1
|
Savage CLG, Orth RD, Bennett ME, Blanchard JJ. Interpersonal consequences of paranoid ideation, negative symptoms and sleep problems in a transdiagnostic sample of individuals with psychosis. J Psychiatr Res 2024; 177:194-202. [PMID: 39029161 DOI: 10.1016/j.jpsychires.2024.07.010] [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: 03/14/2024] [Revised: 06/19/2024] [Accepted: 07/10/2024] [Indexed: 07/21/2024]
Abstract
Paranoid ideation is a transdiagnostic construct that is associated with social impairment and often occurs in psychotic spectrum disorders. Little research has examined how paranoid ideation is related to social behaviors that underlie social impairment and may ultimately lead to social rejection. It is important to consider that negative symptoms and sleep problems also contribute to social impairment. No research has assessed the unique and combined influence of paranoid ideation, negative symptoms, and sleep problems on social impairment. Therefore, the current study examined how paranoid ideation, negative symptoms, and sleep problems contribute to poorer social skills and social rejection in a transdiagnostic sample of persons with psychosis and community members (N = 112). Assessments included diagnostic and symptom interviews, questionnaires, behavioral ratings of social skill and facial displays of affect, and naive observer reactions utilizing thin-slice methodology. Greater paranoid ideation, negative symptoms, and sleep problems were each related to poorer social skill and more negative reactions from observers. When considered in path analyses, negative symptoms were associated with observer reports of less willingness to interact with participants through poorer social skill. These findings demonstrate the symptom correlates of social rejection and how interpersonal behavior may contribute to social exclusion.
Collapse
Affiliation(s)
| | - Ryan D Orth
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Melanie E Bennett
- Department of Psychiatry, University of Maryland, Baltimore, MD, USA
| | - Jack J Blanchard
- Department of Psychology, University of Maryland, College Park, MD, USA
| |
Collapse
|
2
|
Alliende LM, Strauss GP, Yang LH, Mittal VA. Perceptions of stigma in youth at clinical high risk for psychosis and depressive symptomatology. Schizophr Res 2024; 269:79-85. [PMID: 38754312 PMCID: PMC11249038 DOI: 10.1016/j.schres.2024.04.023] [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: 11/23/2023] [Revised: 04/16/2024] [Accepted: 04/27/2024] [Indexed: 05/18/2024]
Abstract
It is unclear what types of stigma youth at clinical high risk for psychosis (CHR) experience, and the relationship between them and symptomatology. 94 CHR youth, and a control group of 45 youth with no psychosis spectrum symptoms (NP) were rated for perceived devaluation (i.e. negative views from others) and internalized mental health stigma (i.e. the extent to which they would agree with said views) as well as positive and mood symptomatology. CHR youth reported stigma more frequently than the NP group (χ2(1) = 53.55, p < .001) and at higher levels (perceived devaluation: t (137) = 8.54, p < .001; internalized stigma: t (137) = 7.48, p < .001). Surprisingly, in the CHR group, positive symptoms held no significant relationship to stigma measures. However, ratings of perceived devaluation stigma were associated with depressive symptomatology (β = 0.27, t = 2.68, p = .0087) and depression scores were conversely associated with perceived devaluation stigma (β = 0.30, t = 2.05, p = .043). These findings speak to the relationship between depressive symptomatology and perceived devaluation stigma in CHR youth. Perceived devaluation stigma showed greater clinical significance and could have different mechanisms than internalized stigma in CHR youth. It is also noteworthy that while positive symptoms play a central role in defining the CHR syndrome, they seem less relevant to the experience of stigma than mood symptoms. These findings highlight the importance of interventions aimed at ameliorating youth's exposure to negative views about mental health as those managing depressive symptomatology.
Collapse
Affiliation(s)
| | | | - Lawrence H Yang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, NY, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, USA
| | | |
Collapse
|
3
|
Blanchard J, Shackman A, Smith J, Orth R, Savage C, Didier P, McCarthy J, Bennett M. Blunted ventral striatal reactivity to social reward is associated with more severe motivation and pleasure de ficits in psychosis. RESEARCH SQUARE 2024:rs.3.rs-4468839. [PMID: 38947025 PMCID: PMC11213233 DOI: 10.21203/rs.3.rs-4468839/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Among individuals living with psychotic disorders, social impairment is common, debilitating, and challenging to treat. While the roots of this impairment are undoubtedly complex, converging lines of evidence suggest that social motivation and pleasure (MAP) deficits play a key role. Yet most neuroimaging studies have focused on monetary rewards, precluding decisive inferences. Here we leveraged parallel social and monetary incentive delay fMRI paradigms to test whether blunted reactivity to social incentives in the ventral striatum-a key component of the distributed neural circuit mediating appetitive motivation and hedonic pleasure-is associated with more severe MAP symptoms in a transdiagnostic sample enriched for psychosis. To maximize ecological validity and translational relevance, we capitalized on naturalistic audiovisual clips of an established social partner expressing positive feedback. Although both paradigms robustly engaged the ventral striatum, only reactivity to social incentives was associated with clinician-rated MAP deficits. This association remained significant when controlling for other symptoms, binary diagnostic status, or ventral striatum reactivity to monetary incentives. Follow-up analyses suggested that this association predominantly reflects diminished striatal activation during the receipt of social reward. These observations provide a neurobiologically grounded framework for conceptualizing the social-anhedonia symptoms and social impairments that characterize many individuals living with psychotic disorders and underscore the need to establish targeted intervention strategies.
Collapse
|
4
|
Peralta V, de Jalón EG, Moreno-Izco L, Peralta D, Janda L, Sánchez-Torres AM, Cuesta MJ. Social exclusion as a major outcome domain of psychotic disorders: early predictors, and associations with non-recovery and clinical staging 21 years after a first episode of psychosis. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02650-0. [PMID: 38772974 DOI: 10.1007/s00127-024-02650-0] [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: 11/20/2023] [Accepted: 03/03/2024] [Indexed: 05/23/2024]
Abstract
PURPOSE People with psychotic disorders have high levels of social exclusion; however, little is known about its early predictors. We present a long-term observational cohort study aimed at examining early risk factors for later social exclusion. METHODS A total of 243 subjects were assessed at their first psychotic episode for early risk factors including sociodemographic variables, familial risk of major mental disorders, perinatal complications, childhood factors, and adolescent factors and re-assessed after a mean follow-up of 21 years for 12 social exclusion domains: leisure activities, housing, work, income, neighborhood deprivation, educational attainment, physical and mental health, family and social support, legal competence, and discrimination. The ability of risk factors to predict social exclusion was examined using hierarchical linear regression. RESULTS Overall social exclusion was independently predicted by low parental socio-economic status, length of follow-up, familial risk of schizophrenia, obstetric complications, neurodevelopmental delay, poor childhood adjustment, childhood adversity, poor adolescent social networks, poor adolescent adjustment, and low premorbid IQ. The model explained 58.2% of the variance in total social exclusion score. Each social exclusion domain was predicted by a different set of variables, which explained between 17.8 and 57.0% of their variance, although low socio-economic status, familial risk of schizophrenia, obstetric complications, childhood adversity, and poor social networks predicted most of the social exclusion domains. CONCLUSION Early risk factors strongly predicted later social exclusion. A multifaceted approach to preventing later social exclusion is crucial in people with a first episode of psychosis and early risk factors of social exclusion.
Collapse
Affiliation(s)
- Victor Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain.
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
| | - Elena García de Jalón
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Lucía Moreno-Izco
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain
| | - David Peralta
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - Lucía Janda
- Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
| | - Ana M Sánchez-Torres
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra (UPNA), Campus de Arrosadia, 31006, Pamplona, Spain
| | - Manuel J Cuesta
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain
| |
Collapse
|
5
|
Zedan SA, Zahid A, Best MW. Examining the effects of diagnostic awareness, positive symptoms, and negative symptoms on stigmatizing attitudes and social exclusion towards schizophrenia. Schizophr Res 2024; 264:482-490. [PMID: 38277738 DOI: 10.1016/j.schres.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Social exclusion towards schizophrenia can occur as a response to symptom presentations and/or diagnostic knowledge. The present study examined stigma towards schizophrenia as a function of diagnostic awareness, positive symptoms, and negative symptoms. METHODS 559 participants were presented with one of eight vignettes depicting an individual in a social situation based on a 2 (label: present, absent) x 2 (positive symptoms: present, absent) x 2 (negative symptoms: present, absent) design. Participants then completed various measures of social exclusion and stigmatizing attitudes. RESULTS A significant three-way interaction between positive symptoms, negative symptoms, and a diagnostic label was found for stigmatizing attitudes such that knowledge of diagnosis was associated with less stigma when symptoms were present but resulted in more stigma when symptoms were absent. A significant interaction between diagnostic label and negative symptoms was found on social distance such that knowledge of diagnosis increased desire for social distance when negative symptoms were present. CONCLUSION Diagnostic awareness increases stigmatizing attitudes and social distance when symptoms are not present. However, when contextualized with the presence of symptoms, diagnostic awareness may reduce exclusion by providing an explanation for those symptoms. Determining when and to whom to disclose one's diagnosis may be helpful to improve social functioning in schizophrenia.
Collapse
Affiliation(s)
- Saleena A Zedan
- Department of Psychology, University of Toronto Scarborough, Scarborough, Ontario, Canada
| | - Aqsa Zahid
- Graduate Department of Psychological Clinical Science, University of Toronto Scarborough, Scarborough, Ontario, Canada
| | - Michael W Best
- Department of Psychology, University of Toronto Scarborough, Scarborough, Ontario, Canada; Graduate Department of Psychological Clinical Science, University of Toronto Scarborough, Scarborough, Ontario, Canada; Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada.
| |
Collapse
|
6
|
Iuso S, Severo M, Trotta N, Ventriglio A, Fiore P, Bellomo A, Petito A. Improvements in Treatment Adherence after Family Psychoeducation in Patients Affected by Psychosis: Preliminary Findings. J Pers Med 2023; 13:1437. [PMID: 37888048 PMCID: PMC10608243 DOI: 10.3390/jpm13101437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
(1) Background: Family psychoeducation is a well-recognized intervention which aims to improve the outcomes of illness in patients affected by psychosis. It has benefits in treatment adherence and leads to a reduction in relapses, higher levels of patient insight, and lower levels of stress within the family and among caregivers. (2) Methods: Eight patients and their families were recruited and randomly assigned to a Falloon-based family psychoeducation (FPP) intervention, and nine patients and their families were randomized to a Gestalt-based family intervention (GT). We compared the outcomes of these two treatment groups at a baseline assessment (T0), at the end of the programs (T1), and 6 and 12 months after the end of the programs (T2 and T3). The assessments included examinations of cognition (The Mini-Mental State Examination (MMSE) and The Five Point Test (5 Point)), the psychopathology and severity of illness (The Brief Psychiatric Rating Scale (BPRS), The Positive and Negative Syndrome Scale (PANSS), and The Clinical Global Impression Scale (CGI)), expressed emotion in families (Expressed Emotionality (Family Questionnaire-EE)), patient quality of life (The World Health Organization Quality of Life-BREF (WHOQOL-B)), social functioning (The Personal Social Performance (SPS)), aggression (Modified Overt Aggression Scale (MOAS)), and treatment adherence (The Brief Medication Adherence Report Scale (BMARS)). The primary aim was to test whether the FFP vs. GT program was more effective in improving treatment adherence over time. (3) Results: treatment adherence improved much more in the FFP group over time at any follow-up: +43.1% at T1, +24.0% at T2, and +41.6% at T3. Other characteristics, including psychopathology and the clinical stability of the subject, did not change over time. (4) Discussion: Family psychoeducation based on the Falloon program was effective at improving treatment adherence and contributed to avoiding relapses in the long term. Further studies on larger samples should be conducted to confirm this evidence, and similar psychoeducational programs should be routinely promoted in the clinical setting.
Collapse
Affiliation(s)
- Salvatore Iuso
- Department of Humanistic Studies, University of Foggia and Italy, 71122 Foggia, Italy;
| | - Melania Severo
- Department of Clinical and Experimental Medicine, Viale Pinto, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy; (M.S.); (N.T.); (A.B.); (A.P.)
| | - Nicoletta Trotta
- Department of Clinical and Experimental Medicine, Viale Pinto, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy; (M.S.); (N.T.); (A.B.); (A.P.)
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, Viale Pinto, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy; (M.S.); (N.T.); (A.B.); (A.P.)
| | - Pietro Fiore
- Department of Clinical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy;
- Neurorehabilitation and Spinal Unit, Institute Clinic Scientific Maugeri IRCCS, 70124 Bari, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, Viale Pinto, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy; (M.S.); (N.T.); (A.B.); (A.P.)
| | - Annamaria Petito
- Department of Clinical and Experimental Medicine, Viale Pinto, Policlinico Riuniti di Foggia, University of Foggia, 71122 Foggia, Italy; (M.S.); (N.T.); (A.B.); (A.P.)
| |
Collapse
|
7
|
Goldberg JO, McKeag SA, Rose AL, Lumsden-Ruegg H, Flett GL. Too Close for Comfort: Stigma by Association in Family Members Who Live with Relatives with Mental Illness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5209. [PMID: 36982117 PMCID: PMC10049681 DOI: 10.3390/ijerph20065209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 06/18/2023]
Abstract
Stigma by association is described in qualitative research of family members who have relatives diagnosed with mental illness, depicting their sense of public shame for having these relationship ties. However, there have been relatively few empirical studies thus far, in part due to the isolation of family members affecting research recruitment. In order to address this gap, an online survey was administered to 124 family members, comparing those who live in the same home with their ill relative (n = 81) and those who do not (n = 43). A remarkable incidence of one in three family members reported experiencing stigma by association. Those living with an ill relative reported comparatively higher levels of stigma by association using an adapted questionnaire measure. Both groups experienced loneliness (moderate levels), but importantly, the cohabiting relatives perceived themselves as lacking support from friends and other family members. Correlational analyses revealed that those with heightened stigma by association reported heightened anti-mattering: that is, feeling that other people treat them as if they are insignificant and invisible. Anti-mattering was also associated with more loneliness and reduced social support. Our discussion focuses on the theme that family members who actually live with mentally ill relatives experience heightened social isolation that is under-recognized due to public stigma concerns, compounded by feeling their own lives do not matter to others. Public health implications are considered for the stigmatized family members who appear to be particularly marginalized.
Collapse
|