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Corcoran E, Althobaiti A, Lewis G, Solmi F, McCloud T, Lewis G. The association between sexual orientation and psychotic like experiences during adolescence: a prospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02636-y. [PMID: 38771351 DOI: 10.1007/s00127-024-02636-y] [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: 06/12/2023] [Accepted: 02/12/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE Psychotic like experiences (PLEs) are relatively common during adolescence and associated with a range of negative outcomes. There is evidence that sexual minorities are at increased risk of mental health problems including depression, anxiety, self-harm and suicidality. However, no study has investigated the association between sexual orientation and psychotic experiences during adolescence. We compared trajectories of PLEs in sexual minority and heterosexual adolescents from 12 to 24 years of age. METHODS We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Participants provided data on sexual orientation at age 16 and PLEs at ages 12, 17 and 24. We used multi-level logistic regression models to test associations between sexual orientation and PLEs, before and after adjusting for covariates. We investigated whether the association differed according to time-point and sex using interaction terms. RESULTS We found evidence that the odds of PLEs were 2.35 times (95% Confidence Interval 1.79-3.06, p < 0.0001) higher among sexual minority compared with heterosexual adolescents, across all ages, after adjusting for covariates. There was no evidence that the association between sexual orientation and PLEs differed according to time-point (p = 0.50) or sex (p = 0.29). CONCLUSION We found an increased risk of psychosis in sexual minorities compared with heterosexuals, which was present from around 12 years of age and persisted until age 24. Early interventions to prevent this mental health inequality could include universal interventions to promote inclusivity and acceptance of diverse sexual orientations.
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Affiliation(s)
- Emma Corcoran
- The Oxford Institute of Clinical Psychology Training and Research, The Oxford Centre for Psychological Health, Isis Education Centre, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Amal Althobaiti
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W17 7NF, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W17 7NF, UK
| | - Francesca Solmi
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W17 7NF, UK
| | - Tayla McCloud
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W17 7NF, UK
| | - Gemma Lewis
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W17 7NF, UK.
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Yildirim Budak B, Yazici Karabulut I. "Truman syndrome" induced by online education: A case report in adolescent-Onset psychosis. Clin Child Psychol Psychiatry 2024; 29:540-549. [PMID: 37850453 DOI: 10.1177/13591045231208349] [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] [Indexed: 10/19/2023]
Abstract
Early-onset schizophrenia (EOS) is an important psychiatric problem characterized by the onset of psychotic symptoms before the age of 18 years. We present the case of a 14-year-old girl who had social anxiety symptoms in the premorbid period and whose psychotic symptoms increased with pandemic restrictions and online education. Our patient's distance from the peer environment and school as well as the fact that she used webcams and online education more frequently in her daily life were risk factors for EOS. In accordance with the case of Truman syndrome, she has delusions that her daily life is secretly filmed and that she is a "TV star." Anti-anxiety treatments were initiated during the pre-pandemic period. After a diagnosis of schizophrenia was made, antipsychotic treatment was initiated. A significant response was observed after paliperidone (extended release) treatment. Close follow-ups revealed decreased delusions and increased functionality. Further studies are required to elucidate whether Truman syndrome and social anxiety are different aspects of a similar spectrum. With increasing digitalization, the direction of psychiatric diseases, including EOS, and measures that can be taken for adolescent mental health in crisis, such as pandemics, should be discussed in future research.
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Affiliation(s)
- Burcu Yildirim Budak
- Department of Child and Adolescent Psychiatry, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Turkey
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Wu SY, Li YC, Chen YW, Chen CL, Pan HC, Lin KC, Lau HY. Construct validity, responsiveness, minimal detectable change, and minimal clinically important difference of the stroke self-efficacy questionnaire in individuals receiving stroke rehabilitation. Disabil Rehabil 2024:1-9. [PMID: 38433459 DOI: 10.1080/09638288.2024.2324122] [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: 04/10/2023] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To assess the clinimetric properties of the Stroke Self-Efficacy Questionnaire (SSEQ) and estimate the minimal detectable change (MDC) and minimal clinically important difference (MCID) from the database of our randomized controlled trials (RCT) of individuals receiving stroke rehabilitation. METHODS We retrieved the pre- and post-intervention scores of the SSEQ and Stroke Impact Scale (SIS) from 80 stroke survivors. The analysis of clinimetric properties was performed using: (1) confirmatory factor analysis and item response theory modeling (IRT) for construct validity; (2) standardized response mean and Glass's delta for responsiveness; (3) MDC based on the standard deviation (SD) or standard error of measurement (SEM) of the SSEQ change scores; (4) MCID determined by the external anchor-SIS; (5) conditional MDC (cMDC) derived from the IRT analysis. RESULTS There was a bi-factorial construct with excellent model-data fit and marked responsiveness. The MDC determined by the SD and SEM were 1.5 and 3.0, respectively, and the MCIDs were 3.3 and 3.7. CONCLUSIONS This study confirmed that SSEQ is a valid and reliable assessment tool for patients receiving stroke rehabilitation. We also provided practical threshold values, especially demonstrating the benefit of using individualized cMDC, to help clinicians better interpret the change in the SSEQ scores.
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Affiliation(s)
- Sz-Yan Wu
- School of Occupational Therapy, National Taiwan University, Taipei, Taiwan
- Department of Physical Therapy, Chung Shan Medical University, Taichung, Taiwan
- Physical Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yi-Chun Li
- Department of Occupational Therapy, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Wen Chen
- School of Occupational Therapy, National Taiwan University, Taipei, Taiwan
- Department of Speech-Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chia-Ling Chen
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Graduate Institute of Early Intervention, Chang Gung University, Taoyuan, Taiwan
| | - Hsiao-Chieh Pan
- Department of Physical Medicine and Rehabilitation, Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan
| | - Keh-Chung Lin
- School of Occupational Therapy, National Taiwan University, Taipei, Taiwan
- Division of Occupational Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Hiu-Ying Lau
- School of Occupational Therapy, National Taiwan University, Taipei, Taiwan
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Wiedemann A, Stochl J, Russo D, Patel U, Ashford PA, Ali N, Jones PB, Perez J. Clinical presentation of psychotic experiences in patients with common mental disorders attending the UK primary care improving access to psychological therapies (IAPT) Programme. J Affect Disord 2024; 344:233-241. [PMID: 37838262 DOI: 10.1016/j.jad.2023.10.073] [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: 05/02/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Improving Access to Psychological Therapies (IAPT) services address anxiety and depression in primary care, with psychotic disorders typically excluded. Our previous research found 1 in 4 patients report distressing psychotic experiences (PE) alongside common mental disorders, yet little is known about their clinical presentation and impact on recovery. METHODS We used the Community Assessment of Psychic Experiences - Positive Scale (CAPE-P15) to assess the clinical presentation and symptomatic profile of PE within IAPT settings across three National Health Service (NHS) trusts, serving a diverse population in Southern England. We identified different classes based on the reported PE frequencies using latent class analysis. RESULTS A total of 2042 IAPT patients completed the CAPE-P15. The mean age was 39.8 (±15.3) years. We identified five distinct classes of symptom profiles, findings that PE were common, especially self-referential and persecutory ideas. Prevalence and intensity increased across classes, extending to bizarre experiences and perceptual abnormalities in the fifth and least common class. Perceptual abnormalities were a strong indicator of symptom severity, with patients being the least likely to achieve recovery by the end of treatment. LIMITATIONS Data were collected during a service evaluation. Replication of these findings across other IAPT services could prove beneficial. We did not collect information on negative PE. CONCLUSIONS Patients seeking treatment for anxiety and depression in primary care commonly experience a wide range of positive PE. Self-referential and persecutory ideation were prevalent; perceptual abnormalities were infrequent. Providing information about prevalence and tailoring therapy may help reduce patient distress.
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Affiliation(s)
- Anna Wiedemann
- Department of Psychiatry, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, UK; National Institute for Health Research, Applied Research Collaboration, East of England, UK.
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, UK; National Institute for Health Research, Applied Research Collaboration, East of England, UK; Department of Kinanthropology and Humanities, Charles University, Czechia
| | - Debra Russo
- Department of Psychiatry, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Ushma Patel
- Department of Psychiatry, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | | | - Naima Ali
- Department of Psychiatry, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, UK; National Institute for Health Research, Applied Research Collaboration, East of England, UK
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, UK; Cambridgeshire and Peterborough NHS Foundation Trust, UK; National Institute for Health Research, Applied Research Collaboration, East of England, UK; Department of Kinanthropology and Humanities, Charles University, Czechia; Norwich Medical School, University of East Anglia, UK; Institute of Biomedical Research, Department of Medicine, University of Salamanca, Spain
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Rimvall MK, Vassard D, Christensen R, Nielsen SM, Pagsberg AK, Correll CU, Jeppesen P. Do psychotic experiences act as effect modifiers in youths with common mental health problems allocated to transdiagnostic cognitive behavioural therapy versus management as usual? Secondary analyses of the Mind-My-Mind randomized trial. Early Interv Psychiatry 2024; 18:26-33. [PMID: 37078563 DOI: 10.1111/eip.13423] [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: 04/30/2022] [Revised: 12/28/2022] [Accepted: 03/28/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Psychotic experiences (PEs) are common in help-seeking youths with non-psychotic mental health problems, yet the clinical importance of PEs as potential effect modifiers of psychotherapy interventions has been scarcely examined. We examined if PEs were associated with a differential response to transdiagnostic cognitive behavioural therapy (CBT) aimed at common emotional and behavioural problems. METHODS We present secondary analyses from the Mind My Mind (MMM) trial that randomized 396, 6-16-year-old youths to either 9-13 sessions of transdiagnostic modular community-based CBT (MMM) or community-based management as usual (MAU). MMM was superior to MAU in reducing parent-reported impact of mental health problems according to the Strengths and Difficulties Questionnaire (SDQ). PEs were assessed by semi-structured screening interviews at baseline. The contrast between subgroups (presence/absence of PEs) was calculated to test if PEs are potential effect modifiers regarding the change in parent-reported SDQ-impact (primary outcome, rated 0[low]-10[high]) and other SDQ-related outcomes. RESULTS Baseline PEs were present in 74 (19%) of youths. The superior effect of MMM on changes in SDQ-impact from baseline to week 18 was not effect modified by the presence of PEs (PEs[yes] -0.89 [95%CI -1.77;-0.01] vs. PEs[no] -1.10 [95%CI -1.52;-0.68], p-value for interaction .68). For secondary outcomes similar patterns were observed. Limitations Statistical power was limited to show if PEs modified treatment response. Replication and meta-analytic evidence are needed. CONCLUSIONS The beneficial effects of MMM transdiagnostic CBT did not differ by PE-status, indicating that youths with emotional and behavioural problems could be offered such psychotherapy irrespective of co-occurring PEs.
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Affiliation(s)
- Martin Køster Rimvall
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital-Psychiatry Region Zealand, Roskilde, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark
| | - Ditte Vassard
- Child and Adolescent Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Sabrina Mai Nielsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Anne Katrine Pagsberg
- Child and Adolescent Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christoph U Correll
- Department of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, New York, USA
- Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Pia Jeppesen
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital-Psychiatry Region Zealand, Roskilde, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Oh BH, Du J, Smith L, Koyanagi A. Psychotic experiences are associated with greater impairment among students in higher education with depression and anxiety in the United States. J Affect Disord 2024; 344:325-328. [PMID: 37838267 DOI: 10.1016/j.jad.2023.10.083] [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: 05/08/2023] [Revised: 09/30/2023] [Accepted: 10/10/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Psychotic experiences are associated with depression and anxiety, but emerging research suggests that psychotic experiences are also associated with impairment within psychopathology. METHODS We analyzed a subsample from the Healthy Minds Study (2020-2021; N = 91,435) and used multivariable logistic regression to examine the associations between psychotic experiences and impairment resulting from depression and anxiety, adjusting for age, gender, and race/ethnicity. RESULTS Around one-in-five students with depression or anxiety impairment reported 12-month psychotic experiences. Psychotic experiences were associated with greater odds of depression impairment and anxiety impairment, adjusting for age, gender, race/ethnicity. Odds ratios varied depending on the type of psychotic experience and the outcomes. CONCLUSION Psychotic experiences are associated with greater odds of impairment resulting from depression and anxiety. In clinical practice, psychotic experiences may serve as a useful marker of assessing impairment resulting from psychopathology.
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Affiliation(s)
- By Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, CA, USA.
| | - Jinyu Du
- Southern Methodist University, USA.
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom.
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.
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Granö N, Lintula S, Therman S, Marttunen M, Lång U, Ranta K. Factor and network analysis of psychosis-like experiences and depressive symptoms in a sample of Finnish adolescents entering psychiatric services. Early Interv Psychiatry 2023; 17:1199-1206. [PMID: 37062875 DOI: 10.1111/eip.13417] [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: 10/01/2022] [Revised: 01/28/2023] [Accepted: 03/28/2023] [Indexed: 04/18/2023]
Abstract
AIM Psychosis-Like Experiences (PLEs) and depressive symptoms are correlated in clinical adolescent populations. However, symptom-level associations between the two phenomena are not clear. METHODS We analysed factor structures of a PLE instrument, the Prodromal Questionnaire-Brief (PQ-B), based on dimensions of positive symptoms of schizophrenia, and a depression measurement instrument, the Beck Depression Inventory (BDI-21A) and performed a network analysis of item-level associations between the two measures. The sample consisted of 417 adolescents (range 13-18 years of age, mean 14.9 years, 72.4% females) entering secondary psychiatric services at Helsinki metropolitan area, Finland. RESULTS Confirmatory factor analysis resulted in adequately fitting 2-factor solution, one for PQ-B and one for BDI-21, with a strong correlation coefficient of 0.605 between the two factors. In the network analysis, PQ-B and BDI-21 both formed their own clusters, and two significant pathways were estimated between PQ-B and BDI-21 clusters: 1. the association between paranoid thinking and distorted body image, and 2. the association between somatic preoccupation and worry about problems of one's mind. CONCLUSIONS Even though on a general, factor level, PLEs and depressive symptoms were strongly correlated, unique associations between symptoms of the two constructs were sparse. These findings should be considered in the psychiatric assessment and in the care of adolescents.
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Affiliation(s)
- Niklas Granö
- Faculty of Medicine, Department of Psychiatry, Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Sakari Lintula
- Faculty of Medicine, Department of Psychiatry, Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Sebastian Therman
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mauri Marttunen
- Faculty of Medicine, Department of Psychiatry, Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Ulla Lång
- Faculty of Medicine, Department of Psychiatry, Psychiatry, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Klaus Ranta
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
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Powell V, Lennon J, Bevan Jones R, Stephens A, Weavers B, Osborn D, Allardyce J, Potter R, Thapar A, Collishaw S, Thapar A, Heron J, Rice F. Following the children of depressed parents from childhood to adult life: A focus on mood and anxiety disorders. JCPP ADVANCES 2023; 3:e12182. [PMID: 38054049 PMCID: PMC10694536 DOI: 10.1002/jcv2.12182] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 05/02/2023] [Indexed: 12/07/2023] Open
Abstract
Background Parental depression increases risk for anxiety and depression in offspring. The transition from adolescence to adulthood is a common risk period for onset of such disorders. However, relatively few studies have considered development of these disorders from childhood to adulthood including multiple assessments during this transition period. Method Offspring of depressed parents aged 9-17 years at baseline were followed prospectively for 13 years (n = 337). Average length of follow-up was 16 months between the first and second waves, 13 months between the second and third, and 8 years between the third and fourth. Current (3-month) psychopathology was assessed at each wave using diagnostic interviews. We derived estimates of 3-month prevalence, age at first diagnosis, course and comorbidity of disorders. Social functioning in adult life was assessed at the final wave and we assessed how prior and current disorder impacted adult functioning. Results A quarter of young people met criteria for a mood disorder and a third for anxiety disorder at least once. Mood and anxiety disorder prevalence increased from 4.5% and 15.8% respectively in childhood (9-11 years) to 22.3% and 20.9% respectively by age 23-28. Increased prevalence across the transition from adolescence to adulthood was particularly marked in males, while prevalence increased earlier in adolescence in females. Age at first diagnosis varied widely (mood disorder mean = 16.5 years (range 9-26); anxiety disorder mean = 14.5 years (range 9-28)). Over half (52%) reported functional impairment in early adulthood, 31% harmful alcohol use, and 10% self-harm or a suicide attempt. Both previous and current mood or anxiety disorder were associated with functional impairment in early adulthood. Conclusions There is a prolonged risk period for mood and anxiety disorders in this group, with prevalence peaking in early adulthood. This highlights the need for prolonged vigilance and effective targeted interventions in the offspring of depressed parents.
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Affiliation(s)
- Victoria Powell
- Wolfson Centre for Young People's Mental HealthCardiff UniversityWalesUK
- Centre for Neuropsychiatric Genetics and GenomicsCardiff UniversityWalesUK
| | - Jessica Lennon
- Centre for Neuropsychiatric Genetics and GenomicsCardiff UniversityWalesUK
| | - Rhys Bevan Jones
- Wolfson Centre for Young People's Mental HealthCardiff UniversityWalesUK
- Centre for Neuropsychiatric Genetics and GenomicsCardiff UniversityWalesUK
- Cwm Taf Morgannwg University Health Board Health BoardWalesUK
| | - Alice Stephens
- Centre for Neuropsychiatric Genetics and GenomicsCardiff UniversityWalesUK
| | - Bryony Weavers
- Wolfson Centre for Young People's Mental HealthCardiff UniversityWalesUK
- Centre for Neuropsychiatric Genetics and GenomicsCardiff UniversityWalesUK
| | - David Osborn
- Division of PsychiatryFaculty of Brain SciencesUCLUK
| | - Judith Allardyce
- Centre for Neuropsychiatric Genetics and GenomicsCardiff UniversityWalesUK
| | - Robert Potter
- Centre for Neuropsychiatric Genetics and GenomicsCardiff UniversityWalesUK
| | - Ajay Thapar
- Wolfson Centre for Young People's Mental HealthCardiff UniversityWalesUK
- Centre for Neuropsychiatric Genetics and GenomicsCardiff UniversityWalesUK
| | - Stephan Collishaw
- Wolfson Centre for Young People's Mental HealthCardiff UniversityWalesUK
- Centre for Neuropsychiatric Genetics and GenomicsCardiff UniversityWalesUK
| | - Anita Thapar
- Wolfson Centre for Young People's Mental HealthCardiff UniversityWalesUK
- Centre for Neuropsychiatric Genetics and GenomicsCardiff UniversityWalesUK
| | - Jon Heron
- Centre for Academic Mental HealthPopulation Health SciencesBristol Medical SchoolBristol UniversityBristolUK
| | - Frances Rice
- Wolfson Centre for Young People's Mental HealthCardiff UniversityWalesUK
- Centre for Neuropsychiatric Genetics and GenomicsCardiff UniversityWalesUK
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Staines L, Healy C, Kelleher I, Cotter D, Burns A, Cannon M. The association between transient childhood psychotic experiences and psychosocial outcomes in young adulthood: Examining the role of mental disorders and adult attachment. Early Interv Psychiatry 2023; 17:901-909. [PMID: 36646439 PMCID: PMC10947326 DOI: 10.1111/eip.13382] [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: 04/19/2022] [Revised: 10/13/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023]
Abstract
AIM Evidence suggest individuals with mental disorders and psychotic experiences (PE), even transient PE, show poorer psychosocial outcomes relative to those with mental disorders. The concept of "attachment" is hypothesized as the mechanism by which people seek support in times of need. This can be measured as discrete styles or as positive (low avoidance/anxiety)/negative (high avoidance/anxiety) dimensions. Adult attachment has previously been examined on PE risk factors, but not outcomes. This study aimed to examine the relationship between transient childhood PE and adult psychosocial outcomes, comparing those with and without mental disorders. Second, to examine the role of adult attachment. METHOD Participants (n = 103) attended baseline (age 11-13) and 10-year follow-up. PE and mental disorders were measured using the Schedule for Affective Disorders and Schizophrenia for School-aged Children. Attachment and outcomes were measured using self-report measures. Analysis compared those with PE (with/without mental disorders), and mental disorders without PE, to controls, using linear and Poisson regression. RESULTS PE was associated with lower self-esteem (β = -2.28, p = .03), perceived social support from friends (β = -2.80, p = .01), and higher stress in platonic relationships (IRR = 1.64). PE and mental disorders were associated with lower self-esteem (β = -5.74, p = .002), higher stress in romantic (IRR = 1.40) and platonic (IRR = 1.59) relationships, general stress (β = 5.60, p = .006), and mental distress (β = 5.67, p = .001). Mental disorders alone was not associated with any measure. Adult attachment dimensions attenuated some results. CONCLUSIONS This paper illustrates the association between transient PE and adult psychosocial outcomes, with & without co-occurring mental disorders, and demonstrates the role of adult attachment.
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Affiliation(s)
- Lorna Staines
- Royal College of Surgeons in Ireland, Psychiatry, Education and Research CentreBeaumont HospitalDublinIreland
| | - Colm Healy
- Royal College of Surgeons in Ireland, Psychiatry, Education and Research CentreBeaumont HospitalDublinIreland
| | - Ian Kelleher
- Royal College of Surgeons in Ireland, Psychiatry, Education and Research CentreBeaumont HospitalDublinIreland
- Division of PsychiatryCentre for Clinical Brain SciencesUniversity of EdinburghEdinburghUK
| | - David Cotter
- Royal College of Surgeons in Ireland, Psychiatry, Education and Research CentreBeaumont HospitalDublinIreland
- Department of PsychiatryBeaumont HospitalDublinIreland
| | - Annette Burns
- Bamford Centre for Mental Health and Well BeingUlster UniversityColeraineUK
| | - Mary Cannon
- Royal College of Surgeons in Ireland, Psychiatry, Education and Research CentreBeaumont HospitalDublinIreland
- Department of PsychiatryBeaumont HospitalDublinIreland
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Zhou L, Chankoson T, Wu Y, Cai E. Thriving psychological well-being in undergraduate nursing student: a grounded theory study with the life grid approach. BMC Nurs 2023; 22:240. [PMID: 37454074 DOI: 10.1186/s12912-023-01338-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 05/14/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Psychological well-being (PWB) plays a vital role in successful adaptation to the Bachelor of Nursing journey and affects career development. However, there is little known about the functional and social processes associated with enhancing well-being specific to the subjective perspective of nursing students. AIM To investigate how nursing students promote their psychological well-being to conceptualize thriving psychological well-being. METHOD This qualitative study analyzed and reviewed a life grid and semi-structured in-depth interviews of 20 Chinese Nursing graduates by investigators and participants, following Charmaz's constructivist grounded theory. The constant comparative method was used to analyze data. This study took place between 2020 and 2022. RESULTS All participants experienced fluctuations in psychological well-being. This study identified a new understanding of how nursing students enhance their psychological well-being. Thriving awareness was co-constructed as the core category and based on the relationship with a supportive environment, the thriving psychological well-being of nursing students is conceptualized. CONCLUSIONS It is imperative to enhance the psychological counseling and support for nursing students during their clinical placements, during the period just entering university as well as after repeated outbreaks of COVID-19. Nursing educators and administrators could develop appropriate educational programs and interventions based on the theoretical model-Thriving psychological well-being.
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Affiliation(s)
- Lu Zhou
- School of Nursing, Yunnan University of Chinese Medicine, Kunming, China
- Chakrabongse Bhuvanarth International Institute for Interdisciplinary Studies, Rajamangala University of Technology Tawan-OK, Bangkok, Thailand
| | - Thitinan Chankoson
- Faculty of Business Administration for Society, Srinakharinwirot University, Bangkok, Thailand
| | - YuMing Wu
- School of Medicine, Yunnan University of Chinese Medicine, Kunming, China
| | - EnLi Cai
- School of Nursing, Yunnan University of Chinese Medicine, Kunming, China.
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Staines L, Healy C, Murphy F, Byrne J, Murphy J, Kelleher I, Cotter D, Cannon M. Incidence and Persistence of Psychotic Experiences in the General Population: Systematic Review and Meta-Analysis. Schizophr Bull 2023; 49:1007-1021. [PMID: 37402250 DOI: 10.1093/schbul/sbad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND AND HYPOTHESIS Psychotic experiences (PEs) are associated with increased risk for mental disorders, in particular persistent PEs. PEs therefore might be useful within intervention research. We sought to systematically determine the incidence and persistence of PEs in the general population. STUDY DESIGN A double-blind search of databases (Embase, Pubmed PMC, Psychinfo, Medline, and Web of Science) from inception to January 2023 and data extraction, were conducted. Study quality was assessed using the NIH assessment tool. Random effects models were conducted to calculate pooled incidence rate per person-year and proportion of persistent PEs per year. Age and study design were all examined using subgroup analyses. Demographic, risk factors, and outcomes for incidence and persistence of PEs were reported in a narrative synthesis. STUDY RESULTS Using a double-blind screening method for abstract (k = 5763) and full text (k = 250) were screened. In total 91 samples from 71 studies were included, of which 39 were included in a meta-analysis (incidence: k = 17, n = 56 089; persistence: k = 22, n = 81 847). Incidence rate was 0.023 per person-year (95% CI [0.0129;0.0322]). That is, for every 100 people, 2 reported first onset PEs in a year. This was highest in adolescence at 5 per 100(13-17 years). The pooled persistence rate for PEs was 31.0% (95% CI [26.65,35.35]) This was highest in adolescence at 35.8%. Cannabis was particularly associated with incidence of PEs, and persistence of PEs were associated with multiple mental disorders. CONCLUSIONS Each year incidence of PEs is 2 of every 100 people, and persists each year in 31% of cases, this risk is highest in adolescents.
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Affiliation(s)
- Lorna Staines
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Felim Murphy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Jonah Byrne
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Jennifer Murphy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Ian Kelleher
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, EH10 5HF, UK
| | - David Cotter
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychiatry, Beaumont Hospital, Dublin 9, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychiatry, Beaumont Hospital, Dublin 9, Ireland
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12
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Stochl J, Jones H, Soneson E, Wagner AP, Khandaker GM, Zammit S, Heron J, Hammerton G, Bullmore ET, Dolan R, Fonagy P, Goodyer IM, Perez J, Jones PB. Stratification of adolescents across mental phenomena emphasizes the importance of transdiagnostic distress: a replication in two general population cohorts. Eur Child Adolesc Psychiatry 2023; 32:797-807. [PMID: 34792650 PMCID: PMC10147756 DOI: 10.1007/s00787-021-01909-0] [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: 05/07/2021] [Accepted: 11/06/2021] [Indexed: 11/26/2022]
Abstract
Characterizing patterns of mental phenomena in epidemiological studies of adolescents can provide insight into the latent organization of psychiatric disorders. This avoids the biases of chronicity and selection inherent in clinical samples, guides models of shared aetiology within psychiatric disorders and informs the development and implementation of interventions. We applied Gaussian mixture modelling to measures of mental phenomena from two general population cohorts: the Avon Longitudinal Study of Parents and Children (ALSPAC, n = 3018) and the Neuroscience in Psychiatry Network (NSPN, n = 2023). We defined classes according to their patterns of both positive (e.g. wellbeing and self-esteem) and negative (e.g. depression, anxiety, and psychotic experiences) phenomena. Subsequently, we characterized classes by considering the distribution of diagnoses and sex split across classes. Four well-separated classes were identified within each cohort. Classes primarily differed by overall severity of transdiagnostic distress rather than particular patterns of phenomena akin to diagnoses. Further, as overall severity of distress increased, so did within-class variability, the proportion of individuals with operational psychiatric diagnoses. These results suggest that classes of mental phenomena in the general population of adolescents may not be the same as those found in clinical samples. Classes differentiated only by overall severity support the existence of a general, transdiagnostic mental distress factor and have important implications for intervention.
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Affiliation(s)
- Jan Stochl
- Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK.
- National Institute for Health Research Applied Research Collaboration East of England, Cambridge, UK.
- Department of Kinanthropology, Charles University, Prague, Czechia.
| | - Hannah Jones
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma Soneson
- Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK
| | - Adam P Wagner
- National Institute for Health Research Applied Research Collaboration East of England, Cambridge, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Golam M Khandaker
- Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Stanley Zammit
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University School of Medicine, Cardiff, UK
| | - Jon Heron
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gemma Hammerton
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Edward T Bullmore
- Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK
| | - Ray Dolan
- Wellcome Trust Centre for Neuroimaging, University College London, London, UK
| | - Peter Fonagy
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Ian M Goodyer
- Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK
| | - J Perez
- Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK
- National Institute for Health Research Applied Research Collaboration East of England, Cambridge, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Institute of Biomedical Research of Salamanca (IBSAL), Psychiatry Unit, Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Peter B Jones
- Department of Psychiatry, Herchel Smith Building for Brain and Mind Sciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, UK
- National Institute for Health Research Applied Research Collaboration East of England, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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13
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White J, Moore L, Cannings-John R, Hawkins J, Bonell C, Hickman M, Zammit S, Adara L. Association Between Gender Minority Status and Mental Health in High School Students. J Adolesc Health 2023; 72:811-814. [PMID: 36809864 PMCID: PMC10824667 DOI: 10.1016/j.jadohealth.2022.12.028] [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: 06/29/2022] [Revised: 11/17/2022] [Accepted: 12/15/2022] [Indexed: 02/21/2023]
Abstract
PURPOSE Adolescence is a phase when young people begin to explore their gender identity. Adolescents who identify as a gender minority are vulnerable to experiencing mental health problems due to stigmatization of their identity. METHODS A population-wide study compared gender minority and cisgender students (aged 13-14 years) self-reported symptoms of probable depression, anxiety, and conduct disorder, and auditory hallucinations, including the distress and frequency of hallucinations. RESULTS Gender minority students compared to cisgender students had four times the odds of reporting a probable depressive disorder, anxiety disorder, auditory hallucinations, but not conduct disorder. Of those who reported a hallucination, gender minority students were more likely to report hearing them daily but were no more likely to find them distressing. DISCUSSION Gender minority students experience a disproportionate burden of mental health problems. Services and programming should be adapted to better support gender minority high-school students.
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Affiliation(s)
- James White
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK.
| | - Laurence Moore
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Jemma Hawkins
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Chris Bonell
- Department of Public Health, Environment and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew Hickman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Stanley Zammit
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Linda Adara
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, UK
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14
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Southward MW, Cheavens JS, Coccaro EF. Defining the p-factor: an empirical test of five leading theories. Psychol Med 2023; 53:2732-2743. [PMID: 35711145 PMCID: PMC10235655 DOI: 10.1017/s0033291722001635] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/25/2022] [Accepted: 05/13/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Despite statistical evidence of a general factor of psychopathology (i.e., p-factor), there is little agreement about what the p-factor represents. Researchers have proposed five theories: dispositional negative emotionality (neuroticism), impulsive responsivity to emotions (impulsivity), thought dysfunction, low cognitive functioning, and impairment. These theories have primarily been inferred from patterns of loadings of diagnoses on p-factors with different sets of diagnoses included in different studies. Researchers who have directly examined these theories of p have examined a subset of the theories in any single sample, limiting the ability to compare the size of their associations with a p-factor. METHODS In a sample of adults (N = 1833, Mage = 34.20, 54.4% female, 53.3% white) who completed diagnostic assessments, self-report measures, and cognitive tests, we evaluated statistical p-factor structures across modeling approaches and compared the strength of associations among the p-factor and indicators of each of these five theories. RESULTS We found consistent evidence of the p-factor's unidimensionality across one-factor and bifactor models. The p-factor was most strongly and similarly associated with neuroticism (r = .88), impairment (r = .88), and impulsivity (r = .87), χ2(1)s < .15, ps > .70, and less strongly associated with thought dysfunction (r = .78), χ2(1)s > 3.92, ps < .05, and cognitive functioning (r = -.25), χ2(1)s > 189.56, ps < .01. CONCLUSIONS We discuss a tripartite definition of p that involves the transaction of impulsive responses to frequent negative emotions leading to impairment that extends and synthesizes previous theories of psychopathology.
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Affiliation(s)
| | | | - Emil F. Coccaro
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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15
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Wittkamp MF, Krkovic K, Lincoln TM. Effectiveness of a transdiagnostic emotion regulation training in an at-risk sample: a randomized-controlled trial of group-based training versus self-help bibliotherapy. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:411-430. [PMID: 36916191 DOI: 10.1111/bjc.12415] [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: 08/18/2022] [Revised: 01/18/2023] [Accepted: 01/31/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES Subclinical psychotic, depression, and anxiety symptoms form a transdiagnostic 'at-risk state' for the development of mental disorders. Emotion regulation has been identified as a transdiagnostic factor relevant to the formation of these symptoms that can be successfully addressed in clinical interventions. Here, we tested whether a group-based emotion regulation training would be effective in reducing distress and at preventing the transition to mental disorders in an at-risk sample. METHODS Participants with distressing subclinical psychotic, depression, or anxiety symptoms (n = 138) were randomly allocated to either the 8-week group-based affect regulation training (ART; Springer, New York) or an 8-week self-help bibliotherapy (BT). They underwent biweekly measurements during the intervention, as well as at a six- and 12-month follow-up. In an exploratory analysis, we tested whether the ART would be superior to BT in preventing the transition to any mental disorder at 12-month follow-up. We also tested for differences in trajectories of psychopathology and emotion regulation (via questionnaires) and emotion regulation in daily life (via the experience-sampling method). RESULTS Participants in the ART condition showed a greater improvement of emotion regulation in daily life than those with BT, but the ART was not superior over BT in preventing the transition to mental disorders. There were significant longitudinal reductions from pre- to post-intervention for general psychopathology and symptoms but no superiority of the ART over BT. CONCLUSIONS Despite its efficacy in improving emotion regulation skills, the ART does not produce effects on psychopathology that justify its recommendation over self-help approaches.
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Affiliation(s)
- Martin F Wittkamp
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Hamburg, Germany
| | - Katarina Krkovic
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Hamburg, Germany
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16
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Allardyce J, Hollander AC, Rahman S, Dalman C, Zammit S. Association of trauma, post-traumatic stress disorder and non-affective psychosis across the life course: a nationwide prospective cohort study. Psychol Med 2023; 53:1620-1628. [PMID: 34412716 PMCID: PMC10009379 DOI: 10.1017/s0033291721003287] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/30/2021] [Accepted: 07/21/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND We aimed to examine the temporal relationships between traumatic events (TE), post-traumatic stress disorder (PTSD) and non-affective psychotic disorders (NAPD). METHODS A prospective cohort study of 1 965 214 individuals born in Sweden between 1971 and 1990 examining the independent effects of interpersonal and non-interpersonal TE on incidence of PTSD and NAPD using data from linked register data (Psychiatry-Sweden). Mediation analyses tested the hypothesis that PTSD lies on a causal pathway between interpersonal trauma and NAPD. RESULTS Increasing doses of interpersonal and non-interpersonal TE were independently associated with increased risk of NAPD [linear-trend incidence rate ratios (IRR)adjusted = 2.17 [95% confidence interval (CI) 2.02-2.33] and IRRadjusted = 1.27 (95% CI 1.23-1.31), respectively]. These attenuated to a relatively small degree in 5-year time-lagged models. A similar pattern of results was observed for PTSD [linear-trend IRRadjusted = 3.43 (95% CI 3.21-3.66) and IRRadjusted = 1.45 (95% CI 1.39-1.50)]. PTSD was associated with increased risk of NAPD [IRRadjusted = 8.06 (95% CI 7.23-8.99)], which was substantially attenuated in 5-year time-lagged analyses [IRRadjusted = 4.62 (95% CI 3.65-5.87)]. There was little evidence that PTSD diagnosis mediated the relationship between interpersonal TE and NAPD [IRRadjusted = 0.92 (percentile CI 0.80-1.07)]. CONCLUSION Despite the limitations to causal inference inherent in observational designs, the large effect-sizes observed between trauma, PTSD and NAPD in this study, consistent across sensitivity analyses, suggest that trauma may be a component cause of psychotic disorders. However, PTSD diagnosis might not be a good proxy for the likely complex psychological mechanisms mediating this association.
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Affiliation(s)
- Judith Allardyce
- Division of Psychological Medicine and Clinical Neuroscience, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales
- Centre for Clinical Brain Sciences (Division of Psychiatry), University of Edinburgh, Edinburgh, Scotland
| | | | - Syed Rahman
- Dept of Global Public Health, Karolinksa Institutet, Solna, Sweden
| | - Christina Dalman
- Division of Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Psykisk Hälsa, Centrum för epidemiologi och samhällsmedicin, Stockholm, Sweden
| | - Stan Zammit
- Division of Psychological Medicine and Clinical Neuroscience, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, Wales
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, England
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17
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Sahu S, Siddi S, Preti A, Bhatia T, Deshpande SN. Subclinical psychotic symptoms in Indian adults: Application of the Community Assessment of Psychic Experiences (CAPE). Asian J Psychiatr 2023; 81:103451. [PMID: 36682195 PMCID: PMC10101764 DOI: 10.1016/j.ajp.2023.103451] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND The study investigated the psychometric properties of the Community, Assessment of Psychic Experiences (CAPE-42), a self-report instrument in Indians. METHOD CAPE-42 was translated in Hindi and tested on 312 Indian adults recruited online and through paper-pencil assessment. Confirmatory factor analysis (CFA) was employed to establish the factor structure of the positive, negative and depressive dimensions of CAPE-42: the bifactor model was tested to evaluate whether items converge into a major single factor defining psychotic-proneness in individuals. Latent class analysis (LCA) was conducted to identify subgroups with a different endorsement of subclinical psychotic symptoms. , RESULTS CAPE-Hindi showed good reliability (Cronbach's alpha>0.80). CFA confirmed, a good fit for the bifactor model, factor loading was acceptable for all items in the general factor (Omega-h =0.83) and explained the primary variance of the subscales. Residual variance was explained by the positive, negative and depressive factors (Omega H =0.33, 0.04 and 0.12, respectively). LCA identified three classes traceable, to the three dimensions; a low endorsement group (n = 155; 50 %); a less consistent, group with endorsement on positive and depressive items (n = 117; 38 %), and a high, endorsement group (n = 40;13 %). CONCLUSION Hindi CAPE-42 showed good reliability and factorial validity.
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Affiliation(s)
- Sushree Sahu
- National Coordination Unit of Implementation Research under NMHP, ICMR, Centre of Excellence in Mental Health, ABVIMS Dr. Ram Manohar Lohia Hospital, Bangabandhu Sheikh Mujib Road, New Delhi 110001, India
| | - Sara Siddi
- Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, Fundació Sant Joan de Déu, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Antonio Preti
- Department of Neuroscience, University of Turin, Turin, Italy
| | - Triptish Bhatia
- Indo-US Projects and NCU-ICMR, Department of Psychiatry and De-addiction, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences-Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Smita N Deshpande
- Dept. of Psychiatry, De-addiction Services & Resource Center for Tobacco Control, Centre of Excellence in Mental Health, Atal Bihari Vajpayee Institute of Medical Sciences & Dr. Ram Manohar Lohia Hospital, Banga Bandhu Sheikh Mujib Road, New Delhi 110001, India.
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18
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Staines L, Healy C, Corcoran P, Keeley H, Coughlan H, McMahon E, Cotter P, Cotter D, Kelleher I, Wasserman C, Brunner R, Kaess M, Sarchiapone M, Hoven CW, Carli V, Wasserman D, Cannon M. Investigating the effectiveness of three school based interventions for preventing psychotic experiences over a year period - a secondary data analysis study of a randomized control trial. BMC Public Health 2023; 23:219. [PMID: 36726107 PMCID: PMC9890687 DOI: 10.1186/s12889-023-15107-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Psychotic experiences (PEs) are associated with increased risk of later mental disorders and so could be valuable in prevention studies. However, to date few intervention studies have examined PEs. Given this lack of evidence, in the current study a secondary data analysis was conducted on a clustered-randomized control trial (RCT) of 3 school based interventions to reduce suicidal behaviour, to investigate if these may reduce rates of PEs, and prevent PE, at 3-month and 1-year follow-up. METHODS The Irish site of the Saving and Empowering Young Lives in Europe study, trial registration (DRKS00000214), a cluster-RCT designed to examine the effect of school-based interventions on suicidal thoughts and behaviour. Seventeen schools (n = 1096) were randomly assigned to one of three intervention arms or a control arm. The interventions included a teacher training (gate-keeper) intervention, an interactive educational (universal-education) intervention, and a screening and integrated referral (selective-indicative) intervention. The primary outcome of this secondary data-analysis was reduction in point-prevalence of PEs at 12 months. A second analysis excluding those with PEs at baseline was conducted to examine prevention of PEs. Additional analysis was conducted of change in depression and anxiety scores (comparing those with/without PEs) in each arm of the intervention. Statistical analyses were conducted using mixed-effects modelling. RESULTS At 12-months, the screening and referral intervention was associated with a significant reduction in PEs (OR:0.12,95%CI[0.02-0.62]) compared to the control arm. The teacher training and education intervention did not show this effect. Prevention was also observed only in the screening and referral arm (OR:0.30,95%CI[0.09-0.97]). Participants with PEs showed higher levels of depression and anxiety symptoms, compared to those without, and different responses to the screening and referral intervention & universal-education intervention. CONCLUSIONS This study provides the first evidence for a school based intervention that reduce & prevent PEs in adolescence. This intervention is a combination of a school-based screening for psychopathology and subsequent referral intervention significantly reduced PEs in adolescents. Although further research is needed, our findings point to the effectiveness of school-based programmes for prevention of future mental health problems.
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Affiliation(s)
- Lorna Staines
- Department of Psychiatry, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland.
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland
| | - Paul Corcoran
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Helen Keeley
- Child and Adolescent Mental Health Services North Cork, Health Service Executive, Cork, Ireland
| | - Helen Coughlan
- Department of Psychiatry, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland
| | - Elaine McMahon
- National Suicide Research Foundation, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Padraig Cotter
- Research Society of Process Oriented Psychology United Kingdom (RSPOPUK), Old Hampstead Townhall 213 Haverstock Hill, NW3 4QP, London, UK
- Park Royal Centre for Mental Health, Central and North West London (CNWL) NHS Trust, Central Way, Off Acton Lane, NW10 7NS, London, UK
| | - David Cotter
- Department of Psychiatry, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland
- Department of Psychiatry, Beaumont Hospital, Dublin 9, Ireland
| | - Ian Kelleher
- Department of Psychiatry, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, EH10 5HF, Edinburgh, UK
| | - Camilla Wasserman
- Department of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Romuald Brunner
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Marco Sarchiapone
- Department of Medicine and Health Science, University of Molise, Campobasso, Italy
| | - Christina W Hoven
- Department of Child and Adolescent Psychiatry, Columbia University, New York State Psychiatric Institute, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - Vladimir Carli
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP), Karolinska Institute, Stockholm, Sweden
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin, Ireland
- Department of Psychiatry, Beaumont Hospital, Dublin 9, Ireland
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19
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Potharst ES, Truijens D, Seegers ICM, Spaargaren JF, van Steensel FJA, Bögels SM. BOAM: A Visual, Explanatory Diagnostic and Psychoeducation System Used in Collaboration with Families-Feasibility and Acceptability for Children Who Are Non-Responsive to Treatment as Usual. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14693. [PMID: 36429410 PMCID: PMC9691191 DOI: 10.3390/ijerph192214693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 06/16/2023]
Abstract
Many children referred to mental health services have neurodevelopmental problems, which are not always recognized because the resulting emotional and behavioral problems dominate diagnosis and treatment. BOAM (Basic needs, Order, Autonomy and Meaning) is a new diagnostic system consisting of imaginative models that explain the complexity of symptoms and underlying neuropsychological problems in a simple way. It is designed to be used in a transparent, collaborative process with families, so that family members can better understand the nature of mental health problems, thus increasing self-knowledge and mutual understanding. In this study, the feasibility of the BOAM diagnostic trajectory and subsequent treatment informed by this trajectory are evaluated clinically in 34 children who have not responded to or relapsed after treatment as usual (TAU). Parents completed questionnaires pre-test, post-test and at a 3-month follow-up. The treatment drop-out rate was 2.9%. Post-test, parents rated the BOAM trajectory positively. The questionnaires (measuring child psychopathology, attention, executive functioning, family functioning, partner relationships and parenting stress) demonstrated sensitivity to change, and therefore, seems appropriate for a future effectiveness study. A limitation was the high percentage of missing measurements both post-test (41%) and at the follow-up (41%). The BOAM diagnostic trajectory and subsequent treatment may be a feasible alternative for children who do not respond to or relapse after TAU.
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Affiliation(s)
- Eva S. Potharst
- UvA Minds, Academic Outpatient (Child and Adolescent) Treatment Centre of the University of Amsterdam, Banstraat 29, 1071 JW Amsterdam, The Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, The Netherlands
| | - Damiët Truijens
- UvA Minds, Academic Outpatient (Child and Adolescent) Treatment Centre of the University of Amsterdam, Banstraat 29, 1071 JW Amsterdam, The Netherlands
| | - Isabelle C. M. Seegers
- UvA Minds, Academic Outpatient (Child and Adolescent) Treatment Centre of the University of Amsterdam, Banstraat 29, 1071 JW Amsterdam, The Netherlands
| | - Julia F. Spaargaren
- UvA Minds, Academic Outpatient (Child and Adolescent) Treatment Centre of the University of Amsterdam, Banstraat 29, 1071 JW Amsterdam, The Netherlands
| | - Francisca J. A. van Steensel
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, The Netherlands
| | - Susan M. Bögels
- Developmental Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS Amsterdam, The Netherlands
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20
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Li B, Hu T, Tang W. The effects of peer bullying and poverty on suicidality in Chinese left behind adolescents: The mediating role of psychotic-like experiences. Early Interv Psychiatry 2022; 16:1217-1229. [PMID: 35192219 DOI: 10.1111/eip.13271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 11/05/2021] [Accepted: 01/18/2022] [Indexed: 02/05/2023]
Abstract
AIM This study investigated the influence of childhood adversity, such as peer bullying and socioeconomic status, on the suicidal behaviour of left-behind Chinese adolescents to determine whether psychotic-like experiences (PLEs) mediated the associations between these childhood adversities and suicidality; suicidal ideation (serious thoughts about taking one's own life), suicide plans, and suicide attempts. METHODS A representative group of rural adolescents (n = 3346) was recruited from 16 rural high schools in China. Suicidality was assessed using the suicide module from the Mini International Neuropsychiatric Interview Kid. Participants also completed questionnaires on bullying, socioeconomic status, left-behind characteristics, and PLEs. Structural equation modelling was then employed to explore the relationships between these variables. RESULTS Peer bullying, poverty, and left-behind status were all found to significantly increase adolescent suicide risk, the relationships between which were mediated by PLEs. Peer bullying was found to play the most significant role in the PLEs and suicidality, with the risk of suicide increasing with the length of time a child had been left behind. CONCLUSION Adverse life events can lead to a high risk of PLEs, which in turn can increase the risk of suicide. These results could assist in identifying individuals at risk of suicidality and the design of appropriate interventions. The results also highlighted the role PLEs play in suicidality and highlighted the need for further research in this area.
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Affiliation(s)
- Bin Li
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Hu
- Department of Psychology, Chengdu Normal University, Chengdu, China
| | - Wanjie Tang
- Mental Health Center, West China Hospital, Sichuan University, Chengdu, China.,Centre for Educational and Health Psychology, Sichuan University, Chengdu, China
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21
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Stochl J, Soneson E, Stuart F, Fritz J, Walsh AEL, Croudace T, Hodgekins J, Patel U, Russo DA, Knight C, Jones PB, Perez J. Determinants of patient-reported outcome trajectories and symptomatic recovery in Improving Access to Psychological Therapies (IAPT) services. Psychol Med 2022; 52:3231-3240. [PMID: 33682645 PMCID: PMC9693716 DOI: 10.1017/s0033291720005395] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Despite evidence for the general effectiveness of psychological therapies, there exists substantial heterogeneity in patient outcomes. We aimed to identify factors associated with baseline severity of depression and anxiety symptoms, rate of symptomatic change over the course of therapy, and symptomatic recovery in a primary mental health care setting. METHODS Using data from a service evaluation involving 35 527 patients in England's psychological and wellbeing [Improving Access to Psychological Therapies (IAPT)] services, we applied latent growth models to explore which routinely-collected sociodemographic, clinical, and therapeutic variables were associated with baseline symptom severity and rate of symptomatic change. We used a multilevel logit model to determine variables associated with symptomatic recovery. RESULTS Being female, younger, more functionally impaired, and more socioeconomically disadvantaged was associated with higher baseline severity of both depression and anxiety symptoms. Being older, less functionally impaired, and having more severe baseline symptomatology was associated with more rapid improvement of both depression and anxiety symptoms (male gender and greater socioeconomic disadvantage were further associated with rate of change for depression only). Therapy intensity and appointment frequency seemed to have no correlation with rate of symptomatic improvement. Patients with lower baseline symptom severity, less functional impairment, and older age had a greater likelihood of achieving symptomatic recovery (as defined by IAPT criteria). CONCLUSIONS We must continue to investigate how best to tailor psychotherapeutic interventions to fit patients' needs. Patients who begin therapy with more severe depression and/or anxiety symptoms and poorer functioning merit special attention, as these characteristics may negatively impact recovery.
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Affiliation(s)
- Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- National Institute for Health Research Applied Research Collaboration (ARC) East of England (EoE), Cambridge, UK
- Department of Kinanthropology, Charles University, Prague, Czechia
| | - Emma Soneson
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Freya Stuart
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Jessica Fritz
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Annabel E. L. Walsh
- Institution of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tim Croudace
- School of Health Sciences, University of Dundee, Dundee, UK
| | | | - Ushma Patel
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Debra A. Russo
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Clare Knight
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- National Institute for Health Research Applied Research Collaboration (ARC) East of England (EoE), Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- National Institute for Health Research Applied Research Collaboration (ARC) East of England (EoE), Cambridge, UK
- Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
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22
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Brislin SJ, Martz ME, Joshi S, Duval ER, Gard A, Clark DA, Hyde LW, Hicks BM, Taxali A, Angstadt M, Rutherford S, Heitzeg MM, Sripada C. Differentiated nomological networks of internalizing, externalizing, and the general factor of psychopathology (' p factor') in emerging adolescence in the ABCD study. Psychol Med 2022; 52:3051-3061. [PMID: 33441214 PMCID: PMC9693677 DOI: 10.1017/s0033291720005103] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 11/04/2020] [Accepted: 12/03/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND Structural models of psychopathology consistently identify internalizing (INT) and externalizing (EXT) specific factors as well as a superordinate factor that captures their shared variance, the p factor. Questions remain, however, about the meaning of these data-driven dimensions and the interpretability and distinguishability of the larger nomological networks in which they are embedded. METHODS The sample consisted of 10 645 youth aged 9-10 years participating in the multisite Adolescent Brain and Cognitive Development (ABCD) Study. p, INT, and EXT were modeled using the parent-rated Child Behavior Checklist (CBCL). Patterns of associations were examined with variables drawn from diverse domains including demographics, psychopathology, temperament, family history of substance use and psychopathology, school and family environment, and cognitive ability, using instruments based on youth-, parent-, and teacher-report, and behavioral task performance. RESULTS p exhibited a broad pattern of statistically significant associations with risk variables across all domains assessed, including temperament, neurocognition, and social adversity. The specific factors exhibited more domain-specific patterns of associations, with INT exhibiting greater fear/distress and EXT exhibiting greater impulsivity. CONCLUSIONS In this largest study of hierarchical models of psychopathology to date, we found that p, INT, and EXT exhibit well-differentiated nomological networks that are interpretable in terms of neurocognition, impulsivity, fear/distress, and social adversity. These networks were, in contrast, obscured when relying on the a priori Internalizing and Externalizing dimensions of the CBCL scales. Our findings add to the evidence for the validity of p, INT, and EXT as theoretically and empirically meaningful broad psychopathology liabilities.
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Affiliation(s)
- Sarah J. Brislin
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, USA
| | - Meghan E. Martz
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, USA
| | - Sonalee Joshi
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, USA
| | - Elizabeth R. Duval
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, USA
| | - Arianna Gard
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, USA
| | - D. Angus Clark
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, USA
| | - Luke W. Hyde
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, USA
| | - Brian M. Hicks
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, USA
| | - Aman Taxali
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, USA
| | - Mike Angstadt
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, USA
| | - Saige Rutherford
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, USA
| | - Mary M. Heitzeg
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, USA
| | - Chandra Sripada
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, USA
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23
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Byrne JF, Healy C, Mongan D, Susai SR, Zammit S, Fӧcking M, Cannon M, Cotter DR. Transdiagnostic inflammatory subgroups among psychiatric disorders and their relevance to role functioning: a nested case-control study of the ALSPAC cohort. Transl Psychiatry 2022; 12:377. [PMID: 36085284 PMCID: PMC9463145 DOI: 10.1038/s41398-022-02142-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 11/29/2022] Open
Abstract
Individuals with psychotic disorders and depressive disorder exhibit altered concentrations of peripheral inflammatory markers. It has been suggested that clinical trials of anti-inflammatory therapies for psychiatric disorders should stratify patients by their inflammatory profile. Hence, we investigated whether different subgroups of individuals exist across psychiatric disorders, based on their inflammatory biomarker signatures. We measured the plasma concentrations of 17 inflammatory markers and receptors in 380 participants with psychotic disorder, depressive disorder or generalised anxiety disorder and 399 controls without psychiatric symptoms from the ALSPAC cohort at age 24. We employed a semi-supervised clustering algorithm, which discriminates multiple clusters of psychiatric disorder cases from controls. The best fit was for a two-cluster model of participants with psychiatric disorders (Adjusted Rand Index (ARI) = 0.52 ± 0.01) based on the inflammatory markers. Permutation analysis indicated the stability of the clustering solution performed better than chance (ARI = 0.43 ± 0.11; p < 0.001), and the clusters explained the inflammatory marker data better than a Gaussian distribution (p = 0.021). Cluster 2 exhibited marked increases in sTNFR1/2, suPAR, sCD93 and sIL-2RA, compared to cluster 1. Participants in the cluster exhibiting higher inflammation were less likely to be in employment, education or training, indicating poorer role functioning. This study found evidence for a novel pattern of inflammatory markers specific to psychiatric disorders and strongly associated with a transdiagnostic measure of illness severity. sTNFR1/2, suPAR, sCD93 and sIL-2RA could be used to stratify clinical trials of anti-inflammatory therapies for psychiatric disorders.
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Affiliation(s)
- Jonah F Byrne
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.
- SFI FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Mongan
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Subash Raj Susai
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Stan Zammit
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Melanie Fӧcking
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- SFI FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- SFI FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David R Cotter
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- SFI FutureNeuro Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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24
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Staines L, Healy C, Coughlan H, Clarke M, Kelleher I, Cotter D, Cannon M. Psychotic experiences in the general population, a review; definition, risk factors, outcomes and interventions. Psychol Med 2022; 52:1-12. [PMID: 36004805 PMCID: PMC9772919 DOI: 10.1017/s0033291722002550] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 12/31/2022]
Abstract
Psychotic experiences (PE) are common in the general population, in particular in childhood, adolescence and young adulthood. PE have been shown to be associated with an increased risk for later psychotic disorders, mental disorders, and poorer functioning. Recent findings have highlighted the relevance of PE to many fields of healthcare, including treatment response in clinical services for anxiety & depression treatment, healthcare costs and service use. Despite PE relevance to many areas of mental health, and healthcare research, there remains a gap of information between PE researchers and experts in other fields. With this review, we aim to bridge this gap by providing a broad overview of the current state of PE research, and future directions. This narrative review aims to provide an broad overview of the literature on psychotic experiences, under the following headings: (1) Definition and Measurement of PE; (2) Risk Factors for PE; (3) PE and Health; (4) PE and Psychosocial Functioning; (5) Interventions for PE, (6) Future Directions.
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Affiliation(s)
- Lorna Staines
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Helen Coughlan
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Mary Clarke
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychology, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychiatry Beaumont Hospital, Dublin 9, Ireland
| | - Ian Kelleher
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- School of Medicine, University College, Dublin 4, Ireland
- Lucena Clinic Child and Adolescent Mental Health Service, Rathgar, Dublin 6, Ireland
| | - David Cotter
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychiatry Beaumont Hospital, Dublin 9, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- Department Psychiatry Beaumont Hospital, Dublin 9, Ireland
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25
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Speyer LG, Neaves S, Hall HA, Hemani G, Lombardo MV, Murray AL, Auyeung B, Luciano M. Polygenic risks for joint developmental trajectories of internalizing and externalizing problems: findings from the ALSPAC cohort. J Child Psychol Psychiatry 2022; 63:948-956. [PMID: 34856637 DOI: 10.1111/jcpp.13549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Joint developmental trajectories of internalizing and externalizing problems show considerable heterogeneity; however, this can be parsed into a small number of meaningful subgroups. Doing so offered insights into risk factors that lead to different patterns of internalizing/externalizing trajectories. However, despite both domains of problems showing strong heritability, no study has yet considered genetic risks as predictors of joint internalizing/externalizing problem trajectories. METHODS Using parallel process latent class growth analysis, we estimated joint developmental trajectories of internalizing and externalizing difficulties assessed across ages 4 to 16 using the Strengths and Difficulties Questionnaire. Multinomial logistic regression was used to evaluate a range of demographic, perinatal, maternal mental health, and child and maternal polygenic predictors of group membership. Participants included 11,049 children taking part in the Avon Longitudinal Study of Parents and Children. Polygenic data were available for 7,127 children and 6,836 mothers. RESULTS A 5-class model was judged optimal: Unaffected, Moderate Externalizing Symptoms, High Externalizing Symptoms, Moderate Internalizing and Externalizing Symptoms and High Internalizing and Externalizing Symptoms. Male sex, lower maternal age, maternal mental health problems, maternal smoking during pregnancy, higher child polygenic risk scores for ADHD and lower polygenic scores for IQ distinguished affected classes from the unaffected class. CONCLUSIONS While affected classes could be relatively well separated from the unaffected class, phenotypic and polygenic predictors were limited in their ability to distinguish between different affected classes. Results thus add to existing evidence that internalizing and externalizing problems have mostly shared risk factors.
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Affiliation(s)
- Lydia Gabriela Speyer
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Department of Psychology, University of Cambridge, Cambridge, UK
| | - Samuel Neaves
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Gibran Hemani
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Vincent Lombardo
- Laboratory for Autism and Neurodevelopmental Disorders, Center for Neuroscience and Cognitive Systems @UniTn, Istituto Italiano di Tecnologia, Rovereto, Italy.,Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Bonnie Auyeung
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Michelle Luciano
- Department of Psychology, University of Edinburgh, Edinburgh, UK
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26
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Ashford PA, Knight C, Heslin M, Clark AB, Kanaan M, Patel U, Stuart F, Kabir T, Grey N, Murray H, Hodgekins J, Reeve N, Marshall N, Painter M, Clarke J, Russo D, Stochl J, Leathersich M, Pond M, Fowler D, French P, Swart AM, Dixon-Woods M, Byford S, Jones PB, Perez J. Treating common mental disorder including psychotic experiences in the primary care improving access to psychological therapies programme (the TYPPEX study): protocol for a stepped wedge cluster randomised controlled trial with nested economic and process evaluation of a training package for therapists. BMJ Open 2022; 12:e056355. [PMID: 35732378 PMCID: PMC9226877 DOI: 10.1136/bmjopen-2021-056355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION At least one in four people treated by the primary care improving access to psychological therapies (IAPT) programme in England experiences distressing psychotic experiences (PE) in addition to common mental disorder (CMD). These individuals are less likely to achieve recovery. IAPT services do not routinely screen for nor offer specific treatments for CMD including PE. The Tailoring evidence-based psychological therapY for People with common mental disorder including Psychotic EXperiences study will evaluate the clinical and cost-effectiveness of an enhanced training for cognitive behavioural therapists that aims to address this clinical gap. METHODS AND ANALYSIS This is a multisite, stepped-wedge cluster randomised controlled trial. The setting will be IAPT services within three mental health trusts. The participants will be (1) 56-80 qualified IAPT cognitive behavioural therapists and (2) 600 service users who are triaged as appropriate for cognitive behavioural therapy in an IAPT service and have PE according to the Community Assessment of Psychic Experiences-Positive 15-items Scale. IAPT therapists will be grouped into eight study clusters subsequently randomised to the control-intervention sequence. We will obtain pseudonymous clinical outcome data from IAPT clinical records for eligible service users. We will invite service users to complete health economic measures at baseline, 3, 6, 9 and 12-month follow-up. The primary outcome will be the proportion of patients with common mental disorder psychotic experiences who have recovered by the end of treatment as measured by the official IAPT measure for recovery. ETHICS AND DISSEMINATION The study received the following approvals: South Central-Berkshire Research Ethics Committee on 28 April 2020 (REC reference 20/SC/0135) and Health Research Authority (HRA) on 23 June 2020. An amendment was approved by the Ethics Committee on 01 October 2020 and HRA on 27 October 2020. Results will be made available to patients and the public, the funders, stakeholders in the IAPT services and other researchers. TRIAL REGISTRATION NUMBER ISRCTN93895792.
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Affiliation(s)
- Polly-Anna Ashford
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Clare Knight
- Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Margaret Heslin
- King's Health Economics, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Mona Kanaan
- Health Sciences, University of York, York, UK
| | - Ushma Patel
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, Cambridgeshire, UK
| | - Freya Stuart
- Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Thomas Kabir
- The McPin Foundation, London, Greater London, UK
| | - Nick Grey
- Sussex Partnership NHS Foundation Trust, Worthing, West Sussex, UK
- Psychology, University of Sussex, Brighton, Brighton and Hove, UK
| | | | - J Hodgekins
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Nesta Reeve
- Norfolk and Suffolk NHS Foundation Trust, Norwich, Norfolk, UK
| | - Nicola Marshall
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, Cambridgeshire, UK
| | | | - James Clarke
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, Cambridgeshire, UK
| | - Debra Russo
- Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Jan Stochl
- Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
- Kinanthropology, Charles University, Prague, Czechia
| | - Maria Leathersich
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Martin Pond
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | | | - Paul French
- Manchester Metropolitan University, Manchester, Greater Manchester, UK
| | - Ann Marie Swart
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge Primary Care Unit, Cambridge, Cambridgeshire, UK
| | - Sarah Byford
- Centre for the Economics of Mental and Physical Health, King's College London, London, UK
| | - Peter B Jones
- Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Jesus Perez
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, Cambridgeshire, UK
- Medicine, Universidad de Salamanca, IBSAL, Salamanca, Castilla y León, Spain
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27
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Shah JL, Jones N, van Os J, McGorry PD, Gülöksüz S. Early intervention service systems for youth mental health: integrating pluripotentiality, clinical staging, and transdiagnostic lessons from early psychosis. Lancet Psychiatry 2022; 9:413-422. [PMID: 35430004 DOI: 10.1016/s2215-0366(21)00467-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/29/2021] [Accepted: 11/16/2021] [Indexed: 12/21/2022]
Abstract
Challenges associated with operationalising services for the at-risk mental state for psychosis solely in that same diagnostic silo are increasingly well recognised-namely, the differential risk for psychosis being a function of sampling enrichment strategies, declining transition rates to psychosis, questions regarding the validity of transition as an outcome, and the frequent development of non-psychotic disorders. However, recent epidemiological and clinical research suggests that not all threshold-level psychoses are likely to occur homotypically; early-stage non-psychotic syndromes might exhibit heterotypic shifts to a first episode of psychosis, without an identifiable at-risk mental state. These findings, along with the relevance of outcomes beyond traditional diagnoses or syndromes, have substantive implications for developing next-generation early intervention infrastructures. Along with the idea of general at-risk clinics for early-stage pluripotential syndromes, we examine how this reality might affect service design, such as the need for close linkage with centres of expertise for threshold-level disorders when transitions to later stages occur, the balance between generic and specific interventions amid the need for person-centred care, and the challenges this reorientation might pose for broader mental health systems.
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Affiliation(s)
- Jai L Shah
- Prevention and Early Intervention Program for Psychosis (PEPP)-Montreal, Montreal, QC, Canada; ACCESS Open Minds, Douglas Hospital Research Centre, Montreal, QC, Canada; Department of Psychiatry, McGill University, Montreal, QC, Canada.
| | - Nev Jones
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jim van Os
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands; Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands; Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sinan Gülöksüz
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, Netherlands; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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28
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Kehinde F, Bharmal AV, Goodyer IM, Kelvin R, Dubicka B, Midgley N, Fonagy P, Jones PB, Wilkinson P. Cross-sectional and longitudinal associations between psychotic and depressive symptoms in depressed adolescents. Eur Child Adolesc Psychiatry 2022; 31:729-736. [PMID: 33432401 PMCID: PMC9142412 DOI: 10.1007/s00787-020-01704-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 12/07/2020] [Indexed: 11/10/2022]
Abstract
Adults with major depressive disorder (MDD) with psychotic features (delusions and/or hallucinations) have more severe symptoms and a worse prognosis. Subclinical psychotic symptoms are more common in adolescents than adults. However, the effects of psychotic symptoms on outcome of depressive symptoms have not been well studied in adolescents. Depressed adolescents aged 11-17 with and without psychotic symptoms were compared on depression severity scores at baseline and at 28- or 42-week follow-up in two large UK cohorts. Psychotic symptoms were weakly associated with more severe depression at baseline in both cohorts. At follow-up, baseline psychotic symptoms were only associated with depressive symptoms in one sample; in the other, the effect size was close to zero. This supports the DSM5 system of psychotic symptoms being a separate code to severity rather than the ICD10 system which only allows the diagnosis of psychotic depression with severe depression. There was no clear support for psychotic symptoms being a baseline marker of treatment response.
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Affiliation(s)
- Fiona Kehinde
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Royal Free Hospital, London, UK
| | - Aamena Valiji Bharmal
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Imperial GP VTS Scheme, London, UK
| | - Ian M. Goodyer
- Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH UK
| | - Raphael Kelvin
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | | | - Nick Midgley
- Anna Freud National Centre for Children and Families, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Peter Fonagy
- Anna Freud National Centre for Children and Families, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Paul Wilkinson
- Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - IMPACT Consortium
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Anna Freud National Centre for Children and Families, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- University of Manchester, Manchester, UK
- Imperial GP VTS Scheme, London, UK
- Royal Free Hospital, London, UK
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29
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Sun X, So SHW, Chung LKH, Chiu CD, Chan RCK, Leung PWL. Longitudinal bifactor modeling of anxiety, depression and schizotypy - The role of rumination as a shared mechanism. Schizophr Res 2022; 240:153-161. [PMID: 35030443 DOI: 10.1016/j.schres.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/31/2021] [Accepted: 01/02/2022] [Indexed: 11/27/2022]
Abstract
A bifactor model with a general (p) factor reflecting shared variance and specific factors reflecting additional variance in individual symptoms has been introduced to explain common co-occurrence among anxiety, depression and schizotypy. However, longitudinal evidence is lacking and the validity of bifactor modeling is debatable. The current study aimed to examine the presence of the p factor together with specific factors in accounting for relationships between anxiety, depression and schizotypy both cross-sectionally and longitudinally, and to investigate the relationship between these factors and rumination. A validated sample of university students were surveyed on levels of anxiety, depression, schizotypy and rumination at baseline (N = 2291), one year (N = 1833) and two years (N = 1656). Models were estimated using exploratory structural equation modeling (ESEM) and compared at each time point. Longitudinal invariance of the best-fitting model was examined and all potential within- and between-factor stability pathways were tested in an SEM framework. A bifactor model with a p factor and four specific factors (representing residual information of composite anxiety and depression, cognitive-perceptual, interpersonal and disorganized schizotypy respectively) consistently outperformed a correlated-factors model. The bifactor structure appeared longitudinally stable. Within-factor stabilities were moderate, and between-factor pathways reflected a few significant interactions, mostly involving the p factor. Rumination was independently associated with p and four specific factors at each time point. Therefore, there is a p factor accounting for concurrent and sequential co-occurrence of anxiety, depression and schizotypy. Rumination explained partly the p and specific factors. Transdiagnostic interventions should target rumination.
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Affiliation(s)
- Xiaoqi Sun
- Department of Psychology, Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, China; Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Suzanne H W So
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China.
| | - Lawrence K H Chung
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Chui-De Chiu
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Raymond C K Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Chinese Academy of Sciences, Beijing, China; Department of Psychology, the University of Chinese Academy of Sciences, Beijing, China; CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Patrick W L Leung
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
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30
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Wu Z, Jiang Z, Wang Z, Ji Y, Wang F, Ross B, Sun X, Liu Z, Long Y. Association Between Wisdom and Psychotic-Like Experiences in the General Population: A Cross-Sectional Study. Front Psychiatry 2022; 13:814242. [PMID: 35509888 PMCID: PMC9058059 DOI: 10.3389/fpsyt.2022.814242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Wisdom has been empirically researched as a complex psychological characteristic that is associated with many mental health outcomes. However, its association with psychotic-like experiences (PLEs) remains unclear. This is the first work to assess wisdom, explore its association with PLEs, and test its moderating effect on the relation between the frequency of PLEs and their associated distress in the general population. METHODS From January 29th to February 5th, 2021, our online self-administered survey recruited 927 participants (ages 14 to 65) from thirteen Chinese provinces. Convenience sampling was employed. We measured wisdom with the 12-item three-dimensional wisdom scale (3D-WS-12) and PLEs with the 15-item positive subscale of the Community Assessment of Psychic Experiences (CAPE-P15). RESULTS Using the cut-off value of 1.47 in the mean frequency score, we divided our participants into high-PLEs group (188, 22.1%) and low-PLEs group (663, 77.9%). Three-dimensional wisdom score was decreased in the high-PLEs group compared to the low-PLEs group (Kruskal-Wallis t = 59.9, p < 0.001). Wisdom was associated with less frequent PLEs (Spearman's rho = -0.21, p < 0.01) and lower distress related to PLEs (Spearman's rho = -0.28) in the high-PLEs group (all above p < 0.001), which were replicated in the low-PLEs group. Notably, wisdom significantly attenuated the distress associated with PLEs [coefficient = -0.018, Bootstrap 95% CI (-0.029, -0.008)], but only in the low-PLEs group. CONCLUSION Our results implicated that wisdom could protect individuals from distressful subclinical psychotic symptoms and wiser individuals have better general mental health.
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Affiliation(s)
- Zhipeng Wu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
| | - Zhengqian Jiang
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Zhipeng Wang
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Yuqiao Ji
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Feiwen Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
| | - Brendan Ross
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Xiaoqi Sun
- Department of Psychology, Cognition and Human Behavior Key Laboratory of Hunan Province, Hunan Normal University, Changsha, China
| | - Zhening Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
| | - Yicheng Long
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Mental Disorders, Changsha, China
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31
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Coid JW, Zhang Y, Zeng J, Li X, Lv Q, Tang W, Wang Q, Deng W, Guo W, Zhao L, Ma X, Meng Y, Li M, Wang H, Chen T, Yang M, Li T. Testing extra-linearity across a psychosis continuum. BMC Psychiatry 2021; 21:574. [PMID: 34784908 PMCID: PMC8594101 DOI: 10.1186/s12888-021-03498-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/27/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND It is unclear whether psychotic experiences (PEs) gradually merge into states of clinical psychosis along a continuum which correspond to a dimensional classification or whether latent classes appear above a certain severity threshold which correspond better to diagnostic categories of psychosis. METHODS Annual cross-sectional surveys, 2014-19, among Chinese undergraduates (N = 47,004) measured PEs, depression and etiological risk factors using standardized self-report instruments. We created a psychosis continuum with five levels and tested linear and extra-linear contrasts in associated etiological risk factors, before and after adjustment for depression. We carried out latent class analysis. RESULTS Categorical expression of psychosis, including hallucinations and delusions, nuclear symptoms, and nuclear symptoms and depression were found at severe level 5. Etiological risk factors which impacted linearly across the continuum were more common for depression. Child maltreatment impacted extra-linearly on both psychosis and depression. Family history of psychosis impacted linearly on psychosis; male sex and urban birth impacted extra-linearly and were specific for psychosis. Four latent classes were found, but only at level 5. These corresponded to nuclear schizophrenia symptoms, nuclear schizophrenia and depressive symptoms, severe depression, and an unclassified category with moderate prevalence of PEs. CONCLUSION Quantitative and qualitative changes in the underlying structure of psychosis were observed at the most severe level along a psychosis continuum, where four latent classes emerged. These corresponded to existing categorical classifications but require confirmation with clinical interview. PEs are non-specific and our findings suggest some are on a continuum with depression, whilst others are on a continuum with non-affective psychosis. Differing patterns of impact from etiological risk factors across the spectrum of psychopathology determine outcome at the most severe level of these continua.
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Affiliation(s)
- Jeremy W. Coid
- grid.412901.f0000 0004 1770 1022Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Yamin Zhang
- grid.412901.f0000 0004 1770 1022Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Jinkun Zeng
- grid.412901.f0000 0004 1770 1022Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Xiaojing Li
- grid.412901.f0000 0004 1770 1022Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Qiuyue Lv
- grid.412901.f0000 0004 1770 1022Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Wanjie Tang
- grid.13291.380000 0001 0807 1581Institute of Emergency Management and Post-disaster Reconstruction, Sichuan University, Chengdu, Sichuan China ,grid.13291.380000 0001 0807 1581Centre for Psychological Educational and Consultation, Sichuan University, Chengdu, Sichuan China
| | - Qiang Wang
- grid.412901.f0000 0004 1770 1022Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Wei Deng
- grid.412901.f0000 0004 1770 1022Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan China ,grid.469604.90000 0004 1765 5222Hangzhou Seventh People’s Hospital, Affiliated Mental Health Center, Zhejiang University School of Medicine, Hang zhou, Zhejiang China
| | - Wanjun Guo
- grid.412901.f0000 0004 1770 1022Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Liansheng Zhao
- grid.412901.f0000 0004 1770 1022Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Xiaohong Ma
- grid.412901.f0000 0004 1770 1022Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Yajing Meng
- grid.412901.f0000 0004 1770 1022Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Mingli Li
- grid.412901.f0000 0004 1770 1022Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Huiyao Wang
- grid.412901.f0000 0004 1770 1022Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Ting Chen
- grid.412901.f0000 0004 1770 1022Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Min Yang
- grid.13291.380000 0001 0807 1581Department of Epidemiology and Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan China ,grid.13291.380000 0001 0807 1581West China Research Center for Rural Health Development, Sichuan University, Chengdu, Sichuan China
| | - Tao Li
- Mental Health Center and Psychiatric Laboratory, the State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China. .,Hangzhou Seventh People's Hospital, Affiliated Mental Health Center, Zhejiang University School of Medicine, Hang zhou, Zhejiang, China.
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Changes of psychotic-like experiences and their association with anxiety/depression among young adolescents before COVID-19 and after the lockdown in China. Schizophr Res 2021; 237:40-46. [PMID: 34481204 PMCID: PMC8437585 DOI: 10.1016/j.schres.2021.08.020] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 08/18/2021] [Accepted: 08/22/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Lockdown policies during COVID-19 pandemic have potential adverse psychological impacts on youth. However, little is known about their influence on the changes of psychotic-like experiences (PLEs) among adolescents, nor about the possible association between changes in PLEs and changes in anxiety/depression symptoms. We investigated these two questions through a longitudinal comparative study. METHODS In total, 1825 adolescents were surveyed before COVID-19 and after the lockdown in China (T0, October 20th, 2019 and T1, May 18th, 2020). PLEs, anxiety, and depression were measured with paranoia, anxiety and depression subscales of the Mental Health Inventory of Middle school students (MMHI-60). Within-subjects Wilcoxon test, Spearman correlation test, and Kruskal-Wallis test were adopted. RESULTS Significant increase in adolescent PLEs scores was observed after the lockdown (Wilcoxon's w = 9.302, p < 0.001). We also found positive correlation between changes of PLEs and changes of anxiety/depression (Spearman's rho = 0.59/0.53, both p < 0.001). Furthermore, four PLEs trajectories were identified based on the report of PLEs at two timepoints: 60.4% with no PLEs, 9.3% remitted PLEs, 16.7% new PLEs, and 13.6% persistent PLEs. Significant difference was found in changes of anxiety/depression among four groups (p < 0.001); notably, the group with new-onset PLEs had the greatest exacerbation in anxiety/depression symptoms (both p Bonferroni <0.001). CONCLUSIONS This work is the first to identify increases in adolescent PLEs across the COVID-19 pandemic and suggested a close longitudinal association between PLEs and anxiety/depression. Our findings have implications for adolescent mental health crisis interventions during the pandemic.
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Khandaker GM, Stochl J, Zammit S, Lewis G, Dantzer R, Jones PB. Association between circulating levels of C-reactive protein and positive and negative symptoms of psychosis in adolescents in a general population birth cohort. J Psychiatr Res 2021; 143:534-542. [PMID: 33229033 PMCID: PMC8126639 DOI: 10.1016/j.jpsychires.2020.11.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/13/2020] [Accepted: 11/12/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Schizophrenia is associated with elevated levels of circulating C-reactive protein (CRP) and other inflammatory markers, but it is unclear whether these associations extend to psychotic symptoms occurring in adolescence in the general population. A symptom-based approach may provide important clues for apparent trans-diagnostic effect of inflammation, which is also associated with depression and other psychiatric disorders. METHODS Based on data from 2421 participants from the Avon Longitudinal Study of Parents and Children birth cohort, we examined associations of serum CRP levels assessed around age 16 with ten positive and ten negative symptoms of psychosis assessed using questionnaires around age 17, using both individual symptoms and symptom dimension scores as outcomes. Regression models were adjusted for sex, body mass index, depressive symptoms, substance use, and other potential confounders. RESULTS Most prevalent positive symptoms were paranoid ideation (4.8%), visual (4.3%) and auditory (3.5%) hallucinations. Negative symptoms were more strongly correlated with concurrent depressive symptoms (r=0.51; P < 0.001) than positive symptoms (rpb=0.19; P < 0.001). The associations of CRP with positive and negative symptom dimension scores were similar. At individual symptom level, after adjusting for potential confounders including depressive symptoms, CRP was associated with auditory hallucinations (adjusted OR = 2.22; 95% CI, 1.04-4.76) and anhedonia (adjusted OR = 1.13; 95% CI, 1.02-1.26). CONCLUSIONS Inflammation is associated with sub-clinical psychotic symptoms in young people in general population. Association of CRP with symptoms commonly shared between mood and psychotic disorders, such as auditory hallucinations and anhedonia, could be one explanation for the apparent trans-diagnostic effect of inflammation.
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Affiliation(s)
- Golam M Khandaker
- Department of Psychiatry, University of Cambridge, Herchel Smith Building, Forvie Site, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn Hospital, Fulbourn, Cambridge, CB21 5EF, United Kingdom.
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Herchel Smith Building, Forvie Site, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, United Kingdom; Department of Kinanthropology, Charles University, José Martího 31, Prague, 165 52, Czech Republic
| | - Stanley Zammit
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, United Kingdom; Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, CF10 3AT, United Kingdom
| | - Glyn Lewis
- Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom
| | - Robert Dantzer
- Department for Symptom Research, University of Texas MD Anderson Cancer Center, Laboratory of Neuroimmunology, Unit 1055, Office: Z8.5042, 6565 MD Anderson Boulevard, Houston, TX, 77030, USA
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Herchel Smith Building, Forvie Site, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn Hospital, Fulbourn, Cambridge, CB21 5EF, United Kingdom
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Shoham N, Hayes JF, Cooper C, Theodorsson M, Lewis G. Association Between Childhood Visual Acuity and Late Adolescent Psychotic Experiences: A Prospective Birth Cohort Study. Schizophr Bull 2021; 48:325-334. [PMID: 34624117 PMCID: PMC8886579 DOI: 10.1093/schbul/sbab121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A cross-sectional association between visual impairment and psychosis exists, but longitudinal evidence from children and young people is limited. We investigated whether childhood visual acuity was associated with subsequent psychotic experiences. Our sample was 6686 individuals from the Avon Longitudinal Study of Parents and Children (ALSPAC). We investigated whether our primary exposures, best corrected visual acuity at ages 7 and 11, were associated with psychotic experiences at ages 17 and 24. We also tested whether the following exposures at ages 7 and 11 were associated with subsequent psychotic experiences: requiring glasses, presence of any visual impairment, and between-eye visual acuity difference; and at age 7: strabismus, measures of binocular vision, history of eye patch, near vision impairment, and abnormal saccadic or pursuit eye movements. Analyses used multilevel models before and after adjusting for confounders. Odds of psychotic experiences increased with each 0.1-point deterioration in visual acuity score at age 11 (adjusted odds ratio [AOR] 1.23; 95% confidence interval [CI] 1.06-1.42), and at age 7 (AOR 1.18; 95% CI 1.00-1.40). Wearing glasses and visual impairment at age 11 were associated with psychotic experiences (AOR 1.63; 95% CI 1.21-2.19; AOR 1.64; 95% CI 1.23-2.19, respectively). There was no evidence of an association with other visual exposures. Visual acuity impairment in childhood is associated with psychotic experiences in late adolescence. Future research should aim to elucidate the nature of this association.
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Affiliation(s)
- Natalie Shoham
- Division of Psychiatry, University College London, London, UK,Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK,To whom correspondence should be addressed; Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London W1C 7NF, UK; e-mail:
| | - Joseph F Hayes
- Division of Psychiatry, University College London, London, UK,Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK,Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | | | - Gemma Lewis
- Division of Psychiatry, University College London, London, UK
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Chan SKW, Lee KKW, Chan VHY, Pang HH, Wong CSM, Hui CLM, Chang WC, Lee EHM, Chan WC, Cheung EFC, Chiu HFK, Chiang TP, Lam M, Lau JTF, Ng RMK, Hung SF, Lam LCW, Chen EYH. The 12-month prevalence of psychotic experiences and their association with clinical outcomes in Hong Kong: an epidemiological and a 2-year follow up studies. Psychol Med 2021; 51:2501-2508. [PMID: 32466813 DOI: 10.1017/s0033291720001452] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The relationship between the subtypes of psychotic experiences (PEs) and common mental health symptoms remains unclear. The current study aims to establish the 12-month prevalence of PEs in a representative sample of community-dwelling Chinese population in Hong Kong and explore the relationship of types of PEs and common mental health symptoms. METHOD This is a population-based two-phase household survey of Chinese population in Hong Kong aged 16-75 (N = 5719) conducted between 2010 and 2013 and a 2-year follow-up study of PEs positive subjects (N = 152). PEs were measured with Psychosis Screening Questionnaire (PSQ) and subjects who endorsed any item on the PSQ without a clinical diagnosis of psychotic disorder were considered as PE-positive. Types of PEs were characterized using a number of PEs (single v. multiple) and latent class analysis. All PE-positive subjects were assessed with common mental health symptoms and suicidal ideations at baseline and 2-year follow-up. PE status was also assessed at 2-year follow-up. RESULTS The 12-month prevalence of PEs in Hong Kong was 2.7% with 21.1% had multiple PEs. Three latent classes of PEs were identified: hallucination, paranoia and mixed. Multiple PEs and hallucination latent class of PEs were associated with higher levels of common mental health symptoms. PE persistent rate at 2-year follow-up was 15.1%. Multiple PEs was associated with poorer mental health at 2-year follow-up. CONCLUSIONS Results highlighted the transient and heterogeneous nature of PEs, and that multiple PEs and hallucination subtype of PEs may be specific indices of poorer common mental health.
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Affiliation(s)
- Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong
| | | | - Veronica Hei Yan Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Herbert H Pang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Corine Sau Man Wong
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Christy Lai Ming Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong
| | - Edwin Ho Ming Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | - Wai Chi Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | | | | | | | | | - Joseph Tak Fai Lau
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong
| | | | - Se Fong Hung
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
| | | | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong
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Mamah D, Mutiso VN, Ndetei DM. Psychotic-like experiences among 9,564 Kenyan adolescents and young adults. Psychiatry Res 2021; 302:113994. [PMID: 34029986 DOI: 10.1016/j.psychres.2021.113994] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 05/07/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate the prevalence and characteristics of psychotic-like experiences (PLE) in a large cohort of Kenyan adolescents and young adults. METHOD The Washington Early Recognition Center Affectivity and Psychosis (WERCAP) Screen was used to the study the 12-month prevalence of PLE's among 9,564 Kenyan youths (aged 15-25 yrs), and the rates of psychosis high-risk (HR) and medium-risk (MR) cases, based on cut-off scores. Relationships with clinical, demographic and economic profiles were investigated. RESULTS Across all participants, 72% reported having had at least one PLE over the last year. 4.6% and 30.6% were HR and MR based on symptom scores. There were similar PLE rates in females and males. PLE severity correlated with mood (r=0.67), stress (r=0.46), and autistic traits (r=0.18). PLE severity was also related to poverty, lower education attainment, and underemployment. Compared to controls, HR and MR youths were more likely to report lifetime substance use and to have more significant use. CONCLUSION Psychosis screening can provide valuable information about individuals and may help identify those who may require clinical assessment and intervention to improve outcomes. This is particularly relevant in many parts of Africa where the resources are limited for treating more advanced illness.
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Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University Medical School, 660 S. Euclid, Saint Louis, Missouri, 63110, USA.
| | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; Department of Psychiatry, University of Nairobi, Kenya
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Hiekkaranta AP, Kirtley OJ, Lafit G, Decoster J, Derom C, de Hert M, Gülöksüz S, Jacobs N, Menne-Lothmann C, Rutten BPF, Thiery E, van Os J, van Winkel R, Wichers M, Myin-Germeys I. Emotion regulation in response to daily negative and positive events in youth: The role of event intensity and psychopathology. Behav Res Ther 2021; 144:103916. [PMID: 34224990 DOI: 10.1016/j.brat.2021.103916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 05/14/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
Environmental and individual contextual factors profoundly influence how people regulate their emotions. The current article addresses the role of event intensity and psychopathology (an admixture of depression, anxiety, and psychoticism) on emotion regulation in response to naturally occurring events. For six days each evening, a youth sample (aged 15-25, N = 713) recorded the intensity of the most positive and most negative event of the day and their subsequent emotion regulation. The intensity of negative events was positively associated with summed total emotion regulation effort, strategy diversity, engaging in rumination, situation modification, emotion expression, and sharing and negatively associated with reappraisal and acceptance. The intensity of positive events was positively associated with strategy diversity, savoring, emotion expression, and sharing. Higher psychopathology symptoms were only related to ruminating more about negative events. We interpret these findings as support for the role of context in the degree of effort and type of emotion regulation that young people engage in.
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Affiliation(s)
- Anu P Hiekkaranta
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium.
| | - Olivia J Kirtley
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium
| | - Ginette Lafit
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium; Department of Psychology, Research Group of Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | - Jeroen Decoster
- Sint-Kamillus, University Psychiatric Center, Bierbeek, Belgium
| | - Catherine Derom
- Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium; KU Leuven, Department of Human Genetics, University Hospital Gasthuisberg, Leuven, Belgium
| | - Marc de Hert
- University Psychiatric Centre KU Leuven, Department of Neurosciences, KU Leuven, Belgium; Antwerp Health Law and Ethics Chair - AHLEC University Antwerpen, Antwerp, Belgium
| | - Sinan Gülöksüz
- School for Mental Health and Neuroscience MHeNS, South Limburg Mental Health and Teaching Network, EURON, Department of Psychiatry and Neuropsychology, Maastricht University, the Netherlands; Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Nele Jacobs
- School for Mental Health and Neuroscience MHeNS, South Limburg Mental Health and Teaching Network, EURON, Department of Psychiatry and Neuropsychology, Maastricht University, the Netherlands; Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, the Netherlands
| | - Claudia Menne-Lothmann
- School for Mental Health and Neuroscience MHeNS, South Limburg Mental Health and Teaching Network, EURON, Department of Psychiatry and Neuropsychology, Maastricht University, the Netherlands
| | - Bart P F Rutten
- School for Mental Health and Neuroscience MHeNS, South Limburg Mental Health and Teaching Network, EURON, Department of Psychiatry and Neuropsychology, Maastricht University, the Netherlands
| | - Evert Thiery
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Jim van Os
- School for Mental Health and Neuroscience MHeNS, South Limburg Mental Health and Teaching Network, EURON, Department of Psychiatry and Neuropsychology, Maastricht University, the Netherlands; Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands; Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, UK
| | - Ruud van Winkel
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium; University Psychiatric Centre KU Leuven, Department of Neurosciences, KU Leuven, Belgium
| | - Marieke Wichers
- University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, Groningen, the Netherlands
| | - Inez Myin-Germeys
- KU Leuven, Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium
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Stein F, Meller T, Brosch K, Schmitt S, Ringwald K, Pfarr JK, Meinert S, Thiel K, Lemke H, Waltemate L, Grotegerd D, Opel N, Jansen A, Nenadić I, Dannlowski U, Krug A, Kircher T. Psychopathological Syndromes Across Affective and Psychotic Disorders Correlate With Gray Matter Volumes. Schizophr Bull 2021; 47:1740-1750. [PMID: 33860786 PMCID: PMC8530386 DOI: 10.1093/schbul/sbab037] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION More than a century of research on the neurobiological underpinnings of major psychiatric disorders (major depressive disorder [MDD], bipolar disorder [BD], schizophrenia [SZ], and schizoaffective disorder [SZA]) has been unable to identify diagnostic markers. An alternative approach is to study dimensional psychopathological syndromes that cut across categorical diagnoses. The aim of the current study was to identify gray matter volume (GMV) correlates of transdiagnostic symptom dimensions. METHODS We tested the association of 5 psychopathological factors with GMV using multiple regression models in a sample of N = 1069 patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for MDD (n = 818), BD (n = 132), and SZ/SZA (n = 119). T1-weighted brain images were acquired with 3-Tesla magnetic resonance imaging and preprocessed with CAT12. Interactions analyses (diagnosis × psychopathological factor) were performed to test whether local GMV associations were driven by DSM-IV diagnosis. We further tested syndrome specific regions of interest (ROIs). RESULTS Whole brain analysis showed a significant negative association of the positive formal thought disorder factor with GMV in the right middle frontal gyrus, the paranoid-hallucinatory syndrome in the right fusiform, and the left middle frontal gyri. ROI analyses further showed additional negative associations, including the negative syndrome with bilateral frontal opercula, positive formal thought disorder with the left amygdala-hippocampus complex, and the paranoid-hallucinatory syndrome with the left angular gyrus. None of the GMV associations interacted with DSM-IV diagnosis. CONCLUSIONS We found associations between psychopathological syndromes and regional GMV independent of diagnosis. Our findings open a new avenue for neurobiological research across disorders, using syndrome-based approaches rather than categorical diagnoses.
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Affiliation(s)
- Frederike Stein
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany,Center for Mind Brain and Behavior, University of Marburg, Marburg, Germany,To whom correspondence should be addressed; Department of Psychiatry and Psychotherapy, Philipps-Universität Marburg, Rudolf-Bultmann-Str. 8, 35039 Marburg, Germany; tel: +49-6421-58-63831, fax: +49-6421-58-68939, e-mail:
| | - Tina Meller
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany,Center for Mind Brain and Behavior, University of Marburg, Marburg, Germany
| | - Katharina Brosch
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany,Center for Mind Brain and Behavior, University of Marburg, Marburg, Germany
| | - Simon Schmitt
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany,Center for Mind Brain and Behavior, University of Marburg, Marburg, Germany
| | - Kai Ringwald
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany,Center for Mind Brain and Behavior, University of Marburg, Marburg, Germany
| | - Julia Katharina Pfarr
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany,Center for Mind Brain and Behavior, University of Marburg, Marburg, Germany
| | - Susanne Meinert
- Department of Psychiatry University of Münster, Münster, Germany
| | - Katharina Thiel
- Department of Psychiatry University of Münster, Münster, Germany
| | - Hannah Lemke
- Department of Psychiatry University of Münster, Münster, Germany
| | - Lena Waltemate
- Department of Psychiatry University of Münster, Münster, Germany
| | | | - Nils Opel
- Department of Psychiatry University of Münster, Münster, Germany
| | - Andreas Jansen
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany,Center for Mind Brain and Behavior, University of Marburg, Marburg, Germany
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany,Center for Mind Brain and Behavior, University of Marburg, Marburg, Germany
| | - Udo Dannlowski
- Department of Psychiatry University of Münster, Münster, Germany
| | - Axel Krug
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany,Center for Mind Brain and Behavior, University of Marburg, Marburg, Germany,Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany,Center for Mind Brain and Behavior, University of Marburg, Marburg, Germany
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Abstract
Psychiatry's most recent foray into the area of risk and prevention has been spear-headed by work on at-risk mental states for psychotic disorders. Twenty-five years' research and clinical application have led us to reformulate the clinical evolution of these syndromes, blurred unhelpful conceptual boundaries between childhood and adult life by adopting a developmental view and has changed the shape of many mental health services as part of a global movement to increase quality. But there are problems: fragmentary psychotic experiences are common in young people but transition from risk-state to full syndrome is uncommon away from specialist clinics with rarefied referrals and can, anyway, be subtle; diagnostic over-shadowing by the prospect of schizophrenia and other psychotic disorders may divert clinical attention from the kaleidoscopic and disabling range of probably treatable psychopathology with which people with risk syndromes present. We use a 19th Century lyric poem, The Lady of Shallot, as an allegory for Psychiatry warning us against regarding these mental states only as pointers towards diagnoses that probably will not occur. Viewed from the fresh perspective of common mental disorders they tell us a great deal about the psychopathological crucible of the second and third decades, the nature of diagnosis, and point towards new treatment paradigms.
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Affiliation(s)
- Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
- CAMEO, Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn, CB21 5EF, UK
- Norwich Medical School, University of East Anglia (UEA), Norwich, NR4 7TJ, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
- CAMEO, Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn, CB21 5EF, UK
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40
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Clark DA, Hicks BM, Angstadt M, Rutherford S, Taxali A, Hyde L, Weigard A, Heitzeg MM, Sripada C. The General Factor of Psychopathology in the Adolescent Brain Cognitive Development (ABCD) Study: A Comparison of Alternative Modeling Approaches. Clin Psychol Sci 2021; 9:169-182. [PMID: 34621600 PMCID: PMC8494184 DOI: 10.1177/2167702620959317] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Many models of psychopathology include a single general factor of psychopathology (GFP) or "p factor" to account for covariation across symptoms. The Adolescent Brain Cognitive Development (ABCD) Study provides a rich opportunity to study the development of the GFP. However, a variety of approaches for modeling the GFP have emerged, raising questions about how modeling choices impact estimated GFP scores. We used the ABCD baseline assessment (ages 9-10 years-old; N=11,875) of the parent-rated Child Behavior Checklist (CBCL) to examine the implications of modeling the GFP using items versus scales; using a priori CBCL scales versus data-driven dimensions; and using bifactor, higher-order, or single-factor models. Children's rank-ordering on the GFP was stable across models, with GFP scores similarly related to criterion variables. Results suggest that while theoretical debates about modeling the GFP continue, the practical implications of these choices for rank-ordering children and assessing external associations will often be modest.
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41
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Rimvall MK, Wolf RT, Olsen EM, Skovgaard AM, Clemmensen L, Oxholm AS, Verhulst F, Rask CU, van Os J, Jeppesen P. Healthcare Costs, School Performance, and Health-related Quality of Life in Adolescence Following Psychotic Experiences in Preadolescence: A Longitudinal Cohort Study. Schizophr Bull 2020; 47:682-691. [PMID: 33345286 PMCID: PMC8673435 DOI: 10.1093/schbul/sbaa175] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Psychotic experiences (PEs) are common in the general population in preadolescence. The implications of PEs on socioeconomic outcomes, including educational attainment, are scarcely described. We aimed to estimate how preadolescent PEs were associated with later healthcare costs, school performance, and health-related quality of life (HRQoL) in adolescence. A total of 1607 preadolescents from the general population Copenhagen Child Cohort 2000 were assessed for PEs at age 11-12 years and followed up over 5 years using register-based data on mental and somatic healthcare costs, and school performance at age 16. Furthermore, HRQoL was assessed for a subsample of the children at age 16-17. We adjusted for perinatal and family sociodemographic adversities, prior parental mental illness and healthcare use, child IQ-estimate at age 11-12, and parent-rated general psychopathology of their child. PEs were associated with slightly poorer school performance. However, preadolescents with PEs more often reported HRQoL within the lowest 10th percentile (OR = 2.74 [95% CI 1.71-4.37]). Preadolescents who reported PEs had higher average total healthcare costs over the following 5 years. The costs for individuals with PEs were higher for mental healthcare services across primary to tertiary care, but not for somatic care. After adjustments, PEs remained independently associated with higher costs and poorer HRQoL, but not with poorer school performance. In conclusion, PEs are important in mental health screening of preadolescents and identify a group of young people with increased healthcare service-use throughout adolescence and who report poorer HRQoL in adolescence, over and above parent-rated general psychopathology of their child.
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Affiliation(s)
- Martin Køster Rimvall
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,To whom correspondence should be addressed; Gentofte Hospitalsvej 3A, 1. sal, 2900 Hellerup, Denmark; tel: 0045-38-66-50-00, e-mail:
| | - Rasmus Trap Wolf
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Denmark,Department of Public Health, Danish Centre for Health Economics (DaCHE), University of Southern Denmark, Odense, Denmark
| | - Else Marie Olsen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Center for Clinical Research and Prevention, Capital Region of Denmark, Denmark
| | - Anne Mette Skovgaard
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lars Clemmensen
- Center for Telepsychiatry, Mental Health Services, Region of Southern Denmark, Odense, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne Sophie Oxholm
- Department of Public Health, Danish Centre for Health Economics (DaCHE), University of Southern Denmark, Odense, Denmark
| | - Frank Verhulst
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Department of Child Psychiatry/Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Charlotte Ulrikka Rask
- Aarhus University Hospital, Department of Child and Adolescent Psychiatry, Research Unit, Aarhus, Denmark,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jim van Os
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands,Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands,Department of Psychosis Studies, King’s College London, King’s Health Partners, Institute of Psychiatry, London, UK
| | - Pia Jeppesen
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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42
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Lo Moro G, Soneson E, Jones PB, Galante J. Establishing a Theory-Based Multi-Level Approach for Primary Prevention of Mental Disorders in Young People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9445. [PMID: 33339317 PMCID: PMC7766147 DOI: 10.3390/ijerph17249445] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/06/2020] [Accepted: 12/12/2020] [Indexed: 12/14/2022]
Abstract
The increasing prevalence of mental health disorders and psychosocial distress among young people exceeds the capacity of mental health services. Social and systemic factors determine mental health as much as individual factors. To determine how best to address multi-level risk factors, we must first understand the distribution of risk. Previously, we have used psychometric methods applied to two epidemiologically-principled samples of people aged 14-24 to establish a robust, latent common mental distress (CMD) factor of depression and anxiety normally distributed across the population. This was linearly associated with suicidal thoughts and non-suicidal self-harm such that effective interventions to reduce CMD across the whole population could have a greater total benefit than those that focus on the minority with the most severe scores. In a randomised trial of mindfulness interventions in university students (the Mindful Student Study), we demonstrated a population-shift effect whereby the intervention group appeared resilient to a universal stressor. Given these findings, and in light of the COVID-19 pandemic, we argue that population-based interventions to reduce CMD are urgently required. To target all types of mental health determinants, these interventions must be multi-level. Careful design and evaluation, interdisciplinary work, and extensive local stakeholder involvement are crucial for these interventions to be effective.
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Affiliation(s)
- Giuseppina Lo Moro
- Department of Public Health Sciences, University of Turin, 10126 Torino, Italy;
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK;
| | - Emma Soneson
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK;
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK;
- National Institute for Health Research Applied Research Collaboration East of England, Cambridge CB2 8AH, UK
| | - Julieta Galante
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK;
- National Institute for Health Research Applied Research Collaboration East of England, Cambridge CB2 8AH, UK
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43
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Aloba O, Opakunle T. The Brief 10-Item Community Assessment of Psychic Experiences-Positive Scale (Brief CAPE-P10): Initial psychometric properties, gender measurement invariance and mean differences among Nigerian adolescents. Early Interv Psychiatry 2020; 14:723-733. [PMID: 31749283 DOI: 10.1111/eip.12903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 10/08/2019] [Accepted: 10/31/2019] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to evaluate the Community Assessment of Psychic Experiences-Positive Scale (CAPE-P) for its psychometric properties in terms of its reliability and validity, in addition to its factor structure and gender measurement invariance among Nigerian adolescents (n = 1336, Mage = 15.15). METHODS The sample consisted of 606 (45.4%) males, who completed the 20-items CAPE-P in addition to the Positive and Negative Suicide Ideation Inventory (PANSI), the Hospital Anxiety and Depression Scale (HADS) and the Rosenberg Self-Esteem Scale (RSES). We compared 11 a priori models of the CAPE-P with the aim of identifying the one with the best fit indices applying Confirmatory Factor Analysis (CFA). Gender measurement invariance was examined with nested multiple-group confirmatory factor analysis (MGCFA). RESULTS All the 11 a priori models had poor fit indices. An examination of the scale's 20 items revealed that 10 items had poor correlation with the overall scale. The remaining 10 items which we labelled as the Brief CAPE-P10 were subjected to CFA which yielded a 3-factor model (Bizarre Experiences-5 items, Delusional Ideation-3 items and Perceptual Anomalies-2 items) with satisfactory fit indices (CFI = 0.961, SRMR = 0.0376, RMSEA = 0.062/90% CI = 0.052-0.069). The validity and reliability of the Brief CAPE-P10 and its subscales were modestly satisfactory. MGCFA affirmed the configural, metric and scalar gender invariance of the 3-factor Brief CAPE-P10. CONCLUSIONS The Brief CAPE-P10 is a promising instrument for the evaluation of PLEs among Nigerian adolescents.
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Affiliation(s)
- Olutayo Aloba
- Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Tolulope Opakunle
- Department of Mental Health, State Specialist Hospital, Osogbo, Nigeria
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44
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Knight C, Russo D, Stochl J, Jones PB, Perez J. More sensitive identification of psychotic experiences in common mental disorder by primary mental healthcare services - effect on prevalence and recovery: casting the net wider. BJPsych Open 2020; 6:e136. [PMID: 33153513 PMCID: PMC7745243 DOI: 10.1192/bjo.2020.120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Psychotic experiences may emerge in more severe cases of common mental disorders (CMD). Previous work identified that 30% of patients treated by mental health services in primary healthcare, specifically the Improving Access to Psychological Therapies (IAPT) programme in England, reported psychotic experiences, began treatment with more severe CMD and were less likely to reach recovery. AIMS To replicate our previous assessment of psychotic experiences in the IAPT programme using a more sensitive threshold and determine its impact on the prevalence of psychotic experience and likelihood of recovery. Additionally, to compare recovery rates between patients with and without psychotic experiences at the end of therapy. METHOD The Community Assessment of Psychic Experiences (CAPE-P15) with a cut-off of 1.30 was used to determine the prevalence of psychotic experiences. Recovery rates were determined using measures collected in the IAPT programme for depression (PHQ-9) and anxiety (GAD-7). Multi-group growth models estimated improvement trajectories. RESULTS In total, 2042 patients with CMD completed the CAPE-P15. The mean age was 39.8. The prevalence of psychotic experiences was 18% higher when using a lower threshold. The recovery rate for patients with psychotic experiences was lower (36%) than for those without (64%). Despite sharing similar improvement trajectories, the higher initial severity of CMD among patients with psychotic experiences impeded likelihood of recovery. CONCLUSIONS As psychotic experiences may be a marker of severity in CMD, the benefits of identifying these in IAPT populations may also apply to patients with milder experiences. Further investigation of the consequential demands on service provision and how this would affect clinical practice is recommended.
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Affiliation(s)
- Clare Knight
- Department of Psychiatry, University of Cambridge, UK
| | - Debra Russo
- Department of Psychiatry, University of Cambridge, UK
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge; and NIHR Applied Research Collaboration (ARC) East of England, Cambridge, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge; and NIHR Applied Research Collaboration (ARC) East of England, Cambridge, UK
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge; NIHR Applied Research Collaboration (ARC) East of England, Cambridge; and Norwich Medical School, University of East Anglia, Norwich, UK
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45
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Rozalski V, Benning SD. Divergences among Three Higher-Order Self-Report Psychopathology Factors in Normal-Range Personality and Emotional Late Positive Potential Reactivity. JOURNAL OF RESEARCH IN PERSONALITY 2020; 82. [PMID: 32863467 DOI: 10.1016/j.jrp.2019.103861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Personality is related to psychopathology and its higher-order structures, but there is little research regarding neurobiological associations of higher-order psychopathology factors. This study examined the factor structure of a wide range of psychopathology and its associations with both personality and emotional reactivity revealed through the late positive potential (LPP) in a sample of 275 undergraduates. A three-factor structure of psychopathology emerged comprising Internalizing (INT), Externalizing (EXT), and Aberrant Experiences (ABX). EXT predicted aggressive disconstraint, whereas both INT and ABX predicted Alienation and Stress Reaction. INT uniquely predicted low Well-Being, and ABX predicted a rigid absorption combined with interpersonal detachment. ABX correlated with reduced parietal emotional LPP reactivity, whereas INT correlated with stronger frontal LPP reactivity to emotional versus neutral pictures.
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46
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Fritz J, Stochl J, Goodyer IM, van Harmelen AL, Wilkinson PO. Embracing the positive: an examination of how well resilience factors at age 14 can predict distress at age 17. Transl Psychiatry 2020; 10:272. [PMID: 32759937 PMCID: PMC7406495 DOI: 10.1038/s41398-020-00944-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 07/14/2020] [Indexed: 12/24/2022] Open
Abstract
One-in-two people suffering from mental health problems develop such distress before or during adolescence. Research has shown that distress can predict itself well over time. Yet, little is known about how well resilience factors (RFs), i.e. those factors that decrease mental health problems, predict subsequent distress. Therefore, we investigated which RFs are the best indicators for subsequent distress and with what accuracy RFs predict subsequent distress. We examined three interpersonal (e.g. friendships) and seven intrapersonal RFs (e.g. self-esteem) and distress in 1130 adolescents, at age 14 and 17. We estimated the RFs and a continuous distress-index using factor analyses, and ordinal distress-classes using factor mixture models. We then examined how well age-14 RFs and age-14 distress predict age-17 distress, using stepwise linear regressions, relative importance analyses, as well as ordinal and linear prediction models. Low brooding, low negative and high positive self-esteem RFs were the most important indicators for age-17 distress. RFs and age-14 distress predicted age-17 distress similarly. The accuracy was acceptable for ordinal (low/moderate/high age-17 distress-classes: 62-64%), but low for linear models (37-41%). Crucially, the accuracy remained similar when only self-esteem and brooding RFs were used instead of all ten RFs (ordinal = 62%; linear = 37%); correctly predicting for about two-in-three adolescents whether they have low, moderate or high distress 3 years later. RFs, and particularly brooding and self-esteem, seem to predict subsequent distress similarly well as distress can predict itself. As assessing brooding and self-esteem can be strength-focussed and is time-efficient, those RFs may be promising for risk-detection and translational intervention research.
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Affiliation(s)
- J. Fritz
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - J. Stochl
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Cambridge, UK ,grid.4491.80000 0004 1937 116XDepartment of Kinanthropology, Charles University, Charles, Czech Republic
| | - I. M. Goodyer
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - A.-L. van Harmelen
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - P. O. Wilkinson
- grid.5335.00000000121885934Department of Psychiatry, University of Cambridge, Cambridge, UK
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Harden KP, Engelhardt LE, Mann FD, Patterson MW, Grotzinger AD, Savicki SL, Thibodeaux ML, Freis SM, Tackett JL, Church JA, Tucker-Drob EM. Genetic Associations Between Executive Functions and a General Factor of Psychopathology. J Am Acad Child Adolesc Psychiatry 2020; 59:749-758. [PMID: 31102652 PMCID: PMC6986791 DOI: 10.1016/j.jaac.2019.05.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 05/03/2019] [Accepted: 05/10/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Symptoms of psychopathology covary across diagnostic boundaries, and a family history of elevated symptoms for a single psychiatric disorder places an individual at heightened risk for a broad range of other psychiatric disorders. Both twin-based and genome-wide molecular methods indicate a strong genetic basis for the familial aggregation of psychiatric disease. This has led researchers to prioritize the search for highly heritable childhood risk factors for transdiagnostic psychopathology. Cognitive abilities that involve the selective control and regulation of attention, known as executive functions (EFs), are a promising set of risk factors. METHOD In a population-based sample of child and adolescent twins (n = 1,913, mean age = 13.1 years), we examined genetic overlap between both EFs and general intelligence (g) and a transdiagnostic dimension of vulnerability to psychopathology, comprising symptoms of anxiety, depression, neuroticism, aggression, conduct disorder, oppositional defiant disorder, hyperactivity, and inattention. Psychopathology symptoms in children were rated by children and their parents. RESULTS Latent factors representing general EF and g were highly heritable (h2 = 86%-92%), and genetic influences on both sets of cognitive abilities were robustly correlated with transdiagnostic genetic influences on psychopathology symptoms (genetic r values ranged from -0.20 to -0.38). CONCLUSION General EF and g robustly index genetic risk for transdiagnostic symptoms of psychopathology in childhood. Delineating the developmental and neurobiological mechanisms underlying observed associations between cognitive abilities and psychopathology remains a priority for ongoing research.
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48
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Phenomenological characteristics and explanations of unusual perceptual experiences, thoughts and beliefs in a population sample of early adolescents. Ir J Psychol Med 2020; 39:173-184. [PMID: 32458773 DOI: 10.1017/ipm.2020.26] [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] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Often referred to as psychotic experiences, unusual perceptual experiences, thoughts and beliefs (UPTBs) are not uncommon in youth populations. Phenomenological studies of these experiences are lacking. This study aimed to (1) describe the phenomenological characteristics of UPTBs in a sample of young adolescents and (2) explore how young people made sense of those experiences. METHODS Participants were 53 young people aged 11-13 years from a population-based study of mental health. All met criteria for UPTBs following clinical interviews as part of the study. Documentary data on UPTBs in the form of transcribed notes, recorded during clinical interviews, were analysed using content analysis. Data on UPTBs were coded, organised into categorical themes and quantified using descriptive statistics. Qualitative themes on how participants made sense of their experiences were identified. RESULTS Participants reported UPTBs across four domains: auditory verbal, auditory non-verbal, non-auditory perceptual experiences and unusual thoughts and beliefs. UPTBs were phenomenologically rich and diverse. Young people sought to make sense of their experiences in multiple ways: normalising them, externalising them by attributing them to paranormal entities and distancing them from psychiatric explanations. Uncertainty about the source of UPTBs was identified as a superordinate theme. CONCLUSION Findings from this study offer new insights into the phenomenological qualities and characteristics of UPTBs in young adolescents. They also reveal that early adolescents may not make sense of their experiences within a psychiatric framework. These findings highlight the need to develop a more phenomenologically sensitive and nuanced approach to studying UPTBs in young people.
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Polek E, Neufeld SAS, Wilkinson P, Goodyer I, St Clair M, Prabhu G, Dolan R, Bullmore ET, Fonagy P, Stochl J, Jones PB. How do the prevalence and relative risk of non-suicidal self-injury and suicidal thoughts vary across the population distribution of common mental distress (the p factor)? Observational analyses replicated in two independent UK cohorts of young people. BMJ Open 2020; 10:e032494. [PMID: 32398331 PMCID: PMC7223145 DOI: 10.1136/bmjopen-2019-032494] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To inform suicide prevention policies and responses to youths at risk by investigating whether suicide risk is predicted by a summary measure of common mental distress (CMD (the p factor)) as well as by conventional psychopathological domains; to define the distribution of suicide risks over the population range of CMD; to test whether such distress mediates the medium-term persistence of suicide risks. DESIGN Two independent population-based cohorts. SETTING Population based in two UK centres. PARTICIPANTS Volunteers aged 14-24 years recruited from primary healthcare registers, schools and colleges, with advertisements to complete quotas in age-sex-strata. Cohort 1 is the Neuroscience in Psychiatry Network (n=2403); cohort 2 is the ROOTS sample (n=1074). PRIMARY OUTCOME MEASURES Suicidal thoughts (ST) and non-suicidal self-injury (NSSI). RESULTS We calculated a CMD score using confirmatory bifactor analysis and then used logistic regressions to determine adjusted associations between risks and CMD; curve fitting was used to examine the relative prevalence of STs and NSSI over the population distribution of CMD. We found a dose-response relationship between levels of CMD and risk of suicide. The majority of all subjects experiencing ST and NSSI (78% and 76% in cohort 1, and 66% and 71% in cohort 2) had CMD scores no more than 2 SDs above the population mean; higher scores indicated the highest risk but were, by definition, infrequent. Pathway mediation models showed that CMD mediated the longitudinal course of both ST and NSSI. CONCLUSIONS NSSI and ST in youths reflect CMD that also mediates their persistence. Universal prevention strategies reducing levels of CMD in the whole population without recourse to screening or measurement may prevent more suicides than approaches targeting youths with the most severe distress or with psychiatric disorders.
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Affiliation(s)
- Ela Polek
- Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
- Psychology, University College Dublin, Dublin, Ireland
| | | | - Paul Wilkinson
- Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Ian Goodyer
- Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
| | | | - Gita Prabhu
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, University College, London, UK
| | - Ray Dolan
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
- Max Planck University College London Centre for Computational Psychiatry and Ageing Research, University College, London, UK
| | | | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Jan Stochl
- Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
- NIHR Applied Research Collaboration East of England, Cambridge, Cambridgeshire, UK
| | - Peter B Jones
- Psychiatry, University of Cambridge, Cambridge, Cambridgeshire, UK
- NIHR Applied Research Collaboration East of England, Cambridge, Cambridgeshire, UK
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Abstract
An important advance in understanding and defining mental disorders has been the development of empirical approaches to mapping dimensions of dysfunction and their interrelatedness. Such empirical approaches have consistently observed intercorrelations among the many forms of psychopathology, leading to the identification of a general factor of psychopathology (the p factor). In this article, we review empirical support for p, including evidence for the stability and criterion validity of p. Further, we discuss the strong relationship between p and both the general factor of personality and the general factor of personality disorder, substantive interpretations of p, and the potential clinical utility of p. We posit that proposed substantive interpretations of p do not explain the full range of symptomatology typically included in p. The most plausible explanation is that p represents an index of impairment that has the potential to inform the duration and intensity of a client's mental health treatment.
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Affiliation(s)
- Gregory T Smith
- Department of Psychology, University of Kentucky, Lexington, Kentucky 40506, USA; , , , ,
| | - Emily A Atkinson
- Department of Psychology, University of Kentucky, Lexington, Kentucky 40506, USA; , , , ,
| | - Heather A Davis
- Department of Psychology, University of Kentucky, Lexington, Kentucky 40506, USA; , , , ,
| | - Elizabeth N Riley
- Department of Psychology, University of Kentucky, Lexington, Kentucky 40506, USA; , , , ,
| | - Joshua R Oltmanns
- Department of Psychology, University of Kentucky, Lexington, Kentucky 40506, USA; , , , ,
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