Hearing spirits? Religiosity in individuals at risk for psychosis-Results from the Brazilian SSAPP cohort

Development of mental health first aid guidelines for psychosis for Brazil: A Delphi expert consensus study

Psychotic symptoms can be highly debilitating for those experiencing them. Community members, including family and friends, can play a crucial role in providing support to a person during the early stages of psychosis, provided they have the necessary resources. Mental health first aid guidelines for psychosis have been developed for high-income countries and this study aimed to adapt those guidelines for Brazil. A Delphi expert consensus method was used to gather the views and opinions of 28 health professionals and 24 individuals with lived experience of psychosis in Brazil over two survey rounds. Firstly, 403 statements were translated from English to Brazilian-Portuguese. In the Round 1 survey, participants were asked to rate each statement based on how important they believed it was for it to be included in the Brazilian guidelines. They were also asked to suggest new actions if they wished. Consensus was reached on 257 statements. Eight new statements were created and endorsed from panelists' comments, and a further 45 statements were unique to the Brazilian guidelines. There was a modest level of similarity between the English-language and Brazilian guidelines. However, the Brazilian guidelines had a greater focus on the importance of family support for people with psychosis and stigma as a possible barrier for openly discussing help-seeking actions for mental health problems in Brazil.

The role of religiosity types in the phenomenology of hallucinations: A large cross-sectional community-based study in a predominantly Muslim society

Religiosity is a multidimensional construct known to influence the occurrence of hallucinations. However, it remains unknown how different religiosity types affect clinically relevant phenomenological features of hallucinations. Therefore, we wished to explore associations between intrinsic and extrinsic (non-organizational and organizational) religiosity and hallucinations severity, distress or impact on daily function in a non-clinical Muslim population. We recruited a representative sample of full-time students at Qatar's only national university via systematic random sampling and administered the Questionnaire of Psychotic Experiences online. The study design was cross-sectional. Using structural equation modeling, we estimated effects of the religiosity types on hallucinations severity, distress or impact on daily function in the past week while accounting for sociodemographic variables, anxiety, depressive symptoms, and, delusions. Extrinsic non-organizational religiosity (ENORG) was associated with experiencing reduced distress or impact on daily function from hallucinations both directly and indirectly through intrinsic religiosity. In contrast, extrinsic non-organizational religiosity (EORG) was associated with increased hallucinations distress or impact albeit only through higher intrinsic religiosity. We found no association between any religiosity types and hallucinations severity. Younger and married participants from lower socio-economic class had comparatively more severe hallucinations and more distress from them. Qatari nationality was positively associated EORG and negatively associated with hallucinations distress or impact. Evidence of differential associations between the religiosity types, socioeconomic and cultural groups, and distress or impact from past week's hallucinations supports the importance of alignment between religious, mental health, and well-being education.

Cannabis use influences disorganized symptoms severity but not transition in a cohort of non-help-seeking individuals at-risk for psychosis from São Paulo, Brazil

BACKGROUND

Cannabis use is associated with an increased risk of developing a psychotic disorder. However, in individuals with at-risk mental states for psychosis (ARMS) this association is not clear, as well as the impact of cannabis use on symptom severity. The objective of this study was to evaluate the association of cannabis use patterns and ARMS risk status, transition to psychotic and psychiatric disorders, and psychopathology.

METHOD

A sample of 109 ARMS and 197 control individuals was drawn from the general population. Lifetime, maximum and current amount of cannabis use were assessed with the South Westminster modified questionnaire. Participants were followed-up for a mean of 2.5 years and reassessed for transition to any psychiatric disorder.

RESULTS

There were no differences between ARMS and controls regarding lifetime use, current amount of use, or maximum amount of cannabis use. There were also no differences between those who transitioned to a psychiatric disorder and those who did not regarding cannabis use variables. In ARMS individuals, cannabis use was significantly related to disorganization symptoms.

CONCLUSION

The results of this study suggest that cannabis plays a role in the psychopathology of ARMS individuals, leading to more severe symptomatology.

Detecting at-risk mental states for psychosis (ARMS) using machine learning ensembles and facial features

AIMS

Our study aimed to develop a machine learning ensemble to distinguish "at-risk mental states for psychosis" (ARMS) subjects from control individuals from the general population based on facial data extracted from video-recordings.

METHODS

58 non-help-seeking medication-naïve ARMS and 70 healthy subjects were screened from a general population sample. At-risk status was assessed with the Structured Interview for Prodromal Syndromes (SIPS), and "Subject's Overview" section was filmed (5-10 min). Several features were extracted, e.g., eye and mouth aspect ratio, Euler angles, coordinates from 51 facial landmarks. This elicited 649 facial features, which were further selected using Gradient Boosting Machines (AdaBoost combined with Random Forests). Data was split in 70/30 for training, and Monte Carlo cross validation was used.

RESULTS

Final model reached 83 % of mean F1-score, and balanced accuracy of 85 %. Mean area under the curve for the receiver operator curve classifier was 93 %. Convergent validity testing showed that two features included in the model were significantly correlated with Avolition (SIPS N2 item) and expression of emotion (SIPS N3 item).

CONCLUSION

Our model capitalized on short video-recordings from individuals recruited from the general population, effectively distinguishing between ARMS and controls. Results are encouraging for large-screening purposes in low-resource settings.

Inequality and barriers in psychosis prevention: A systematic review on clinical high-risk for psychosis studies from developing countries

Background

The clinical high-risk for psychosis (CHR) paradigm is one of the best studied preventive paradigms in psychiatry. However, most studies have been conducted in high-income countries. It is unclear if knowledge from such countries applies to low and middle-income countries (LAMIC), and if there are specific limitations hindering CHR research there. Our aim is to systematically review studies on CHR from LAMIC.

Methods

A multistep PRISMA-compliant literature search was performed in PubMed and Web of Science for articles published until 1/03/2022, conducted in LAMIC, addressing the concept and correlates of CHR. Study characteristics as well as limitations were reported. Corresponding authors of the included studies were invited to answer an online poll. Quality assessment was done with the MMAT.

Results

A total of 109 studies were included in the review: none from low-income countries, 8 from lower middle-income countries, and 101 from upper middle-income countries. The most frequent limitations were small sample size (47.9%), cross-sectional design (27.1%), and follow-up issues (20.8%). Mean quality of included studies was of 4.4. Out of the 43 corresponding authors, 12 (27.9%) completed the online poll. They cited further limitations as few financial resources (66.7%), no involvement of population (58.2%) and cultural barriers (41.7%). Seventy five percent researchers reported that CHR research should be conducted differently in LAMIC compared to high-income countries, due to structural and cultural issues. Stigma was mentioned in three out of five sections of the poll.

Discussion

Results show the discrepancy of available evidence on CHR in LAMIC, given the shortage of resources in such countries. Future directions should aim to increase the knowledge on individuals at CHR in such settings, and to address stigma and cultural factors that may play a role in the pathways toward care in psychosis.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=316816, CRD42022316816.

Religious hallucinations in Lebanese patients with schizophrenia and their association with religious coping

PURPOSE

to evaluate the relationship between religious hallucinations and religious coping among Lebanese patients with schizophrenia.

METHODS

We have studied the prevalence of religious hallucinations (RH) among 148 hospitalized Lebanese patients suffering from schizophrenia or schizoaffective disorder in November 2021 exhibiting religious delusions (RD), and their relationship with religious coping using the brief Religious Coping Scale (RCOPE). The PANSS scale was used to evaluate psychotic symptoms.

RESULTS

After adjustment over all variables, more psychotic symptoms (higher total PANSS scores) (aOR = 1.02) and more religious negative coping (aOR = 1.11) were significantly associated with higher odds of having religious hallucinations, whereas watching religious programs (aOR = 0.34) was significantly associated with lower odds of having religious hallucinations.

CONCLUSION

This paper highlights the important role of religiosity that has to play in the formation of religious hallucinations in schizophrenia. Significant association was found between negative religious coping and the emergence of religious hallucinations.

Prevalence of spiritual and religious experiences in the general population: A Brazilian nationwide study

Spiritual and religious experiences (SREs) are common subjective phenomena related to the awareness of transcendence, which transforms one's perception of life, death and suffering. Despite the high prevalence of SREs worldwide, not enough studies have been conducted beyond Europe and North America. To fill this gap, this study investigates the prevalence of SREs in Brazil and their association with socio-demographic variables. This online cross-sectional study includes participants from all regions of Brazil. Sixteen SREs were investigated, being categorized into 4 groups: mystical, mediumistic, psi-related and past life/near-death experiences. Prevalence was calculated as percentages and multinomial logistic regression models were used. A total of 1,053 Brazilians were included; 92% reported one SRE in their lifetime and 47.5% experienced at least one SRE frequently. Participants reported having had at least one mystical experience (35%), one psi-related experience (27.7%), and one mediumistic experience (11%). Half the sample had "felt the presence of a dead person" and 70% experienced precognitive dreams at least once. In a multivariate analysis, SREs were associated with the female gender but showed no associations with income, education, employment status and ethnicity. Mystical experiences were associated with age 55 and older. In summary, SREs are very prevalent across different strata of the population, and deserve more attention from researchers and clinicians in order to clarify their nature and implications for mental health care and research in Brazil.

COX-2 pathway is upregulated in ultra-high risk individuals for psychosis

BACKGROUND

The identification of Ultra-High Risk (UHR) individuals is thought to be useful for early intervention to improve psychosis outcomes. However, transition rates vary widely, and there is an effort to make these criteria more specific and accurate. Neuroinflammation has been discussed in the pathophysiology of psychosis. The metabolism of eicosanoids is a key process in inflammatory states. Therefore, we investigated whether the study of the inflammatory COX-2 pathway through the quantification of the eicosanoid levels can be a useful approach for the characterisation of UHR individuals.

METHODS

One hundred and twenty-two individuals were included in this study (67 UHR and 55 controls) based on performance on the Prodromal Questionnaire. UHR status was assessed by Structured Interview for Prodromal Syndromes (SIPS). We determined the levels of Prostaglandin F_2α (PGF_2α), Prostaglandin E₂ (PGE₂), and Thromboxane B₂ (TxB₂) in plasma using ELISA assays.

RESULTS

Concentrations of PGE₂ and TxB₂ were increased in UHR compared to controls (p = 0.01 and p < 0.05, respectively). PGE₂ and PGF_2α levels were correlated to negative symptoms (p < 0.01 and p < 0.05), whereas TxB₂ correlated with positive symptoms (p = 0.05) as assessed by the SIPS.

CONCLUSIONS

Our findings suggest that overactivation of the COX-2 pathway may be related to an increased risk for psychosis. However, our data do not allow us to draw conclusions related to the cause-effect mechanisms. Future studies should determine whether the levels of the eicosanoids have a predictive value for the transition of UHR to frank psychosis.

Equity in Mental Health Services for Youth at Clinical High Risk for Psychosis: Considering Marginalized Identities and Stressors

Prevention and early intervention programs have been initiated worldwide to serve youth at Clinical High Risk for Psychosis (CHR-P), who are adolescents and young adults experiencing subclinical psychosis and functional impairment. The primary goals of these efforts are to prevent or mitigate the onset of clinical psychosis, while also treating comorbid issues. It is important to consider issues of diversity, equity, and inclusion in CHR-P work, especially as these programs continue to proliferate around the world. Further, there is a long history in psychiatry of misdiagnosing and mistreating psychosis in individuals from racial and ethnic minority groups. Although there have been significant developments in early intervention psychosis work, there is evidence that marginalized groups are underserved by current CHR-P screening and intervention efforts. These issues are compounded by the contexts of continued social marginalization and significant mental health disparities in general child/adolescent services. Within this narrative review and call to action, we use an intersectional and minority stress lens to review and discuss current issues related to equity in CHR-P services, offer evidence-based recommendations, and propose next steps. In particular, our intersectional and minority stress lenses incorporate perspectives for a range of marginalized and underserved identities related to race, ethnicity, and culture; faith; immigration status; geography/residence; gender identity; sexual orientation; socioeconomic status/class; and ability status.

Religiosity and prevalence of suicide, psychiatric disorders and psychotic symptoms in the French general population

We aimed to examine the association between religious beliefs and observance and the prevalence of psychiatric disorders, psychotic symptoms and history of suicide attempts in the French general population. The cross-sectional survey interviewed 38,694 subjects between 1999 and 2003, using the MINI. Current religious beliefs and observance were identified by means of two questions: "are you a believer?" and "are you religiously observant?". We studied the association between religiosity and psychiatric outcomes using a multivariable logistic regression model adjusted for sociodemographic characteristics, including migrant status. Religious beliefs were positively associated with psychotic symptoms and disorders [OR = 1.37, 95% CI (1.30-1.45) and OR = 1.38, 95% CI (1.20-1.58)], unipolar depressive disorder [OR = 1.15, 95% CI (1.06-1.23)] and generalized anxiety disorder [OR = 1.13, 95% CI (1.06-1.21)], but negatively associated with bipolar disorder [OR = 0.83, 95% CI (0.69-0.98)], alcohol use disorders [OR = 0.69, 95% CI (0.62-0.77)], substance use disorders [OR = 0.60, 95% CI (0.52-0.69)] and suicide attempts [OR = 0.90, 95% CI (0.82-0.99)]. Religious observance was positively associated with psychotic symptoms and disorders [OR = 1.38, 95% CI (1.20-1.58) and OR = 1.25, 95% CI (1.07-1.45)], but negatively associated with social anxiety disorder [OR = 0.87, 95% CI (0.76-0.99)], alcohol use disorders [OR = 0.60, 95% CI (0.51-0.70)], substance use disorders [OR = 0.48, 95% CI (0.38-0.60)] and suicide attempts [OR = 0.80, 95% CI (0.70-0.90)]. Among believers, religious observance was not associated with psychotic outcomes. Religiosity appears to be a complex and bidirectional determinant of psychiatric symptoms and disorders. In this respect, religiosity should be more thoroughly assessed in epidemiological psychiatric studies, as well as in clinical practice.

Increased PLA2 activity in individuals at ultra-high risk for psychosis

Phospholipase A₂ is the main enzyme in the metabolism of membrane phospholipids. It comprises a family of enzymes divided into iPLA₂, cPLA₂ and sPLA₂. Studies have reported increased PLA₂ activity in psychotic patients, which suggests an accelerated breakdown of membrane phospholipids. In the present study we investigated whether increased PLA₂ activity is also present in individuals at ultra-high risk (UHR) for psychosis. One-hundred fifty adults were included in this study (85 UHR and 65 controls). UHR was assessed using the "structured interview for prodromal syndromes". PLA₂ activity was determined in platelets by a radio-enzymatic assay. We found in UHR individuals increased activities of iPLA₂ (p < 0.001) and cPLA₂ (p = 0.012) as compared to controls. No correlations were found between socio-demographic and clinical parameters and PLA₂ activity. Our findings suggest that increased PLA₂ activities may be useful as a biological risk-marker for psychotic disorders.

Use of a Bayesian Network Model to predict psychiatric illness in individuals with 'at risk mental states' from a general population cohort

The 'at risk mental state' (ARMS) paradigm has been introduced in psychiatry to study prodromal phases of schizophrenia. With time it was seen that the ARMS state can also precede mental disorders other than schizophrenia, such as depression and anxiety. However, several problems hamper the paradigm's use in preventative medicine, such as varying transition rates across studies, the use of non-naturalistic samples, and the multifactorial nature of psychiatric disorders. To strengthen ARMS predictive power, there is a need for a holistic model incorporating-in an unbiased fashion-the small-effect factors that cause mental disorders. Bayesian networks, a probabilistic graphical model, was used in a populational cohort of 83 ARMS individuals to predict conversion to psychiatric illness. Nine predictors-including state, trait, biological and environmental factors-were inputted. Dopamine receptor 2 polymorphism, high private religiosity, and childhood trauma remained in the final model, which reached an 85.51% (SD = 0.1190) accuracy level in predicting conversion. This is the first time a robust model was produced with Bayesian networks to predict psychiatric illness among at risk individuals from the general population. This could be an important tool to strengthen predictive measures in psychiatry which should be replicated in larger samples to provide the model further learning.

Ninety Years of Multiple Psychotic-Like and Spiritual Experiences in a Doctor Honoris Causa: A Case Report and Literature Review

ABSTRACT

Psychotic experiences are common experiences shared by a considerable part of the world's population. Moreover, most of the individuals who report these experiences also report those called spiritual and dissociative phenomena. In specific culture and religious backgrounds, these experiences are frequently seen as a part of normal human experiences, usually called mediumship. We report a case of a famous Brazilian medium with 90 years of experiencing psychotic-like, dissociative and/or spiritual experiences, but coped well with the experiences and never sought psychiatric or psychological assistance. The medium received several honorific prizes, such as doctor honoris causa from different institutions, published more than 200 books, and ran a nonprofit organization that takes care of 5000 people daily. Finally, we review the literature on this topic and stress the urge for more research aiming to distinguish pathological and nonpathological psychotic experiences to avoid overmedicalization and iatrogenic treatments.

Ethnic variations in duration of untreated psychosis: report from the CRIS-FEP study

OBJECTIVES

There is inconsistent evidence on the influence of ethnicity on duration of untreated psychosis (DUP). We investigated ethnic differences in DUP in a large epidemiological dataset of first episode psychosis patients in an inner city area of south London, UK.

METHODS

We analysed data on 558 first episode psychosis patients at the South London and Maudsley NHS Trust, between 2010 and 2012. We performed multivariable logistic regression to estimate the odds of a short DUP (≤ 6 months) by ethnic group, controlling for confounders.

RESULTS

There was no evidence that ethnicity is associated with duration of untreated psychosis. However, we found evidence that a short DUP was strongly associated with age, living circumstances, and pathways to care variables (involuntary admission, out of office hour contact, accident and emergency referral, criminal justice agency referral and family involvement in help-seeking). Conversely, a long DUP was associated with report of social isolation, living alone, being single and General Practitioner referral.

CONCLUSION

Our findings suggest that indicators of social isolation were associated with long DUP. Our data also show that pathways into care characteristics play significant role in DUP. Thus, the challenge of tackling the issue of timely access to EI under the new Access and Waiting Time standard for psychosis requires a multilevel approach, including joint working with communities, public awareness of psychosis, less restrictive referral pathways and adequate resourcing of early intervention for psychosis services. These will go a long way in addressing patients' needs rather than be determined by service structures.

Patterns of religiosity and spirituality of psychiatrists in Brazil and the implications for clinical practice: a latent profile analysis

BACKGROUND

Although there is consensus, in psychiatry, over the inclusion of religious and spiritual aspects when evaluating and treating the patient, investigation of these dimensions is rare. There is evidence as to the relationship between psychiatrists' religious/spiritual beliefs and their willingness to discuss a patient's religion and spirituality (R/S). Due to the lack of information about how psychiatrists in Brazil deal with R/S in patient care, the aim of the present study is to analyze the religious/spiritual profile of these professionals and to ascertain its influence on attitudes and behavior in clinical practice.

METHODS

Five hundred and ninety-two psychiatrists from Brazil answered a questionnaire about R/S in clinical practice. The latent profile analysis was used to search for differences of religious/spiritual profiles. The ANOVA and Pearson's chi-square tests were employed to identify any correlation between clinical opinion and behaviors according to the different profiles.

RESULTS

Two religious/spiritual profiles were identified (entropy value > 0,96): the so called "less religious" group (n = 245), comprised predominantly by men, professionally more experienced, with a higher level of academic education (Master or PhD degrees) and were the ones who least enquired about their patients' R/S; and the "more religious" psychiatrists (n = 347) those who had higher consideration for R/S on health, and who more often addressed R/S with their patients and therefore usually ascribed importance to include R/S in their professional training.

CONCLUSION

The latent profile analysis produced two distinct classes between the Brazilian psychiatrists according to their R/S views: the more religious professionals, who investigate the patient's R/S in a more detailed manner, and the less religious, who tend to disregard this aspect.