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Aoki S, Nozawa E. Pilot Study on Classification of Sensory Symptoms in PTSD. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2024; 17:283-293. [PMID: 38938954 PMCID: PMC11199429 DOI: 10.1007/s40653-023-00602-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 06/29/2024]
Abstract
PTSD treatment that focused on a sensory symptoms is increasing. The study aimed to explore symptoms and abnormalities in the five senses exhibited by persons with PTSD and to examine whether there are any differences depending on type of traumatic experience. Questionnaire was followed by interviews to clinical psychologists involved in the treatment of PTSD. 249 PTSD symptoms exhibited in the sensory organs were collected. Sensory symptoms were classified into three categories according to the type of symptoms and the type of traumatic events. Cluster 1 is a group formed by child abuse and violence together with audition, tactile, and hyperarousal. Cluster 2 is made up of natural disaster, accident, and sexual assault together with vision, olfaction and intrusion. Cluster 3 is made up of multiple traumas together with gustation and dissociation. It is speculated that the survivors of Child abuse and violence are hypersensitive to sounds, the presence of others, and physical contact because they try to quickly sense when a perpetrator is approaching. Natural disasters, accidents, and sexual assault are events with strong smell and severe visual impact, it is possible that they may easily cause reliving of the event in the form of shocking visual images and smells in flashbacks. Dissociation symptoms were related with complex trauma and taste. The mouth is the site of first contact between mother and child, and it is possible that gustatory dissociation may occur mainly in cases of severe and repeated trauma since early childhood.
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Affiliation(s)
- Sanae Aoki
- Faculty of Psychology, Department of Clinical Psychology, Rissho University, 4-2-16 Osaki, Shinagawa, Tokyo, 141-8602 Japan
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2
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Buck B, Tauscher JS, Whiting E, Wang W, Campbell AT, Ben-Zeev D. Identifying mechanisms of persecutory ideation maintenance with smartphone technology: Examining threat importance, certainty, rumination, and behavior change. Psychiatry Res 2024; 333:115751. [PMID: 38309010 PMCID: PMC10923100 DOI: 10.1016/j.psychres.2024.115751] [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: 10/11/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 02/05/2024]
Abstract
Previous cross-sectional and laboratory research has identified risk factors for persecutory ideation including rumination, negative affect, and safety-seeking behaviors. Questions remain about what in-the-moment factors link general negative affect to PI as well as which maintain PI over time. In the present study, N = 219 individuals completed momentary assessments of PI as well as four factors (attributing threats as certain and important, ruminating, and changing one's behavior in response) proposed to maintain PI over time. Linear mixed effects models were used to analyze multiple time-varying relationships, including these factors predicting negative affect and vice versa, as well as factors predicting maintenance of PI over time. Linear mixed effects models were used to analyze multiple time-varying relationships, examining each PI-related factor predicting negative affect, negative affect predicting each PI-related factor, as well as each factor predicting maintenance of PI over time. All four factors were associated with increases in subsequent day self-reported severity of PI, suggesting all four increased the likelihood of maintaining or worsening next-day PI. Results of this study confirm that the proposed factors are key in maintaining a cycle by which PI and negative affect are maintained over time. These factors may represent targets for momentary interventions.
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Affiliation(s)
- Benjamin Buck
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.
| | - Justin S Tauscher
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Erica Whiting
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Weichen Wang
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Andrew T Campbell
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Dror Ben-Zeev
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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3
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Piesse E, Paulik G, Mathersul D, Valentine L, Kamitsis I, Bendall S. An exploration of the relationship between voices, dissociation, and post-traumatic stress disorder symptoms. Psychol Psychother 2023; 96:1015-1028. [PMID: 37800445 DOI: 10.1111/papt.12493] [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: 11/30/2022] [Revised: 08/09/2023] [Accepted: 08/23/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVES Extensive research has shown voice hearing to be associated with symptoms of Post-Traumatic Stress Disorder (PTSD) and dissociation. However, most studies have adopted a quantitative design, using cross-sectional data sampling methods, precluding temporal relationships between variables from being defined. DESIGN Using a qualitative design, this study sought to identify potential symptom relationships by addressing the research question: what is the nature of the temporal relationship between voices, dissociation and PTSD symptoms? METHODS Seven voice hearers (aged 27 to 68 years) participated in a semi-structured interview exploring voice hearing, PTSD symptoms, and dissociation. The interviews were analysed using Interpretative Phenomenological Analysis. RESULTS One superordinate theme was identified in the data. Voices were observed to occur in dynamic interrelationship with PTSD symptoms and dissociation, and were frequently experienced before and after PTSD symptoms and dissociative episodes. CONCLUSIONS Implications for theoretical understandings of voice hearing and future research are discussed.
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Affiliation(s)
- Emily Piesse
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
| | - Georgie Paulik
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
- Perth Voices Clinic, Murdoch University, Murdoch, Western Australia, Australia
- School of Psychological Science, University of Western Australia, Nedlands, Western Australia, Australia
| | - Danielle Mathersul
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, Western Australia, Australia
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Lee Valentine
- Orygen and Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Ilias Kamitsis
- Orygen and Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Sarah Bendall
- Orygen and Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
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Schaug JP, Storebø OJ, Pedersen MB, Haahr UH, Simonsen E. How first-episode psychosis patients' subjective beliefs about their childhood trauma's causal effect provide support for potential schizophrenia subtypes. Schizophr Res 2023; 262:175-183. [PMID: 37992561 DOI: 10.1016/j.schres.2023.11.005] [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: 06/03/2022] [Revised: 10/04/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Childhood and adolescent trauma is a risk factor for developing psychosis-spectrum disorders. The current study aimed to assess how childhood trauma might predict psychosis symptomatology, and how patients' beliefs of whether trauma is the cause of psychosis might affect this association. METHODS Ninety-six first-episode psychosis patients were assessed for childhood traumatic experiences with the Brief Betrayal Trauma Survey, and for psychosis symptoms with the Positive and Negative Syndrome Scale. RESULTS Non-interpersonal trauma predicted higher positive symptoms, whereas more trauma domains experienced predicted lower negative symptoms. Almost half of the participants believed trauma to be related to psychosis, were 12 times more likely to reexperience trauma through psychosis, and had higher excitative and emotional symptoms. Non-interpersonal trauma also predicted higher positive symptoms in this group. Those who did not believe trauma to be the cause of psychosis had higher negative symptoms, and a negative dose-response was found for negative and disorganised symptoms, in which more trauma domains experienced predicted lower scores. CONCLUSIONS Results imply two traumagenic pathways to psychosis, one characterised by positive, excitative, and emotional symptoms, and one negative subtype, characterised by negative and disorganised symptoms. Clinical implications for how findings might contribute to better treatments are discussed.
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Affiliation(s)
- Julie Perrine Schaug
- Centre for Evidence-Based Psychiatry, Psychiatric Research Unit, Psychiatric Services Region Zealand, 4200 Slagelse, Denmark
| | - Ole Jakob Storebø
- Centre for Evidence-Based Psychiatry, Psychiatric Research Unit, Psychiatric Services Region Zealand, 4200 Slagelse, Denmark; Department of Psychology, University of Southern Denmark, Faculty of Health Sciences, 5230 Odense M, Denmark; Department of Child and Adolescent Psychiatry, Psychiatry Region Zealand, 4000 Roskilde, Denmark.
| | - Marlene Buch Pedersen
- Early Psychosis Intervention Centre, Psychiatric Services Region Zealand East, 4000 Roskilde, Denmark
| | - Ulrik Helt Haahr
- Psychiatric Research Unit, Psychiatric Services Region Zealand, 4200 Slagelse, Denmark
| | - Erik Simonsen
- Early Psychosis Intervention Centre, Psychiatric Services Region Zealand East, 4000 Roskilde, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
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van den Berg D, Tolmeijer E, Jongeneel A, Staring ABP, Palstra E, van der Gaag M, Hardy A. Voice phenomenology as a mirror of the past. Psychol Med 2023; 53:2954-2962. [PMID: 34991770 PMCID: PMC10235665 DOI: 10.1017/s0033291721004955] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Post-traumatic mechanisms are theorised to contribute to voice-hearing in people with psychosis and a history of trauma. Phenomenological links between trauma and voices support this hypothesis, as they suggest post-traumatic processes contribute to the content of, and relationships with, voices. However, research has included small samples and lacked theory-based comprehensive assessments. METHOD In people with distressing voices (n = 73) who experienced trauma prior to voice-hearing, trauma-voice links were assessed both independently and dependently (descriptions were presented and rated separately and together, respectively) by both participants and researchers. A structured coding frame assessed four types of independent links (i.e. victimisation type, physiological-behavioural, emotional, and cognitive response themes including negative self-beliefs) and three types of dependent links: relational (similar interaction with/response to, voice and trauma); content (voice and trauma content are exactly the same); and identity (voice identity is the same as perpetrator). RESULTS Independent links were prevalent in participants (51-58%) and low to moderately present in researcher ratings (8-41%) for significant themes. Identification of negative self-beliefs in trauma was associated with a significantly higher likelihood of negative self-beliefs in voices [participants odds ratio (OR) 9.8; researchers OR 4.9]. Participants and researchers also reported many dependent links (80%, 66%, respectively), most frequently relational links (75%, 64%), followed by content (60%, 25%) and identity links (51%, 22%). CONCLUSION Trauma appears to be a strong shaping force for voice content and its psychological impact. The most common trauma-voice links involved the experience of cognitive-affective psychological threat, embodied in relational experiences. Trauma-induced mechanisms may be important intervention targets.
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Affiliation(s)
- David van den Berg
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Psychosis Research, Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN The Hague, The Netherlands
| | - Eva Tolmeijer
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Psychosis Research, Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN The Hague, The Netherlands
| | - Alyssa Jongeneel
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Psychosis Research, Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN The Hague, The Netherlands
| | - Anton B. P. Staring
- ABC Department for First Episode Psychosis, Altrecht Psychiatric Institute, ABC straat 8, 3512 PX Utrecht, The Netherlands
| | - Eline Palstra
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Psychosis Research, Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN The Hague, The Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Psychosis Research, Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN The Hague, The Netherlands
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, UK
- South London & Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX, UK
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6
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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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7
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Malin DH, Tsai PH, Campbell JR, Moreno GL, Chapman HL, Suzaki A, Keivan MS, Gibbons KM, Morales ER, Burstein ES, Ward CP. Pimavanserin reverses multiple measures of anxiety in a rodent model of post-traumatic stress disorder. Eur J Pharmacol 2023; 939:175437. [PMID: 36502961 DOI: 10.1016/j.ejphar.2022.175437] [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: 08/08/2022] [Revised: 11/08/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022]
Abstract
Pimavanserin is a highly selective 5-HT2A inverse agonist in current medical use. Prior studies suggest that 5-HT2A serotonin receptors may play a role in anxiety and emotional memory. Therefore, pimavanserin was tested in a rat model of PTSD to determine whether it might ameliorate PTSD-like symptoms. The lifetime prevalence of PTSD is estimated to be 125% higher in women than men. Consequently, in an effort to create a robust model of PTSD that was more representative of human PTSD prevalence, 20-week old female rats of the emotionally hyperreactive Lewis strain were used for these studies. The rats were single-housed and exposed twice to restraint stress coupled with predator odor or to a sham-stressed condition. Twenty days after the second stress or sham-stress exposure, rats were injected with saline alone or with 0.3 or 1.0 mg/kg pimavanserin, doses that were confirmed to substantially block 5-HT2A receptor activity in this study without causing any non-specific behavioral or adverse effects. One hour later, rats were tested for anxiety through acoustic startle response, the elevated plus-maze and three parameters of open field behavior. Five days later, blood was sampled for plasma corticosterone. The stressed/saline-injected rats had higher anxiety scores and corticosterone levels than sham-stressed/saline-injected rats. Pimavanserin significantly and generally dose-dependently reversed these persistent stress effects, but had no significant effect on the behavioral measures in normal, non-stressed rats. These results, consistent with a role for the 5-HT2A receptor, suggest that pimavanserin might have potential to reduce some consequences of traumatic stress.
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Affiliation(s)
| | | | | | | | | | - Aoi Suzaki
- University of Houston-Clear Lake, United States
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8
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Dryden‐Mead T, Nelson B, Bendall S. "They may be confronting but they are good questions to be asking" young people's experiences of completing a trauma and PTSD screening tool in an early psychosis program. Psychol Psychother 2022; 95:1090-1107. [PMID: 35942544 PMCID: PMC9804455 DOI: 10.1111/papt.12420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 07/26/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND There is a history of inadequate enquiry about, and assessment of, trauma in young people within Early Psychosis services and even when screening does occur there is little known about how young people experience this process. AIMS This study aimed to explore young people's experiences of completing a trauma and PTSD screening tool when receiving a service in an Early Psychosis Program. METHOD Semi-structured interviews were conducted with 10 young people, aged 18-24 years, to explore their subjective experience of this process. Transcripts were analysed via interpretative phenomenological analysis. RESULTS Four super-ordinate themes were identified: (i) an emotional experience, (ii) the importance of the relationship with the clinician, (iii) an opportunity to reflect on past experiences, and (iv) the ability to be able to provide honest responses. Results from this study indicated that young people expected to be asked about their trauma experiences, acknowledged that this was challenging for them but found that this was made easier due to the relationship they had built with the clinician, the timing of the screening and also, possibly, by the written style format of the questionnaires. CONCLUSIONS Young people in this study accepted the need for screening for traumatic histories, and expected to be asked about their traumatic experiences, despite the possibility of a short-term increase in distress. The support offered by a trusted clinician, whom the young person had built a relationship with, appeared to be an important component to the willingness and the ability of the young person to complete the questionnaires. This reinforces the fact that screening for trauma in an early psychosis service can be conducted in a way that is safe and acceptable to young people.
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Affiliation(s)
- Tracey Dryden‐Mead
- Centre for Youth Mental HealthThe University of MelbourneMelbourneVic.Australia
| | - Barnaby Nelson
- Orygen, the National Centre of Excellence in Youth Mental Health and Centre for Youth Mental HealthThe University of MelbourneMelbourneVic.Australia
| | - Sarah Bendall
- Orygen, the National Centre of Excellence in Youth Mental Health and Centre for Youth Mental HealthThe University of MelbourneMelbourneVic.Australia
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9
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Burger SR, van der Linden T, Hardy A, de Bont P, van der Vleugel B, Staring ABP, de Roos C, van Zelst C, Gottlieb JD, Mueser KT, van Minnen A, de Jongh A, Marcelis M, van der Gaag M, van den Berg D. Trauma-focused therapies for post-traumatic stress in psychosis: study protocol for the RE.PROCESS randomized controlled trial. Trials 2022; 23:851. [PMID: 36199107 PMCID: PMC9532824 DOI: 10.1186/s13063-022-06808-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/30/2022] [Indexed: 08/29/2023] Open
Abstract
INTRODUCTION Many people with psychotic disorders experience symptoms of post-traumatic stress disorder (PTSD). In recent years, several trauma-focused therapies (TFTs), including cognitive restructuring (CR), prolonged exposure (PE), and eye movement desensitization and reprocessing (EMDR) have been studied and found to be safe and effective in reducing PTSD symptoms in individuals with psychosis. However, studies were conducted in different countries, with varying inclusion criteria, therapy duration, control groups, and trial outcomes. RE.PROCESS will be the first study to compare the impact of CR, PE, and EMDR with a waiting list control condition within the same context. METHODS AND ANALYSIS This is the protocol of a pragmatic, single-blind, multicentre, superiority randomized controlled trial, in which CR, PE, and EMDR are compared to a waiting list control condition for TFT (WL) in a naturalistic treatment setting. Inclusion criteria are as follows: age ≥ 16 years; meeting full DSM-5 diagnostic criteria for PTSD on the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), with a total CAPS score ≥ 23; and a psychotic disorder in the schizophrenia spectrum confirmed by the Structured Clinical Interview for DSM-5 (SCID-5). Participants (N=200) will be randomly allocated to 16 sessions of one of the TFTs or WL, in addition to receiving treatment as usual (TAU) for psychosis. The primary objective is to compare the effects of CR, PE, and EMDR to WL on researcher-rated severity of PTSD symptoms over time from baseline to 6-month follow-up. Secondary objectives are to examine these effects at the separate time-points (i.e., mid-treatment, post-treatment, and at 6-month follow-up) and to test the effects for clinician-rated presence of PTSD diagnosis, and self-rated severity of (complex) PTSD symptoms. DISCUSSION This is the first RCT to directly compare the effects of CR, PE, and EMDR within the same context to TAU on PTSD symptoms in individuals with psychosis and PTSD. Secondary effects on clinical and functional outcomes will be investigated both directly after therapy and long term. TRIAL REGISTRATION ISRCTN ISRCTN56150327 . Registered 18 June 2019.
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Affiliation(s)
- Simone R Burger
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Room MF-B543, Van der Boechorstraat 7, Amsterdam, 1081 BT, the Netherlands. .,Department of Psychosis Research and Innovation, Parnassia Psychiatric Institute, The Hague, the Netherlands.
| | - Tineke van der Linden
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Room MF-B543, Van der Boechorstraat 7, Amsterdam, 1081 BT, the Netherlands.,Department of Research and Innovation, GGzE Mental Health Institute, Eindhoven, the Netherlands
| | - Amy Hardy
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London & Maudsley NHS Foundation Trust, London, UK
| | - Paul de Bont
- GGZ Oost-Brabant Mental Health Institute, Boekel, the Netherlands
| | | | | | - Carlijn de Roos
- Academic Centre for Child and Adolescent Psychiatry Level, Amsterdam University Medical Centre (location AMC), Amsterdam, The Netherlands
| | - Catherine van Zelst
- Department of Psychosis Research and Innovation, Parnassia Psychiatric Institute, The Hague, the Netherlands
| | - Jennifer D Gottlieb
- Cambridge Health Alliance & Harvard Medical School Department of Psychiatry, Cambridge, MA, USA
| | | | - Agnes van Minnen
- Behavourial Science Institute, Radboud Universiteit Nijmegen, Nijmegen, the Netherlands.,PSYTREC Mental Health Institute, Bilthoven, the Netherlands
| | - Ad de Jongh
- PSYTREC Mental Health Institute, Bilthoven, the Netherlands.,Department of Behavioral Science, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands.,Institute of Health and Society, University of Worcester, Worcester, UK.,School of Psychology, Queen's University, Belfast, Northern Ireland
| | - Machteld Marcelis
- Department of Research and Innovation, GGzE Mental Health Institute, Eindhoven, the Netherlands.,Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Room MF-B543, Van der Boechorstraat 7, Amsterdam, 1081 BT, the Netherlands.,Department of Psychosis Research and Innovation, Parnassia Psychiatric Institute, The Hague, the Netherlands
| | - David van den Berg
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Room MF-B543, Van der Boechorstraat 7, Amsterdam, 1081 BT, the Netherlands.,Department of Psychosis Research and Innovation, Parnassia Psychiatric Institute, The Hague, the Netherlands
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10
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Quenneville AF, Kalogeropoulou E, Nicastro R, Weibel S, Chanut F, Perroud N. Anxiety disorders in adult ADHD: A frequent comorbidity and a risk factor for externalizing problems. Psychiatry Res 2022; 310:114423. [PMID: 35152068 DOI: 10.1016/j.psychres.2022.114423] [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: 12/22/2020] [Revised: 01/13/2022] [Accepted: 01/27/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION ADHD is a common neurodevelopmental disorder and is highly prevalent in adults. It is associated with several negative outcomes, impacting well-being and global functioning. ADHD is highly associated with comorbidities, anxiety disorders being probably the most frequent. The goal of our study is to assess the prevalence of anxiety disorders and their impact in adults with ADHD. METHOD 353 individuals diagnosed with ADHD were recruited. Severity of ADHD was assessed as well as lifetime anxiety disorders and other psychiatric comorbidities. We performed logistic and linear regressions to test the impact of lifetime anxiety disorders on demographic and clinical variables. RESULTS More than half of the patients had at least one anxiety disorder. The presence of comorbid anxiety disorders was associated with worse clinical presentation (positive history of suicide attempts, higher disposition toward anger, higher rate of hospitalization and psychotic symptoms) and with a lower level of education. CONCLUSION Anxiety disorders are highly prevalent in ADHD and are associated with higher levels of suicidality and disposition towards anger, more severe clinical presentation and lower functioning. Comorbid anxiety needs to be evaluated and treated by clinicians to limit distress, aggression towards self and others and to improve quality of life.
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Affiliation(s)
- Andréanne Filion Quenneville
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland; Department of Psychiatry and Addictology, Clinique des troubles relationnels et dépendances, Hôpital en Santé Mentale Albert-Prévost, University of Montreal, CIUSSS Nord-de-l'Ile-de-Montréal, 6555 Boulevard Gouin West, Montreal, QC H4K 1B3, Canada.
| | - Eleni Kalogeropoulou
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Rosetta Nicastro
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Sébastien Weibel
- Department of Psychiatry, Strasbourg University Hospital, Strasbourg, France; Inserm U1114, Strasbourg, France
| | - Florence Chanut
- Department of Psychiatry and Addictology, Clinique des troubles relationnels et dépendances, Hôpital en Santé Mentale Albert-Prévost, University of Montreal, CIUSSS Nord-de-l'Ile-de-Montréal, 6555 Boulevard Gouin West, Montreal, QC H4K 1B3, Canada
| | - Nader Perroud
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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11
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Langer ÁI, Wardenaar K, Wigman JTW, Ulloa JL, Núñez D. A Latent Profile Analysis of Psychotic Experiences, Non-psychotic Symptoms, Suicidal Ideation and Underlying Mechanisms in a Sample of Adolescents From the General Population. Front Psychiatry 2022; 13:926556. [PMID: 35832591 PMCID: PMC9271879 DOI: 10.3389/fpsyt.2022.926556] [Citation(s) in RCA: 2] [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] [Received: 04/22/2022] [Accepted: 05/30/2022] [Indexed: 11/23/2022] Open
Abstract
Psychotic experiences (PEs) are prevalent in the general population, particularly in adolescents. PEs are associated with various negative outcomes such as psychotic, depressive, anxiety and post-traumatic stress disorders and suicidal behavior. Recent studies in the general population have suggested that what makes PEs relevant is not so much the experiences per se, but their association with non-psychotic comorbidity and other transdiagnostic domains. Thus, there is a need for a better understanding of how PEs exist in a larger psychopathological context in adolescents. In the present study we aimed to explore this, using latent profile analysis (LPA) to identify different patterns in which PEs, psychiatric symptoms and psychological processes co-occur. LPA was conducted using data from an adolescent general population subsample (n = 335) with PEs. We conducted LPA, using measures of PEs, psychiatric symptoms and behaviors (depression, anxiety post-traumatic stress disorder and suicidal behavior) and cognitive and affective processes of entrapment/defeat and emotional regulation as manifest variables. We found that the best fit was obtained with a four-class solution that distinguished primarily between different levels of overall severity: "low symptomatology" (19.1%), "mild-moderate symptomatology" (39.4%), "moderate symptomatology" (33.7%); "high symptomatology" (7.8%). Levels of depression, post-traumatic stress symptoms and defeat/entrapment were most differentiated between classes. The high symptomatology group showed the highest scores in all psychiatric symptoms suicidal ideation, and emotional/cognitive domains, except in cognitive reappraisal. This group also showed the highest usage of emotional suppression. Our results suggest that the assessment of mental health risk in adolescents should be aware that PEs exist in a broad context of other domains of psychopathology and transdiagnostic cognitive and affective processes.
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Affiliation(s)
- Álvaro I Langer
- Mind-Body Lab, Institute of Psychological Studies, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile.,Agencia Nacional de Investigaciòn y Desarrollo (ANID), Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile.,Associative Research Program, Center of Cognitive Sciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - Klaas Wardenaar
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, Netherlands
| | - Johanna T W Wigman
- Department of Psychiatry, Interdisciplinary Centre for Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, Netherlands
| | - José Luis Ulloa
- Agencia Nacional de Investigaciòn y Desarrollo (ANID), Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile.,Associative Research Program, Center of Cognitive Sciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - Daniel Núñez
- Agencia Nacional de Investigaciòn y Desarrollo (ANID), Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago, Chile.,Associative Research Program, Center of Cognitive Sciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
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12
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Maisey S, Correia H, Paulik G. The role of self-compassion on the relationship between trauma and hearing voices. Clin Psychol Psychother 2021; 29:698-705. [PMID: 34476866 DOI: 10.1002/cpp.2663] [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: 01/14/2021] [Revised: 06/16/2021] [Accepted: 08/18/2021] [Indexed: 11/11/2022]
Abstract
Traumatic life events are associated with increased risk of hearing voices and posttraumatic stress (PTS) symptoms have been implicated in this relationship. Studies indicate that increased self-compassion is associated with reduced PTS symptoms and voice-distress. The present study sought to examine whether self-compassion moderated the relationship between PTS symptoms and voice-distress. Self-report and clinician-administered questionnaires were used to measure self-compassion, PTS symptom severity, voice-frequency, and voice-distress in 62 trauma-affected voice-hearers who presented to a community voice-hearing clinic. Correlation analyses revealed that PTS symptom severity was positively correlated with voice-distress, but not voice-frequency, and that self-compassion was negatively correlated with voice-distress and PTS symptom severity. While self-compassion did not moderate the relationship between PTS symptom severity and voice-distress, it was associated with a significant reduction in voice-distress, at all levels of PTS symptom severity. Preliminary findings suggest self-compassion may play an important role in reducing voice-distress and thus warrant further consideration of self-compassion as a target in treatment for help-seeking voice-hearers.
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Affiliation(s)
- Sarah Maisey
- School of Psychology and of Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
| | - Helen Correia
- School of Psychology and of Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
| | - Georgie Paulik
- School of Psychology and of Exercise Science, Murdoch University, Murdoch, Western Australia, Australia.,Perth Voices Clinic, Murdoch, Western Australia, Australia.,School of Psychological Science, University of Western Australia, Crawley, Western Australia, Australia
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13
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Juckel G, Mavrogiorgou P. [Traumatization and Schizophrenic Disorders - A Multidimensional View]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 90:512-522. [PMID: 34388829 DOI: 10.1055/a-1535-1655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Prevalence of traumatizing of patients with schizophrenia is higher as in the normal community. Meta analyses show significant relationships between traumatic experiences in childhood and psychotic disorders. Patients with schizophrenia as well as those with posttraumatic stress disorder (PTSD) are characterized by brain morphological changes (mygdala und Hippocampus). In these two patient groups, neuroendocrinological disturbances (cortisol und α-amylase) as well as a worse clinical outcome could be additionally found. In the psychodynamic theoretical discussion, there are only few approaches concerning trauma and psychosis. Specifically here, the name of Frieda Fromm-Reichmann should be noted, who already pointed out the great meaning of child traumatization (especially physical and sexual abuse) for the later manifestation of schizophrenia. She also developed first principles of analytic psychosis therapy with the working on the deep life anxiety caused by the trauma in the here and now of the transference situation. It is assumed that schizophrenic disorders and PTSD have to be understood as trauma consequence diseases, which occur in comorbidty in a so far unknown extent.
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Affiliation(s)
- Georg Juckel
- Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum, Ruhr-Universität Bochum
| | - Paraskevi Mavrogiorgou
- Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum, Ruhr-Universität Bochum
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14
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Hua LL, Alderman EM, Chung RJ, Grubb LK, Lee J, Powers ME, Upadhya KK, Wallace SB. Collaborative Care in the Identification and Management of Psychosis in Adolescents and Young Adults. Pediatrics 2021; 147:peds.2021-051486. [PMID: 34031232 DOI: 10.1542/peds.2021-051486] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatricians are often the first physicians to encounter adolescents and young adults presenting with psychotic symptoms. Although pediatricians would ideally be able to refer these patients immediately into psychiatric care, the shortage of child and adolescent psychiatry services may sometimes require pediatricians to make an initial assessment or continue care after recommendations are made by a specialist. Knowing how to identify and further evaluate these symptoms in pediatric patients and how to collaborate with and refer to specialty care is critical in helping to minimize the duration of untreated psychosis and to optimize outcomes. Because not all patients presenting with psychotic-like symptoms will convert to a psychotic disorder, pediatricians should avoid prematurely assigning a diagnosis when possible. Other contributing factors, such as co-occurring substance abuse or trauma, should also be considered. This clinical report describes psychotic and psychotic-like symptoms in the pediatric age group as well as etiology, risk factors, and recommendations for pediatricians, who may be among the first health care providers to identify youth at risk.
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Affiliation(s)
- Liwei L. Hua
- Catholic Charities of Baltimore, Baltimore, Maryland
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15
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Strålin P, Hetta J. First episode psychosis: register-based study of comorbid psychiatric disorders and medications before and after. Eur Arch Psychiatry Clin Neurosci 2021; 271:303-313. [PMID: 32458108 PMCID: PMC7960599 DOI: 10.1007/s00406-020-01139-6] [Citation(s) in RCA: 3] [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] [Received: 11/27/2019] [Accepted: 05/04/2020] [Indexed: 01/02/2023]
Abstract
Comorbid psychiatric disorders are common in first episode psychosis. We investigated comorbid disorders before, at, and after a first hospital-treated psychosis in a naturalistic nation-wide cohort (n = 2091) with a first psychosis hospitalization between 2007 and 2011, and at ages between 16 and 25. Swedish population registers were used to identify the cohort and to collect data on diagnoses at hospitalizations and medications. The proportions of cases with hospitalizations or medications increased year by year before and decreased in the years after the first psychosis hospitalization. In the 2 years before, 30% had hospitalizations with other psychiatric diagnoses and 60% had psychiatric medications. At the first psychosis hospitalization, 46% had other comorbid psychiatric diagnoses or self-harm. In the 2 years before or at the first psychosis hospitalization, 17% had anxiety or stress disorders at hospitalizations, 12% depressive disorders, 5.4% manic or bipolar disorders, 8.6% personality disorders, 26% substance use disorders, and 15% neurodevelopmental disorders. 8.2% had hospitalizations for self-harm. At most, around 30% of the cases were estimated not to have had any comorbid psychiatric disorders before or at the first psychosis presentation. Early comorbid affective, anxiety or personality disorders or self-harm were associated with a worse outcome, as measured by new psychiatric hospitalizations. The outcome was worst for personality disorders with 73% re-hospitalizations within 1 year and for patients with self-harm with 70% re-hospitalizations. In conclusion, most cases with a first psychosis hospitalization had clinical presentations indicating comorbid psychiatric disorders. Cases with comorbidity had a higher risk for re-hospitalizations.
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Affiliation(s)
- Pontus Strålin
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jerker Hetta
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
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16
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Jacob L, Smith L, McDermott D, Haro JM, Stickley A, Koyanagi A. Relationship between sexual orientation and psychotic experiences in the general population in England. Psychol Med 2021; 51:138-146. [PMID: 31694728 DOI: 10.1017/s003329171900309x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Non-heterosexual individuals are at high risk for a variety of factors associated with the emergence of psychotic experiences (PEs) (e.g. common mental disorders, substance use, and stress). However, there is a scarcity of data on the association between sexual orientation and PEs. Therefore, the aim of this study was to examine the sexual orientation-PE relationship, and to identify potential mediators in this relationship. METHODS This study used nationally representative cross-sectional data from the 2007 Adult Psychiatric Morbidity Survey. Sexual orientation was dichotomized into heterosexual and non-heterosexual. Past 12-month PE was assessed with the Psychosis Screening Questionnaire. Regression and mediation analyses were conducted to analyze the association between sexual orientation and PEs, and to identify potential mediators involved in this relationship. RESULTS The final sample consisted of 7275 individuals aged ⩾16 years. The prevalence of non-heterosexual orientation and any PE was 7.1% and 5.5%, respectively. After adjusting for sex, age, and ethnicity, non-heterosexual orientation was positively associated with any PE (odds ratio 1.99, 95% confidence interval 1.34-2.93). The strongest mediators involved in this relationship were borderline personality disorder (BPD) traits (mediated percentage = 33.5%), loneliness (29.1%), and stressful life events (25.4%). CONCLUSIONS These findings suggest that there is a positive relationship between sexual orientation and PEs in the general population in England, and that underlying mechanisms may involve BPD traits, loneliness, and stressful life events. Future studies with a longitudinal design are warranted to shed more light on how these factors are implicated in the association between sexual orientation and PEs.
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Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux78180, France
- Research and development unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona08830, Spain
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Daragh McDermott
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, UK
| | - Josep Maria Haro
- Research and development unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona08830, Spain
| | - Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Ai Koyanagi
- Research and development unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona08830, Spain
- ICREA, Pg. Lluis Companys 23, Barcelona, Spain
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17
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Ho GWK, Hyland P, Karatzias T, Bressington D, Shevlin M. Traumatic life events as risk factors for psychosis and ICD-11 complex PTSD: a gender-specific examination. Eur J Psychotraumatol 2021; 12:2009271. [PMID: 34900125 PMCID: PMC8654406 DOI: 10.1080/20008198.2021.2009271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Numerous studies found robust associations between psychosis and posttraumatic stress disorder (PTSD), but few have examined the relationships between psychosis and recently formulated ICD-11 Complex PTSD (CPTSD). Further, no known study has examined the effects of different traumatic life events on CPTSD and psychotic-like symptoms in a manner that permits gender-specific effects to be identified. OBJECTIVE Using a nationally representative sample of 1,020 Irish adults, we examined gender-differences in (a) psychotic-like symptoms, CPTSD, and exposure to 21 different traumatic life events, and (b) the unique associations between different traumas with CPTSD and Psychosis. METHOD Bivariate analyses and structural equation modelling were performed. RESULTS Consistent with the literature, no gender differences were observed in psychotic-like symptoms. Females reported slightly higher levels of CPTSD and were more likely to be exposed to sexual and emotional abuse, whereas men reported greater exposure to physical violence, accidents, and disasters. Psychosis symptoms were explained by trauma exposure to a considerate degree and at a level similar to CPTSD; a moderate correlation was also found between CPTSD and Psychosis. Physical/emotional neglect was the only traumatic life event that significantly and most strongly predicted both conditions. Two gender-specific associations between different traumatic life events and CPTSD and Psychosis were identified out of the 42 possible effects modelled. CONCLUSIONS The present investigation provides initial evidence that psychotic-like symptoms and CPTSD are moderately correlated constructs in the general population. Results also highlight the importance of conducting a detailed assessment of trauma history for all clients presenting with symptoms of CPTSD, psychosis, or both.
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Affiliation(s)
- Grace W K Ho
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, Scotland.,Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, Scotland
| | - Daniel Bressington
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, Northern Ireland
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18
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Tortelli A, Perquier F, Melchior M, Lair F, Encatassamy F, Masson C, K’ourio H, Gourevitch R, Mercuel A. Mental Health and Service Use of Migrants in Contact with the Public Psychiatry System in Paris. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249397. [PMID: 33333905 PMCID: PMC7765309 DOI: 10.3390/ijerph17249397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND Migrants, and particularly asylum seekers, are at increased risk of psychiatric disorders in comparison with natives. At the same time, inequalities in access to mental health care are observed. METHODS In order to evaluate whether the Parisian public psychiatric system is optimally structured to meet the needs of this population, we examined data on mental health and service use considering three different levels: the global system treatment level, a psychiatric reception center, and mobile teams specializing in access to psychiatric care for asylum seekers. RESULTS We found higher treatment rates among migrants than among natives (p < 0.001) but inequalities in pathways to care: more mandatory admissions (OR = 1.36, 95% CI: 1.02-1.80) and fewer specialized consultations (OR = 0.56, 95% CI: 0.38-0.81). We observed a mismatch between increased need and provision of care among migrants without stable housing or seeking asylum. CONCLUSIONS Inequalities in the provision of care for migrants are observed in the Parisian public psychiatric system, particularly for those experiencing poor social and economic conditions. There is a need to facilitate access to mental health care and develop more tailored interventions to reduce discontinuity of care.
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Affiliation(s)
- Andrea Tortelli
- Pôle Psychiatrie Précarité, Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences, 75014 Paris, France; (F.L.); (C.M.); (A.M.)
- Pierre Louis Institute for Epidemiology and Public Health (IPLESP/INSERM UMR_S 1136), 75012 Paris, France;
- Institut des Migrations, 75013 Paris, France
- Correspondence:
| | - Florence Perquier
- Departement d’Epidémiologie, Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences, 75014 Paris, France;
| | - Maria Melchior
- Pierre Louis Institute for Epidemiology and Public Health (IPLESP/INSERM UMR_S 1136), 75012 Paris, France;
- Institut des Migrations, 75013 Paris, France
| | - François Lair
- Pôle Psychiatrie Précarité, Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences, 75014 Paris, France; (F.L.); (C.M.); (A.M.)
| | - Fabien Encatassamy
- CPOA: Centre Psychiatrique d’Orientation et d’Accueil, Hôpital Sainte-Anne, Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences-1, rue Cabanis, F-75014 Paris, France; (F.E.); (H.K.); (R.G.)
| | - Chloé Masson
- Pôle Psychiatrie Précarité, Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences, 75014 Paris, France; (F.L.); (C.M.); (A.M.)
| | - Hélène K’ourio
- CPOA: Centre Psychiatrique d’Orientation et d’Accueil, Hôpital Sainte-Anne, Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences-1, rue Cabanis, F-75014 Paris, France; (F.E.); (H.K.); (R.G.)
| | - Raphaël Gourevitch
- CPOA: Centre Psychiatrique d’Orientation et d’Accueil, Hôpital Sainte-Anne, Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences-1, rue Cabanis, F-75014 Paris, France; (F.E.); (H.K.); (R.G.)
| | - Alain Mercuel
- Pôle Psychiatrie Précarité, Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences, 75014 Paris, France; (F.L.); (C.M.); (A.M.)
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19
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Stickley A, Sumiyoshi T, Narita Z, Oh H, DeVylder JE, Jacob L, Koyanagi A. Physical injury and psychotic experiences in 48 low- and middle-income countries. Psychol Med 2020; 50:2751-2758. [PMID: 31637996 DOI: 10.1017/s0033291719002897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Psychotic experiences (PEs) may be associated with injuries, but studies focusing specifically on low- and middle-income countries (LAMICs) are scarce. Thus, the current study examined the link between injuries and PEs in a large number of LAMICs. METHOD Cross-sectional data were used from 242 952 individuals in 48 LAMICs that were collected during the World Health Survey in 2002-2004 to examine the association between traffic-related and other (non-traffic-related) forms of injury and PEs. Multivariable logistic regression analysis and meta-analysis were used to examine associations while controlling for a variety of covariates including depression. RESULTS In fully adjusted analyses, any injury [odds ratio (OR) 2.07, 95% confidence interval (CI) 1.85-2.31], traffic injury (OR 1.84, 95% CI 1.53-2.21) and other injury (OR 2.09, 95% CI 1.84-2.37) were associated with higher odds for PEs. Results from a country-wise analysis showed that any injury was associated with significantly increased odds for PEs in 39 countries with the overall pooled OR estimated by meta-analysis being 2.46 (95% CI 2.22-2.74) with a moderate level of between-country heterogeneity (I2 = 56.3%). Similar results were observed across all country income levels (low, lower-middle and upper-middle). CONCLUSIONS Different types of injury are associated with PEs in LAMICs. Improving mental health systems and trauma capacity in LAMICs may be important for preventing injury-related negative mental health outcomes.
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Affiliation(s)
- A Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
- The Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden
| | - T Sumiyoshi
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Z Narita
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - H Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - J E DeVylder
- Graduate School of Social Service, Fordham University, New York, NY, USA
| | - L Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux78180, France
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain
| | - A Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain
- ICREA, Pg. Lluis Companys 23, Barcelona, Spain
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20
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Bidirectional pathways between psychosocial risk factors and paranoid ideation in a general nonclinical population. Dev Psychopathol 2020; 34:421-430. [PMID: 33084551 DOI: 10.1017/s0954579420001030] [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: 11/07/2022]
Abstract
We investigated (a) whether psychosocial factors (experienced stress, anticipatory worry, social detachment, sleeping disturbances, alcohol use) predict the course of paranoid ideation between the ages of 24 to 50 years and (b) whether the predictive relationships are more likely to proceed from the psychosocial factors to paranoid ideation, or vice versa. The participants (N = 1534-1553) came from the population-based Young Finns study. Paranoid ideation and psychosocial factors were assessed by reliable self-report questionnaires in 2001, 2007, and 2011/2012. The data were analyzed using growth curve and structural equation models. High experienced stress, anticipatory worry, social detachment, frequent sleeping disturbances, and frequent alcohol use predicted more paranoid ideation. More risk factors predicted increasing paranoid ideation. There were bidirectional predictive relationships of paranoid ideation with experienced stress, anticipatory worry, social detachment, and sleeping disturbances. The link between alcohol use and paranoid ideation was only correlative. In conclusion, paranoid ideation increases by reciprocal interactions with stress, worry, social detachment, and sleeping disturbances. The findings support the threat-anticipation model of paranoid ideation, providing important implications for treatment of paranoia.
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21
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Self-Reported Cognitive Functions Predict the Trajectory of Paranoid Ideation Over a 15-Year Prospective Follow-Up. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10142-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Background
This study investigated whether self-reported cognitive functions (i.e. task orientation, distractibility, persistence, flexibility, and perseverance) predict the trajectory of paranoid ideation over a 15-year prospective follow-up in adulthood.
Methods
The participants came from the population-based Young Finns study (N = 1210‒1213). Paranoid ideation was assessed with the Paranoid Ideation Scale of the Symptom Checklist-90 Revised (SCL-90R) in 1997, 2001, 2007, and 2012. Self-reported cognitive functions were evaluated in 1997 with the Task orientation, Distractibility, Persistence, and Flexibility scales of the DOTS-R (the Revised Dimensions of Temperament Survey) and the Perseverance scale of the FCB-TI (the Formal Characteristics of Behaviour – Temperament Inventory). The data was analyzed using growth curve models that were adjusted for age, sex, and socioeconomic factors in childhood and adulthood.
Results
Low self-reported task orientation, low persistence, high distractibility, low flexibility, and high perseverance predicted higher level of paranoid ideation over the 15-year follow-up.
Conclusions
Self-reported cognitive functions seem to predict paranoid ideation over a long-term follow-up. Promoting cognitive functions in early interventions may have long-term protective influences against the development of paranoid ideation in non-clinical populations.
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22
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Rathke H, Poulsen S, Carlsson J, Palic S. PTSD with secondary psychotic features among trauma-affected refugees: The role of torture and depression. Psychiatry Res 2020; 287:112898. [PMID: 32179211 DOI: 10.1016/j.psychres.2020.112898] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/21/2020] [Accepted: 02/23/2020] [Indexed: 01/17/2023]
Abstract
This cross-sectional study examined the prevalence of PTSD with secondary psychotic symptoms (PTSD-SP), its comorbidities, and its association with torture and depression in treatment-seeking refugees. Data were pooled from the Danish Database on Refugees with Trauma (DART). The sample represents approximately 90% of trauma-affected refugee-patients (N = 627) attending a Danish psychiatric outpatient clinic from 2008 to 2013. PTSD, secondary psychotic symptoms, and comorbidities were assessed with structured and routine clinical interviews. The association of PTSD-SP with torture and depression was investigated using hierarchical logistic regression. The prevalence of PTSD-SP in treatment-seeking refugees with PTSD was 30%. Among these, 44% fulfilled the criteria for Enduring Personality Change After Catastrophic Experience (EPCACE). Psychotic symptoms comprised hallucinations and persecutory delusions, often reflecting trauma-related themes. Comorbidity with depression was high (79%). Neither torture, nor other war-trauma (ex-combatant, imprisonment, civilian war trauma) predicted PTSD-SP, but comorbid depression did. Depression only explained a small amount of the total PTSD-SP variance. Results indicate that PTSD-SP is common in treatment-seeking refugees. However, its etiology is poorly understood. This highlights the need for further research to improve diagnosis and treatment for this patient group.
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Affiliation(s)
- Hannah Rathke
- Competence Center for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Maglevænget 21, Ballerup 2750, Denmark.
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, Copenhagen K 1353, Denmark
| | - Jessica Carlsson
- Competence Center for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Maglevænget 21, Ballerup 2750, Denmark
| | - Sabina Palic
- Competence Center for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Maglevænget 21, Ballerup 2750, Denmark
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Brand RM, Bendall S, Hardy A, Rossell SL, Meyer D, Thomas N. Moment-to-moment associations between posttraumatic stress symptoms and auditory hallucinations in the flow of daily life. Psychiatry Res 2020; 285:112838. [PMID: 32044599 DOI: 10.1016/j.psychres.2020.112838] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 11/23/2022]
Abstract
Traumatic events are associated with increased risk of auditory hallucinations (AHs) and posttraumatic stress symptoms have been implicated in this relationship. We aimed to explore the moment-to-moment relationship between posttraumatic stress symptoms and AHs in daily-life. Twenty-eight people with persistent AHs and a history of traumatic events completed six-days of ecological momentary assessment. We assessed AHs, trauma memory intrusions, avoidance, and hyperarousal at ten time points each day. Multi-level modelling showed that the severity of trauma memory intrusions (but not avoidance or hyperarousal) within the preceding hour was associated with the occurrence of AHs. This relationship was significantly stronger for people with a direct link between the content of their AHs and trauma history. In time-lagged analyses, main effects of trauma memory intrusions, avoidance, and hyperarousal on AHs were not significant. Trauma memory intrusions have momentary associations with AHs and this relationship is stronger and more enduring for those with a direct link between their AH and the trauma. Our findings are in keeping with the proposal that intrusive trauma memories are associated with the occurrence of (some) AHs.
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Affiliation(s)
- Rachel M Brand
- Centre for Mental Health, Swinburne University, PO Box 218, Hawthorn, VIC 3122, Australia.
| | - Sarah Bendall
- Orygen: The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052, Australia; The Centre for Youth Mental Health, The University of Melbourne, VIC 3010, Australia
| | - Amy Hardy
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; South London & Maudsley NHS Foundation Trust, UK
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University, PO Box 218, Hawthorn, VIC 3122, Australia; Psychiatry, St Vincent's Hospital Melbourne, Australia
| | - Denny Meyer
- Centre for Mental Health, Swinburne University, PO Box 218, Hawthorn, VIC 3122, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University, PO Box 218, Hawthorn, VIC 3122, Australia
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Bortolon C, Raffard S. Affective and cognitive factors associated with hallucination proneness in the general population: the role of shame and trauma-related intrusions. Cogn Neuropsychiatry 2019; 24:406-420. [PMID: 31549568 DOI: 10.1080/13546805.2019.1670152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Feelings of shame may be an important factor implicated in the onset and maintenance of hallucination (or hearing voices). Shame has been shown to increase trauma-related intrusions and avoidance and may reinforce negative beliefs about the self, which in turn may contribute to hallucinations in clinical and non-clinical populations. To our knowledge, no study has so far explored the role of shame in hallucination-proneness. Therefore, the main goal of the present study is to explore the mediation role of shame, trauma-related intrusions and avoidance in the association between childhood trauma and hallucination-proneness.Methods: Self-report questionnaires were used to assess past traumatic experiences, trauma-related symptoms, shame, and hallucination proneness in 175 participants from the general population.Results: Mediation analyses (joint-significance test and Monte Carlo test) showed that both shame and intrusions mediated the association between childhood trauma and hallucination-proneness.Conclusions: Our results reinforce the importance of considering previous experiences of trauma and trauma-related symptoms, including feelings of shame in individuals experiencing hallucinations. Moreover, this study reinforces previous studies showing some preliminary evidence that compassion-focused therapy, whose primary goal is to reduce shame by increasing self-compassion, could have a significant effect on voices whose content is hostile.
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Affiliation(s)
- Catherine Bortolon
- Laboratoire Inter-universitaire de Psychologie: Personnalité, Cognition et Changement Social, Université Grenoble Alpes, Saint Martin d'Hères, France
| | - Stéphane Raffard
- Service Universitaire de Psychiatrie Adulte, Hôpital La Colombière, Centre Hospitaliere Universitaire de Montpellier, Montpellier, France.,Laboratoire Epsylon, Montpellier, France
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25
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Reductions in reported persecutory ideation and psychotic-like experiences during exposure therapy for posttraumatic stress disorder. Psychiatry Res 2019; 272:190-195. [PMID: 30584951 DOI: 10.1016/j.psychres.2018.12.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 11/22/2022]
Abstract
While psychotic-like experiences (PLEs), including persecutory ideation and auditory or visual hallucinations, are common in PTSD, questions remain about their relationships to core PTSD symptoms and responsiveness to treatment. This study examined data from a waitlist (WL) controlled clinical study of the effect of virtual reality (VR) and prolonged exposure (PE) in a sample of active-duty service members with deployment-related trauma (n = 161). PLEs were assessed and examined with regard to their responsiveness to trauma focused treatment (combining conditions) relative to the WL, as well as their relationships to PTSD symptoms. Persecutory ideation symptoms, which were most closely related to PTSD Cluster C (avoidance and numbing) symptoms, were reduced post-treatment in the trauma-focused condition relative to WL. Auditory and visual hallucinations-which were most closely associated with PTSD re-experiencing-decreased from baseline to post-treatment assessments for WL and exposure therapy participants. The presence of PLEs at baseline did not predict a reduced PTSD symptom response to treatment. Trauma-focused treatments appear effective in addressing psychotic-like experiences that can emerge in individuals with PTSD.
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Peach N, Alvarez‐Jimenez M, Cropper SJ, Sun P, Bendall S. Testing models of post‐traumatic intrusions, trauma‐related beliefs, hallucinations, and delusions in a first episode psychosis sample. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2018; 58:154-172. [DOI: 10.1111/bjc.12206] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/06/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Natalie Peach
- School of Psychological Sciences The University of Melbourne Parkville Victoria Australia
| | - Mario Alvarez‐Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health Parkville Victoria Australia
- The Centre for Youth Mental Health The University of Melbourne Parkville Victoria Australia
| | - Simon J. Cropper
- School of Psychological Sciences The University of Melbourne Parkville Victoria Australia
| | - Pamela Sun
- School of Psychological Sciences Monash University Clayton Victoria Australia
| | - Sarah Bendall
- Orygen, The National Centre of Excellence in Youth Mental Health Parkville Victoria Australia
- The Centre for Youth Mental Health The University of Melbourne Parkville Victoria Australia
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27
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Holt L, Sellwood W, Slade P. Birth experiences, trauma responses and self-concept in postpartum psychotic-like experiences. Schizophr Res 2018; 197:531-538. [PMID: 29402582 DOI: 10.1016/j.schres.2017.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/07/2017] [Accepted: 12/26/2017] [Indexed: 11/20/2022]
Abstract
The frequency of psychotic-like experiences (PLEs) amongst new mothers is beginning to be explored but the mechanisms underlying such experiences are yet to be understood. First time mothers (N=10,000) receiving maternity care via the UK National Health Service were contacted postnatally via Emma's Diary, an online resource for mothers. Measures assessed birth experience, trauma appraisals, post-traumatic stress symptoms, adjustment to motherhood, self-concept clarity and PLEs (in the form of hallucinations and delusions). There was a 13.9% response rate (N=1393) and 1303 participants reported experiencing at least one PLE (93.5%). Three competing nested path models were analysed. A more negative birth experience directly predicted delusions, but not hallucinations. Trauma appraisals and poorer adjustment to motherhood indirectly predicted PLEs, via disturbed self-concept clarity. Post-traumatic stress symptoms directly predicted the occurrence of all PLEs. PLEs in first time mothers may be more common than previously thought. A key new understanding is that where new mothers have experienced birth as traumatic and are struggling with adjustment to their new role, this can link to disturbances in a coherent sense of self (self-concept clarity) and be an important predictor of PLEs. Understanding the development of PLEs in new mothers may be helpful in postnatal care, as would public health interventions aimed at reducing the sense of abnormality or stigma surrounding such experiences.
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Affiliation(s)
- Lyndsey Holt
- Mersey Care NHS Foundation Trust, Park Lodge CMHT, Orphan Drive, Liverpool L6 7UN, UK.
| | - William Sellwood
- Division of Health Research, University of Lancaster, Bailrigg LA1 4YW, UK.
| | - Pauline Slade
- Institute of Psychology, Health & Society, University of Liverpool, Brownlow Hill, Liverpool LG9 3GB, UK.
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28
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Quidé Y, O'Reilly N, Watkeys OJ, Carr VJ, Green MJ. Effects of childhood trauma on left inferior frontal gyrus function during response inhibition across psychotic disorders. Psychol Med 2018; 48:1454-1463. [PMID: 28994360 DOI: 10.1017/s0033291717002884] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Childhood trauma is a risk factor for psychosis. Deficits in response inhibition are common to psychosis and trauma-exposed populations, and associated brain functions may be affected by trauma exposure in psychotic disorders. We aimed to identify the influence of trauma-exposure on brain activation and functional connectivity during a response inhibition task. METHODS We used functional magnetic resonance imaging to examine brain function within regions-of-interest [left and right inferior frontal gyrus (IFG), right dorsolateral prefrontal cortex, right supplementary motor area, right inferior parietal lobule and dorsal anterior cingulate cortex], during the performance of a Go/No-Go Flanker task, in 112 clinical cases with psychotic disorders and 53 healthy controls (HCs). Among the participants, 71 clinical cases and 21 HCs reported significant levels of childhood trauma exposure, while 41 clinical cases and 32 HCs did not. RESULTS In the absence of effects on response inhibition performance, childhood trauma exposure was associated with increased activation in the left IFG, and increased connectivity between the left IFG seed region and the cerebellum and calcarine sulcus, in both cases and healthy individuals. There was no main effect of psychosis, and no trauma-by-psychosis interaction for any other region-of-interest. Within the clinical sample, the effects of trauma-exposure on the left IFG activation were mediated by symptom severity. CONCLUSIONS Trauma-related increases in activation of the left IFG were not associated with performance differences, or dependent on clinical diagnostic status; increased IFG functionality may represent a compensatory (overactivation) mechanism required to exert adequate inhibitory control of the motor response.
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Affiliation(s)
- Y Quidé
- School of Psychiatry,University of New South Wales,Randwick,NSW,Australia
| | - N O'Reilly
- School of Psychiatry,University of New South Wales,Randwick,NSW,Australia
| | - O J Watkeys
- School of Psychiatry,University of New South Wales,Randwick,NSW,Australia
| | - V J Carr
- School of Psychiatry,University of New South Wales,Randwick,NSW,Australia
| | - M J Green
- School of Psychiatry,University of New South Wales,Randwick,NSW,Australia
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29
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Quidé Y, Cohen-Woods S, O'Reilly N, Carr VJ, Elzinga BM, Green MJ. Schizotypal personality traits and social cognition are associated with childhood trauma exposure. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2018; 57:397-419. [PMID: 29923348 DOI: 10.1111/bjc.12187] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Childhood trauma is a common risk factor for adult psychiatric disorders, such as schizophrenia (SZ) and bipolar-I disorder (BD). However, its association with schizotypal personality traits, as well as cognitive and social cognitive abilities, is less well studied in these populations. METHODS In a cohort of 79 SZ cases, 84 BD cases, and 75 healthy controls (HCs), clinically significant levels of childhood trauma exposure (according to scores on the Childhood Trauma Questionnaire; CTQ) were evident in 54 SZ, 55 BD, and 26 HC individuals. Trauma-exposed and non-exposed groups were compared on schizotypal personality features (schizotypy) measured with the Schizotypal Personality Questionnaire (SPQ). Cognitive assessments included executive function, working memory, attention, and immediate and delayed memory. Social cognitive measures assessed facial emotion processing and theory-of-mind abilities. RESULTS Trauma-exposed participants showed higher levels of schizotypy, especially suspiciousness, relative to non-exposed individuals, regardless of clinical or HC status. Furthermore, trauma-exposed individuals showed deficits specifically in social cognitive, but not general cognitive abilities, regardless of clinical or HC status. These trauma-related results were found in the context of higher schizotypy levels in both SZ and BD relative to HC, and lower cognitive and social cognitive performance in SZ, relative to BD and HC groups. CONCLUSIONS These findings suggest that childhood trauma exposure impacts long-term schizotypy outcomes, especially paranoid ideation (suspiciousness), as well as complex social cognitive abilities in both healthy and psychotic populations. However, cognitive deficits associated with psychotic illness may not be distinguishable from those related to trauma exposure in previous studies. PRACTITIONER POINTS Findings Childhood trauma exposure is associated with increased schizotypal features (in particular paranoid ideation) and complex social cognitive abilities, independently of the diagnosis of psychotic disorder. Cognitive and social cognitive deficits were larger in schizophrenia compared to bipolar-I cases and healthy controls, but increased schizotypal features were observed in both schizophrenia and bipolar-I disorder relative to healthy controls. Limitations We were unable to distinguish the specific effects of particular childhood trauma exposures due to the high rate of exposure to more than one type of maltreatment. Retrospective assessment of childhood trauma in adulthood cannot be externally validated, and associations with behavioural traits in later life may be confounded by other factors not studied here.
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Affiliation(s)
- Yann Quidé
- School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia.,Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Sarah Cohen-Woods
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Nicole O'Reilly
- School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia
| | - Vaughan J Carr
- School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia.,Neuroscience Research Australia, Randwick, New South Wales, Australia.,Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Bernet M Elzinga
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, the Netherlands.,Clinical, Health and Neuropsychology Unit, Leiden University, the Netherlands
| | - Melissa J Green
- School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia.,Neuroscience Research Australia, Randwick, New South Wales, Australia
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30
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Jacob L, Haro JM, Koyanagi A. Post-traumatic stress symptoms are associated with physical multimorbidity: Findings from the Adult Psychiatric Morbidity Survey 2007. J Affect Disord 2018. [PMID: 29522958 DOI: 10.1016/j.jad.2018.02.063] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Studies on the association between symptoms of post-traumatic stress disorder (PTSD) and physical multimorbidity (i.e., ≥2 chronic conditions) are lacking. Thus, we assessed the association between PTSD symptoms and physical multimorbidity using nationally representative, community-based data of the UK adult population. METHODS Data from the 2007 Adult Psychiatric Morbidity Survey were analyzed. PTSD symptoms were assessed using the 10-item Trauma Screening Questionnaire (TSQ). A total score of ≥6 points indicated a probable PTSD. Information was collected on 20 doctor/other health professional diagnosed physical health conditions that were present in the past 12 months. Multimorbidity was defined as ≥2 physical diseases. Multivariable logistic regression and mediation analyses were conducted to analyze the association between PTSD and physical multimorbidity, and the influence of behavioral and psychological factors in this association. RESULTS Among 7403 individuals aged ≥16 years [mean age (SD) = 46.3 (18.6) years; 51.5% females], the prevalence of PTSD increased from 2.1% in individuals with no physical conditions to 5.4% in those with ≥4 physical conditions. After adjustment for sociodemographic factors and lifetime occurrence of a traumatic event, PTSD was associated with higher odds for physical multimorbidity (Odds Ratio [OR] = 2.47; 95% Confidence Interval [CI]: 1.71-3.56). Anxiety, depression, and disordered eating explained 35%, 21%, and 8% of the PTSD-multimorbidity association, respectively. LIMITATIONS Causality or temporal associations cannot be established due to the cross-sectional nature of the study. In addition, PTSD and physical conditions were assessed using self-reports. CONCLUSIONS PTSD symptoms may be risk factors for physical multimorbidity. Anxiety and depressive symptoms might play an important role in this association. Screening for chronic physical conditions among individuals with PTSD and treating them simultaneously may lead to better clinical outcomes.
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Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Paris 5, 15 rue de l'École de Médecine, Paris 75006, France.
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
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31
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Maijer K, Begemann MJH, Palmen SJMC, Leucht S, Sommer IEC. Auditory hallucinations across the lifespan: a systematic review and meta-analysis. Psychol Med 2018; 48:879-888. [PMID: 28956518 DOI: 10.1017/s0033291717002367] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Auditory Hallucinations (AH) are nowadays regarded as symptoms following a continuum; from a (transient) phenomenon in healthy individuals on one end to a symptom of (psychiatric) illnesses at the other. An accumulating number of epidemiological studies focused on the prevalence of AH in the general population, but results vary widely. The current meta-analysis aims to synthesize existing evidence on lifetime prevalence of AH across the lifespan. METHODS We conducted a quantitative review and meta-analysis according to PRISMA guidelines. Studies were combined to calculate a mean lifetime general population AH prevalence rate. Moreover, prevalences were calculated for four age groups: children (5-12 years), adolescents (13-17 years), adults (18-60 years) and elderly (⩾60 years). RESULTS We retrieved 25 study samples including 84 711 participants. Mean lifetime prevalence rate of AH was 9.6% (95% CI 6.7-13.6%). The mean lifetime prevalence was similar in children (12.7%) and adolescents (12.4%), but these two groups differed significantly from the adults (5.8%) and the elderly (4.5%). Significant heterogeneity indicated that there is still dispersion in true prevalence rates between studies, even within the different age categories. CONCLUSIONS Current meta-analysis shows that AH are quite common (up to one in ten individuals) in the general population during lifetime, with children and adolescents reporting these experiences significantly more often compared with adults and elderly. Large follow-up studies on the longitudinal course of AH are needed to reveal associated risk and resilience factors.
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Affiliation(s)
- K Maijer
- Department of Psychiatry,University Medical Center Utrecht and Brain Center Rudolf Magnus,Heidelberglaan 100, 3485CX Utrecht,The Netherlands
| | - M J H Begemann
- Department of Psychiatry,University Medical Center Utrecht and Brain Center Rudolf Magnus,Heidelberglaan 100, 3485CX Utrecht,The Netherlands
| | - S J M C Palmen
- Department of Psychiatry,University Medical Center Utrecht and Brain Center Rudolf Magnus,Heidelberglaan 100, 3485CX Utrecht,The Netherlands
| | - S Leucht
- Department of Psychiatry and Psychotherapy,Klinikum rechts der Isar,Ismaningerstr. 22, 81675 München,Germany
| | - I E C Sommer
- Department of Psychiatry,University Medical Center Utrecht and Brain Center Rudolf Magnus,Heidelberglaan 100, 3485CX Utrecht,The Netherlands
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Gawęda Ł, Prochwicz K, Adamczyk P, Frydecka D, Misiak B, Kotowicz K, Szczepanowski R, Florkowski M, Nelson B. The role of self-disturbances and cognitive biases in the relationship between traumatic life events and psychosis proneness in a non-clinical sample. Schizophr Res 2018; 193:218-224. [PMID: 28712969 DOI: 10.1016/j.schres.2017.07.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 07/08/2017] [Accepted: 07/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Traumatic life events have been established as an environmental risk factor for psychosis. However, the exact mechanisms by which traumatic life events increase risk for psychosis are unknown. In the present study we tested an integrative model of traumatic life events being related to psychosis proneness via self-disturbances and cognitive biases. METHODS The sample consisted of 653 healthy people. Traumatic life events, self-disturbances, cognitive biases and psychosis proneness were assessed with self-report questionnaires. The direct and an indirect model of the relationship between traumatic life events and psychosis proneness were compared using path analyses with structural equation modelling in a cross-sectional study. RESULTS There was a significant direct effect of traumatic life events on psychosis proneness. However, path analysis suggested better fit of the indirect model including paths from trauma to psychosis proneness via cognitive biases and self-disturbances. There were significant paths from traumatic life events to cognitive biases and self-disorders. Self-disorders significantly predicted cognitive biases. Finally, cognitive biases and self-disorders significantly predicted psychosis proneness. Exclusion of any paths, apart from direct path in the model, significantly reduced model fitness. DISCUSSION The results revealed that a direct relationship between trauma and psychosis proneness became insignificant when taking into account the influence of self-disorders and cognitive biases. This suggests that the interactions between disrupted self-experience, impaired information processing and traumatic life events are of importance in psychosis proneness. This model should be further tested in a longitudinal study on a clinical sample.
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Affiliation(s)
- Łukasz Gawęda
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg Eppendorf, Hamburg, Germany; II Department of Psychiatry, Medical University of Warsaw, Poland.
| | | | - Przemysław Adamczyk
- Department of Community Psychiatry, Chair of Psychiatry, Medical College, Jagiellonian University, Krakow, Poland; Psychophysiology Laboratory, Institute of Psychology, Jagiellonian University, Krakow, Poland
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Poland
| | - Błażej Misiak
- Department of Genetics, Wroclaw Medical University, Poland
| | - Kamila Kotowicz
- Department of Psychiatry, Wroclaw Medical University, Poland
| | - Remigiusz Szczepanowski
- Faculty of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Marcin Florkowski
- Faculty of Education, Psychology and Sociology, University of Zielona Gora, Poland
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
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Wadsworth P, Krahe E, Searing K. An Ecological Model of Well-being After Sexual Assault: The Voices of Victims and Survivors. FAMILY & COMMUNITY HEALTH 2018; 41:37-46. [PMID: 29135793 DOI: 10.1097/fch.0000000000000168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In this article, the authors describe factors that enhance or detract from well-being after adult sexual assault from the perspective of sexual assault victims and survivors. The authors present a holistic view of the complex ways in which women respond to and cope with the impact of adult sexual assault while trying to create a sense of well-being. The forces that facilitate or detract from well-being are organized into an ecological model. The data originate from a grounded theory study in 2015, with 22 adult female adult sexual assault victims/survivors.
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Affiliation(s)
- Pamela Wadsworth
- Bronson School of Nursing, Western Michigan University, Kalamazoo (Dr Wadsworth and Ms Searing); and School of Health Services Administration, College of Health Professions, University of Phoenix, Phoenix, Arizona (Dr Krahe)
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34
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Hardy A. Pathways from Trauma to Psychotic Experiences: A Theoretically Informed Model of Posttraumatic Stress in Psychosis. Front Psychol 2017; 8:697. [PMID: 28588514 PMCID: PMC5440889 DOI: 10.3389/fpsyg.2017.00697] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 04/21/2017] [Indexed: 12/18/2022] Open
Abstract
In recent years, empirical data and theoretical accounts relating to the relationship between childhood victimization and psychotic experiences have accumulated. Much of this work has focused on co-occurring Posttraumatic Stress Disorder or putative causal mechanisms in isolation from each other. The complexity of posttraumatic stress reactions experienced in psychosis remains poorly understood. This paper therefore attempts to synthesize the current evidence base into a theoretically informed, multifactorial model of posttraumatic stress in psychosis. Three trauma-related vulnerability factors are proposed to give rise to intrusions and to affect how people appraise and cope with them. First, understandable attempts to survive trauma become habitual ways of regulating emotion, manifesting in cognitive-affective, behavioral and interpersonal responses. Second, event memories, consisting of perceptual and episodic representations, are impacted by emotion experienced during trauma. Third, personal semantic memory, specifically appraisals of the self and others, are shaped by event memories. It is proposed these vulnerability factors have the potential to lead to two types of intrusions. The first type is anomalous experiences arising from emotion regulation and/or the generation of novel images derived from trauma memory. The second type is trauma memory intrusions reflecting, to varying degrees, the retrieval of perceptual, episodic and personal semantic representations. It is speculated trauma memory intrusions may be experienced on a continuum from contextualized to fragmented, depending on memory encoding and retrieval. Personal semantic memory will then impact on how intrusions are appraised, with habitual emotion regulation strategies influencing people's coping responses to these. Three vignettes are outlined to illustrate how the model accounts for different pathways between victimization and psychosis, and implications for therapy are considered. The model is the first to propose how emotion regulation and autobiographical memory may lead to a range of intrusive experiences in psychosis, and therefore attempts to explain the different phenomenological associations observed between trauma and intrusions. However, it includes a number of novel hypotheses that require empirical testing, which may lead to further refinement. It is anticipated the model will assist research and practice, in the hope of supporting people to manage the impact of victimization on their lives.
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Affiliation(s)
- Amy Hardy
- Institute of Psychiatry, Psychology & Neuroscience, King’s College LondonLondon, UK
- Psychosis Clinical Academic Group, South London and Maudsley NHS Foundation TrustLondon, UK
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35
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Koyanagi A, Oh H, Haro JM, Hirayama F, DeVylder J. Child death and maternal psychosis-like experiences in 44 low- and middle-income countries: The role of depression. Schizophr Res 2017; 183:41-46. [PMID: 27863934 DOI: 10.1016/j.schres.2016.11.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/09/2016] [Accepted: 11/10/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Studies on the effect of child death on the mental wellbeing of women in low- and middle-income countries (LMICs) are scarce despite the high child mortality rates. Thus, the aim of the current study was to assess the association between child death and psychosis-like experiences (PLEs), as well as the role of depression in this association. METHODS Data from 44 LMICs which participated in the World Health Survey (WHS) were analyzed. A total of 59,444 women who ever gave birth, aged 18-49years, without a self-reported lifetime psychosis diagnosis, were included in the analysis. The World Mental Health Survey version of the Composite International Diagnostic Interview (CIDI) was used to establish the diagnosis of past 12-month DSM-IV depression, and assess four positive psychotic symptoms. Depression was defined as self-reported lifetime depression diagnosis and/or past 12-month depression. Multivariable logistic regression analyses were performed. RESULTS After adjustment for potential confounders, women who experienced child death had higher odds for all types of PLEs (when unadjusted for depression) (OR 1.20-1.71; p<0.05) and depression (OR=1.64; 95%CI=1.39-1.93). When adjusted for depression, only delusion of control was strongly associated with child death (OR=1.54; 95%CI=1.20-1.97). CONCLUSIONS Child death may be an important determinant of mental wellbeing among women in LMICs. Given the known adverse health outcomes associated with PLEs and depression, as well as the co-occurrence of these symptoms, mental health care may be particularly important for mothers who have experienced child loss in LMICs.
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Affiliation(s)
- Ai Koyanagi
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain.
| | - Hans Oh
- University of California Berkeley School of Public Health, 50 University Hall #7360, Berkeley, CA 94720-7360, USA; Prevention Research Center, Pacific Institute for Research and Evaluation, 180 Grand Avenue Suite #1200, Oakland, CA 94612, USA.
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain.
| | - Fumi Hirayama
- Medical Network Group, Innovation Center for Medical Redox Navigation, Kyushu University, West Wing 5F, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Jordan DeVylder
- School of Social Work, University of Maryland, 525 W Redwood Street, Baltimore, MD 21201, USA.
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[Decision Support for the Therapy Planning for Young Refugees and Asylum-Seekers with Posttraumatic Disorders]. Prax Kinderpsychol Kinderpsychiatr 2017; 65:707-728. [PMID: 27923340 DOI: 10.13109/prkk.2016.65.10.707] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Decision Support for the Therapy Planning for Young Refugees and Asylum-Seekers with Posttraumatic Disorders Due to the Convention on the Rights of the Child and § 6 of the Asylum Seekers' Benefit Act, there are legal and ethical obligations for the care of minor refugees suffering from trauma-related disorders. In Germany, psychotherapeutic care of adolescent refugees is provided by specialized treatment centers and Child and Adolescent psychiatries with specialized consultation-hours for refugees. Treatment of minor refugees is impeded by various legal and organizational barriers. Many therapists have reservations and uncertainties regarding an appropriate therapy for refugees due to a lack of experience. This means that only a fraction of the young refugees with trauma-related disorders find an ambulatory therapist. In a review of international literature, empirical findings on (interpreter-aided) diagnostics and therapy of young refugees were presented. Practical experiences on therapeutic work with traumatized young refugees were summarized in a decision tree for therapy planning in the ambulatory setting. The decision tree was developed to support therapists in private practices by structuring the therapy process.
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Brand RM, Rossell SL, Bendall S, Thomas N. Can We Use an Interventionist-Causal Paradigm to Untangle the Relationship between Trauma, PTSD and Psychosis? Front Psychol 2017; 8:306. [PMID: 28316580 PMCID: PMC5334316 DOI: 10.3389/fpsyg.2017.00306] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/17/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Rachel M Brand
- Centre for Mental Health, Swinburne UniversityHawthorn, VIC, Australia; The Voices Clinic, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical SchoolMelbourne, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne UniversityHawthorn, VIC, Australia; The Voices Clinic, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical SchoolMelbourne, VIC, Australia; Psychiatry, St. Vincent's HospitalFitzroy, VIC, Australia
| | - Sarah Bendall
- Orygen: The National Centre of Excellence in Youth Mental HealthParkville, VIC, Australia; The Centre for Youth Mental Health, The University of MelbourneParkville, VIC, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne UniversityHawthorn, VIC, Australia; The Voices Clinic, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical SchoolMelbourne, VIC, Australia
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38
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Steenkamp MM, Blessing EM, Galatzer-Levy IR, Hollahan LC, Anderson WT. Marijuana and other cannabinoids as a treatment for posttraumatic stress disorder: A literature review. Depress Anxiety 2017; 34:207-216. [PMID: 28245077 DOI: 10.1002/da.22596] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 01/17/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) is common in the general population, yet there are limitations to the effectiveness, tolerability, and acceptability of available first-line interventions. We review the extant knowledge on the effects of marijuana and other cannabinoids on PTSD. Potential therapeutic effects of these agents may largely derive from actions on the endocannabinoid system and we review major animal and human findings in this area. Preclinical and clinical studies generally support the biological plausibility for cannabinoids' potential therapeutic effects, but underscore heterogeneity in outcomes depending on dose, chemotype, and individual variation. Treatment outcome studies of whole plant marijuana and related cannabinoids on PTSD are limited and not methodologically rigorous, precluding conclusions about their potential therapeutic effects. Reported benefits for nightmares and sleep (particularly with synthetic cannabinoid nabilone) substantiate larger controlled trials to determine effectiveness and tolerability. Of concern, marijuana use has been linked to adverse psychiatric outcomes, including conditions commonly comorbid with PTSD such as depression, anxiety, psychosis, and substance misuse. Available evidence is stronger for marijuana's harmful effects on the development of psychosis and substance misuse than for the development of depression and anxiety. Marijuana use is also associated with worse treatment outcomes in naturalistic studies, and with maladaptive coping styles that may maintain PTSD symptoms. Known risks of marijuana thus currently outweigh unknown benefits for PTSD. Although controlled research on marijuana and other cannabinoids' effects on PTSD remains limited, rapid shifts in the legal landscape may now enable such studies, potentially opening new avenues in PTSD treatment research.
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Affiliation(s)
| | | | | | - Laura C Hollahan
- Langone School of Medicine, New York, University, New York, NY, USA
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Murdoch M, Spoont MR, Kehle-Forbes SM, Harwood EM, Sayer NA, Clothier BA, Bangerter AK. Persistent Serious Mental Illness Among Former Applicants for VA PTSD Disability Benefits and Long-Term Outcomes: Symptoms, Functioning, and Employment. J Trauma Stress 2017; 30:36-44. [PMID: 28099769 PMCID: PMC6487633 DOI: 10.1002/jts.22162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 07/21/2016] [Accepted: 09/14/2016] [Indexed: 11/11/2022]
Abstract
UNLABELLED Millions of U.S. veterans have returned from military service with posttraumatic stress disorder (PTSD), for which a substantial number receive U.S. Department of Veterans Affairs (VA) disability benefits. Although PTSD is treatable, comorbid serious mental illness (defined here as schizophrenia, schizoaffective disorder, and bipolar spectrum disorders) could complicate these veterans' recovery. Using VA administrative data, we examined the burden of persistent serious mental illness in a nationally representative cohort of 1,067 men and 1,513 women who applied for VA PTSD disability benefits between 1994 and 1998 and served during or after the Vietnam conflict. Self-reported outcomes were restricted to the 713 men and 1,015 women who returned surveys at each of 3 collection points. More than 10.0% of men and 20.0% of women had persistent serious mental illness; of these, more than 80.0% also had persistent PTSD. On repeated measures modeling, those with persistent serious mental illness consistently reported more severe PTSD symptoms and poorer functioning in comparison to other participants (ps < .001); their employment rate did not exceed 21.0%. Interactions between persistent serious mental illness and PTSD were significant only for employment (p = .002). Persistent serious mental illness in this population was almost 2 to 19 times higher than in the general U.S. POPULATION The implications of these findings are discussed.
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Affiliation(s)
- Maureen Murdoch
- Section of General Internal Medicine, Minneapolis VA Health Care System, Minneapolis MN, USA,Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA,Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Michele Roxanne Spoont
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA,Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA,National Centers for PTSD, Pacific Islands Division, Department of Veterans Affairs, Honolulu, HI, USA,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA,Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, MN, USA
| | - Shannon Marie Kehle-Forbes
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA,Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Eileen Mae Harwood
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA,Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis MN, USA
| | - Nina Aileen Sayer
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA,Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA,Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN, USA,Department of Psychology, College of Liberal Arts, University of Minnesota, Minneapolis, MN, USA
| | - Barbara Ann Clothier
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Ann Kay Bangerter
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
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40
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Mayo D, Corey S, Kelly LH, Yohannes S, Youngquist AL, Stuart BK, Niendam TA, Loewy RL. The Role of Trauma and Stressful Life Events among Individuals at Clinical High Risk for Psychosis: A Review. Front Psychiatry 2017; 8:55. [PMID: 28473776 PMCID: PMC5397482 DOI: 10.3389/fpsyt.2017.00055] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/27/2017] [Indexed: 11/15/2022] Open
Abstract
The experience of childhood trauma (CT) and stressful life events (SLEs) is associated with subsequent development of a variety of mental health conditions, including psychotic illness. Recent research identifying adolescents and young adults at clinical high risk (CHR) for psychosis allows for prospective evaluation of the impact of trauma and adverse life events on psychosis onset and other outcomes, addressing etiological questions that cannot be answered in studies of fully psychotic or non-clinical populations. This article provides a comprehensive review of the current emerging literature on trauma and adverse life events in the CHR population. Up to 80% of CHR youth endorse a lifetime history of childhood traumatic events and victimization (e.g., bullying). Several studies have shown that the experience of CT predicts psychosis onset among CHR individuals, while the literature on the influence of recent SLEs (e.g., death of a loved one) remains inconclusive. Multiple models have been proposed to explain the link between trauma and psychosis, including the stress-vulnerability and stress-sensitivity hypotheses, with emphases on both cognitive processes and neurobiological mechanisms (e.g., the hypothalamic-pituitary-adrenal axis). Despite the preponderance of CHR individuals who endorse either CT or SLEs, no clinical trials have been conducted evaluating interventions for trauma in CHR youth to date. Furthermore, the current process of formal identification and assessment of trauma, SLEs, and their impact on CHR youth is inconsistent in research and clinical practice. Recommendations for improving trauma assessment, treatment, and future research directions in the CHR field are provided.
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Affiliation(s)
- Danessa Mayo
- Imaging Research Center, Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA
| | - Sarah Corey
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Leah H Kelly
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Seghel Yohannes
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Alyssa L Youngquist
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Barbara K Stuart
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Tara A Niendam
- Imaging Research Center, Department of Psychiatry and Behavioral Sciences, University of California Davis, Sacramento, CA, USA
| | - Rachel L Loewy
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
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41
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Okkels N, Trabjerg B, Arendt M, Pedersen CB. Traumatic Stress Disorders and Risk of Subsequent Schizophrenia Spectrum Disorder or Bipolar Disorder: A Nationwide Cohort Study. Schizophr Bull 2017; 43:180-186. [PMID: 27245172 PMCID: PMC5216852 DOI: 10.1093/schbul/sbw082] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Traumatic stress disorders are prevalent in patients with schizophrenia and bipolar disorder. However, there is a lack of prospective longitudinal studies investigating the risk of severe mental illness for people diagnosed with traumatic stress disorders. We aimed to assess if patients with acute stress reaction (ASR) or post-traumatic stress disorder (PTSD) are at increased risk of schizophrenia spectrum disorders or bipolar disorder. METHODS We performed a prospective cohort study covering the entire Danish population including information on inpatient and outpatient mental hospitals over 2 decades. Predictors were in- or outpatient diagnoses of ASR or PTSD. We calculated incidence rate ratios (IRR) with 95% CIs of schizophrenia, schizophrenia spectrum disorder, and bipolar disorder. RESULTS Persons with a traumatic stress disorder had a significantly increased risk of schizophrenia (IRR 3.80, CI 2.33-5.80), schizophrenia spectrum disorder (IRR 2.34, CI 1.46-3.53), and bipolar disorder (IRR 4.22, CI 2.25-7.13). Risks were highest in the first year after diagnosis of the traumatic stress disorder and remained significantly elevated after more than 5 years. Mental illness in a parent could not explain the association. CONCLUSION Our findings support an association between diagnosed traumatic stress disorders and subsequent schizophrenia spectrum disorder or bipolar disorder. If replicated, this may increase clinical focus on patients with traumatic stress disorders.
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Affiliation(s)
- Niels Okkels
- *To whom correspondence should be addressed; Clinic for OCD and Anxiety Disorders, Aarhus University Hospital, Risskov, Tretommervej 3, 8240 Risskov, Denmark; tel: +45-28-53-06-37, fax: +45-78-47-24-29, e-mail:
| | - Betina Trabjerg
- National Centre for Register Based Research, Aarhus University, Aarhus, Denmark;,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark
| | - Mikkel Arendt
- Clinic for OCD and Anxiety Disorders, Aarhus University Hospital, Risskov, Denmark
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Kimmel MC, Lara-Cinisomo S, Melvin K, Di Florio A, Brandon A, Meltzer-Brody S. Treatment of severe perinatal mood disorders on a specialized perinatal psychiatry inpatient unit. Arch Womens Ment Health 2016; 19:645-53. [PMID: 26802019 DOI: 10.1007/s00737-016-0599-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/09/2016] [Indexed: 12/29/2022]
Abstract
Perinatal patients with bipolar and psychotic mood disorder exacerbations are challenging to treat and often receive suboptimal care. We sought to examine the treatment patterns and outcomes on one of the only US-based Perinatal Psychiatry Inpatient Units (PPIU). Perinatal patients admitted to the PPIU completed self-report measures at admission and before discharge. Retrospective chart reviews extracted history, diagnoses (current and past), and medication treatment. Patients who had discharge diagnoses of bipolar disorder, major depression with psychotic features, or postpartum psychosis were included. Forty-seven met the diagnostic inclusion criteria. Over an average length of stay (ALOS) of 9.96 days, there was significant improvement in depressive and anxiety symptoms and daily functioning (Work and Social Adjustment Scale). Psychiatric comorbidity was common. Polypharmacy was utilized in 87 %. The most common medications prescribed at discharge were antipsychotics, alone or in combination with mood stabilizers or antidepressants. ECT was performed in 10 % of cases. The complexity of patients with severe mood disorders or psychosis admitted to the PPIU supports individualized treatment plans that address both primary diagnosis and psychiatric comorbidities. Our results provide important information that can be disseminated to others to improve clinical outcomes for severe perinatal mood disorders.
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Affiliation(s)
- Mary C Kimmel
- Department of Psychiatry, University of North Carolina-Chapel Hill, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA.
| | - S Lara-Cinisomo
- Department of Psychiatry, University of North Carolina-Chapel Hill, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA.,University of Illinois Urbana-Champaign, Champaign, USA
| | - K Melvin
- Department of Psychiatry, University of North Carolina-Chapel Hill, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA.,Cardiff University, Cardiff, UK
| | - A Di Florio
- Department of Psychiatry, University of North Carolina-Chapel Hill, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA
| | - A Brandon
- Department of Psychiatry, University of North Carolina-Chapel Hill, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA
| | - S Meltzer-Brody
- Department of Psychiatry, University of North Carolina-Chapel Hill, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA
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de Bont PAJM, van den Berg DPG, van der Vleugel BM, de Roos C, de Jongh A, van der Gaag M, van Minnen AM. Prolonged exposure and EMDR for PTSD v. a PTSD waiting-list condition: effects on symptoms of psychosis, depression and social functioning in patients with chronic psychotic disorders. Psychol Med 2016; 46:2411-2421. [PMID: 27297048 DOI: 10.1017/s0033291716001094] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND In patients with psychotic disorders, the effects of psychological post-traumatic stress disorder (PTSD) treatment on symptoms of psychosis, depression and social functioning are largely unknown METHOD In a single-blind randomized controlled trial (RCT) 155 outpatients in treatment for psychosis (61.3% schizophrenic disorder, 29% schizoaffective disorder) were randomized to eight sessions prolonged exposure (PE; n = 53) or eye movement desensitization and reprocessing (EMDR) (n = 55), or a waiting-list condition (WL, n = 47) for treatment of their co-morbid PTSD. Measures were performed on (1) psychosis: severity of delusions (PSYRATS-DRS), paranoid thoughts (GPTS), auditory verbal hallucinations (PSYRATS-AHRS), and remission from psychotic disorder (SCI-SR-PANSS); (2) depression (BDI-II); (3) social functioning (PSP). Outcomes were compared at baseline, post-treatment, 6-month follow-up and over all data points. RESULTS Both PE and EMDR were significantly associated with less severe paranoid thoughts post-treatment and at 6-month follow-up, and with more patients remitting from schizophrenia, at post-treatment (PE and EMDR) and over time (PE). Moreover, PE was significantly associated with a greater reduction of depression at post-treatment and at 6-month follow-up. Auditory verbal hallucinations and social functioning remained unchanged. CONCLUSIONS In patients with chronic psychotic disorders PE and EMDR not only reduced PTSD symptoms, but also paranoid thoughts. Importantly, in PE and EMDR more patients accomplished the status of their psychotic disorder in remission. Clinically, these effects are highly relevant and provide empirical support to the notion that delivering PTSD treatment to patients with psychotic disorders and PTSD deserves increasing recognition and acceptance among clinicians.
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Affiliation(s)
- P A J M de Bont
- Mental Health Organization (MHO) GGZ Oost Brabant Land van Cuijk en Noord Limburg,Boxmeer,The Netherlands
| | | | - B M van der Vleugel
- Community Mental Health Service GGZ Noord-Holland Noord,Alkmaar,The Netherlands
| | - C de Roos
- MHO Rivierduinen,Leiden,The Netherlands
| | - A de Jongh
- Department of Behavioral Sciences,Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam,Amsterdam,The Netherlands
| | - M van der Gaag
- Department of Clinical Psychology,VU University Amsterdam and EMGO Institute for Health and Care Research,Van der Boechorststraat 1,BT Amsterdam,The Netherlands
| | - A M van Minnen
- Radboud University Nijmegen, Behavioural Science Institute,NijCare,HE Nijmegen,The Netherlands
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Yanos PT, Vayshenker B, Pleskach P, Mueser KT. Insight among people with severe mental illness, co-occurring PTSD and elevated psychotic symptoms: Correlates and relationship to treatment participation. Compr Psychiatry 2016; 68:172-7. [PMID: 27234199 PMCID: PMC4890539 DOI: 10.1016/j.comppsych.2016.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 03/28/2016] [Accepted: 04/23/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is a dearth of research on what factors are predictive of insight among people with severe mental illness and co-occurring PTSD. METHOD Data were drawn from 146 participants with severe mental illness, co-occurring PTSD and elevated psychotic symptoms participating in a randomized controlled trial comparing two interventions for PTSD among people with severe mental illness. We examined the clinical and demographic correlates of insight at baseline, the relationship between baseline insight and treatment participation, the relationship between treatment participation and post-treatment insight, and the relationship between change in insight and change in other clinical variables. RESULTS Impaired insight was relatively common, with roughly half the sample demonstrating mild or moderate impairment at baseline. Baseline insight was associated with fewer psychotic and disorganized symptoms, and greater emotional discomfort and PTSD knowledge, but was not associated with negative symptoms, PTSD symptoms, depression/anxiety, or treatment participation. Participation in PTSD treatment was associated with increased insight at post-treatment. Improved insight was associated with improvements in disorganization and negative symptoms, but not with knowledge of PTSD or positive symptoms. DISCUSSION The findings suggest that engagement in treatment that includes educating people about PTSD may lead to improvements in insight and related improvements in other psychiatric symptoms.
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Affiliation(s)
- Philip T. Yanos
- John Jay College of Criminal Justice and the Graduate Center, City University of New York,Corresponding Author: John Jay College of Criminal Justice, CUNY, Psychology Department, 524 W. 59 St., 10 Floor, New York, NY 10019. Tel.: 212-237-8773.
| | - Beth Vayshenker
- John Jay College of Criminal Justice and the Graduate Center, City University of New York
| | | | - Kim T. Mueser
- Center for Psychiatric Rehabilitation, Boston University
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45
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Ayazi T, Swartz L, Eide AH, Lien L, Hauff E. Psychotic-like experiences in a conflict-affected population: a cross-sectional study in South Sudan. Soc Psychiatry Psychiatr Epidemiol 2016; 51:971-9. [PMID: 27236268 DOI: 10.1007/s00127-016-1243-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/22/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE This study investigates the prevalence of psychotic-like experiences (PLEs) and examines exposure to potentially traumatic events and other relevant risk factors for PLEs in the general population of a conflict-affected, low-income country. METHODS We conducted a cross-sectional community based study of four Greater Bahr el Ghazal States, South Sudan (n = 1200). The Harvard Trauma Questionnaire was applied to investigate exposure to potentially traumatic events. The Mini-International Neuropsychiatric Interview was used to detect PLEs. RESULTS The estimated prevalence of lifetime PLEs was 23.3 % and the rate of PLEs which were evaluated as bizarre was 9.5 %. Exposure to higher number of potentially traumatic events, younger age, rural residency, being unemployed, not having a regular income and having traditional religion were significantly associated with having PLEs. PLEs were significantly associated with reporting of psychological distress when controlling for other covariates. CONCLUSIONS The finding of association between traumatic exposure and PLEs calls for greater attention to the diversity of negative mental health outcomes in conflict-affected populations.
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Affiliation(s)
- Touraj Ayazi
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, P.O box 1171, Blindern, 0318, Oslo, Norway.
| | - Leslie Swartz
- Department of Psychology, Alan J. Flisher Centre for Public Mental Health, Stellenbosch University Private, Bag X1, Matieland, 7602, South Africa
| | - Arne H Eide
- SINTEF Technology and Society, P.O. Box 124, Blindern, 0314, Oslo, Norway
| | - Lars Lien
- National Center for Dual Diagnosis, Innlandet Hospital Trust, Furnesvegen 26, 2380, Brumunddal, Norway
- Faculty of public health, Hedmark University College, P.O.Box 400, 2418, Elverum, Norway
| | - Edvard Hauff
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, P.O box 1171, Blindern, 0318, Oslo, Norway
- Division of Mental Health and Addiction, Department of Research and Development, Oslo University Hospital, Ulleval Kirkeveien 166, Building 20, 0407, Oslo, Norway
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Hardy A, Emsley R, Freeman D, Bebbington P, Garety PA, Kuipers EE, Dunn G, Fowler D. Psychological Mechanisms Mediating Effects Between Trauma and Psychotic Symptoms: The Role of Affect Regulation, Intrusive Trauma Memory, Beliefs, and Depression. Schizophr Bull 2016; 42 Suppl 1:S34-43. [PMID: 27460616 PMCID: PMC4960432 DOI: 10.1093/schbul/sbv175] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Evidence suggests a causal role for trauma in psychosis, particularly for childhood victimization. However, the establishment of underlying trauma-related mechanisms would strengthen the causal argument. In a sample of people with relapsing psychosis (n = 228), we tested hypothesized mechanisms specifically related to impaired affect regulation, intrusive trauma memory, beliefs, and depression. The majority of participants (74.1%) reported victimization trauma, and a fifth (21.5%) met symptomatic criteria for Posttraumatic Stress Disorder. We found a specific link between childhood sexual abuse and auditory hallucinations (adjusted OR = 2.21, SE = 0.74, P = .018). This relationship was mediated by posttraumatic avoidance and numbing (OR = 1.48, SE = 0.19, P = .038) and hyperarousal (OR = 1.44, SE = 0.18, P = .045), but not intrusive trauma memory, negative beliefs or depression. In contrast, childhood emotional abuse was specifically associated with delusions, both persecutory (adjusted OR = 2.21, SE = 0.68, P = .009) and referential (adjusted OR = 2.43, SE = 0.74, P = .004). The link with persecutory delusions was mediated by negative-other beliefs (OR = 1.36, SE = 0.14, P = .024), but not posttraumatic stress symptoms, negative-self beliefs, or depression. There was no evidence of mediation for referential delusions. No relationships were identified between childhood physical abuse and psychosis. The findings underline the role of cognitive-affective processes in the relationship between trauma and symptoms, and the importance of assessing and treating victimization and its psychological consequences in people with psychosis.
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Affiliation(s)
- Amy Hardy
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK;
| | - Richard Emsley
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Paul Bebbington
- UCL Mental Health Sciences Unit, University College London, London, UK
| | - Philippa A. Garety
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK;,NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Elizabeth E. Kuipers
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK;,NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Graham Dunn
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK
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Dickson JM, Barsky J, Kinderman P, King D, Taylor PJ. Early relationships and paranoia: Qualitative investigation of childhood experiences associated with the development of persecutory delusions. Psychiatry Res 2016; 238:40-45. [PMID: 27086209 DOI: 10.1016/j.psychres.2016.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 02/02/2016] [Accepted: 02/07/2016] [Indexed: 12/01/2022]
Abstract
Research suggests a link between Persecutory Delusions (PDs) and early interpersonal difficulties. However, little research has explored the first-hand experience of navigating such adversities in those who later developed PDs. The current study reports on a qualitative investigation of the early interpersonal experiences and challenges faced by a sample of individuals who have recovered from PDs, using a semi-structured interview. A sample of seven individuals who have previously experienced PDs were recruited from two National Health Services (NHS) and an Early Intervention Psychosis service in England. Using an Interpretative Phenomenological Analytic (IPA) approach, the analysis identified three main themes (early experiences, impact of early experiences, coping with adversity). Early experiences captured early inconsistent and problematic relationships in childhood, and experiences of victimization. Exploring the impact of these early events revealed important roles for the participants' inconsistent sense of self, their negative perception of others, and their disturbed social functioning and substance use. Coping with adversity revealed distinct forms of avoidant and proactive coping. The findings are consistent with models of PDs that emphasise the impact of early interpersonal experiences, and offer support for attachment and cognitive factors.
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Affiliation(s)
- Joanne M Dickson
- Institute of Psychology, Health & Society, University of Liverpool, L69 3GB, United Kingdom
| | - Jamie Barsky
- Tameside & Glossop CAMHS, Peninne Care NHS Foundation Trust, Springleigh Clinic, Stalybridge SK15 2AU, United Kingdom
| | - Peter Kinderman
- Institute of Psychology, Health & Society, University of Liverpool, L69 3GB, United Kingdom
| | - David King
- Psychology Department, Mersey Care NHS Trust, Rathbone Hospital, Liverpool L13 4AW, United Kingdom
| | - Peter J Taylor
- Institute of Psychology, Health & Society, University of Liverpool, L69 3GB, United Kingdom.
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48
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Effects of childhood trauma on working memory in affective and non-affective psychotic disorders. Brain Imaging Behav 2016; 11:722-735. [DOI: 10.1007/s11682-016-9548-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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