1
|
Shiohama T, Uchikawa H, Nitta N, Takatani T, Matsuda S, Ortug A, Takahashi E, Sawada D, Shimizu E, Fujii K, Aoki I, Hamada H. Brain morphological analysis in mice with hyperactivation of the hedgehog signaling pathway. Front Neurosci 2024; 18:1449673. [PMID: 39290714 PMCID: PMC11405378 DOI: 10.3389/fnins.2024.1449673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 08/20/2024] [Indexed: 09/19/2024] Open
Abstract
Hedgehog signaling is a highly conserved pathway that plays pivotal roles in morphogenesis, tumorigenesis, osteogenesis, and wound healing. Previous investigations in patients with Gorlin syndrome found low harm avoidance traits, and increased volumes in the cerebrum, cerebellum, and cerebral ventricles, suggesting the association between brain morphology and the constitutive hyperactivation of hedgehog signaling, while the changes of regional brain volumes in upregulated hedgehog signaling pathway remains unclear so far. Herein, we investigated comprehensive brain regional volumes using quantitative structural brain MRI, and identified increased volumes of amygdala, striatum, and pallidum on the global segmentation, and increased volumes of the lateral and medial parts of the central nucleus of the amygdala on the detail segmentation in Ptch heterozygous deletion mice. Our data may enhance comprehension of the association between brain morphogenic changes and hyperactivity in hedgehog signaling.
Collapse
Affiliation(s)
- Tadashi Shiohama
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hideki Uchikawa
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nobuhiro Nitta
- Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, QST, Chiba, Japan
- Central Institute for Experimental Medicine and Life Science Bio Imaging Center, Yokohama, Japan
| | - Tomozumi Takatani
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shingo Matsuda
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Pharmacotherapeutics, Showa Pharmaceutical University, Tokyo, Japan
- Department of Ultrastructural Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Alpen Ortug
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States
- Department of Radiology, Harvard Medical School, Boston, MA, United States
| | - Emi Takahashi
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States
- Department of Radiology, Harvard Medical School, Boston, MA, United States
| | - Daisuke Sawada
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Eiji Shimizu
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Katsunori Fujii
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
- Department of Pediatrics, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Ichio Aoki
- Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, QST, Chiba, Japan
| | - Hiromichi Hamada
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| |
Collapse
|
2
|
Onyeama F, Melegkovits E, Yu N, Parvez A, Rodrigues A, Billings J, Kelleher I, Cannon M, Bloomfield MAP. A systematic review and meta-analysis of the traumatogenic phenotype hypothesis of psychosis. BJPsych Open 2024; 10:e146. [PMID: 39118412 DOI: 10.1192/bjo.2024.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Developmental trauma increases psychosis risk and is associated with poor prognosis. It has been proposed that psychosis in survivors of developmental trauma gives rise to a distinct 'traumatogenic' phenotype. AIMS Given the implications for personalised treatment, we sought to explore the traumatogenic psychosis phenotype hypothesis in a systematic review and meta-analysis of studies comparing psychotic presentations between adults with and without developmental trauma histories. METHOD We registered the systematic review on PROSPERO (CRD42019131245) and systematically searched EMBASE, Medline and PsycINFO. The outcomes of interests were quantitative and qualitative comparisons in psychotic symptom expression (positive, negative, cognitive) and other domains of psychopathology, including affect regulation, sleep, depression and anxiety, between adults with and without experience of developmental trauma. RESULTS Of 34 studies included (N = 13 150), 11 were meta-analysed (n = 2842). A significant relationship was found between developmental trauma and increased symptom severity for positive (Hedge's g = 0.27; 95% CI 0.10-0.44; P = 0.002), but not negative symptoms (Hedge's g = 0.13; 95% CI -0.04 to 0.30; P = 0.14). Developmental trauma was associated with greater neurocognitive, specifically executive, deficits, as well as poorer affect, dissociation and social cognition. Furthermore, psychotic symptom content thematically related to traumatic memories in survivors of developmental trauma. CONCLUSIONS Our findings that developmental trauma is associated with more severe positive and affective symptoms, and qualitative differences in symptom expression, support the notion that there may be a traumatogenic psychosis phenotype. However, underdiagnosis of post-traumatic stress disorder may also explain some of these findings. More research is needed to explore this further.
Collapse
Affiliation(s)
- Franca Onyeama
- Division of Psychiatry, University College London, UK; and Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Institute of Mental Health, Faculty of Brain Sciences, Division of Psychiatry, University College London, UK
| | - Eirini Melegkovits
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Institute of Mental Health, Faculty of Brain Sciences, Division of Psychiatry, University College London, UK
| | - Nicole Yu
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Institute of Mental Health, Faculty of Brain Sciences, Division of Psychiatry, University College London, UK
| | - Ameerah Parvez
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Institute of Mental Health, Faculty of Brain Sciences, Division of Psychiatry, University College London, UK; and UCL Medical School, University College London, UK
| | - Artur Rodrigues
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Institute of Mental Health, Faculty of Brain Sciences, Division of Psychiatry, University College London, UK; and Department of Biology, Faculdade de Ciências da Universidade do Porto, Portugal
| | - Jo Billings
- Division of Psychiatry, University College London, UK
| | - Ian Kelleher
- School of Medicine and Medical Sciences, University College Dublin, Ireland; Department of Psychiatry, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Ireland; and Lucena Clinic, St John of God Community Mental Health Services, Dublin, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Michael A P Bloomfield
- Translational Psychiatry Research Group, Research Department of Mental Health Neuroscience, Institute of Mental Health, Faculty of Brain Sciences, Division of Psychiatry, University College London, UK; Traumatic Stress Clinic, St Pancras Hospital, Camden and Islington NHS Foundation Trust, London, UK; National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, UK; and National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
3
|
Remmers MCC, Reijs RP, Hoebe CJPA. Defining and distinguishing early life stress, trauma, adversity, toxic and chronic stress and allostatic load: a descriptive review. Scand J Public Health 2024:14034948241260105. [PMID: 39087715 DOI: 10.1177/14034948241260105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
AIMS Various concepts are used to study the impact of stress on childhood development. These concepts are often used inconsistently or interchangeably. Our main objectives were to determine how selected stress concepts (chronic stress, toxic stress, allostatic load, early life stress, childhood adversity, childhood trauma and adverse childhood experiences; ACEs) are defined, operationalized and described, and to provide a theoretical context to aid the choice for a preferred concept in public health research. METHODS For this descriptive review, we systematically searched for literature published before 4 August 2021, on PubMed, Embase and PsycInfo. Two independent reviewers included studies. Exclusion criteria were: no systematic review, not peer reviewed, not published in English, selected stress concepts were no predetermined variable or a substantial topic in the discussion, full text was unobtainable or study described non-human or non-childhood populations. Data extraction forms were used. Descriptives were gathered, publication fields were identified through Journal Citation Reports categories, and verbatim descriptions were ordered in text and Venn diagrams. RESULTS Of 264 screened studies, 124 were included. ACEs, childhood adversity and childhood trauma were used most. ACEs were the main concept used most frequently (47.6%). A total of 11 of 14 public and environmental health journals used ACEs. All concepts refer to prolonged, repeated, interpersonal stress from 0 to 18 years, that can alter physiological systems. Four concepts were stressor oriented, two concepts focused on stress response and effect and one on the state of challenged homeostasis. CONCLUSIONS ACEs seem most fitting for public health setting, due to their operationalizability, large set of core experiences and widespread use.
Collapse
Affiliation(s)
- Maarten C C Remmers
- Department of Social Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Youth Health Care, Public Health Service Limburg-North, Venlo, Netherlands
| | - Rianne P Reijs
- Department of Social Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Youth Health Care, Living Lab Public Health Mosa, Public Health Service South Limburg, Heerlen, Netherlands
| | - Christian J P A Hoebe
- Department of Social Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Sexual Health, Infectious Diseases and Environmental Health, Living Lab Public Health Mosa, Public Health Service South Limburg, Heerlen, Netherlands
- Department of Medical Microbiology, Infectious Diseases and Infection Prevention, Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, Netherlands
| |
Collapse
|
4
|
Assefa Fentahun B, Belete Mossie T, Damtew Hailu R, Bete T, Moges Demeke S. Adverse childhood experiences among people with schizophrenia at comprehensive specialized hospitals in Bahir Dar, Ethiopia: a comparative study. Front Psychiatry 2024; 15:1387833. [PMID: 38835545 PMCID: PMC11148370 DOI: 10.3389/fpsyt.2024.1387833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/29/2024] [Indexed: 06/06/2024] Open
Abstract
Background People who have encountered adverse childhood experiences (ACEs) are predisposed to developing schizophrenia, experiencing exacerbated symptoms, and facing an elevated risk of disease relapse. It is imperative to evaluate the prevalence of ACEs to comprehend the specific attributes of this condition and enable the implementation of suitable interventions. Aims The aim of this study was to assess the prevalence of ACEs and its determinants among people with schizophrenia and the patient attendants in Bahir Dar, Ethiopia. Method A comparative cross-sectional study was carried out at the Comprehensive Specialized Hospitals in Bahir Dar, Ethiopia, from April 26 to June 10, 2023. A total of 291 individuals with schizophrenia and 293 individuals from the patient attendants were selected using a systematic random sampling method. A proportional odds model ordinal logistic regression analysis was used to identify the factors associated with ACEs. Results The occurrence of at least one ACE among individuals diagnosed with schizophrenia was 69.4%, while patient attendants had a 46.8%, as indicated by the Chi-square test, which showed a significant difference at p <0.05. The study findings indicated that individuals with schizophrenia who have encountered four or more ACEs are more inclined to have lower educational attainment (AOR: 4.69 [1.94 - 11.61]), low resilient coping mechanisms (AOR: 2.07 [1.11 - 3.90]), and poor social support (AOR: 3.93 [2.13 - 7.32]). Conversely, factors such as rural residency, illiteracy, and heightened attachment-related anxiety were found to be notably associated with the patient attendants. Conclusion In this study, the substantial prevalence of ACEs emphasized the necessity for ACE screening and the implementation of evidence-based interventions to address and alleviate the overall burden of ACEs.
Collapse
Affiliation(s)
- Birhanu Assefa Fentahun
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Belete Mossie
- Department of Psychiatry, College Medical and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Rekik Damtew Hailu
- Department of Psychiatry, College Medical and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tilahun Bete
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | | |
Collapse
|
5
|
Sangimino M, Babbitt K, Lee HS, Park S. Bodily experiences of trauma and psychosis risk. Psychiatry Res 2024; 337:115961. [PMID: 38754253 DOI: 10.1016/j.psychres.2024.115961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 05/05/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024]
Abstract
Bodily self-disturbances including anomalous embodiment of emotions are observed in psychosis-spectrum conditions. Psychosis is also associated with trauma exposure but the relationship between altered bodily experiences and trauma has not been extensively investigated in individuals at risk for psychosis (HR). We implemented a mapping task to localize felt sensations associated with trauma. Results show that trauma experiences were always localized in the body. HR reported increased rates of traumatic experiences than low-risk group (LR). HR reported sensations associated with trauma across widespread body areas. Further research is needed to elucidate how trauma might lead to psychotic-like experiences via bodily self-disturbances.
Collapse
Affiliation(s)
- Michael Sangimino
- Department of Psychology, Vanderbilt University, Nashville, TN 37240, USA
| | - Kathryn Babbitt
- Department of Psychology, Vanderbilt University, Nashville, TN 37240, USA
| | - Hyeon-Seung Lee
- Department of Psychology, Vanderbilt University, Nashville, TN 37240, USA
| | - Sohee Park
- Department of Psychology, Vanderbilt University, Nashville, TN 37240, USA.
| |
Collapse
|
6
|
Cowan HR, Mittal VA, Addington J, Bearden CE, Cadenhead KS, Cornblatt BA, Keshavan M, Mathalon DH, Perkins DO, Stone W, Tsuang MT, Woods SW, Cannon TD, Walker EF. Longitudinal Trajectories of Premorbid Social and Academic Adjustment in Youth at Clinical High Risk for Psychosis: Implications for Conversion. Schizophr Bull 2024:sbae050. [PMID: 38706103 DOI: 10.1093/schbul/sbae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND AND HYPOTHESIS Social and academic adjustment deteriorate in the years preceding a psychotic disorder diagnosis. Analyses of premorbid adjustment have recently been extended into the clinical high risk for psychosis (CHR) syndrome to identify risk factors and developmental pathways toward psychotic disorders. Work so far has been at the between-person level, which has constrained analyses of premorbid adjustment, clinical covariates, and conversion to psychosis. STUDY DESIGN Growth-curve models examined longitudinal trajectories in retrospective reports of premorbid social and academic adjustment from youth at CHR (n = 498). Interaction models tested whether known covariates of premorbid adjustment problems (attenuated negative symptoms, cognition, and childhood trauma) were associated with different premorbid adjustment trajectories in converters vs non-converters (ie, participants who did/did not develop psychotic disorders within 2-year follow-up). STUDY RESULTS Converters reported poorer social adjustment throughout the premorbid period. Converters who developed psychosis with an affective component reported poorer academic adjustment throughout the premorbid period than those who developed non-affective psychosis. Tentatively, baseline attenuated negative symptoms may have been associated with worsening social adjustment in the premorbid period for non-converters only. Childhood trauma impact was associated with fewer academic functioning problems among converters. Cognition effects did not differ based on conversion status. CONCLUSIONS Premorbid social function is an important factor in risk for conversion to psychosis. Negative symptoms and childhood trauma had different relationships to premorbid functioning in converters vs non-converters. Mechanisms linking symptoms and trauma to functional impairment may be different in converters vs non-converters, suggesting possible new avenues for risk assessment.
Collapse
Affiliation(s)
- Henry R Cowan
- Psychiatry, The Ohio State University, Columbus, OH, USA
- Psychology, Michigan State University, East Lansing, MI, USA
| | - Vijay A Mittal
- Psychology, Psychiatry, Medical Social Sciences, Northwestern University, Evanston, IL, USA
| | | | - Carrie E Bearden
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
- Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | | | | | - Matcheri Keshavan
- Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - Daniel H Mathalon
- Psychiatry, University of California San Francisco, San Francisco, CA, USA
- San Francisco VA Medical Center, San Francisco, CA, USA
| | - Diana O Perkins
- Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - William Stone
- Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - Ming T Tsuang
- Psychiatry, University of California San Diego, San Diego, CA, USA
| | | | - Tyrone D Cannon
- Psychiatry, Yale University, New Haven, CT, USA
- Psychology, Yale University, New Haven, CT, USA
| | - Elaine F Walker
- Psychology and Psychiatry, Emory University, Atlanta, GA, USA
| |
Collapse
|
7
|
Kisely S, Arnautovska U, Siskind D, Warren N, Najman JM. Admissions for psychosis following agency-notified child maltreatment at 40-year-follow-up: Results from the Childhood Adversity and Lifetime Morbidity (CALM) cohort. Schizophr Res 2024; 267:247-253. [PMID: 38581827 DOI: 10.1016/j.schres.2024.03.040] [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: 06/16/2023] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Abstract
There is substantial evidence of an association between self-reported child maltreatment (CM) and subsequent psychosis in retrospective data. Such findings may be affected by recall bias. Prospective studies of notifications to statutory agencies address recall bias but are less common and subject to attrition bias. These studies may therefore be underpowered to detect significant associations for some CM types such as sexual abuse. This study therefore linked administrative health data to a large birth cohort that included notifications to child protection agencies. We assessed psychiatric outcomes of CM as measured by inpatient admissions for non-affective psychoses (ICD10 codes F20-F29) to both public and private hospitals in Brisbane, Australia. Follow-up was up to 40 years old. There were 6087 cohort participants whose data could be linked to the administrative health data. Of these, 10.1 % had been the subject of a CM notification. Seventy-two participants (1.2 %) had been admitted for non-affective psychosis by 40-year follow-up. On adjusted analysis, all notified and substantiated types of CM were associated with admissions for non-affective psychosis. This included neglect, physical, sexual or emotional abuse, as well as notifications for multiple CM types. For instance, there was a 2.72-fold increase in admissions following any agency notification (95 % CI = 1.53-4.85). All maltreatment types therefore show a significant association with subsequent admissions for psychosis up to the age of 40. Screening for CM in individuals who present with psychosis is, therefore, indicated, as well as greater awareness that survivors of CM may be at higher risk of developing psychotic symptoms.
Collapse
Affiliation(s)
- Steve Kisely
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba 4102, Queensland, Australia; Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Canada; Metro South Addiction and Mental Health Service, Brisbane, Australia.
| | - Urska Arnautovska
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba 4102, Queensland, Australia; Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Dan Siskind
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba 4102, Queensland, Australia; Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Nicola Warren
- Princess Alexandra Hospital Southside Clinical Unit, Greater Brisbane Clinical School, Medical School, The University of Queensland, Woolloongabba 4102, Queensland, Australia; Metro South Addiction and Mental Health Service, Brisbane, Australia
| | - Jake Moses Najman
- School of Public Health, The University of Queensland, Public Health Building, Herston 4006, Queensland, Australia; School of Social Sciences, The University of Queensland, St Lucia 4072, Queensland, Australia
| |
Collapse
|
8
|
Barans S, Friedman B, Lardier DT, Saavedra JL, Bustillo JR, Halperin D, Lenroot RK, Tohen M, Winger S, Crisanti AS. Trauma exposure and disclosure in Hispanic youth at clinical high risk for psychosis: A retrospective review study. Early Interv Psychiatry 2024; 18:58-62. [PMID: 37246499 PMCID: PMC10682256 DOI: 10.1111/eip.13430] [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: 08/03/2022] [Revised: 01/13/2023] [Accepted: 03/28/2023] [Indexed: 05/30/2023]
Abstract
AIM This exploratory study aimed to examine differences in rates of self and clinician-reports of trauma in youth at clinical high risk for psychosis (CHR) and whether rates of reporting differed by ethnicity. METHODS Self-reported history of trauma was collected at intake amongst youth at CHR enrolled in Coordinated Specialty Care (CSC) services (N = 52). A structured chart review was conducted for the same sample to identify clinician-reported history of trauma throughout treatment in CSC. RESULTS For all patients, frequency of self-reported trauma at intake to CSC (56%) was lower compared to clinician-reports of trauma throughout treatment (85%). Hispanic patients self-reported trauma at intake (35%) less frequently than non-Hispanics (69%) (p = .02). No differences were found in clinician reported exposure to trauma by ethnicity throughout treatment. CONCLUSION Whilst further research is needed, these findings suggest the need for formalised, repeated, and culturally appropriate assessments of trauma within CSC.
Collapse
Affiliation(s)
- Samuel Barans
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Bess Friedman
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - David T Lardier
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Justine L Saavedra
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Juan R Bustillo
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Dawn Halperin
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Rhoshel K Lenroot
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Mauricio Tohen
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Sarah Winger
- Behavioral Health, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Annette S Crisanti
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| |
Collapse
|
9
|
Cullen AE, Labad J, Oliver D, Al-Diwani A, Minichino A, Fusar-Poli P. The Translational Future of Stress Neurobiology and Psychosis Vulnerability: A Review of the Evidence. Curr Neuropharmacol 2024; 22:350-377. [PMID: 36946486 PMCID: PMC10845079 DOI: 10.2174/1570159x21666230322145049] [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] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/17/2022] [Accepted: 12/27/2022] [Indexed: 03/23/2023] Open
Abstract
Psychosocial stress is a well-established risk factor for psychosis, yet the neurobiological mechanisms underlying this relationship have yet to be fully elucidated. Much of the research in this field has investigated hypothalamic-pituitary-adrenal (HPA) axis function and immuno-inflammatory processes among individuals with established psychotic disorders. However, as such studies are limited in their ability to provide knowledge that can be used to develop preventative interventions, it is important to shift the focus to individuals with increased vulnerability for psychosis (i.e., high-risk groups). In the present article, we provide an overview of the current methods for identifying individuals at high-risk for psychosis and review the psychosocial stressors that have been most consistently associated with psychosis risk. We then describe a network of interacting physiological systems that are hypothesised to mediate the relationship between psychosocial stress and the manifestation of psychotic illness and critically review evidence that abnormalities within these systems characterise highrisk populations. We found that studies of high-risk groups have yielded highly variable findings, likely due to (i) the heterogeneity both within and across high-risk samples, (ii) the diversity of psychosocial stressors implicated in psychosis, and (iii) that most studies examine single markers of isolated neurobiological systems. We propose that to move the field forward, we require well-designed, largescale translational studies that integrate multi-domain, putative stress-related biomarkers to determine their prognostic value in high-risk samples. We advocate that such investigations are highly warranted, given that psychosocial stress is undoubtedly a relevant risk factor for psychotic disorders.
Collapse
Affiliation(s)
- Alexis E. Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, United Kingdom
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Solna, Sweden
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Javier Labad
- CIBERSAM, Sabadell, Barcelona, Spain
- Department of Mental Health and Addictions, Consorci Sanitari del Maresme, Mataró, Spain
| | - Dominic Oliver
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Adam Al-Diwani
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Amedeo Minichino
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- National Institute of Health Research Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
10
|
Dube SR, Li ET, Fiorini G, Lin C, Singh N, Khamisa K, McGowan J, Fonagy P. Childhood verbal abuse as a child maltreatment subtype: A systematic review of the current evidence. CHILD ABUSE & NEGLECT 2023; 144:106394. [PMID: 37586139 DOI: 10.1016/j.chiabu.2023.106394] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND In recent years, the prevalence of childhood emotional abuse has surpassed other forms of maltreatment. Childhood verbal abuse (CVA) is a key attribute of emotional abuse, yet CVA is not recognized as its own form of maltreatment and thus, has not received adequate attention. Clear terminology, definitions, and measures are needed to aid in assessing the occurrence and impact of CVA for its recognition and prevention. OBJECTIVE We aim to synthesize the evidence on the terms, definitions, and measurements of CVA and identify outcomes associated with CVA. PARTICIPANTS AND SETTING A systematic review focused on adult perpetration of CVA among children and adolescents using clinical, community-based, and population-based samples. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed and four databases were utilized in May 2022: PsycINFO, MEDLINE, EMBASE, and ProQuest. A total of 149 quantitative and 17 qualitative studies were identified. RESULTS Across studies reviewed, the most common perpetrators of CVA were parents, mothers, and teachers. Definitional themes for CVA included negative speech volume, tone, and speech content, and their immediate impact. The most frequent measures cited were Adverse Childhood Experiences Study (ACE) Questionnaire and the Conflict Tactics Scale (CTS); 50 % used self-created measures. CVA was associated with a range of internalizing and externalizing outcomes across the lifespan. CONCLUSIONS Recognizing CVA as a form of maltreatment will be a starting point for its identification and prevention. Primary prevention of CVA using trauma-informed approaches must include adult training on the importance of safety, support, and nurturance during verbal communication with children.
Collapse
Affiliation(s)
- Shanta R Dube
- Director, Department of Public Health, Master of Public Health Program, Levine College of Health Sciences, Wingate University, Wingate, NC, United States of America.
| | - Elizabeth T Li
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Guilherme Fiorini
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Caleb Lin
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Nikita Singh
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Kumayl Khamisa
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Jennifer McGowan
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Peter Fonagy
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| |
Collapse
|
11
|
Nieto L, Domínguez-Martínez T, Navarrete L, Rosel-Vales M, Saracco-Álvarez R, Celada-Borja C, Rascón-Gasca ML, Samperio LGM. The effect of stressful life events on the risk for psychosis: differences between Mexican at clinical and familial high risk. Front Psychiatry 2023; 14:1254993. [PMID: 37840805 PMCID: PMC10570822 DOI: 10.3389/fpsyt.2023.1254993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023] Open
Abstract
Background Stressful life events (SLEs) in the development of early psychosis have been little studied in low-income countries. This study examines differences in the prevalence of SLEs in Mexican at clinical high risk (CHR) and those with familial high risk for psychosis who do not meet CHR criteria (non-CHR FHR). We also analyze the association between SLEs and CHR. Methods Participants included 43 persons with CHR and 35 with non-CHR FHR. CHR criteria were assessed with the Comprehensive Assessment of At-Risk Mental State. SLEs were assessed using the Questionnaire of Stressful Life Events. Results Participants with CHR reported more SLEs associated with negative academic experiences than those in the non-CHR FHR group. Bullying (OR = 7.77, 95% CI [1.81, 33.32]) and low educational level (OR = 21.25, 95% CI [5.19, 46.90]) were the strongest predictors of CHR, while starting to live with a partner (OR = 0.26, 95% CI [0.10, 0.84]) was associated with a lower risk of CHR. Conclusion Negative school experiences increase the risk of psychosis, particularly bullying, suggesting that schools may be ideal settings for implementing individual preventive strategies to reduce risk factors and increase protective factors to improve the prognosis of those at risk of developing psychosis. In Latin America, there are multiple barriers to early intervention in psychosis. It is thus crucial to identify risk and protective factors at the onset and in the course of psychosis in order to design effective preventive interventions.
Collapse
Affiliation(s)
- Lourdes Nieto
- Centro de Investigación en Salud Mental Global, Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz-UNAM, Mexico City, Mexico
| | - Tecelli Domínguez-Martínez
- Centro de Investigación en Salud Mental Global, Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz-UNAM, Mexico City, Mexico
| | - Laura Navarrete
- Departamento de Estudios Psicosociales en Poblaciones Específicas, Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Mauricio Rosel-Vales
- Clínica de Esquizofrenia, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Ricardo Saracco-Álvarez
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - César Celada-Borja
- Clínica de Esquizofrenia, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Maria Luisa Rascón-Gasca
- Departamento de Ciencias Sociales en Salud, Direccion de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | | |
Collapse
|
12
|
Andreou C, Eickhoff S, Heide M, de Bock R, Obleser J, Borgwardt S. Predictors of transition in patients with clinical high risk for psychosis: an umbrella review. Transl Psychiatry 2023; 13:286. [PMID: 37640731 PMCID: PMC10462748 DOI: 10.1038/s41398-023-02586-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
Diagnosis of a clinical high-risk (CHR) state enables timely treatment of individuals at risk for a psychotic disorder, thereby contributing to improving illness outcomes. However, only a minority of patients diagnosed with CHR will make the transition to overt psychosis. To identify patients most likely to benefit from early intervention, several studies have investigated characteristics that distinguish CHR patients who will later develop a psychotic disorder from those who will not. We aimed to summarize evidence from systematic reviews and meta-analyses on predictors of transition to psychosis in CHR patients, among characteristics and biomarkers assessed at baseline. A systematic search was conducted in Pubmed, Scopus, PsychInfo and Cochrane databases to identify reviews and meta-analyses of studies that investigated specific baseline predictors or biomarkers for transition to psychosis in CHR patients using a cross-sectional or longitudinal design. Non-peer-reviewed publications, gray literature, narrative reviews and publications not written in English were excluded from analyses. We provide a narrative synthesis of results from all included reviews and meta-analyses. For each included publication, we indicate the number of studies cited in each domain and its quality rating. A total of 40 publications (21 systematic reviews and 19 meta-analyses) that reviewed a total of 272 original studies qualified for inclusion. Baseline predictors most consistently associated with later transition included clinical characteristics such as attenuated psychotic and negative symptoms and functioning, verbal memory deficits and the electrophysiological marker of mismatch negativity. Few predictors reached a level of evidence sufficient to inform clinical practice, reflecting generalizability issues in a field characterized by studies with small, heterogeneous samples and relatively few transition events. Sample pooling and harmonization of methods across sites and projects are necessary to overcome these limitations.
Collapse
Affiliation(s)
- Christina Andreou
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
- Center of Brain, Behavior, and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Sofia Eickhoff
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Marco Heide
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Renate de Bock
- University Psychiatric Clinics Basel, Wilhelm Klein-Strasse 27, 4002, Basel, Switzerland
| | - Jonas Obleser
- Center of Brain, Behavior, and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
- Department of Psychology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Stefan Borgwardt
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
- Center of Brain, Behavior, and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
| |
Collapse
|
13
|
Fekih-Romdhane F, Stambouli M, Malaeb D, Farah N, Cheour M, Obeid S, Hallit S. Insomnia and distress as mediators on the relationship from cyber-victimization to self-reported psychotic experiences: a binational study from Tunisia and Lebanon. BMC Psychiatry 2023; 23:524. [PMID: 37475011 PMCID: PMC10360279 DOI: 10.1186/s12888-023-05019-w] [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: 02/16/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND While expansive research has accumulated concerning the association between traditional, face-to-face peer victimization and psychosis, a paucity of empirical research has been undertaken so far to investigate these associations with experiences of new and evolving ways of victimization through the digital world. Exploring these associations is highly relevant and timely, given that emerging adults are heavy users of digital technologies, highly exposed to online risks, and are at the peak age of onset of psychosis. This study aimed to test the hypothesis that psychological distress and insomnia symptoms have a significant indirect mediating effect on the association between cyber-victimization and self-reported positive psychotic experiences (SRPEs) in a binational sample of Tunisian and Lebanese community adults. METHOD The total sample was composed of 3766 participants; 3103 were from Lebanon (Mean age: 21.73 ± 3.80 years, 63.6% females) and 663 from Tunisia (Mean age: 26.32 ± 4.86 years, 59.9% females). Online anonymous self-report questionnaires were administered to all participants. RESULTS Higher SRPEs were found in Lebanese participants compared to Tunisians, in single participants compared to married ones, in those with a university level of education compared to secondary or less, in those who live in rural areas compared to urban, in those who do not smoke, do not drink alcohol and do not use marijuana or any other illegal drug. Furthermore, more cyber-victimization, a higher insomnia severity and psychological distress were significantly associated with higher SRPEs. After adjusting for potential confounders, mediation analysis demonstrated that higher cyber-victimization was significantly associated with more insomnia severity/psychological distress; which were, in turn, significantly associated with greater SRPEs. Finally, more cyber-victimization was significantly and directly associated with more positive dimension. CONCLUSION Identifying insomnia and distress as mediators could provide novel insight for psychosis prevention efforts and intervention targets for cyber-victimized individuals prone to experience subclinical psychotic symptoms.
Collapse
Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry “Ibn Omrane”, Razi hospital, Manouba, 2010 Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Manel Stambouli
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry “Ibn Omrane”, Razi hospital, Manouba, 2010 Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Nour Farah
- Faculty of Science, Lebanese University, Fanar, Lebanon
| | - Majda Cheour
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry “Ibn Omrane”, Razi hospital, Manouba, 2010 Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
| |
Collapse
|
14
|
Georgiades A, Almuqrin A, Rubinic P, Mouhitzadeh K, Tognin S, Mechelli A. Psychosocial stress, interpersonal sensitivity, and social withdrawal in clinical high risk for psychosis: a systematic review. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:38. [PMID: 37330526 DOI: 10.1038/s41537-023-00362-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/28/2023] [Indexed: 06/19/2023]
Abstract
Stress has repeatedly been implicated in the onset and exacerbation of positive symptoms of psychosis. Increasing interest is growing for the role of psychosocial stress in the development of psychosis symptoms in individuals at Clinical High Risk (CHR) for psychosis. A systematic review was therefore conducted to summarize the existing evidence base regarding psychosocial stress, interpersonal sensitivity, and social withdrawal in individuals at CHR for psychosis. An electronic search of Ovid (PsychINFO, EMBASE, MEDLINE, and GLOBAL HEALTH) was conducted until February 2022. Studies that examined psychosocial stress in CHR were included. Twenty-nine studies were eligible for inclusion. Psychosocial stress, interpersonal sensitivity, and social withdrawal were higher in CHR individuals compared to healthy controls and there was some evidence of their association with positive symptoms of psychosis. Two types of psychosocial stressors were found to occur more frequently with CHR status, namely daily stressors, and early and recent trauma, while significant life events did not appear to be significant. Greater exposure to psychosocial stress, emotional abuse, and perceived discrimination significantly increased risk of transition to psychosis in CHR. No studies examined the role of interpersonal sensitivity on transition to psychosis in CHR. This systematic review provides evidence for the association of trauma, daily stressors, social withdrawal, and interpersonal sensitivity with CHR status. Further studies investigating the impact of psychosocial stress on psychosis symptom expression in individuals at CHR and its effects on transition to psychosis are therefore warranted.
Collapse
Affiliation(s)
- A Georgiades
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK.
- Brent Early Intervention Service, CNWL, NHS Foundation Trust, 27-29 Fairlight Avenue, London, NW10 8AL, UK.
| | - A Almuqrin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - P Rubinic
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - K Mouhitzadeh
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - S Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - A Mechelli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| |
Collapse
|
15
|
Ottesen A, T. V. Hegelstad W, Joa I, Opjordsmoen SE, Rund BR, Røssberg JI, Simonsen E, Johannessen JO, Larsen TK, Haahr UH, McGlashan TH, Friis S, Melle I. Childhood trauma, antipsychotic medication, and symptom remission in first-episode psychosis. Psychol Med 2023; 53:2399-2408. [PMID: 37144963 PMCID: PMC10123824 DOI: 10.1017/s003329172100427x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND To what extent psychotic symptoms in first-episode psychosis (FEP) with a history of childhood interpersonal trauma (CIT) are less responsive to antipsychotic medication is not known. In this longitudinal study, we compare symptom trajectories and remission over the first 2 years of treatment in FEP with and without CIT and examine if differences are linked to the use of antipsychotics. METHODS FEP (N = 191) were recruited from in- and outpatient services 1997-2000, and assessed at baseline, 3 months, 1 and 2 years. Inclusion criteria were 15-65 years, actively psychotic with a DSM-IV diagnosis of psychotic disorder and no previous adequate treatment for psychosis. Antipsychotic medication is reported as defined daily dosage (DDD). CIT (<18) was assessed with the Brief Betrayal Trauma Survey, and symptomatic remission based on scores from the Positive and Negative Syndrome Scale. RESULTS CIT (n = 63, 33%) was not associated with symptomatic remission at 2 years follow-up (71% in remission, 14% in relapse), or time to first remission (CIT 12/ no-CIT 9 weeks, p = 0.51). Those with CIT had significantly more severe positive, depressive, and excited symptoms. FEP with physical (N = 39, 20%) or emotional abuse (N = 22, 14, 7%) had higher DDD at 1 year (p < 0.05). Mean DDD did not excerpt a significant between-group effect on symptom trajectories of positive symptoms. CONCLUSION Results indicate that antipsychotic medication is equally beneficial in the achievement of symptomatic remission in FEP after 2 years independent of CIT. Still, FEP patients with CIT had more severe positive, depressive, and excited symptoms throughout.
Collapse
Affiliation(s)
- Akiah Ottesen
- NORMENT Centre, Division of Mental Health and Addiction Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - W. T. V. Hegelstad
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Inge Joa
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health, Network for Medical Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Stein E. Opjordsmoen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, Oslo, Norway
- Vestre Viken Hospital Trust, Drammen, Norway
| | - Jan Ivar Røssberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jan Olav Johannessen
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health, Network for Medical Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Tor K. Larsen
- TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Institute of Psychiatry, University of Bergen, Bergen, Norway
| | - Ulrik Helt Haahr
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
| | | | - Svein Friis
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- NORMENT Centre, Division of Mental Health and Addiction Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
16
|
Domínguez-Martínez T, Sheinbaum T, Fresán A, Nieto L, López SR, Robles R, Lara MDC, de la Fuente-Sandoval C, Barrantes-Vidal N, Saracco R, Franco-Paredes K, Díaz-Reséndiz F, Rosel M. Psychosocial factors associated with the risk of developing psychosis in a Mexican general population sample. Front Psychiatry 2023; 14:1095222. [PMID: 36873227 PMCID: PMC9979221 DOI: 10.3389/fpsyt.2023.1095222] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/25/2023] [Indexed: 02/18/2023] Open
Abstract
Epidemiological evidence has linked an array of sociodemographic and psychosocial factors with an increased risk of developing psychosis. However, research in samples from low- and middle-income countries is still scarce. This study used a Mexican sample to explore (i) sociodemographic and psychosocial differences between individuals with and without a positive screen for Clinical High-Risk for psychosis (CHR), and (ii) sociodemographic and psychosocial factors associated with screening positive for CHR. The sample consisted of 822 individuals from the general population who completed an online survey. Of the participants, 17.3% (n = 142) met the CHR screening criteria. Comparisons between those who screened positive (CHR-positive group) and those who did not (Non-CHR group) showed that participants in the CHR-positive group were younger, had a lower educational level, and reported more mental health problems than the Non-CHR group. Furthermore, relative to the Non-CHR group, the CHR-positive group had a greater prevalence of medium/high risk associated with cannabis use, a higher prevalence of adverse experiences (bullying, intimate partner violence, and experiencing a violent or unexpected death of a relative or friend), as well as higher levels of childhood maltreatment, poorer family functioning, and more distress associated with the COVID-19 pandemic. Groups did not differ in sex, marital/relationship status, occupation, and socio-economic status. Finally, when examined in multivariate analyses, the variables associated with screening positive for CHR were: having an unhealthy family functioning (OR = 2.75, 95%CI 1.69-4.46), a higher risk associated with cannabis use (OR = 2.75, 95%CI 1.63-4.64), a lower level of education (OR = 1.55, 95%CI 1.003-2.54), having experienced a major natural disaster (OR = 1.94, 95%CI 1.18-3.16), having experienced a violent or unexpected death of a relative or friend (OR = 1.85, 95%CI 1.22-2.81), higher levels of childhood emotional abuse (OR = 1.88, 95%CI 1.09-3.25), physical neglect (OR = 1.68, 95%CI 1.08-2.61), and physical abuse (OR = 1.66, 95%CI 1.05-2.61), and higher COVID-related distress (OR = 1.10, 95%CI 1.01-1.20). An older age was a protective factor for screening positive for CHR (OR = 0.96, 95%CI 0.92-0.99). Overall, the findings highlight the importance of examining potential psychosocial contributors to psychosis vulnerability across different sociocultural contexts to delineate risk and protective processes relevant to specific populations and better target preventive intervention efforts.
Collapse
Affiliation(s)
- Tecelli Domínguez-Martínez
- Centro de Investigación en Salud Mental Global, Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”-UNAM, Mexico City, Mexico
| | - Tamara Sheinbaum
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Mexico City, Mexico
| | - Ana Fresán
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Mexico City, Mexico
| | - Lourdes Nieto
- Centro de Investigación en Salud Mental Global, Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”-UNAM, Mexico City, Mexico
| | - Steven R. López
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
| | - Rebeca Robles
- Centro de Investigación en Salud Mental Global, Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”-UNAM, Mexico City, Mexico
| | - Ma del Carmen Lara
- Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | | | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
- Sant Pere Claver - Fundació Sanitària, Barcelona, Spain
- Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
| | - Ricardo Saracco
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Mexico City, Mexico
| | | | | | - Mauricio Rosel
- Clínica de Esquizofrenia, Instituto Nacional de Psiquiatría “Ramón de la Fuente Muñiz”, Mexico City, Mexico
| |
Collapse
|
17
|
Farris MS, Braun A, Liu L, Bearden CE, Cadenhead KS, Cornblatt BA, Keshavan M, Mathalon DH, McGlashan TH, Perkins DO, Stone WS, Tsuang MT, Walker EF, Woods SW, Cannon TD, Addington J. Longitudinal impact of trauma in the North American Prodrome Longitudinal Study-3. Early Interv Psychiatry 2022; 16:1211-1216. [PMID: 35152553 PMCID: PMC9374846 DOI: 10.1111/eip.13270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 11/03/2021] [Accepted: 01/18/2022] [Indexed: 11/30/2022]
Abstract
AIM Individuals at clinical high risk (CHR) for psychosis have been shown to experience more trauma than the general population. However, although the effects of trauma appear to impact some symptoms it does not seem to increase the risk of transition to psychosis. The aim of this article was to examine the prevalence of trauma, and its association with longitudinal clinical and functional outcomes in a large sample of CHR individuals. METHODS From the North American Prodrome Longitudinal Study-3 (NAPLS-3) 690 CHR individuals and 91 healthy controls from nine study sites between 2015 and 2018 were assessed. Historical trauma experiences were captured at baseline. Participants completed longitudinal assessments measuring clinical outcomes including positive and negative symptoms, depression, social and role functioning and assessing transition to psychosis. RESULTS From the 690 CHR participants and 96 healthy controls, 343 (49.6%) and 15 (15.6%), respectively, reported a history of trauma (p < .001). Emotional neglect (70.3%) was the most commonly reported type of trauma, followed by psychological abuse (57.4%). Among CHR participants, time to transition to psychosis was not associated with trauma. Baseline depression and suspiciousness/persecutory ideas were statistically significantly different between CHR individuals who did or did not experience trauma. However, when examining clinical and functional outcomes over 12-months of follow-up, there were no differences between those who experienced trauma and those who did not. CONCLUSION Overall, trauma is a significantly prevalent among CHR individuals. The effects of trauma on transition and longitudinal clinical and functional outcomes were not significant.
Collapse
Affiliation(s)
- Megan S. Farris
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Amy Braun
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Lu Liu
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E. Bearden
- Departments of Psychiatry and Biobehavioral Sciences and Psychology, UCLA, Los Angeles, CA, United States of America
| | | | - Barbara A. Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, United States of America
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, United States of America
| | - Daniel H. Mathalon
- Department of Psychiatry, UCSF, and SFVA Medical Center, San Francisco, CA, United States of America
| | - Thomas H. McGlashan
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Diana O. Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States of America
| | - William S. Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, United States of America
| | - Ming T. Tsuang
- Department of Psychiatry, UCSD, San Diego, CA, United States of America
- Institute of Genomic Medicine, University of California, La Jolla, CA, United States of America
| | - Elaine F. Walker
- Departments of Psychology and Psychiatry, Emory University, Atlanta, GA, United States of America
| | - Scott W. Woods
- Department of Psychiatry, Yale University, New Haven, CT, United States of America
| | - Tyrone D. Cannon
- Department of Psychology, Yale University, New Haven, CT, United States of America
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
18
|
Zhou J, Fan A, Zhou X, Pao C, Xiao L, Feng Y, Xi R, Chen Y, Huang Q, Dong B, Zhou J. Interrelationships between childhood maltreatment, depressive symptoms, functional impairment, and quality of life in patients with major depressive disorder: A network analysis approach. CHILD ABUSE & NEGLECT 2022; 132:105787. [PMID: 35917751 DOI: 10.1016/j.chiabu.2022.105787] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/22/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Childhood maltreatment continues to pose a great challenge to psychiatry. Although there is growing evidence demonstrating that childhood maltreatment is an important risk factor for depressive disorders, it remains to be elucidated which specific symptoms occur after exposure to different kinds of childhood maltreatment, and whether certain pathways may account for these associations. PARTICIPANTS AND SETTINGS A total of 203 adult patients (18-53 years old) with MDD, diagnosed by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, were recruited from the outpatient clinic of Beijing Anding Hospital, Capital Medical University. METHODS Childhood maltreatment, depressive symptoms, functional impairment, and quality of life were evaluated by the Childhood Trauma Questionnaire - Short Form (CTQ-SF), 17-item Hamilton Depression Rating Scale (HAMD-17), Sheehan Disability Scale (SDS), and Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF). Undirected network analysis was used to explore the most relevant connections between them. Bayesian network analysis was used to estimate a directed acyclic graph (DAG) while investigating the most likely direction of the putative causal association. RESULTS In network analysis, the strongest edges were a positive correlation between emotional abuse and suicidal behavior as well as a negative association between emotional neglect and age of onset. In DAG analysis, emotional abuse emerged as the most pivotal network node, triggering both suicidal behaviors and depression symptoms. CONCLUSIONS Emotional abuse appears to be an extremely harmful form of childhood maltreatment in the clinical presentation of depression. This study has promise in informing the clinical intervention of depression.
Collapse
Affiliation(s)
- Jia Zhou
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China
| | - Anyuyang Fan
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xinyi Zhou
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Christine Pao
- Mental Health and Behavioral Science Service, Bruce W. Carter VA Medical Center, Miami, FL, United States
| | - Le Xiao
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yuan Feng
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Rui Xi
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China; Beijing Institute of Mental Health, Beijing, China
| | - Yun Chen
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China; Beijing Institute of Mental Health, Beijing, China
| | - Qingzhi Huang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China; Beijing Institute of Mental Health, Beijing, China
| | - Bin Dong
- Institute of Child and Adolescent Health, School of Public Health, Peking University, Beijing, China.
| | - Jingjing Zhou
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| |
Collapse
|
19
|
Rosenfield PJ, Jiang D, Pauselli L. Childhood adversity and psychotic disorders: Epidemiological evidence, theoretical models and clinical considerations. Schizophr Res 2022; 247:55-66. [PMID: 34210561 DOI: 10.1016/j.schres.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 02/08/2023]
Abstract
While genetic factors play a critical role in the risk for schizophrenia and other psychotic disorders, increasing evidence points to the role of childhood adversity as one of several environmental factors that can significantly impact the development, manifestations and outcome of these disorders. This paper reviews the epidemiological evidence linking childhood adversity and psychotic disorders and explores various theoretical models that seek to explain the connection. We discuss neurobiological parallels between the impact of childhood trauma and psychosis on the brain and then explore the impact of childhood adversity on different domains of clinical presentation. Finally, implications for prevention and treatment are considered, both on individual and structural levels.
Collapse
Affiliation(s)
- Paul J Rosenfield
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America.
| | - David Jiang
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America.
| | - Luca Pauselli
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America.
| |
Collapse
|
20
|
Braun A, Liu L, Bearden CE, Cadenhead KS, Cornblatt BA, Keshavan M, Mathalon DH, McGlashan TH, Perkins DO, Seidman LJ, Stone W, Tsuang MT, Walker EF, Woods SW, Cannon TD, Addington J. Bullying in clinical high risk for psychosis participants from the NAPLS-3 cohort. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1379-1388. [PMID: 35113189 DOI: 10.1007/s00127-022-02239-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/22/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Bullying is associated with a heightened risk for poor outcomes, including psychosis. This study aimed to replicate previous findings on bullying prevalence in clinical high-risk (CHR) individuals, to assess the longitudinal course of clinical and functional variables between bullied and non-bullied CHR and the association of bullying with premorbid functioning, clinical outcome, transition to psychosis and risk of violence. METHODS The sample consisted of 691 CHR participants and 96 healthy controls. Participants reported whether they had experienced bullying and how long it had lasted. Assessments included DSM-5 diagnoses, attenuated psychotic symptoms, negative symptoms, social and role functioning, depression, stress, premorbid functioning, and risk of violence. The bullied and non-bullied CHR groups were compared at baseline and further longitudinally on clinical and functioning variables and transition to psychosis. RESULTS Bullying was more prevalent among CHR individuals than healthy controls. Bullied CHR had a higher prevalence of PTSD and more severe depression and stress at baseline than non-bullied CHR. There was no impact of bullying on clinical and functional variables over time. Bullying was not related to final clinical status or transition to psychosis. However, bullied participants had poorer premorbid functioning and a greater risk of violence. CONCLUSION While bullying may not impact the likelihood of CHR individuals to transition to psychosis, it may be a risk factor for development of the at-risk state and may be related to a greater risk of violence. Future studies should consider bullying perpetration among CHR individuals.
Collapse
Affiliation(s)
- Amy Braun
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Lu Liu
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Carrie E Bearden
- Departments of Psychiatry and Biobehavioral Sciences and Psychology, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, CA, USA
| | | | | | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - Daniel H Mathalon
- Department of Psychiatry, UCSF, and SFVA Medical Center, San Francisco, CA, USA
| | | | - Diana O Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Larry J Seidman
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - William Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Boston, MA, USA
| | - Ming T Tsuang
- Department of Psychiatry, UCSD, San Diego, CA, USA.,Institute of Genomic Medicine, University of California, La Jolla, CA, USA
| | - Elaine F Walker
- Departments of Psychology and Psychiatry, Emory University, Atlanta, GA, USA
| | - Scott W Woods
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| |
Collapse
|
21
|
Faustino B. Minding my brain: Fourteen neuroscience-based principles to enhance psychotherapy responsiveness. Clin Psychol Psychother 2022; 29:1254-1275. [PMID: 35112428 DOI: 10.1002/cpp.2719] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 12/21/2021] [Accepted: 01/28/2022] [Indexed: 11/12/2022]
Abstract
Intersections between psychotherapy and neurosciences are at its dawn. The quest to understand the neural underpinnings of psychological processes has led several generations of scientists to explore neural correlates between mind, brain, and behavior. Neuroscience methods and research has given psychology new perspectives and insights about the structure and function of complex neural pathways, that underly human functioning (cognition, emotion, motivation, and interpersonal behavior). By translating neuroscientific findings into psychotherapeutic principles of change, it is possible to promote responsiveness towards brain dysfunction that underlies patients' psychological malfunctioning. In psychotherapy, responsiveness is a core aspect of the therapeutic change process, especially to adapt psychological interventions to patients' motivational stages and preferences, coping styles, neurobehavioral modes, and emotional needs. Within a transtheoretical and translational approach, contemporary neuroscientific findings are revised, discussed, and used to attempt to build-on fourteen theoretical brain-based principles that may be applied to psychotherapy. Translating these empirical findings into practical principles, clinical strategies and tasks is expected to enhance psychotherapy responsiveness grounded on a science-based knowledge of brain functioning.
Collapse
Affiliation(s)
- Bruno Faustino
- Faculdade de Psicologia da Universidade de Lisboa, Portugal.,HEI-Lab, Lusófona University, Lisbon, Portugal
| |
Collapse
|
22
|
Dvir Y. Childhood Trauma and Psychosis: A Brief Updated Review and Case Study. Child Adolesc Psychiatr Clin N Am 2022; 31:91-98. [PMID: 34801157 DOI: 10.1016/j.chc.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Significant evidence suggests strong links between childhood trauma and psychosis, with childhood trauma considered a significant risk factor for psychosis, causing a more severe presentation of psychotic illness with a dose-response effect. The relationship between anxiety, mood, posttraumatic stress disorder, and childhood trauma and psychosis and the difficulties distinguishing between overlapping symptoms require careful attention of the treating clinician considering the presentation and treatment course. Finally, there also appears to be a link between childhood trauma and violent behavior in individuals with psychotic illness. More research is needed into the effectiveness and safety of trauma-focused psychotherapeutic interventions.
Collapse
Affiliation(s)
- Yael Dvir
- Department of Psychiatry, University of Massachusetts Chan Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
| |
Collapse
|
23
|
Rossi R, Collazzoni A, Talevi D, Gibertoni D, Quarta E, Rossi A, Stratta P, Di Lorenzo G, Pacitti F. Personal and contextual components of resilience mediate risky family environment's effect on psychotic-like experiences. Early Interv Psychiatry 2021; 15:1677-1685. [PMID: 33369062 DOI: 10.1111/eip.13111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 09/04/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Psychotic-like experiences (PLEs) index an increased risk for subsequent psychotic disorders. A risky family environment is a well-established risk factor for PLEs; however, different contextual and personal resiliency factors may differentially mediate its effect on PLEs. OBJECTIVE In this study, we propose a two-dimensional model of resilience. Our aim is to address separately the mediational role of personal and contextual resiliency factors between a risky family environment and PLEs in a community sample. METHODS AND MATERIALS Five-hundred University students completed an on-line questionnaire, including the Resilience Scale for Adults (RSA), the 16-item version of the Prodromal Questionnaire (iPQ-16) and the Risky Family Questionnaire (RFQ). Mediation was assessed using Structural Equation Modelling with bootstrapping estimation of indirect effect. RESULTS The direct effects of personal and contextual resilience on PLEs were respectively -0.69 [-0.97, -0.41] (P < .001) and - 0.19 [-0.58, 0.20] (ns); the indirect effect through personal resilience was 0.03[0.01, 0.04] (P < .001). Personal resilience mediated 27.4% of the total effect of risky family environment on PLEs. DISCUSSION Personal resilience, as opposite to contextual resilience, mediates the effect of a risky family environment on PLEs. Low personal resilience may represent an individual risk factor that transmits the effect of risky family environment on PLEs and could represent a central aspect of individualized prevention and treatment strategies.
Collapse
Affiliation(s)
- Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Collazzoni
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Dalila Talevi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Dino Gibertoni
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Eleonora Quarta
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paolo Stratta
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Francesca Pacitti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
24
|
Bemrose HV, Akande IO, Cullen AE. Self-esteem in individuals at ultra-high risk for psychosis: A systematic review and meta-analysis. Early Interv Psychiatry 2021; 15:775-786. [PMID: 32860493 DOI: 10.1111/eip.13034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/22/2020] [Accepted: 08/02/2020] [Indexed: 11/27/2022]
Abstract
AIM Low self-esteem (LSE) has been reported among individuals with psychosis and is hypothesized to act as a risk and maintenance factor for the disorder. However, the extent to which LSE also characterizes individuals deemed at ultra-high risk (UHR) for psychosis (who present features consistent with the prodromal phase of illness), has yet to be quantified using meta-analysis. This is important given that LSE is a potentially modifiable target for early intervention services aiming to reduce the risk of psychosis transition in this population. METHODS We searched Medline, Embase, PsycINFO and Web of Science Core Collection for studies examining self-esteem in UHR and healthy individuals. Random-effects models were used to examine group differences in self-esteem (Hedges'g) with exploratory meta-regression analyses employed to investigate the effect of study characteristics (mean age of UHR group, the proportion of male participants in the UHR group and study quality) on standardized mean differences. RESULTS Six studies were eligible for inclusion. Significant differences in self-esteem were observed, with individuals at UHR showing reduced self-esteem relative to healthy controls (g = -1.33 [-1.73 to -0.94] P < .001).However, there was evidence of substantial heterogeneity (I2 = 75%). Exploratory meta-regression analyses indicated a significant effect of the mean age of the UHR group on effect sizes (B = -0.26, P = .02). CONCLUSIONS UHR youth present with lower levels of self-esteem than healthy individuals, a difference that appears to be more pronounced with advancing age. We discuss clinical implications and provide recommendations for future studies.
Collapse
Affiliation(s)
- Holly V Bemrose
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Isaac O Akande
- Outreach and Support in South London (OASIS), South London and Maudsley NHS Foundation Trust, London, UK
| | - Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| |
Collapse
|
25
|
Chaiyachati BH, Gur RE. Effect of child abuse and neglect on schizophrenia and other psychotic disorders. Pharmacol Biochem Behav 2021; 206:173195. [PMID: 33961909 PMCID: PMC10961915 DOI: 10.1016/j.pbb.2021.173195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/20/2021] [Accepted: 04/29/2021] [Indexed: 12/25/2022]
Abstract
Childhood experiences impact long-term physical and behavioral health outcomes including potential risk for schizophrenia and psychosis. Negative experiences, such as child abuse and neglect, have been specifically associated with risk for schizophrenia and psychosis. This review provides a brief overview of child abuse and neglect, including its position within the larger field of trauma and adversity and its long term consequences. The link to schizophrenia is then explored. Principles of treatment and outcomes for schizophrenia with antecedent child abuse and neglect are then reviewed. Finally, next steps and points of prevention are highlighted.
Collapse
Affiliation(s)
- Barbara H Chaiyachati
- The Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; The University of Pennsylvania, Lifespan Brain Institute of Penn-Medicine and CHOP, Philadelphia, PA, United States of America; The Center for Pediatric Clinical Effectiveness and Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; The Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, United States of America.
| | - Raquel E Gur
- The Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; The University of Pennsylvania, Lifespan Brain Institute of Penn-Medicine and CHOP, Philadelphia, PA, United States of America
| |
Collapse
|
26
|
Uchikawa H, Fujii K, Shiohama T, Nakazato M, Shimizu E, Miyashita T, Shimojo N. Specific temperament in patients with nevoid basal cell carcinoma syndrome. Pediatr Int 2021; 63:177-182. [PMID: 32745364 DOI: 10.1111/ped.14419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/15/2020] [Accepted: 07/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nevoid basal cell carcinoma syndrome (NBCCS) is a neurocutaneous disease, characterized by tumorigenesis and developmental anomalies due to aberrant sonic hedgehog (Shh) signaling. Patients with NBCCS typically appear calm and carefree, suggesting that a specific personality in these patients may be associated with an enhanced hedgehog pathway. Our study aimed to determine the personality type in these patients. METHODS We enrolled 14 mentally normal patients with genetically confirmed NBCCS (seven males and seven females; mean age = 25.2 years) and 20 controls (10 males and 10 females; mean age = 27.9 years). The patients were assessed with the Japanese version of the Temperament and Character Inventory, based on the seven-dimensional model of temperament and character, and their clinical symptoms were evaluated. The amygdala volumes of six patients with NBCCS were measured using magnetic resonance imaging with image-processing software. RESULTS Patients with NBCCS scored significantly lower on harm avoidance (0.89) than controls (1.00; P = 0.0084). Moreover, patients with NBCCS and developmental malformations such as rib anomalies, who may have experienced Shh signaling enhancement from the prenatal period, scored significantly lower on harm avoidance (0.80 [P = 0.0031]). The left amygdala volume was also significantly reduced in patients with NBCCS (P = 0.0426). CONCLUSIONS Patients with NBCCS who experienced increased Shh signaling from the prenatal period showed significantly lower harm avoidance related to serotonin. The left amygdala volume was significantly reduced in these patients. Our results indicate that Shh signaling may influence the human personality.
Collapse
Affiliation(s)
- Hideki Uchikawa
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan.,Department of Pediatrics, Eastern Chiba Medical Center, Togane, Japan
| | - Katsunori Fujii
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tadashi Shiohama
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Michiko Nakazato
- Department of Psychiatry, International University of Health and Welfare, Narita, Japan
| | - Eiji Shimizu
- Department of Cognitive Behavioral Physiology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Toshiyuki Miyashita
- Department of Genetics, Kitasato University School of Medicine, Sagamihara, Japan
| | - Naoki Shimojo
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan
| |
Collapse
|
27
|
Frydecka D, Kotowicz K, Gawęda Ł, Prochwicz K, Kłosowska J, Rymaszewska J, Samochowiec A, Samochowiec J, Podwalski P, Pawlak-Adamska E, Szmida E, Cechnicki A, Misiak B. Effects of interactions between variation in dopaminergic genes, traumatic life events, and anomalous self-experiences on psychosis proneness: Results from a cross-sectional study in a nonclinical sample. Eur Psychiatry 2020; 63:e104. [PMID: 33213551 PMCID: PMC8057383 DOI: 10.1192/j.eurpsy.2020.103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background There is a growing number of studies showing interactions between genetic polymorphisms associated with dopaminergic neurotransmission and traumatic life events (TLEs) on a risk of psychotic-like experiences (PLEs). Anomalous self-experiences (ASEs) have been associated both with TLEs as well as with PLEs. However, it remains unknown what is the role of ASEs in the complexity of gene–environment interactions on the emergence of PLEs. Patients and methods We included 445 young adults—university students from three big cities in Poland. We used the Traumatic Events Checklist to assess TLEs, the Inventory of Psychotic-Like anomalous self-experiences in order to measure ASEs, and the Prodromal Questionnaire (PQ16) to record the level of PLEs. The following gene polymorphisms, related to dopaminergic neurotransmission, were determined: the catechol-O-methyltransferase (COMT) rs4680 polymorphism, the dopamine D2 receptor (DRD2) rs6277 polymorphism, and the dopamine transporter 1 (DAT1) rs28363170 polymorphism. Results There was a significant effect of the interaction between the DAT1 polymorphism, a severity of ASEs, and a history of TLEs on the level of PLEs. Among the DAT1 10R/10R homozygotes with low level of ASEs, a severity of PLEs was significantly higher in individuals with a history of any TLEs. Higher scores of the PQ16 were associated with a greater severity of ASEs both in the DAT1 9R allele carriers and the DAT1 10R/10R homozygotes. Conclusion Our findings imply that genetic liability related to aberrant dopamine transport might impact the association between TLEs and PLEs in subjects with high levels of ASEs.
Collapse
Affiliation(s)
- Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, 50-367Wroclaw, Poland
| | - Kamila Kotowicz
- Department of Psychiatry, Wroclaw Medical University, 50-367Wroclaw, Poland
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | | | - Joanna Kłosowska
- Institute of Psychology, Jagiellonian University, 30-060Krakow, Poland
| | - Joanna Rymaszewska
- Department of Psychiatry, Wroclaw Medical University, 50-367Wroclaw, Poland
| | - Agnieszka Samochowiec
- Institute of Psychology, Department of Clinical Psychology, University of Szczecin, 71-017Szczecin, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, 71-460Szczecin, Poland
| | - Piotr Podwalski
- Department of Psychiatry, Pomeranian Medical University, 71-460Szczecin, Poland
| | - Edyta Pawlak-Adamska
- Department of Experimental Therapy, Laboratory of Immunopathology, Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 51-114Wroclaw, Poland
| | - Elżbieta Szmida
- Department of Genetics, Wroclaw Medical University, 50-368Wroclaw, Poland
| | - Andrzej Cechnicki
- Department of Community Psychiatry, Chair of Psychiatry, Medical College Jagiellonian University, Krakow, Poland
| | - Błażej Misiak
- Department of Genetics, Wroclaw Medical University, 50-368Wroclaw, Poland
| |
Collapse
|
28
|
Samaey C, Van der Donck S, van Winkel R, Boets B. Facial Expression Processing Across the Autism-Psychosis Spectra: A Review of Neural Findings and Associations With Adverse Childhood Events. Front Psychiatry 2020; 11:592937. [PMID: 33281648 PMCID: PMC7691238 DOI: 10.3389/fpsyt.2020.592937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/09/2020] [Indexed: 11/13/2022] Open
Abstract
Autism spectrum disorder (ASD) and primary psychosis are classified as distinct neurodevelopmental disorders, yet they display overlapping epidemiological, environmental, and genetic components as well as endophenotypic similarities. For instance, both disorders are characterized by impairments in facial expression processing, a crucial skill for effective social communication, and both disorders display an increased prevalence of adverse childhood events (ACE). This narrative review provides a brief summary of findings from neuroimaging studies investigating facial expression processing in ASD and primary psychosis with a focus on the commonalities and differences between these disorders. Individuals with ASD and primary psychosis activate the same brain regions as healthy controls during facial expression processing, albeit to a different extent. Overall, both groups display altered activation in the fusiform gyrus and amygdala as well as altered connectivity among the broader face processing network, probably indicating reduced facial expression processing abilities. Furthermore, delayed or reduced N170 responses have been reported in ASD and primary psychosis, but the significance of these findings is questioned, and alternative frequency-tagging electroencephalography (EEG) measures are currently explored to capture facial expression processing impairments more selectively. Face perception is an innate process, but it is also guided by visual learning and social experiences. Extreme environmental factors, such as adverse childhood events, can disrupt normative development and alter facial expression processing. ACE are hypothesized to induce altered neural facial expression processing, in particular a hyperactive amygdala response toward negative expressions. Future studies should account for the comorbidity among ASD, primary psychosis, and ACE when assessing facial expression processing in these clinical groups, as it may explain some of the inconsistencies and confound reported in the field.
Collapse
Affiliation(s)
- Celine Samaey
- Department of Neurosciences, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium
| | - Stephanie Van der Donck
- Department of Neurosciences, Center for Developmental Psychiatry, KU Leuven, Leuven, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
| | - Ruud van Winkel
- Department of Neurosciences, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium
- University Psychiatric Center (UPC), KU Leuven, Leuven, Belgium
| | - Bart Boets
- Department of Neurosciences, Center for Developmental Psychiatry, KU Leuven, Leuven, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
| |
Collapse
|
29
|
Fusar-Poli P, Salazar de Pablo G, Correll CU, Meyer-Lindenberg A, Millan MJ, Borgwardt S, Galderisi S, Bechdolf A, Pfennig A, Kessing LV, van Amelsvoort T, Nieman DH, Domschke K, Krebs MO, Koutsouleris N, McGuire P, Do KQ, Arango C. Prevention of Psychosis: Advances in Detection, Prognosis, and Intervention. JAMA Psychiatry 2020; 77:755-765. [PMID: 32159746 DOI: 10.1001/jamapsychiatry.2019.4779] [Citation(s) in RCA: 275] [Impact Index Per Article: 68.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Detection, prognosis, and indicated interventions in individuals at clinical high risk for psychosis (CHR-P) are key components of preventive psychiatry. OBJECTIVE To provide a comprehensive, evidence-based systematic appraisal of the advancements and limitations of detection, prognosis, and interventions for CHR-P individuals and to formulate updated recommendations. EVIDENCE REVIEW Web of Science, Cochrane Central Register of Reviews, and Ovid/PsychINFO were searched for articles published from January 1, 2013, to June 30, 2019, to identify meta-analyses conducted in CHR-P individuals. MEDLINE was used to search the reference lists of retrieved articles. Data obtained from each article included first author, year of publication, topic investigated, type of publication, study design and number, sample size of CHR-P population and comparison group, type of comparison group, age and sex of CHR-P individuals, type of prognostic assessment, interventions, quality assessment (using AMSTAR [Assessing the Methodological Quality of Systematic Reviews]), and key findings with their effect sizes. FINDINGS In total, 42 meta-analyses published in the past 6 years and encompassing 81 outcomes were included. For the detection component, CHR-P individuals were young (mean [SD] age, 20.6 [3.2] years), were more frequently male (58%), and predominantly presented with attenuated psychotic symptoms lasting for more than 1 year before their presentation at specialized services. CHR-P individuals accumulated several sociodemographic risk factors compared with control participants. Substance use (33% tobacco use and 27% cannabis use), comorbid mental disorders (41% with depressive disorders and 15% with anxiety disorders), suicidal ideation (66%), and self-harm (49%) were also frequently seen in CHR-P individuals. CHR-P individuals showed impairments in work (Cohen d = 0.57) or educational functioning (Cohen d = 0.21), social functioning (Cohen d = 1.25), and quality of life (Cohen d = 1.75). Several neurobiological and neurocognitive alterations were confirmed in this study. For the prognosis component, the prognostic accuracy of CHR-P instruments was good, provided they were used in clinical samples. Overall, risk of psychosis was 22% at 3 years, and the risk was the highest in the brief and limited intermittent psychotic symptoms subgroup (38%). Baseline severity of attenuated psychotic (Cohen d = 0.35) and negative symptoms (Cohen d = 0.39) as well as low functioning (Cohen d = 0.29) were associated with an increased risk of psychosis. Controlling risk enrichment and implementing sequential risk assessments can optimize prognostic accuracy. For the intervention component, no robust evidence yet exists to favor any indicated intervention over another (including needs-based interventions and control conditions) for preventing psychosis or ameliorating any other outcome in CHR-P individuals. However, because the uncertainty of this evidence is high, needs-based and psychological interventions should still be offered. CONCLUSIONS AND RELEVANCE This review confirmed recent substantial advancements in the detection and prognosis of CHR-P individuals while suggesting that effective indicated interventions need to be identified. This evidence suggests a need for specialized services to detect CHR-P individuals in primary and secondary care settings, to formulate a prognosis with validated psychometric instruments, and to offer needs-based and psychological interventions.
Collapse
Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom.,OASIS Service, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Maudsley Biomedical Research Centre, National Institute for Health Research, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom.,Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, New York.,The Feinstein Institute for Medical Research, Center for Psychiatric Neuroscience, Manhasset, New York.,Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Andreas Meyer-Lindenberg
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Mark J Millan
- Centre for Therapeutic Innovation in Neuropsychiatry, Institut de Recherche Servier, Croissy sur Seine, Paris, France
| | - Stefan Borgwardt
- Department of Psychiatry, University of Basel, Basel, Switzerland.,Department of Psychiatry, Psychosomatics and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania L. Vanvitelli, Naples, Italy
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine with Early Intervention and Recognition Centre, Vivantes Klinikum Am Urban, Charité-Universitätsmedizin, Berlin, Germany.,Vivantes Klinikum im Friedrichshain, Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Charité-Universitätsmedizin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.,Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Center, Psychiatric Center Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center School for Mental Health and Neuroscience, Maastricht, the Netherlands
| | - Dorien H Nieman
- Amsterdam University Medical Centers, Academic Medical Center, Department of Psychiatry, Amsterdam, the Netherlands
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Basics in NeuroModulation (NeuroModul), Medical Faculty, University of Freiburg, Germany
| | - Marie-Odile Krebs
- INSERM, IPNP UMR S1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université Paris Descartes, Université de Paris, CNRS, GDR3557-Institut de Psychiatrie, Paris, France.,Faculté de Médecine Paris Descartes, GHU Paris-Sainte-Anne, Service Hospitalo-Universitaire, Paris, France
| | - Nikolaos Koutsouleris
- University Hospital, Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany.,Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom
| | - Philip McGuire
- Maudsley Biomedical Research Centre, National Institute for Health Research, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Institute of Psychiatry, Psychology & Neuroscience, Department of Psychosis Studies, King's College London, London, United Kingdom
| | - Kim Q Do
- Center for Psychiatric Neuroscience, Lausanne University Hospital, Lausanne-Prilly, Switzerland
| | - Celso Arango
- Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Madrid, Spain
| |
Collapse
|
30
|
Tognin S, Catalan A, Modinos G, Kempton MJ, Bilbao A, Nelson B, Pantelis C, Riecher-Rössler A, Bressan R, Barrantes-Vidal N, Krebs MO, Nordentoft M, Ruhrmann S, Sachs G, Rutten BPF, van Os J, de Haan L, van der Gaag M, McGuire P, Valmaggia LR. Emotion Recognition and Adverse Childhood Experiences in Individuals at Clinical High Risk of Psychosis. Schizophr Bull 2020; 46:823-833. [PMID: 32080743 PMCID: PMC7345818 DOI: 10.1093/schbul/sbz128] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate the association between facial affect recognition (FAR) and type of adverse childhood experiences (ACEs) in a sample of clinical high risk (CHR) individuals and a matched sample of healthy controls (HCs). METHODS In total, 309 CHR individuals and 51 HC were recruited as part of an European Union-funded multicenter study (EU-GEI) and included in this work. During a 2-year follow-up period, 65 CHR participants made a transition to psychosis (CHR-T) and 279 did not (CHR-NT). FAR ability was measured using a computerized version of the Degraded Facial Affect Recognition (DFAR) task. ACEs were measured using the Childhood Experience of Care and Abuse Questionnaire, the Childhood Trauma Questionnaire, and the Bullying Questionnaire. Generalized regression models were used to investigate the relationship between ACE and FAR. Logistic regressions were used to investigate the relationship between FAR and psychotic transition. RESULTS In CHR individuals, having experienced emotional abuse was associated with decreased total and neutral DFAR scores. CHR individuals who had experienced bullying performed better in the total DFAR and in the frightened condition. In HC and CHR, having experienced the death of a parent during childhood was associated with lower DFAR total score and lower neutral DFAR score, respectively. Analyses revealed a modest increase of transition risk with increasing mistakes from happy to angry faces. CONCLUSIONS Adverse experiences in childhood seem to have a significant impact on emotional processing in adult life. This information could be helpful in a therapeutic setting where both difficulties in social interactions and adverse experiences are often addressed.
Collapse
Affiliation(s)
- Stefania Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, UK,To whom correspondence should be addressed; tel: +44(0)2078480415, fax: +44 (0)20 7848 0287, e-mail:
| | - Ana Catalan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,Department of Psychiatry, Basurto University Hospital, Bilbao, Spain,Department of Neuroscience, University of the Basque Country, Leioa, Spain
| | - Gemma Modinos
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), London, UK
| | - Amaia Bilbao
- Research Unit, Basurto University Hospital, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Christos Pantelis
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Rodrigo Bressan
- LiNC – Lab Integrative Neuroscience, Depto Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo – UNIFESP, São Paulo, Brazil
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut (Universitat Autònoma de Barcelona), Fundació Sanitària Sant Pere Claver, Spanish Mental Health Research Network (CIBERSAM), Madrid, Spain
| | - Marie-Odile Krebs
- INSERM, IPNP UMR S1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université Paris Descartes, Université de Paris, CNRS, GDR3557-Institut de Psychiatrie, Paris, France,Faculté de Médecine Paris Descartes, GHU Paris – Sainte-Anne, Service Hospitalo-Universitaire, Paris, France
| | - Merete Nordentoft
- Mental Health Center Copenhagen and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Center Glostrup, Mental Health Services in the Capital Region of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands,Department of Psychiatry, UMC Utrecht Brain Center, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Lieuwe de Haan
- Department of Early Psychosis, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology and Amsterdam Public Mental Health research institute, Faculty of Behavioural and Movement Sciences, VU University, Amsterdam, The Netherlands,Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | | | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, UK,National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), London, UK
| | - Lucia R Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| |
Collapse
|
31
|
Cullen AE, Addington J, Bearden CE, Stone WS, Seidman LJ, Cadenhead KS, Cannon TD, Cornblatt BA, Mathalon DH, McGlashan TH, Perkins DO, Tsuang MT, Woods SW, Walker EF. Stressor-Cortisol Concordance Among Individuals at Clinical High-Risk for Psychosis: Novel Findings from the NAPLS Cohort. Psychoneuroendocrinology 2020; 115:104649. [PMID: 32197198 PMCID: PMC7193890 DOI: 10.1016/j.psyneuen.2020.104649] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 02/19/2020] [Accepted: 03/04/2020] [Indexed: 01/02/2023]
Abstract
Whilst elevations in basal cortisol levels have been reported among individuals at-risk for psychosis, the extent to which this represents hyperresponsivity of the hypothalamic-pituitary-adrenal (HPA) axis to psychosocial stressors encountered in the natural environment is currently unclear. We aimed to examine stressor-cortisol concordance among youth at clinical high-risk (CHR) for psychosis in the North American Prodrome Longitudinal Study 2 (NAPLS 2) and the relationship with clinical outcome. At baseline, CHR (N = 457) and healthy (N = 205) individuals provided salivary cortisol samples and completed daily stressor, life event, and childhood trauma measures. CHR youth were categorised as remitted, symptomatic, progression of positive symptoms, or psychosis conversion at the two-year follow-up. Within-group regression models tested associations between psychosocial stressors and cortisol; standardised beta coefficients (Stβ) were subsequently derived to enable within-group pooling of effect sizes across stressor types. After adjustment for potential confounders, all CHR subgroups reported greater exposure to life events and daily stressors, and more distress in relation to these events, relative to controls. All CHR groups were also more likely to experience childhood trauma; only CHR converters, however, were characterised by elevated basal cortisol. Daily stressor distress was significantly associated with cortisol in controls (β = 0.60, 95% CI: 0.12-1.08) and CHR youth who converted to psychosis (β = 0.91, 95% CI: 0.05-1.78). In controls only, life event exposure was associated with cortisol (β = 0.45, 95% CI: 0.08-0.83). When pooled across stressors, stressor-cortisol concordance was substantially higher among CHR converters (Stβ = 0.26, 95% CI: 0.07 to 0.44) relative to CHR progressed (Stβ = 0.02, 95% CI: -0.11 to 0.15), symptomatic (Stβ = 0.01, 95% CI: -0.11 to 0.12), and remitted groups (Stβ = 0.00, 95% CI: -0.13 to 0.13); however, unexpectedly, healthy controls showed intermediate levels of concordance (Stβ = 0.15, 95% CI: 0.05 to 0.26). In conclusion, whilst all CHR subgroups showed increased psychosocial stress exposure and distress relative to controls, only those who later converted to psychosis were characterised by significantly elevated basal cortisol levels. Moreover, only CHR converters showed a higher magnitude of stressor-cortisol concordance compared to controls, although confidence intervals overlapped considerably between these two groups. These findings do not support the notion that all individuals at CHR for psychosis show HPA hyperresponsiveness to psychosocial stressors. Instead, CHR individuals vary in their response to stressor exposure/distress, perhaps driven by genetic or other vulnerability factors.
Collapse
Affiliation(s)
- Alexis E. Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom,Corresponding author at: Institute of Psychiatry, Psychology & Neuroscience (PO67), 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, United Kingdom.
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Carrie E. Bearden
- Department of Psychiatry and Behavioural Sciences and Psychology, UCLA, Los Angeles, United States
| | - William S. Stone
- Harvard Medical School, Departments of Psychiatry at Massachusetts Mental Health Center Public Psychiatry Division, Beth Israel Deaconess Medical Center, Massachusetts, General Hospital, Boston, MA, United States
| | - Larry J. Seidman
- Harvard Medical School, Departments of Psychiatry at Massachusetts Mental Health Center Public Psychiatry Division, Beth Israel Deaconess Medical Center, Massachusetts, General Hospital, Boston, MA, United States
| | - Kristin S. Cadenhead
- Department of Psychiatry, University of California, San Diego, CA, United States
| | - Tyrone D. Cannon
- Department of Psychiatry, Yale University, New Haven, Connecticut, United States
| | - Barbara A. Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, United States
| | - Daniel H. Mathalon
- Department of Psychiatry, University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | | | - Diana O. Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States
| | - Ming T. Tsuang
- Department of Psychiatry, University of California, San Diego, CA, United States
| | - Scott W. Woods
- Department of Psychiatry, Yale University, New Haven, CT, United States
| | - Elaine F. Walker
- Department of Psychology, Emory University, Atlanta, GA, United States,Department of Psychiatry, Emory University, Atlanta, GA, United States,Corresponding author at: 487 PAIS Building, 36 Eagle Row, Emory University, Atlanta, GA, 30322, United States.
| |
Collapse
|
32
|
Piotrowski P, Frydecka D, Kotowicz K, Stańczykiewicz B, Samochowiec J, Szczygieł K, Misiak B. A history of childhood trauma and allostatic load in patients with psychotic disorders with respect to stress coping strategies. Psychoneuroendocrinology 2020; 115:104645. [PMID: 32171901 DOI: 10.1016/j.psyneuen.2020.104645] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 12/14/2022]
Abstract
Elevated allostatic load (AL) index, which is a cumulative measure of biological dysregulations associated with stress exposure, has been demonstrated in patients with psychosis. However, it remains unknown whether a history of childhood trauma (CT) might contribute to elevated AL index in psychosis. Therefore, we aimed to investigate the association between AL index, a history of CT and coping styles in patients with psychotic disorders. Participants were 65 patients with schizophrenia-spectrum disorders and 56 healthy controls (HCs). The AL index was computed based on percentile distributions of 15 biomarkers in HCs. The AL index was significantly higher in patients with psychosis. A history of parental antipathy was associated with elevated AL index in both groups of participants. A history of any categories of CT and sexual abuse were associated with higher AL index only in patients with psychosis. Social diversion (seeking social interactions in case of stressful experiences) mediated the association between sexual abuse and the AL index in the group of patients. There was a significant direct effect of sexual abuse on the AL index (this specific CT was associated with higher AL index). However, indirect effect of sexual trauma on AL through social diversion was opposite to direct effect. Childhood adversities, especially sexual abuse and parental antipathy, might contribute to elevated AL index in patients with psychosis. The effect of sexual abuse on the AL index might be specific to psychosis. Engagement in social interactions in case of stressful situations might alleviate biological dysregulations associated with CT.
Collapse
Affiliation(s)
- Patryk Piotrowski
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10 Street, 50-367 Wroclaw, Poland
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10 Street, 50-367 Wroclaw, Poland
| | - Kamila Kotowicz
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10 Street, 50-367 Wroclaw, Poland
| | - Bartłomiej Stańczykiewicz
- Department of Nervous System Diseases, Wroclaw Medical University, Bartla 5 Street, 51-618 Wroclaw, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-460 Szczecin, Poland
| | - Krzysztof Szczygieł
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-460 Szczecin, Poland
| | - Błażej Misiak
- Department of Genetics, Wroclaw Medical University, Marcinkowskiego 1 Street, 50-368 Wroclaw, Poland.
| |
Collapse
|
33
|
Ayerbe L, Pérez-Piñar M, Foguet-Boreu Q, Ayis S. Psychosis in children of separated parents: A systematic review and meta-analysis. Eur Psychiatry 2020; 63:e3. [PMID: 32093793 PMCID: PMC7315852 DOI: 10.1192/j.eurpsy.2019.15] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Parental separation is a very common childhood adversity. The association between other adverse childhood experiences and an increased risk of psychosis has been reported. However, the evidence on the risk of psychosis for children of separated parents is limited. In this systematic review, cohort, case-control, and cross-sectional studies, comparing the risk of psychotic disorders for people with and without separated parents, were searched, critically appraised, and summarized. METHODS Studies were searched in PubMed, EMBASE, PsycINFO, and the Web of Science, from database inception to September 2019. A meta-analysis, using random-effects models, was undertaken to obtain pooled estimates of the risk of psychosis among participants with separated parents. RESULTS Twelve studies, with 305,652 participants from 22 countries, were included in the review. A significantly increased risk of psychosis for those with separated parents was observed, with a pooled odds ratio: 1.53 (95% confidence interval [CI]: 1.29-1.76), p < 0.001. The association remained significant when cohort, case-control, and cross-sectional studies were analyzed separately. The five cohort studies included in this review showed and increased risk of psychosis with odds ratio: 1.47 (95% CI: 1.26-1.69), p < 0.001. CONCLUSIONS Parental separation is a common childhood adversity associated with an increased risk of psychosis. Although the risk for an individual child of separated parents is still low, given the high proportion of couple that separate, the increased rates of psychosis may be substantial in the population. Further studies on the risk of psychosis in those with separated parents, and the explanatory factors for this association, are required.
Collapse
Affiliation(s)
- Luis Ayerbe
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Centre of Primary Care and Public Health, Queen Mary University of London, London, United Kingdom
- Carnarvon Medical Centre, Southend-on-Sea, United Kingdom
| | | | - Quintí Foguet-Boreu
- Department of Psychiatry, Vic University Hospital, Vic, Spain
- Faculty of Health Sciences and Welfare, University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
| | - Salma Ayis
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, South London at King’s College Hospital NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
34
|
Cullen AE, Rai S, Vaghani MS, Mondelli V, McGuire P. Cortisol Responses to Naturally Occurring Psychosocial Stressors Across the Psychosis Spectrum: A Systematic Review and Meta-Analysis. Front Psychiatry 2020; 11:513. [PMID: 32595532 PMCID: PMC7300294 DOI: 10.3389/fpsyt.2020.00513] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/19/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Individuals with established psychosis and those at high-risk for the disorder have been found to show abnormalities within the hypothalamic-pituitary-adrenal (HPA) axis, including elevations in basal and diurnal cortisol, but a blunted cortisol awakening response. However, the extent to which these features are associated with psychosocial stressors encountered in the natural environment (which are known to be more commonly experienced by these groups, and more distressing) is currently unclear. We therefore conducted a systematic review and meta-analysis to investigate the concordance between naturally-occurring psychosocial stressors and cortisol levels in these populations. METHODS PubMed, PsycINFO, and EMBASE were searched up to November 2019 to identify studies examining the concordance between psychosocial stressors and cortisol in healthy controls and individuals on the psychosis spectrum (patients with established psychosis and/or high-risk individuals). An overall meta-analysis (including data for all stressor-cortisol pairings) was performed to determine the degree of concordance irrespective of group status, with meta-regression employed to test whether the degree of concordance differed in established psychosis and high-risk groups compared to controls. Planned stratified analyses were then performed to examine group differences (where established psychosis and high-risk groups were combined) within individual stressor-cortisol pairings. RESULTS Eighteen studies (16 datasets) were eligible for inclusion. The overall model, comprising 134 effect sizes, showed that stressors and cortisol measures were only weakly correlated [r=0.05 (95% CI: -0.00 to 0.10), p=0.059] and that neither established psychosis status (r=0.01, p=0.838) nor high-risk status (r=0.02, p=0.477) had a significant effect of the strength of correlation. In stratified analyses, significant differences between healthy controls and psychosis spectrum groups were observed for only one of the six stressor-cortisol pairings examined, where life event exposure and diurnal cortisol were positively correlated in controls [r=0.25 (95% CI: 0.01 to 0.46)], but negatively correlated in the psychosis spectrum group [r=-0.28 (95% CI: -0.49 to -0.04)]. CONCLUSIONS Overall, we observed poor concordance between naturally-occurring psychosocial stressors and cortisol irrespective of stressor type, cortisol measure, or group status. We consider a range of methodological factors that may have obscured the ability to detect "true" associations and provide recommendations for future studies in this field.
Collapse
Affiliation(s)
- Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sushma Rai
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Meghna S Vaghani
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| |
Collapse
|