. JOURNAL OF CAREER ASSESSMENT 2016. [DOI: 10.1177/1069072716679996] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Career Decision-Making Profile (CDMP) was developed by Gati and colleagues in 2010 as an attempt to reliably measure which strategies individuals apply when making career decisions. In order to provide counseling and coaching professionals with a German version of the scale, we translated and validated the German version (G-CDMP) in two studies (total N = 622). Results of Study 1 verified the proposed 12-factor structure by means of confirmatory factor analyses, confirming that the G-CDMP assesses 12 distinct career decision-making strategies. Results of Study 2 demonstrated the G-CDMP’s construct validity on subscale level by relating it to self-evaluations (e.g., occupational self-efficacy) and personality (i.e., the Big Five) as well as to career-related constructs, such as career adaptability and cognitive reactions toward career-life decisions (e.g., life satisfaction). As the studies provide support for the G-CDMP’s factor structure and its construct validity, implications for its use during career counseling are discussed.
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Affiliation(s)
- Katharina Ebner
- Department of Business and Economics, University of Erlangen-Nuremberg, Nuremberg, Germany
| | - Lisa Thiele
- Department of Industrial/Organizational and Social Psychology, Technical University Braunschweig, Braunschweig, Germany
| | - Daniel Spurk
- Department of Work and Industrial Psychology, University Bern, Bern, Switzerland
| | - Simone Kauffeld
- Department of Industrial/Organizational and Social Psychology, Technical University Braunschweig, Braunschweig, Germany
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31
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Salokangas RKR, Schultze-Lutter F, Hietala J, Heinimaa M, From T, Ilonen T, Löyttyniemi E, von Reventlow HG, Juckel G, Linszen D, Dingemans P, Birchwood M, Patterson P, Klosterkötter J, Ruhrmann S. Depression predicts persistence of paranoia in clinical high-risk patients to psychosis: results of the EPOS project. Soc Psychiatry Psychiatr Epidemiol 2016; 51:247-57. [PMID: 26643940 DOI: 10.1007/s00127-015-1160-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/17/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The link between depression and paranoia has long been discussed in psychiatric literature. Because the causality of this association is difficult to study in patients with full-blown psychosis, we aimed to investigate how clinical depression relates to the presence and occurrence of paranoid symptoms in clinical high-risk (CHR) patients. METHODS In all, 245 young help-seeking CHR patients were assessed for suspiciousness and paranoid symptoms with the structured interview for prodromal syndromes at baseline, 9- and 18-month follow-up. At baseline, clinical diagnoses were assessed by the Structured Clinical Interview for DSM-IV, childhood adversities by the Trauma and Distress Scale, trait-like suspiciousness by the Schizotypal Personality Questionnaire, and anxiety and depressiveness by the Positive and Negative Syndrome Scale. RESULTS At baseline, 54.3% of CHR patients reported at least moderate paranoid symptoms. At 9- and 18-month follow-ups, the corresponding figures were 28.3 and 24.4%. Depressive, obsessive-compulsive and somatoform disorders, emotional and sexual abuse, and anxiety and suspiciousness associated with paranoid symptoms. In multivariate modelling, depressive and obsessive-compulsive disorders, sexual abuse, and anxiety predicted persistence of paranoid symptoms. CONCLUSION Depressive disorder was one of the major clinical factors predicting persistence of paranoid symptoms in CHR patients. In addition, obsessive-compulsive disorder, childhood sexual abuse, and anxiety associated with paranoia. Effective pharmacological and psychotherapeutic treatment of these disorders and anxiety may reduce paranoid symptoms in CHR patients.
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Affiliation(s)
- Raimo K R Salokangas
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland.
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jarmo Hietala
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland.,Psychiatric Clinic, Turku University Central Hospital, Turku, Finland.,Turku Psychiatric Clinic, Turku Mental Health Centre, Turku, Finland
| | - Markus Heinimaa
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland
| | - Tiina From
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland
| | - Tuula Ilonen
- Department of Psychiatry, University of Turku, Kunnallissairaalantie 20, 20700, Turku, Finland
| | | | - Heinrich Graf von Reventlow
- Ev. Zentrum für Beratung und Therapie am Weißen Stein, Evangelischer Regionalverband Frankfurt am Main, Frankfurt Am Main, Germany
| | - Georg Juckel
- Department of Psychiatry, LWL University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Don Linszen
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Department of Psychiatry and Psychology, University of Maastricht, Maastricht, The Netherlands
| | - Peter Dingemans
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Mediant, Enschede, The Netherlands
| | - Max Birchwood
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Paul Patterson
- Youthspace, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | | | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
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Stigma as a stressor and transition to schizophrenia after one year among young people at risk of psychosis. Schizophr Res 2015; 166:43-8. [PMID: 26036814 DOI: 10.1016/j.schres.2015.05.027] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 05/05/2015] [Accepted: 05/14/2015] [Indexed: 01/13/2023]
Abstract
According to stress-vulnerability models, social stressors contribute to the onset of schizophrenia. Stigma and discrimination associated with mental illness may be a stressor for young people at risk of psychosis even prior to illness onset, but quantitative longitudinal data on this issue are lacking. We examined the cognitive appraisal of stigma-related stress as predictor of transition to schizophrenia among young people at risk of psychosis. In Zürich, Switzerland, 172 participants between 13 and 35years old and with either high or ultra-high risk of psychosis or risk of bipolar disorder were included. With 71 dropouts, transition was assessed during 12months among 101 participants of whom 13 converted to schizophrenia. At baseline, the cognitive appraisal of stigma as a stressor was measured by self-report, based on the primary appraisal of stigma as harmful and the secondary appraisal of resources to cope with stigma. Positive and negative symptoms were examined using the Positive and Negative Syndrome Scale. Compared with participants who did not convert to schizophrenia, converters had significantly more positive (p<.001) and negative (p<.001) symptoms and reported higher levels of stigma-related harm (p=.003) and stress (p=.009) at baseline. More perceived harm due to stigma at baseline predicted transition to schizophrenia (odds ratio 2.34, 95%-CI 1.19-4.60) after adjusting for age, gender, symptoms and functioning. Stigma stress may increase the risk of transition to schizophrenia. Research is needed on interventions that reduce public negative attitudes towards young people at risk and that support individuals at risk to cope with stigma-related stress.
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33
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Ciufolini S, Morgan C, Morgan K, Fearon P, Boydell J, Hutchinson G, Demjaha A, Girardi P, Doody GA, Jones PB, Murray R, Dazzan P. Self esteem and self agency in first episode psychosis: Ethnic variation and relationship with clinical presentation. Psychiatry Res 2015; 227:213-8. [PMID: 25868868 DOI: 10.1016/j.psychres.2015.03.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 02/28/2015] [Accepted: 03/03/2015] [Indexed: 11/15/2022]
Abstract
The impact of self esteem and Locus of Control (LoC) on clinical presentation across different ethnic groups of patients at their first psychotic episode (FEP) remains unknown. We explored these constructs in 257 FEP patients (Black n=95; White British n=119) and 341 controls (Black n=70; White British n=226), and examined their relationship with symptom dimensions and pathways to care. FEP patients presented lower self-esteem and a more external LoC than controls. Lower self esteem was associated with a specific symptoms profile (more manic and less negative symptoms), and with factors predictive of poorer outcome (longer duration of untreated psychosis (DUP) and compulsory mode of admission). A more external LoC was associated with more negative symptoms and an insidious onset. When we explored these constructs across different ethnic groups, we found that Black patients had significantly higher self esteem than White British. This was again associated with specific symptom profiles. While British patients with lower self esteem were more likely to report delusions, hallucinations and negative symptoms, Black patients with a lower self esteem showed less disorganization symptoms. These findings suggest that self esteem and LoC may represent one way in which social experiences and contexts differentially influence vulnerable individuals along the pathway to psychosis.
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Affiliation(s)
- Simone Ciufolini
- King׳s College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King׳s College London, London, UK.
| | - Craig Morgan
- King׳s College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, UK
| | - Kevin Morgan
- University of Westminster, Department of Psychology, London, UK
| | - Paul Fearon
- Trinity College Dublin, Department of Psychiatry, Dublin, Ireland
| | - Jane Boydell
- King׳s College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, UK
| | - Gerard Hutchinson
- University of West Indies, Department of Psychiatry, St. Augustine, Trinidad and Tobago
| | - Arsjme Demjaha
- King׳s College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, UK
| | - Paolo Girardi
- University of La Sapienza, Department of Psychiatry, Rome, Italy
| | - Gill A Doody
- University of Nottingham, Department of Psychiatry, Nottingham, UK
| | - Peter B Jones
- University of Cambridge, Department of Psychiatry, Addenbrooke׳s Hospital, Cambridge, UK
| | - Robin Murray
- King׳s College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, UK
| | - Paola Dazzan
- King׳s College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King׳s College London, London, UK
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34
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Schultze-Lutter F, Michel C, Schmidt SJ, Schimmelmann BG, Maric NP, Salokangas RKR, Riecher-Rössler A, van der Gaag M, Nordentoft M, Raballo A, Meneghelli A, Marshall M, Morrison A, Ruhrmann S, Klosterkötter J. EPA guidance on the early detection of clinical high risk states of psychoses. Eur Psychiatry 2015; 30:405-16. [PMID: 25735810 DOI: 10.1016/j.eurpsy.2015.01.010] [Citation(s) in RCA: 256] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/29/2015] [Accepted: 01/29/2015] [Indexed: 01/15/2023] Open
Abstract
The aim of this guidance paper of the European Psychiatric Association is to provide evidence-based recommendations on the early detection of a clinical high risk (CHR) for psychosis in patients with mental problems. To this aim, we conducted a meta-analysis of studies reporting on conversion rates to psychosis in non-overlapping samples meeting any at least any one of the main CHR criteria: ultra-high risk (UHR) and/or basic symptoms criteria. Further, effects of potential moderators (different UHR criteria definitions, single UHR criteria and age) on conversion rates were examined. Conversion rates in the identified 42 samples with altogether more than 4000 CHR patients who had mainly been identified by UHR criteria and/or the basic symptom criterion 'cognitive disturbances' (COGDIS) showed considerable heterogeneity. While UHR criteria and COGDIS were related to similar conversion rates until 2-year follow-up, conversion rates of COGDIS were significantly higher thereafter. Differences in onset and frequency requirements of symptomatic UHR criteria or in their different consideration of functional decline, substance use and co-morbidity did not seem to impact on conversion rates. The 'genetic risk and functional decline' UHR criterion was rarely met and only showed an insignificant pooled sample effect. However, age significantly affected UHR conversion rates with lower rates in children and adolescents. Although more research into potential sources of heterogeneity in conversion rates is needed to facilitate improvement of CHR criteria, six evidence-based recommendations for an early detection of psychosis were developed as a basis for the EPA guidance on early intervention in CHR states.
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Affiliation(s)
- F Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - C Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - S J Schmidt
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - B G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - N P Maric
- School of Medicine, University of Belgrade and Clinic of Psychiatry, Clinical Center of Serbia, Belgrade, Serbia
| | | | - A Riecher-Rössler
- Center for Gender Research and Early Detection, Psychiatric University Clinics Basel, Basel, Switzerland
| | - M van der Gaag
- Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands; Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - M Nordentoft
- Mental Health Center Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - A Raballo
- Department of Mental Health, Reggio Emilia Public Health Centre, Reggio Emilia, Italy; Regional Working Group on Early Detection of Psychosis, Emilia Romagna Regional Health Service, Bologna, Italy
| | - A Meneghelli
- Dipartimento di Salute Mentale, Centro per l'Individuazione e l'Intervento Precoce nelle Psicosi-Programma 2000, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - M Marshall
- School of Medicine, University of Manchester, Manchester, UK; LANTERN Centre, Lancashire Care NHS Foundation Trust, Preston, UK
| | - A Morrison
- School of Psychological Sciences, University of Manchester, Manchester, UK; Psychosis Research Unit, Greater Manchester West NHS Mental Health Trust, Manchester, UK
| | - S Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - J Klosterkötter
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
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35
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Patterns and correlates of expressed emotion, perceived criticism, and rearing style in first admitted early-onset schizophrenia spectrum disorders. J Nerv Ment Dis 2014; 202:783-7. [PMID: 25259947 DOI: 10.1097/nmd.0000000000000209] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to assess patterns and correlates of family variables in 31 adolescents treated for their first episode of a schizophrenia spectrum disorder (early-onset schizophrenia [EOS]). Expressed emotion, perceived criticism, and rearing style were assessed. Potential correlates were patient psychopathology, premorbid adjustment, illness duration, quality of life (QoL), sociodemographic variables, patient and caregiver "illness concept," and caregiver personality traits and support. Families were rated as critical more frequently by patients than raters (55% vs. 13%). Perceived criticism was associated with worse QoL in relationship with parents and peers. An adverse rearing style was associated with a negative illness concept in patients, particularly with less trust in their physician. Future research should examine perceived criticism as a predictor of relapse and indicator of adolescents with EOS who need extended support and treatment. Rearing style should be carefully observed because of its link with patients' illness concept and, potentially, to service engagement and medication adherence.
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36
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Ruhrmann S, Schultze-Lutter F, Schmidt SJ, Kaiser N, Klosterkötter J. Prediction and prevention of psychosis: current progress and future tasks. Eur Arch Psychiatry Clin Neurosci 2014; 264 Suppl 1:S9-16. [PMID: 25256263 DOI: 10.1007/s00406-014-0541-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 09/06/2014] [Indexed: 12/28/2022]
Abstract
Prevention of psychoses has been intensively investigated within the past two decades, and particularly, prediction has been much advanced. Depending on the applied risk indicators, current criteria are associated with average, yet significantly heterogeneous transition rates of ≥30 % within 3 years, further increasing with longer follow-up periods. Risk stratification offers a promising approach to advance current prediction as it can help to reduce heterogeneity of transition rates and to identify subgroups with specific needs and response patterns, enabling a targeted intervention. It may also be suitable to improve risk enrichment. Current results suggest the future implementation of multi-step risk algorithms combining sensitive risk detection by cognitive basic symptoms (COGDIS) and ultra-high-risk (UHR) criteria with additional individual risk estimation by a prognostic index that relies on further predictors such as additional clinical indicators, functional impairment, neurocognitive deficits, and EEG and structural MRI abnormalities, but also considers resilience factors. Simply combining COGDIS and UHR criteria in a second step of risk stratification produced already a 4-year hazard rate of 0.66. With regard to prevention, two recent meta-analyses demonstrated that preventive measures enable a reduction in 12-month transition rates by 54-56 % with most favorable numbers needed to treat of 9-10. Unfortunately, psychosocial functioning, another important target of preventive efforts, did not improve. However, these results are based on a relatively small number of trials; and more methodologically sound studies and a stronger consideration of individual profiles of clinical needs by modular intervention programs are required.
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Affiliation(s)
- Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany,
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