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Stevenson A, Misra S, Girma E, Isvoranu AM, Akena D, Alemayehu M, Atwoli L, Gelaye B, Gichuru S, Kariuki SM, Kwobah EK, Kyebuzibwa J, Mwema RM, Newman CP, Newton CRJC, Ongeri L, Stroud RE, Teferra S, Koenen KC, Seedat S. Relationships between trauma types and psychotic symptoms: A network analysis of patients with psychotic disorders in a large, multi-country study in East Africa. Compr Psychiatry 2024; 133:152504. [PMID: 38876004 PMCID: PMC11253580 DOI: 10.1016/j.comppsych.2024.152504] [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: 12/11/2023] [Revised: 04/30/2024] [Accepted: 05/30/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND The link between trauma exposure and psychotic disorders is well-established. Further, specific types of trauma may be associated with specific psychotic symptoms. Network analysis is an approach that can advance our understanding of the associations across trauma types and psychotic symptoms. METHODS We conducted a network analysis with data from 16,628 adult participants (mean age [standard deviation] = 36.3 years [11.5]; 55.8% males) with psychotic disorders in East Africa recruited between 2018 and 2023. We used the Life Events Checklist and the Mini International Neuropsychiatric Interview to determine whether specific trauma types experienced over the life course and specific psychotic symptoms were connected. We used an Ising model to estimate the network connections and bridge centrality statistics to identify nodes that may influence trauma types and psychotic symptoms. RESULTS The trauma type "exposure to a war zone" had the highest bridge strength, betweenness, and closeness. The psychotic symptom "odd or unusual beliefs" had the second highest bridge strength. Exposure to a war zone was directly connected to visual hallucinations, odd or unusual beliefs, passivity phenomena, and disorganized speech. Odd or unusual beliefs were directly connected to transportation accidents, physical assault, war, and witnessing sudden accidental death. CONCLUSION Specific trauma types and psychotic symptoms may interact bidirectionally. Screening for psychotic symptoms in patients with war-related trauma and evaluating lifetime trauma in patients with odd or unusual beliefs in clinical care may be considered points of intervention to limit stimulating additional psychotic symptoms and trauma exposure. This work reaffirms the importance of trauma-informed care for patients with psychotic disorders.
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Affiliation(s)
- Anne Stevenson
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA; Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Supriya Misra
- Department of Public Health, San Francisco State University, San Francisco, CA, USA
| | - Engida Girma
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Dickens Akena
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Melkam Alemayehu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lukoye Atwoli
- Department of Mental Health and Behavioural Sciences, School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya; Brain and Mind Institute, The Aga Khan University, Nairobi, Kenya; Department of Medicine, Medical College East Africa, The Aga Khan University, Nairobi, Kenya
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA; Department of Psychiatry, Harvard Medical School and the Chester M. Pierce MD, Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Stella Gichuru
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Symon M Kariuki
- Neurosciences Unit, Clinical Department, KEMRI-Wellcome Trust Research Programme-Coast, Kilifi, Kenya; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Joseph Kyebuzibwa
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rehema M Mwema
- Neurosciences Unit, Clinical Department, KEMRI-Wellcome Trust Research Programme-Coast, Kilifi, Kenya
| | - Carter P Newman
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Charles R J C Newton
- Neurosciences Unit, Clinical Department, KEMRI-Wellcome Trust Research Programme-Coast, Kilifi, Kenya; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Linnet Ongeri
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Rocky E Stroud
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA; Psychiatric & Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Soraya Seedat
- South African Medical Research Council Unit on the Genomics of Brain Disorders, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Del Pozo-Herce P, Miguel AGD, Gonzalez-Rosas L, Alejandro-Rubio O, Pascual-Lapuerta C, Porras-Segovia A. Grief as a Risk Factor for Psychosis: A Systematic Review. Curr Psychiatry Rep 2024; 26:379-393. [PMID: 38833148 DOI: 10.1007/s11920-024-01512-5] [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] [Accepted: 05/06/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE OF REVIEW The assessment of the risk of triggering psychosis upon exposure to grief is a challenge in clinical practice. Adequate diagnosis and early prevention are essential and may be helpful in the evolution of normal grief. We aimed to identify studies exploring grief as a risk factor for developing psychosis. RECENT FINDINGS A systematic review of 3 databases (PubMed, EMBASE, and Cochrane Library) was conducted. RESULTS In the first approach 618 studies were identified. After the selection process, 15 studies were included in the review. The association between grief and the risk of developing psychosis occurred at younger ages (before 18 years of age) in a first-degree relative and as a consequence of suicide or accidental death. We found that risk factors such as comorbidity, mental problems, unemployment, economic difficulties, and close ties with the deceased have a negative impact on health causing greater vulnerability to psychosis with a risk of developing complicated grief, with statistically significant results regarding the associations between early parental death and the probability of developing psychosis in adulthood.
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Affiliation(s)
- Pablo Del Pozo-Herce
- Department of Psychiatry, Fundación Jiménez Díaz University Hospital, Madrid, Spain.
- Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain.
| | | | - Luis Gonzalez-Rosas
- Department of Psychiatry, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | | | | | - Alejandro Porras-Segovia
- Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
- Department of Psychiatry, Hospital Rey Juan Carlos, Madrid, Spain
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Gouse BM, Oblath R, Gibbs JS, Reagan EG, Brown HE. COVID-19 pandemic and emergency department visits for psychosis: Visit volume, restraint use, medication use, psychiatric hospitalization, and length of stay. Schizophr Res 2024; 267:301-307. [PMID: 38603838 DOI: 10.1016/j.schres.2024.02.017] [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: 01/04/2023] [Revised: 07/07/2023] [Accepted: 02/14/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Individuals with a schizophrenia spectrum disorder were at heightened risk for interruptions in psychiatric care during the coronavirus-19 (COVID 19) pandemic. There is limited work exploring the pandemic's impact on emergency department (ED) visit volume, use of restraint and parenteral medications, inpatient psychiatric (IP) hospitalization, and ED length of stay (LOS) among this population. METHODS We retrospectively examined 2134 ED visits with a billing code for psychosis between March 1, 2019-February 28, 2021. We used Poisson regression analysis to compare ED visit volume between the pandemic and pre-pandemic periods. Restraint use, parenteral antipsychotic or benzodiazepine use, IP hospitalization, and ED LOS were compared between the two periods using chi-square tests and independent samples t-tests. RESULTS Overall volume of psychosis-related ED visits during the pandemic did not differ significantly from the prior year. Rates of restraint use (16.2 % vs 11.6 %, p < .01), parenteral antipsychotic (22.6 % vs 14.9, p < .001), and parenteral benzodiazepine (22.3 % vs 16.3 %, p < .001) use were significantly higher during the pandemic. Fewer patients had an IP hospital disposition during the pandemic than the year prior (57.8 % vs. 61.9 %, p < .05). ED LOS was longer during the pandemic compared to pre-pandemic (28.37 h vs 20.26 h, p < .001). CONCLUSIONS Although the volume of psychosis-related ED visits remained constant, restraint and parenteral medication use rates were significantly higher during the pandemic. ED LOS increased but fewer ED visits resulted in IP hospitalization. These findings underscore the importance of planning for increased acuity of psychosis ED presentations during public health emergencies.
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Affiliation(s)
- Brittany M Gouse
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston 02118, USA; Wellness and Recovery After Psychosis Research Program, Boston Medical Center, Boston, MA 02118, USA.
| | - Rachel Oblath
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston 02118, USA
| | - Jada S Gibbs
- Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Ellen G Reagan
- Wellness and Recovery After Psychosis Research Program, Boston Medical Center, Boston, MA 02118, USA
| | - Hannah E Brown
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston 02118, USA; Wellness and Recovery After Psychosis Research Program, Boston Medical Center, Boston, MA 02118, USA
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Smit R, Luckhoff HK, Phahladira L, Du Plessis S, Emsley R, Asmal L. Relapse in schizophrenia: The role of factors other than non-adherence to treatment. Early Interv Psychiatry 2024. [PMID: 38320862 DOI: 10.1111/eip.13510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 11/20/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
AIM Relapse rates are very high in schizophrenia. However, little is known about the predictors of the time to relapse other than treatment non-adherence. We investigated possible risk factors for the time to relapse in patients with first-episode schizophrenia (n = 107) who received assured treatment by way of long-acting injectable antipsychotic over 24 months and who underwent regular clinical, cognitive, and metabolic assessments. METHODS Using Cox regression analyses we assessed selected premorbid and baseline potential predictors of time to relapse. Relapse was defined using operationally defined relapse criteria. RESULTS In the primary analysis only neurological soft signs total score retained significance, with higher scores predicting shorter time to relapse (HR = 1.05, 95% CI = 1.01-1.10, p = .029). In a more detailed secondary analysis poorer social relationships predicted shorter time to relapse (HR = 0.85, 95% CI = 0.76-0.95, p = .003). CONCLUSION Our predominantly negative findings suggest that many of the previously implicated risk factors for the time to relapse are mediated by non-adherence rather than having a direct effect on relapse-proneness. Neurological soft signs, and perhaps quality of life in social relationships appear to play a role and merit further investigation.
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Affiliation(s)
- R Smit
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - H K Luckhoff
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - L Phahladira
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - S Du Plessis
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - R Emsley
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - L Asmal
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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Aoki J, Zaitsu T, Oshiro A, Aida J. Association of Stressful Life Events With Oral Health Among Japanese Workers. J Epidemiol 2024; 34:16-22. [PMID: 36642514 PMCID: PMC10701250 DOI: 10.2188/jea.je20220225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/11/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Psychological stress can cause various mental and physical health problems. The previous results on stress and oral health are inconsistent, possibly because of the narrow stress measurements. We aimed to examine the association between a broader range of stressful life events and oral health among workers. METHODS This cross-sectional study analyzed anonymous individual data from a national survey in Japan. Data on stressful life events, oral health problems which are one or more of tooth pain, gum swelling/bleeding, and difficulty chewing, and covariates were obtained using a self-reported questionnaire. Covariates used included gender, age group, and disease under treatment. Logistic regression analysis was used to estimate the association between stressful life events and oral health problems. We then estimated the causal treatment effects of stress using the augmented inverse-probability weighting (AIPW) method. RESULTS Among the 274,881 subjects, 152,850 men (55.6%) and 122,031 women (44.4%) with a mean age of 47.0 (standard deviation, 14.4) years, 4.0% reported oral health problems, with a prevalence of 2.1% among those without any stress. The prevalence increased with stress score, reaching 15.4% for those with the maximum stress score. The adjusted odds ratio of this group compared to those without any stress was 9.2 (95% confidence interval [CI], 8.2-10.3). The estimated prevalence of oral health problems by the AIPW analysis was 2.2% (95% CI, 2.1-2.3%) for those without any stress and 14.4% (95% CI, 12.1-16.7%) for those with the maximum stress scores. CONCLUSION There was a clear dose-response association between stressful life events and oral health problems.
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Affiliation(s)
- Jin Aoki
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takashi Zaitsu
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akiko Oshiro
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jun Aida
- Department of Oral Health Promotion, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Colizzi M, Bortoletto R, Antolini G, Bhattacharyya S, Balestrieri M, Solmi M. Biobehavioral Interactions between Endocannabinoid and Hypothalamicpituitary- adrenal Systems in Psychosis: A Systematic Review. Curr Neuropharmacol 2024; 22:495-520. [PMID: 37533248 PMCID: PMC10845076 DOI: 10.2174/1570159x21666230801150032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/02/2023] [Accepted: 02/05/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND The diathesis-stress paradigm and the cannabinoid-hypothesis have been proposed as possible pathophysiological models of schizophrenia. However, they have historically been studied independently of each other. OBJECTIVE This PRISMA 2020-compliant systematic review aimed at reappraising the interplay between the hypothalamic-pituitary-adrenal (HPA) axis and the endocannabinoid (eCB) system in psychosis- spectrum disorder risk and outcome. METHODS All pathophysiological and outcome clinical studies, concomitantly evaluating the two systems in psychosis-spectrum disorder risk and different stages of illness, were gathered from electronic databases (Pubmed, Web of Science, and Scopus), and discussed. RESULTS 41 eligible outputs were extracted, focusing on at least a biological measure (9 HPA-related studies: 4 eCB-interventional, 1 HPA-interventional, 1 both HPA-interventional and non-interventional, 3 non-interventional; 2 eCB-related studies: non-interventional), environmental measures only (29 studies: 1 eCB- interventional, 28 non-interventional), and genetic measures (1 study: non-interventional). Independent contributions of aberrancies in the two systems to the physiopathology and outcome of psychosis were confirmed. Also, concomitant alterations in the two systems, either genetically defined (e.g., CNR1 genetic variation), biologically determined (e.g., dysfunctional HPA axis or endocannabinoid signaling), or behaviorally imputed (e.g., cannabis use, stress exposure, and response), were consistently reported in psychosis. Further, a complex biobehavioral perturbation was revealed not only within each system (e.g., cannabis use affecting the eCB tone, stress exposure affecting the HPA axis), but also across the two systems (e.g., THC affecting the HPA axis, childhood trauma affecting the endocannabinoid signaling). CONCLUSION There is a need to concomitantly study the two systems' mechanistic contribution to psychosis in order to establish more refined biological relevance.
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Affiliation(s)
- Marco Colizzi
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine 33100, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Riccardo Bortoletto
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine 33100, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Giulia Antolini
- Child and Adolescent Neuropsychiatry Unit, Maternal-Child Integrated Care Department, Integrated University Hospital of Verona, Verona 37126, Italy
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Matteo Balestrieri
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine 33100, Italy
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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Ma Y, Chiappelli J, Kvarta MD, Bruce H, van der Vaart A, Goldwaser EL, Du X, Sampath H, Lightner S, Endres J, Yusuf A, Yuen A, Narvaez S, Campos-Saravia D, Kochunov P, Hong LE. Effects of independent versus dependent stressful life events on major symptom domains of schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:84. [PMID: 38065979 PMCID: PMC10709301 DOI: 10.1038/s41537-023-00415-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/17/2023] [Indexed: 02/12/2024]
Abstract
We evaluated two models to link stressful life events (SLEs) with the psychopathology of schizophrenia spectrum disorders (SSD). We separated SLEs into independent (iSLEs, unlikely influenced by one's behavior) and dependent (dSLEs, likely influenced by one's behavior). Stress-diathesis and stress generation models were evaluated for the relationship between total, i- and d- SLEs and the severity of positive, negative, and depressive symptoms in participants with SSD. Participants with SSD (n = 286; 196 males; age = 37.5 ± 13.5 years) and community controls (n = 121; 83 males; 35.4 ± 13.9 years) completed self-report of lifetime negative total, i- and d- SLEs. Participants with SSD reported a significantly higher number of total SLEs compared to controls (B = 1.11, p = 6.4 × 10-6). Positive symptom severity was positively associated with the total number of SLEs (β = 0.20, p = 0.001). iSLEs (β = 0.11, p = 0.09) and dSLEs (β = 0.21, p = 0.0006) showed similar association with positive symptoms (p = 0.16) suggesting stress-diathesis effects. Negative symptom severity was negatively associated with the number of SLEs (β = -0.19, p = 0.003) and dSLEs (β = -0.20, p = 0.001) but not iSLEs (β = -0.04, p = 0.52), suggesting stress generation effects. Depressive symptom severity was positively associated with SLEs (β = 0.34, p = 1.0 × 10-8), and the association was not statistically stronger for dSLEs (β = 0.33, p = 2.7 × 10-8) than iSLEs (β = 0.21, p = 0.0006), p = 0.085, suggesting stress-diathesis effects. The SLE - symptom relationships in SSD may be attributed to stress generation or stress-diathesis, depending on symptom domain. Findings call for a domain-specific approach to clinical intervention for SLEs in SSD.
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Affiliation(s)
- Yizhou Ma
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Joshua Chiappelli
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mark D Kvarta
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Heather Bruce
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew van der Vaart
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eric L Goldwaser
- Department of Psychiatry, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, NY, USA
| | - Xiaoming Du
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hemalatha Sampath
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Samantha Lightner
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jane Endres
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Akram Yusuf
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alexa Yuen
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Samantha Narvaez
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Danny Campos-Saravia
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - L Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
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Choi SL, Choi JM, McDonough IM, Jiang Z, Black SR. Aging alone and financial insecurity predict depression: a path analysis of objective and subjective indices. Aging Ment Health 2023; 27:2238-2247. [PMID: 37561077 DOI: 10.1080/13607863.2023.2243446] [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: 01/24/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVES This study draws on conservation of resources theory and transactional stress theory to guide our understanding of how social isolation, financial insecurity, and social support serve as a balance of both risk and protection for late-life depression. METHODS Data were from the Leave-Behind Questionnaire in the 2016 (N = 4293) and 2018 (N = 4714) waves of the Health and Retirement Study. We conducted a cross-sectional path analysis via structural equation modeling, including objective and subjective perspectives. The same model was tested in both samples. RESULTS Both social isolation and financial insecurity were associated with depression. We found several mediating risks and protective factors of these relationships. Objective financial status affected depression through both perceived financial insecurity and perceived social isolation, whereas objective isolation affected depression through perceived social support. This mediation model was -significant after adjusting for confounders. CONCLUSION This study underscores the importance of investigating the balance between risk and protection for depression, in the rising number of older adults aging alone in society. Findings suggest that objective and perceived measures offer unique windows into psychological constructs. Considering both objective and subjective perspectives may provide alternative targets for subsequent interventions to improve mental health in later life.
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Affiliation(s)
- Shinae L Choi
- Department of Consumer Sciences, College of Human Environmental Sciences, The University of Alabama, Tuscaloosa, AL, USA
| | - Jaimie M Choi
- Carruth Center for Counseling and Psychological Services, West Virginia University, Morgantown, WV, USA
| | - Ian M McDonough
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
| | - Zhehan Jiang
- Institute of Medical Education, Peking University, Beijing, China
| | - Sheila R Black
- Department of Psychology, The University of Alabama, Tuscaloosa, AL, USA
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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.
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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
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10
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Hilberdink CE, van Zuiden M, Olff M, Roseboom TJ, de Rooij SR. The impact of adversities across the lifespan on psychological symptom profiles in late adulthood: a latent profile analysis. J Dev Orig Health Dis 2023; 14:508-522. [PMID: 37477375 DOI: 10.1017/s2040174423000181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
People commonly face adverse circumstances throughout life, which increases risk for psychiatric disorders, such as anxiety, depression, psychosis, and posttraumatic stress disorder (PTSD). Adversities may occur during different periods in life. Especially adversity during early periods has been suggested to put individuals at risk for adverse mental health outcomes. Here, we investigated whether timing of adversity during the prenatal period, childhood, or mid-to-late adulthood differentially impacted classification into late adulthood symptom profiles. We performed sex-stratified Latent Profile Analysis to identify latent profiles regarding anxious, depressive, psychotic, and PTSD symptoms in n = 568 Dutch famine birth cohort members (n = 294 women, n = 274 men, mean age(SD) = 72.9(0.8)). Cross-sectional late adulthood symptomatology, childhood traumatic maltreatment, and adulthood trauma were based on self-report questionnaires. Prenatal adversity was considered present when individuals were prenatally exposed to the 1944-45 Dutch famine. In both men and women we identified one anxious/depressive profile and three profiles with approximately equal severity of all symptom types within each profile, yet differentiating in overall severity (low, mild, high) between profiles. We additionally found a PTSD symptom profile in women. In men, logistic regression models showed significant associations between prenatal, childhood and adulthood adversity, and profile classification, with differential effects depending on timing and most profound effects of child maltreatment. In women, childhood and adulthood adversity significantly increased classification probability into almost all profiles, with no significant effect of prenatal adversity. These findings support a time-dependent and sex-specific impact of adversity during different periods across the lifespan on psychological health, with consequences into late adulthood.
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Affiliation(s)
- C E Hilberdink
- Amsterdam UMC Location University of Amsterdam, Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Mood, Anxiety, Psychosis, Stress and Sleep, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, University of Amsterdam, Amsterdam, The Netherlands
| | - M van Zuiden
- Amsterdam UMC Location University of Amsterdam, Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Mood, Anxiety, Psychosis, Stress and Sleep, Amsterdam, The Netherlands
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - M Olff
- Amsterdam UMC Location University of Amsterdam, Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Neuroscience Research Institute, Mood, Anxiety, Psychosis, Stress and Sleep, Amsterdam, The Netherlands
- ARQ, National Psychotrauma Centre, Diemen, The Netherlands
| | - T J Roseboom
- Department of Epidemiology and Data Science, University of Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - S R de Rooij
- Department of Epidemiology and Data Science, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Aging and Later Life, Health Behaviors and Chronic Diseases, Amsterdam, The Netherlands
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11
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de Haan L, Linszen D, Wouters L, Zwinderman K, Dingemans P. Sustained specialized and family treatment in first-episode schizophrenia or related disorders: a 5-year randomized controlled trial. Psychol Med 2023; 53:4316-4323. [PMID: 35672956 PMCID: PMC10388306 DOI: 10.1017/s003329172200099x] [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: 12/14/2021] [Revised: 03/15/2022] [Accepted: 03/25/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The long-term outcome of first-episode schizophrenia needs improvement. Here, we evaluate the effectiveness of 5 years sustained specialist treatment (ST), ST including Parent groups (ST + P) or treatment as usual (TAU) on psychotic relapse and social functioning. METHODS A three condition randomized, parallel assigned, single-blind efficacy trial, in which 198 first-episode psychosis (FEP) patients aged 15-28 years were included. The effect on time to first relapse, first relapse rates, mean number of relapses per patient, and time to the improvement of social functioning were analyzed using Cox regression or ANOVA. RESULTS We found no significant differences between treatment conditions in the ITT analysis concerning time to first relapse, nor first relapse rate. Mean number of relapses per patient differed at a trend level between ST, ST + P or TAU conditions, respectively: 0.72; 0.62 or 1.02 (p = 0.069). No evidence was found for differential effect of treatment conditions on social functioning. CONCLUSION Five years sustained ST of FEP nor addition of parent groups increased time to first relapse or reduced first relapse rate, compared to sustained TAU. Indications for favorable effects of parent groups were found on relapses per patient.
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Affiliation(s)
- Lieuwe de Haan
- Department of Psychiatry, Early Psychosis, Amsterdam UMC, Amsterdam
| | - Don Linszen
- Department of Psychiatry, Early Psychosis, Amsterdam UMC, Amsterdam
| | - Luuk Wouters
- Department of Psychiatry, Early Psychosis, Amsterdam UMC, Amsterdam
| | | | - Peter Dingemans
- Department of Psychiatry, Early Psychosis, Amsterdam UMC, Amsterdam
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12
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Benrimoh D, Fisher V, Mourgues C, Sheldon AD, Smith R, Powers AR. Barriers and solutions to the adoption of translational tools for computational psychiatry. Mol Psychiatry 2023; 28:2189-2196. [PMID: 37280282 PMCID: PMC10611570 DOI: 10.1038/s41380-023-02114-y] [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: 01/04/2023] [Revised: 04/25/2023] [Accepted: 05/05/2023] [Indexed: 06/08/2023]
Abstract
Computational psychiatry is a field aimed at developing formal models of information processing in the human brain, and how alterations in this processing can lead to clinical phenomena. There has been significant progress in the development of tasks and how to model them, presenting an opportunity to incorporate computational psychiatry methodologies into large- scale research projects or into clinical practice. In this viewpoint, we explore some of the barriers to incorporation of computational psychiatry tasks and models into wider mainstream research directions. These barriers include the time required for participants to complete tasks, test-retest reliability, limited ecological validity, as well as practical concerns, such as lack of computational expertise and the expense and large sample sizes traditionally required to validate tasks and models. We then discuss solutions, such as the redesigning of tasks with a view toward feasibility, and the integration of tasks into more ecologically valid and standardized game platforms that can be more easily disseminated. Finally, we provide an example of how one task, the conditioned hallucinations task, might be translated into such a game. It is our hope that interest in the creation of more accessible and feasible computational tasks will help computational methods make more positive impacts on research as well as, eventually, clinical practice.
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Affiliation(s)
- David Benrimoh
- McGill University School of Medicine, Montreal, QC, Canada
| | - Victoria Fisher
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
| | - Catalina Mourgues
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
| | - Andrew D Sheldon
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA
| | - Ryan Smith
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Albert R Powers
- Yale University School of Medicine and the Connecticut Mental Health Center, New Haven, CT, USA.
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13
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Bhattacharyya S, Schoeler T, Di Forti M, Murray R, Cullen AE, Colizzi M. Stressful life events and relapse of psychosis: analysis of causal association in a 2-year prospective observational cohort of individuals with first-episode psychosis in the UK. Lancet Psychiatry 2023; 10:414-425. [PMID: 37146625 PMCID: PMC10728826 DOI: 10.1016/s2215-0366(23)00110-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Despite accumulating evidence of an association between stressful life events and psychosis relapse, the extent to which this is a causal relationship remains unclear. We aimed to examine the association between exposure to, and number of, stressful life events after initial psychosis onset and psychosis relapse. METHODS In this 2-year prospective observational study, we recruited individuals with first-episode psychosis, aged 18-65 years, who presented to psychiatric services in south London, UK. Participants were assessed via interview, with additional data obtained from electronic clinical records. Stressful life events were recorded at psychosis onset and during the 2-year follow-up using a brief questionnaire that assesses 12 major life events. Psychosis relapse was defined as inpatient admission because of symptom exacerbation within 2 years from psychosis onset. We examined the time to first psychosis relapse and the number and length of relapses using survival and binomial regression analyses. We used fixed-effects regression and cross-lagged path analysis to examine the directionality of effects and control for unmeasured confounders. FINDINGS Between April 12, 2002, and July 26, 2013, 256 individuals with first-episode psychosis (100 [39%] female and 156 [61%] male; 16 [6%] Asian, 140 [55%] Black African or Caribbean, 86 [34%] White, and 14 [6%] mixed ethnicity) were recruited, with a mean age of onset of psychosis of 28·06 years (SD 8·03; range 17·21-56·03). 93 (36%) participants experienced at least one relapse during the 2-year follow-up. 253 individuals had all relevant data and were included in analyses. For people exposed to stressful life events after the onset of psychosis, the adjusted hazard (hazard ratio [HR] 2·60, 95% CI 1·63-4·16, p<0·0001), incidence (incidence rate ratio [IRR] 1·87, 1·24-2·80, p=0·0026), and length (IRR 2·53, 1·40-4·67, p=0·0011) of relapse were greater than for those who were unexposed. These relationships were dose dependent (HR 1·36; 1·09-1·69, p=0·0054; incidence IRR 1·26, 1·02-1·53, p=0·023; length IRR 1·52, 1·12-2·12, p=0·0028). Adjusted fixed-effects models showed a higher (odds ratio [OR] 3·82, 1·82-8·00, p=0·0004) and dose-dependent (OR 1·62, 1·18-2·21, p=0·0028) risk of relapse when stressful life events preceded relapse compared with the period when they did not. Cross-lagged path analysis confirmed an effect of stressful life events on the number of subsequent relapses (β=0·66, p=0·0055) that was dose dependent (β=0·29, p=0·029), but it did not show an effect of relapses on subsequent risk or number of stressful life events. INTERPRETATION These results provide converging evidence of a causal effect of stressful life events on the risk of relapse in psychosis. They suggest that there is a need to develop interventions at the individual and health-service level that could mitigate the harmful effects of stressful life events. FUNDING National Institute for Health Research, UK.
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Affiliation(s)
- Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Tabea Schoeler
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
| | - Marta Di Forti
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robin Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marco Colizzi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Unit of Psychiatry, Department of Medicine (DAME), University of Udine, Udine, Italy
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14
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Hrivikova K, Marko M, Karailievova L, Romanova Z, Oravcova H, Riecansky I, Jezova D. Neuroendocrine response to a psychosocial stress test is not related to schizotypy but cortisol elevation predicts inflexibility of semantic memory retrieval. Psychoneuroendocrinology 2023; 154:106287. [PMID: 37182519 DOI: 10.1016/j.psyneuen.2023.106287] [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: 12/16/2022] [Revised: 03/30/2023] [Accepted: 05/02/2023] [Indexed: 05/16/2023]
Abstract
An altered stress response can contribute to the transition from preclinical psychotic symptoms to the clinical manifestation of schizophrenia and other psychotic disorders. The present study was aimed at testing the hypotheses that (i) the autonomic and neuroendocrine responses under psychosocial stress are dysregulated in individuals with high psychosis proneness (schizotypy); (ii) the magnitude of post-stress autonomic activation and cortisol release predicts alterations in semantic memory retrieval. The study was performed in 73 healthy individuals of both sexes with either high or low schizotypal traits preselected out of 609 individuals using the Schizotypal Personality Questionnaire. A psychosocial stress procedure based on public speech was used as a stress model. We found that individuals with high schizotypy engaged in less adaptive emotional stress-coping strategies than low schizotypy individuals. Yet, the neuroendocrine, immune, and sympathetic activation in response to the stress test was not different between the groups. Irrespective of the exposure to the stressor, individuals with high schizotypy were less fluent when retrieving associations from semantic memory. In addition, we demonstrated that acute psychosocial stress reduced the flexibility of semantic memory retrieval. The post-stress mental inflexibility was reliably predicted by the concomitant elevation of cortisol concentrations in saliva. The present study thus brings novel evidence indicating that the acute psychosocial challenge impairs retrieval flexibility in the semantic domain, which may be due to neuroendocrine activation.
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Affiliation(s)
- K Hrivikova
- Laboratory of Pharmacological Neuroendocrinology, Institute of Experimental Endocrinology, Biomedical Research Center of the Slovak Academy of Sciences, Bratislava, Slovakia
| | - M Marko
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia; Department of Applied Informatics, Faculty of Mathematics, Physics and Informatics, Comenius University in Bratislava, Bratislava, Slovakia
| | - L Karailievova
- Laboratory of Pharmacological Neuroendocrinology, Institute of Experimental Endocrinology, Biomedical Research Center of the Slovak Academy of Sciences, Bratislava, Slovakia
| | - Z Romanova
- Laboratory of Pharmacological Neuroendocrinology, Institute of Experimental Endocrinology, Biomedical Research Center of the Slovak Academy of Sciences, Bratislava, Slovakia
| | - H Oravcova
- Laboratory of Pharmacological Neuroendocrinology, Institute of Experimental Endocrinology, Biomedical Research Center of the Slovak Academy of Sciences, Bratislava, Slovakia; Department of Pharmacology and toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia
| | - I Riecansky
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia; Department of Psychiatry, Faculty of Medicine, Slovak Medical University in Bratislava, Bratislava, Slovakia.
| | - D Jezova
- Laboratory of Pharmacological Neuroendocrinology, Institute of Experimental Endocrinology, Biomedical Research Center of the Slovak Academy of Sciences, Bratislava, Slovakia.
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15
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Destrée L, Albertella L, Jobson L, McGorry P, Chanen A, Ratheesh A, Davey C, Polari A, Amminger P, Yuen HP, Hartmann J, Spooner R, Fontenelle LF, Nelson B. The association between stressful experiences and OCD symptoms in young adults at transdiagnostic risk. J Affect Disord 2023; 328:128-134. [PMID: 36812805 DOI: 10.1016/j.jad.2023.02.059] [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: 09/17/2022] [Revised: 12/06/2022] [Accepted: 02/14/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND It is unclear whether there is a specific association between stressful experiences and obsessive-compulsive symptoms or whether this relationship is due to stressful experiences increasing risk for psychopathology generally. AIMS The current study examined the association between stressful experiences and obsessive-compulsive symptom dimensions, while adjusting for coexisting psychiatric symptoms and psychological distress in a young adult transdiagnostic at-risk sample. METHODS Forty-three participants completed self-report measures assessing obsessive-compulsive symptoms, stressful experiences, and a range of other psychiatric symptoms. Regression models examined the relationship between stressful experiences and different obsessive-compulsive symptoms dimensions (i.e., symmetry, fear of harm, contamination, and unacceptable thoughts), adjusting for the influence of coexisting psychiatric symptoms and psychological distress. RESULTS The results showed that there was an association between stressful experiences and obsessive-compulsive symptoms dimension of symmetry. Symptoms of borderline personality disorder were positively associated with the obsessive-compulsive symptom dimensions of symmetry and fear of harm symptoms. Symptoms of psychosis were found to be negatively associated with the obsessive-compulsive symptoms dimension of fear of harm. CONCLUSIONS These findings have implications for understanding the psychological mechanisms that underlie symmetry symptoms and highlight the need to study OCS dimensions separately to inform more precise, mechanism-targeted interventions.
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Affiliation(s)
- Louise Destrée
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Victoria, Australia; Orygen, Parkville, VIC, Australia.
| | - Lucy Albertella
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Victoria, Australia
| | - Laura Jobson
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences & Monash Biomedical Imaging Facility, Monash University, Victoria, Australia
| | - Patrick McGorry
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrew Chanen
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Aswin Ratheesh
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Christopher Davey
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andrea Polari
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Paul Amminger
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Hok Pan Yuen
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jessica Hartmann
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Rachael Spooner
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Leonardo F Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Brazil; D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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16
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Georgescu RD. Should stressful life events be monitored after a first episode of psychosis? Lancet Psychiatry 2023; 10:373-374. [PMID: 37146626 DOI: 10.1016/s2215-0366(23)00151-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/07/2023]
Affiliation(s)
- Raluca Diana Georgescu
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health and Department of Clinical Psychology and Psychotherapy, Babeș-Bolyai University, Cluj-Napoca 400015, Romania.
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17
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Reilly TJ, Roberts E, Sagnay De La Bastida VC, McGuire P, Dazzan P, Cullen AE. Systematic review of the association between adverse life events and the onset and relapse of postpartum psychosis. Front Psychiatry 2023; 14:1154557. [PMID: 37139317 PMCID: PMC10149966 DOI: 10.3389/fpsyt.2023.1154557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/16/2023] [Indexed: 05/05/2023] Open
Abstract
Postpartum psychosis is defined as a psychotic episode occurring within 4 to 6 weeks of childbirth. While there is robust evidence that adverse life events are associated with the onset and relapse of psychosis outside the postpartum period, the extent to which these contribute to postpartum psychosis is less clear. This systematic review examined whether adverse life events are associated with an increased likelihood of developing postpartum psychosis or subsequent relapse in women diagnosed with postpartum psychosis. The following databases were searched from inception to June 2021: MEDLINE, EMBASE, PsycInfo. Study level data were extracted including setting, number of participants, type of adverse event, and differences between groups. A modified version of the Newcastle-Ottawa Quality Assessments Scale was used to assess risk of bias. In total, 1933 records were identified, of which 17 met the inclusion criteria, comprising nine case-control studies and eight cohort studies. Most studies (16/17) examined the association between adverse life events and the onset of postpartum psychosis, with only in which the outcome was relapse of psychosis. Overall, there were 63 different measures of adversity examined (most of which were examined in a single study only) and 87 associations between these measures and postpartum psychosis tested across the studies. In terms of statistically significant associations with onset/relapse of postpartum psychosis, 15 (17%) were positive (i.e., the adverse event increased the risk of onset/relapse), 4 (5%) were negative, and 68 (78%) were not statistically significant. Our review highlights the diversity of risk factors examined in this field, with few attempts at replication, hence limiting the ability to conclude that any single risk factor is robustly associated with the onset of postpartum psychosis. Further large-scale studies, that attempt to replicate earlier studies, are urgently needed to determine whether adverse life events play a role in the onset and exacerbation of postpartum psychosis. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=260592], identifier [CRD42021260592].
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Affiliation(s)
- Thomas J. Reilly
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Emma Roberts
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | | | - Philip McGuire
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
- NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Alexis E. Cullen
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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18
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Almuqrin A, Georgiades A, Mouhitzadeh K, Rubinic P, Mechelli A, Tognin S. The association between psychosocial stress, interpersonal sensitivity, social withdrawal and psychosis relapse: a systematic review. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:22. [PMID: 37037858 PMCID: PMC10086007 DOI: 10.1038/s41537-023-00349-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/15/2023] [Indexed: 04/12/2023]
Abstract
Psychosis is associated with a high risk of relapse, with 67% of clients relapsing within one year following a first episode. In light of the high personal, social, and healthcare costs of the illness, it is paramount to understand the risk factors associated with psychosis relapse. The current systematic review aims to critically review the role of psychosocial stress in psychosis relapse in individuals with an established psychotic disorder. This review systematically searched Ovid (PsycINFO, EMBASE, MEDLINE) literature databases from inception until 28th February 2022. Sixteen studies were eligible for inclusion. Most studies found that individuals with psychosis demonstrate high levels of psychosocial stress and are more likely to be socially withdrawn compared to healthy controls or other clinical presentations. Most studies reported a statistically significant association between psychosocial stress and psychosis relapse, as well as between social withdrawal and psychosis relapse. However, no studies examined the association between high levels of interpersonal sensitivity and psychosis relapse. Individuals with psychosis tend to experience high levels of psychosocial stress and social withdrawal, and these appear to increase the risk of psychosis relapse. Due to high levels of heterogeneity within the literature, we could only conduct a narrative synthesis of the findings. Future studies would benefit from employing a meta-analytic approach.
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Affiliation(s)
- A Almuqrin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - A Georgiades
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
- Brent Early Intervention Service, 27-29 Fairlight Avenue, London, NW10 8AL, CNWL, NHS Foundation Trust, London, UK
| | - K Mouhitzadeh
- 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
| | - A Mechelli
- 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.
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19
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Airey ND, Taylor CDJ, Vikram A, Berry K. Trauma measures for use with psychosis populations: A systematic review of psychometric properties using COSMIN. Psychiatry Res 2023; 323:115163. [PMID: 36948019 DOI: 10.1016/j.psychres.2023.115163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
Traumatic events play a key role in the development and course of psychosis. Psychotic symptoms themselves and coercive treatment practices can be inherently traumatic. Hence, reliable and valid methods of assessing trauma and its impact (i.e., Post-Traumatic Stress Disorder (PTSD) symptomology) are essential for use with people with psychosis. Many measures are available to select from, but this is the first review to appraise the psychometric properties of trauma measures to guide decision making regarding instrument use. The review was prospectively registered on Prospero (CRD42022306100). Evaluation of methodological and psychometric quality followed Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidance. Twenty-four articles were eligible, with sixteen trauma measures evaluated. Childhood Trauma Questionnaire- Short Form demonstrated the most robust evidence for assessing experience of trauma. The Trauma and Life Experience (TALE) checklist was the only measure to include specific psychosis and iatrogenic harm items. For PTSD measures, the Symptoms of Trauma Scale and PTSD Symptom Scale- Self Report had the highest quality evidence. Psychometric strengths and weaknesses of various trauma measures are comprehensively evaluated, highlighting future research directions to strengthen the evidence base with emphasis on further evaluation of the TALE, which integrates trauma specific to psychosis.
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Affiliation(s)
- Nicola D Airey
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, 2(nd) Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester M25 3BL, UK.
| | - Christopher D J Taylor
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, 2(nd) Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, UK; Community Mental Health Team, Pennine Care NHS Foundation Trust, Humphrey House, Angouleme Way, Bury BL9 0EQ, UK
| | - Anvita Vikram
- Community Mental Health Team, Pennine Care NHS Foundation Trust, Humphrey House, Angouleme Way, Bury BL9 0EQ, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, 2(nd) Floor Zochonis Building, Brunswick Street, Manchester M13 9PL, UK; Greater Manchester Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester M25 3BL, UK
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20
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Colizzi M, Cullen AE, Martland N, Di Forti M, Murray R, Schoeler T, Bhattacharyya S. Association between stressful life events and psychosis relapse: a 2-year prospective study in first-episode psychosis. World Psychiatry 2023; 22:159-160. [PMID: 36640413 PMCID: PMC9840498 DOI: 10.1002/wps.21046] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 01/15/2023] Open
Affiliation(s)
- Marco Colizzi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Unit of Psychiatry, Department of Medicine, University of Udine, Udine, Italy
| | - Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Natasha Martland
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Marta Di Forti
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robin Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tabea Schoeler
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Computational Biology, University of Lausanne, Lausanne, Switzerland
| | - Sagnik Bhattacharyya
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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21
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Riches S, Jeyarajaguru P, Taylor L, Fialho C, Little J, Ahmed L, O’Brien A, van Driel C, Veling W, Valmaggia L. Virtual reality relaxation for people with mental health conditions: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2023:10.1007/s00127-022-02417-5. [PMID: 36658261 PMCID: PMC9852806 DOI: 10.1007/s00127-022-02417-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 12/21/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Vulnerability to stress is linked to poor mental health. Stress management interventions for people with mental health conditions are numerous but they are difficult to implement and have limited effectiveness in this population. Virtual reality (VR) relaxation is an innovative intervention that aims to reduce stress. This review aimed to synthesize evidence of VR relaxation for people with mental health conditions (PROSPERO 269405). METHODS Embase, Medline, PsycInfo, and Web of Science were searched until 17th September 2021. The review was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The Effective Public Health Practice Project (EPHPP) tool assessed methodological quality of studies. RESULTS Searching identified 4550 studies. Eighteen studies (N = 848) were included in the review. Studies were published between 2008 and 2021. Eleven were conducted in Europe. Thirteen studies were controlled trials. Participants were mostly working-age adult outpatients experiencing anxiety or stress-related conditions. Other conditions included eating disorders, depression, bipolar disorder, and psychosis. Five studies tested inpatients. All studies used a range of nature-based virtual environments, such as forests, islands, mountains, lakes, waterfalls, and most commonly, beaches to promote relaxation. Studies provided evidence of the feasibility, acceptability, and short-term effectiveness of VR relaxation to increase relaxation and reduce stress. EPHPP ratings were 'strong' (N = 11), 'moderate' (N = 4), and 'weak' (N = 3). CONCLUSIONS VR relaxation has potential as a low-intensity intervention to promote relaxation and reduce stress for adults with mental health conditions, especially anxiety and stress-related problems. Further research is warranted on this promising intervention.
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Affiliation(s)
- Simon Riches
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK. .,Social Genetic and Developmental Psychiatry Centre, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF, UK. .,South London and Maudsley NHS Foundation Trust, London, BR3 3BX, UK.
| | - Priyanga Jeyarajaguru
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF UK
| | - Lawson Taylor
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF UK
| | - Carolina Fialho
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF UK
| | - Jordan Little
- South London and Maudsley NHS Foundation Trust, London, BR3 3BX UK
| | - Lava Ahmed
- South London and Maudsley NHS Foundation Trust, London, BR3 3BX UK
| | | | - Catheleine van Driel
- University Center for Psychiatry, University of Groningen, University Medical Center Groningen, PO Box 30.001 (HPC CC60), 9700 RB Groningen, The Netherlands
| | - Wim Veling
- University Center for Psychiatry, University of Groningen, University Medical Center Groningen, PO Box 30.001 (HPC CC60), 9700 RB Groningen, The Netherlands
| | - Lucia Valmaggia
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, SE5 8AF UK ,South London and Maudsley NHS Foundation Trust, London, BR3 3BX UK
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22
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Lachowicz AM, Vaessen T, van Aubel E, Butjosa A, Reininghaus U, Myin-Germeys I, Bartels-Velthuis AA, Bruggeman R, Cahn W, de Haan L, Schirmbeck F, Simons CJ, van Os J. Effect of stressful life events on subclinical psychotic symptoms in first-degree relatives and healthy controls. Schizophr Res 2022; 250:92-99. [PMID: 36372001 DOI: 10.1016/j.schres.2022.10.020] [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: 11/11/2021] [Revised: 09/07/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022]
Abstract
Exposure to Stressful Life Events (SLEs) has been linked to psychosis. However, the combined effect of SLEs and familial risk on subclinical psychotic symptoms over time remains unknown. The objective of the present study was to investigate the effect of SLEs on the level of subclinical psychotic symptoms in individuals with and without familial vulnerability for psychosis. Data were collected from siblings of individuals diagnosed with psychotic disorder and healthy controls at baseline (N = 293) and three years later at follow-up (N = 928). We assessed self-reported and observer-rated subclinical positive, negative, and depressive psychotic symptoms. Participants reported the number of SLEs in the preceding 6 months. A multilevel multivariate regression analysis revealed a positive association between the retrospectively assessed number of SLEs and symptom levels, regardless of vulnerability status (p < .001 for all outcomes). The prospective analysis demonstrated that exposure to SLEs at baseline predicted higher levels of subclinical psychotic symptoms at follow-up. However, after controlling for the level of symptoms at baseline, these associations were no longer significant. Again, the vulnerability status did not modify these results. Nevertheless, siblings in our sample were approximating the end of the critical period for the development of psychotic disorder (mean age at baseline M = 29 and follow-up M = 34). The findings partly support the vulnerability-stress model of psychosis, yet do not confirm the role of familial risk in this association. SLEs may represent a risk factor for psychosis at a population level, thus supporting the continuity of the psychosis spectrum in terms of associated risk factors.
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Affiliation(s)
- Aleksandra M Lachowicz
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium.
| | - Thomas Vaessen
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Evelyne van Aubel
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Anna Butjosa
- Unitat de docència, recerca i innovació, Institut de Recerca Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Hospital Infanto-Juvenil Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; ESRC Centre for Society and Mental Health and Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
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23
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Psychotic relapses from the perspective of patients and family members. Arch Psychiatr Nurs 2022; 41:300-305. [PMID: 36428064 DOI: 10.1016/j.apnu.2022.09.012] [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: 08/20/2021] [Revised: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 11/22/2022]
Abstract
This qualitative study was carried out with 10 dyads of patients-family members to explore their perception about psychotic relapses. Data were collected through a semi-structured interview from April to August 2019, in Brazil, and analyzed using the thematic analysis proposed by Braun & Clark. Four main themes emerged from the interviews: (1) defining and describing the psychotic relapses; (2) risk factors for psychotic relapse; (3) protective factors for psychotic relapse; and (4) early warning signs: identification of an episode of psychotic relapse. Exploring the perception of patients with psychotic disorders and their families about relapse is fundamental for the development of relapse risk assessment tools and to guide further research on this topic.
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24
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Effect of Cytomegalovirus on the Immune System: Implications for Aging and Mental Health. Curr Top Behav Neurosci 2022; 61:181-214. [PMID: 35871707 DOI: 10.1007/7854_2022_376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Human cytomegalovirus (HCMV) is a major modulator of the immune system leading to long-term changes in T-lymphocytes, macrophages, and natural killer (NK) cells among others. Perhaps because of this immunomodulatory capacity, HCMV infection has been linked with a host of deleterious effects including accelerated immune aging (premature mortality, increased expression of immunosenescence-linked markers, telomere shortening, speeding-up of epigenetic "clocks"), decreased vaccine immunogenicity, and greater vulnerability to infectious diseases (e.g., tuberculosis) or infectious disease-associated pathology (e.g., HIV). Perhaps not surprisingly given the long co-evolution between HCMV and humans, the virus has also been associated with beneficial effects, such as increased vaccine responsiveness, heterologous protection against infections, and protection against relapse in the context of leukemia. Here, we provide an overview of this literature. Ultimately, we focus on one other deleterious effect of HCMV, namely the emerging literature suggesting that HCMV plays a pathophysiological role in psychiatric illness, particularly depression and schizophrenia. We discuss this literature through the lens of psychological stress and inflammation, two well-established risk factors for psychiatric illness that are also known to predispose to reactivation of HCMV.
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25
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Zukowska Z, Allan S, Eisner E, Ling L, Gumley A. Fear of relapse in schizophrenia: a mixed-methods systematic review. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1305-1318. [PMID: 35152309 PMCID: PMC9246982 DOI: 10.1007/s00127-022-02220-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 01/06/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Fears of relapse in people diagnosed with schizophrenia have long been recognised as an impediment to recovery and wellbeing. However, the extent of the empirical basis for the fear of relapse concept is unclear. A systematic review is required to collate available evidence and define future research directions. METHODS A pre-registered systematic search (PROSPERO CRD42020196964) of four databases (PubMED, MEDLINE-Ovid, PsycINFO-Ovid, and Cochrane Central Register of Controlled Trials) was conducted from their inception to 05/04/2021. RESULTS We found nine eligible studies. Five were quantitative (4 descriptive and 1 randomised controlled trial), and four were qualitative. The available quantitative evidence suggests that fear of relapse may have concurrent positive relationships with depression (r = 0.72) and suicide ideation (r = 0.48), and negative relationship with self-esteem (r = 0.67). Qualitative synthesis suggests that fear of relapse is a complex phenomenon with behavioural and emotional components which has both direct and indirect effects on wellbeing. CONCLUSIONS Evidence in this area is limited and research with explicit service user and carer involvement is urgently needed to develop new and/or refine existing measurement tools, and to measure wellbeing rather than psychopathology. Nonetheless, clinicians should be aware that fear of relapse exists and appears to be positively associated with depression and suicide ideation, and negatively associated with self-esteem. Fear of relapse can include fears of losing personal autonomy and/or social/occupational functioning. It appears to impact carers as well as those diagnosed with schizophrenia.
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Affiliation(s)
- Zofia Zukowska
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland.
| | - Emily Eisner
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
| | - Li Ling
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
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26
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Fakhari A, Allahverdipour H, Esmaeili ED, Chattu VK, Salehiniya H, Azizi H. Early marriage, stressful life events and risk of suicide and suicide attempt: a case-control study in Iran. BMC Psychiatry 2022; 22:71. [PMID: 35090417 PMCID: PMC8796480 DOI: 10.1186/s12888-022-03700-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 01/11/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Early Marriage (EM) and associated Stressful Life Events (SLEs) and consequences such as psychological and physical well-being issues can lead to suicide and suicide attempts (SA). The study aimed to investigate the risk of suicide and SA among early married people who experienced SLEs. METHODS A case-control study was conducted based on the registry for suicide in Malekan county in Iran during 2016-18. Cases included 154 SAs and 32 suicides. Simultaneously, 201 outpatients from the emergency department were chosen as controls. Holms and Rahe life event questionnaire was used to assess SLEs. Sub-group analysis (Mantel-Haenszel) by sex and age groups and multiple logistic regression were used to calculate adjusted Odds Ratios (ORs) with 95% Confidence Intervals (CIs) for the association between EM and suicide risk after adjusting for the potential confounders. RESULTS The proportion (female vs male) of EM among suicides, controls, and SAs was 31.25% (18.7 vs 12.5%), 15.92% (11.9 vs 4.0%), and 13.0% (11.7 vs 1.3%), respectively. In subgroup analyses by sex, EM was associated with an increased risk of suicide in both females and males 2.64 and 2.36 times, respectively. Likewise, subgroup analysis by age groups revealed that EM increased suicide risk in subjects aged 10-15 years, while no association was found for age groups of 26-40 and > 40. After adjusting for the potential confounders, EM (OR: 3.01; 95% CI: 1.15 -7.29), financial problems (OR = 4.50; 95% CI: 1.83 -9.07), and family problems (OR = 2.60; 95% CI: 1.19-9.59), were associated with an increased risk of suicide. However, no association was found between EM, various types of SLEs, and the risk of SA. CONCLUSIONS We found EM and SLEs were correlated with suicide risk, while no evidence found that EM increased the risk of SA. Progress in reducing EM and addressing its serious consequences can occur by a stronger political commitment and by sharing the experiences and voices of the early married. Our study provided preliminary findings to guide future studies; however, methodological and longitudinal studies are needed to understand and address the effect of EM on suicidal behaviors.
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Affiliation(s)
- Ali Fakhari
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Allahverdipour
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Health Education and Promotion, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Vijay Kumar Chattu
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 2C4 Canada
- Department of Public Health, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, 600077 India
- Department of Community Medicine, Faculty of Medicine, Datta Meghe Institute of Medical Sciences, Wardha, 442107 India
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Hosein Azizi
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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27
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Cortisol Levels in Childhood Associated With Emergence of Attenuated Psychotic Symptoms in Early Adulthood. Biol Psychiatry 2022; 91:226-235. [PMID: 34715990 PMCID: PMC7612877 DOI: 10.1016/j.biopsych.2021.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 08/08/2021] [Accepted: 08/11/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND In individuals at clinical high-risk for psychosis, elevated cortisol levels predict subsequent onset of psychotic disorder. However, it is unclear whether cortisol alterations are evident at an earlier clinical stage and promote progression of psychosis expression. This study aimed to address this issue by investigating whether cortisol levels in childhood were associated with the emergence of attenuated psychotic symptoms in early adulthood. In exploratory analyses, we examined whether cortisol and psychosocial stress measures interacted in predicting attenuated psychotic symptoms. METHODS A sample of children (N = 109) enriched for psychosis risk factors were recruited at age 9-12 years and assessed at age 11-14 years (T1) and 17-21 years (T2). Measures of psychopathology, psychosocial stressors, and salivary cortisol were obtained at T1. Attenuated psychotic symptoms were assessed at T2 using the Prodromal Questionnaire. RESULTS Diurnal cortisol (β = 0.915, 95% CI: 0.062-1.769) and daily stressors (β = 0.379, 95% CI: 0.034-0.723) at T1 were independently associated with total Prodromal Questionnaire scores at T2 after accounting for demographic factors and T1 psychopathology. Exploratory analyses indicated a significant interaction between T1 diurnal cortisol and daily stressors (β = 0.743, 95% CI: 0.081-1.405), with the highest predicted T2 total Prodromal Questionnaire scores occurring when both diurnal cortisol and daily stressors were increased. CONCLUSIONS Our findings suggest that daily stressors and elevations in diurnal cortisol in late childhood/early adolescence increases risk for developing attenuated psychotic symptoms. These findings emphasize the importance of assessing environmental and biological risk factors for psychosis during neurodevelopmentally vulnerable time periods.
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28
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Massaro D, Nitzburg G, Dinzeo T. Schizotypy as a predictor for problematic technology use in emerging adults. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-02700-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Lee DY, Kim C, Lee S, Son SJ, Cho SM, Cho YH, Lim J, Park RW. Psychosis Relapse Prediction Leveraging Electronic Health Records Data and Natural Language Processing Enrichment Methods. Front Psychiatry 2022; 13:844442. [PMID: 35479497 PMCID: PMC9037331 DOI: 10.3389/fpsyt.2022.844442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/09/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Identifying patients at a high risk of psychosis relapse is crucial for early interventions. A relevant psychiatric clinical context is often recorded in clinical notes; however, the utilization of unstructured data remains limited. This study aimed to develop psychosis-relapse prediction models using various types of clinical notes and structured data. METHODS Clinical data were extracted from the electronic health records of the Ajou University Medical Center in South Korea. The study population included patients with psychotic disorders, and outcome was psychosis relapse within 1 year. Using only structured data, we developed an initial prediction model, then three natural language processing (NLP)-enriched models using three types of clinical notes (psychological tests, admission notes, and initial nursing assessment) and one complete model. Latent Dirichlet Allocation was used to cluster the clinical context into similar topics. All models applied the least absolute shrinkage and selection operator logistic regression algorithm. We also performed an external validation using another hospital database. RESULTS A total of 330 patients were included, and 62 (18.8%) experienced psychosis relapse. Six predictors were used in the initial model and 10 additional topics from Latent Dirichlet Allocation processing were added in the enriched models. The model derived from all notes showed the highest value of the area under the receiver operating characteristic (AUROC = 0.946) in the internal validation, followed by models based on the psychological test notes, admission notes, initial nursing assessments, and structured data only (0.902, 0.855, 0.798, and 0.784, respectively). The external validation was performed using only the initial nursing assessment note, and the AUROC was 0.616. CONCLUSIONS We developed prediction models for psychosis relapse using the NLP-enrichment method. Models using clinical notes were more effective than models using only structured data, suggesting the importance of unstructured data in psychosis prediction.
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Affiliation(s)
- Dong Yun Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Chungsoo Kim
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South Korea
| | - Seongwon Lee
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea.,Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, South Korea
| | - Sun-Mi Cho
- Department of Psychiatry, Ajou University School of Medicine, Suwon, South Korea
| | - Yong Hyuk Cho
- Department of Psychiatry, Ajou University School of Medicine, Suwon, South Korea
| | - Jaegyun Lim
- Department of Laboratory Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea.,Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, South Korea
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30
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Murray A. Heightened risk factors in the midst of the pandemic: Supporting individuals with psychosis during COVID-19. Perspect Psychiatr Care 2022; 58:164-169. [PMID: 34212395 DOI: 10.1111/ppc.12901] [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: 12/18/2020] [Accepted: 06/14/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This article aims to describe distinct vulnerabilities to the psychosocial stress from coronavirus disease 2019 (COVID-19) on individuals with psychosis and provide practical ways to reduce the vulnerabilities. CONCLUSION Societal changes and stress have come in the wake of the COVID-19. Individuals with psychosis are more susceptible to stress, cognitive biases, and lack social support. Practitioners working with individuals with psychosis are in a unique position to offer ways to reduce risk. PRACTICE IMPLICATIONS Care during the pandemic requires practitioners to pay particular attention to magnified risk factors to individuals with psychosis and create a plan to offer adjunct support.
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Affiliation(s)
- Aimee Murray
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
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31
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Oh H, Goehring J, Rajkumar R, Besecker M, Zhou S, DeVylder JE. COVID-19 dimensions and psychotic experiences among US college students: Findings from the Healthy Mind Study 2020. Schizophr Res 2021; 237:148-152. [PMID: 34534946 PMCID: PMC8438539 DOI: 10.1016/j.schres.2021.09.003] [Citation(s) in RCA: 4] [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: 03/13/2021] [Revised: 08/29/2021] [Accepted: 09/05/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND The COVID-19 pandemic has caused tremendous changes in daily living, which may be related to mental health problems, including psychotic experiences, though research has only begun to assess these associations. METHODS We analyzed data from the Healthy Minds Survey (Fall Semester Cohort 2020), which is a non-probability sample of students attending one of 36 universities in the United States, who completed an online survey during the COVID-19 pandemic (September-December 2020). We used multivariable logistic regression to examine the associations between several COVID-19 dimensions (anxiety, discrimination, financial distress, infection, illness of loved one, death of loved one, caregiving) and 12-month psychotic experiences, adjusting for age, gender, race/ethnicity, and international student status. RESULTS Each individual COVID-19 dimension was significantly associated with greater odds of having 12-month psychotic experiences, with the exception of being a caregiver. When accounting for all COVID-19 dimensions simultaneously in the same model, only COVID-19 related anxiety, financial distress, and infection were associated with psychotic experiences. CONCLUSION COVID-19 dimensions were linked to psychotic experiences among university students, which may also apply to the larger population. This can potentially inform assessment and treatment during the pandemic.
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Affiliation(s)
- Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, 1149 Hill St Suite 1422, Los Angeles, CA 90015, United States of America.
| | - Jessica Goehring
- Suzanne Dworak Peck School of Social Work, University of Southern California, 1149 Hill St Suite 1422, Los Angeles, CA 90015, United States of America
| | - Ravi Rajkumar
- Jawaharlal Institute of Postgraduate Medical Education and Research, India
| | - Megan Besecker
- Suzanne Dworak Peck School of Social Work, University of Southern California, 1149 Hill St Suite 1422, Los Angeles, CA 90015, United States of America
| | - Sasha Zhou
- Department of Public Health, Wayne State University, United States of America
| | - Jordan E. DeVylder
- Fordham University, Graduate School of Social Service, United States of America
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32
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Misiak B, Pruessner M, Samochowiec J, Wiśniewski M, Reginia A, Stańczykiewicz B. A meta-analysis of blood and salivary cortisol levels in first-episode psychosis and high-risk individuals. Front Neuroendocrinol 2021; 62:100930. [PMID: 34171354 DOI: 10.1016/j.yfrne.2021.100930] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/10/2021] [Accepted: 06/19/2021] [Indexed: 11/18/2022]
Abstract
Dysregulated cortisol responses and glucose metabolism have been reported in psychosis. We performed a random-effects meta-analysis of cortisol responses in first-episode psychosis (FEP) and psychosis risk states, taking into consideration glucose metabolism. A total of 47 studies were included. Unstimulated blood cortisol levels were significantly higher (g = 0.48, 95 %CI: 0.25-0.70, p < 0.001) in FEP, but not in psychosis risk states (g = 0.39, 95 %CI: -0.42-1.21, p = 0.342), compared to controls. Cortisol awakening response (CAR) was attenuated in FEP (g = -0.40, 95 %CI: -0.68 - -0.12, p = 0.006), but not in psychosis risk states (p = 0.433). Glucose and insulin levels were positively correlated with unstimulated blood cortisol levels in FEP. Our meta-analysis supports previous findings of elevated blood cortisol levels and attenuated CAR in FEP. Future research should focus on identifying the common denominators for alterations in stress hormones and glucose metabolism.
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Affiliation(s)
- Błażej Misiak
- Department of Psychiatry, Division of Consultation Psychiatry and Neuroscience, Wroclaw Medical University, Pasteura 10 Street, 50-367 Wroclaw, Poland.
| | - Marita Pruessner
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montreal, Canada; Department of Clinical Psychology, University of Konstanz, Konstanz, Germany
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-457 Szczecin, Poland
| | | | - Artur Reginia
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-457 Szczecin, Poland
| | - Bartłomiej Stańczykiewicz
- Department of Nervous System Diseases, Wroclaw Medical University, Bartla 5 Street, 51-618 Wroclaw, Poland
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Benrimoh D, Sheldon A, Sibarium E, Powers AR. Computational Mechanism for the Effect of Psychosis Community Treatment: A Conceptual Review From Neurobiology to Social Interaction. Front Psychiatry 2021; 12:685390. [PMID: 34385938 PMCID: PMC8353084 DOI: 10.3389/fpsyt.2021.685390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Abstract
The computational underpinnings of positive psychotic symptoms have recently received significant attention. Candidate mechanisms include some combination of maladaptive priors and reduced updating of these priors during perception. A potential benefit of models with such mechanisms is their ability to link multiple levels of explanation, from the neurobiological to the social, allowing us to provide an information processing-based account of how specific alterations in self-self and self-environment interactions result in the experience of positive symptoms. This is key to improving how we understand the experience of psychosis. Moreover, it points us toward more comprehensive avenues for therapeutic research by providing a putative mechanism that could allow for the generation of new treatments from first principles. In order to demonstrate this, our conceptual paper will discuss the application of the insights from previous computational models to an important and complex set of evidence-based clinical interventions with strong social elements, such as coordinated specialty care clinics (CSC) in early psychosis and assertive community treatment (ACT). These interventions may include but also go beyond psychopharmacology, providing, we argue, structure and predictability for patients experiencing psychosis. We develop the argument that this structure and predictability directly counteract the relatively low precision afforded to sensory information in psychosis, while also providing the patient more access to external cognitive resources in the form of providers and the structure of the programs themselves. We discuss how computational models explain the resulting reduction in symptoms, as well as the predictions these models make about potential responses of patients to modifications or to different variations of these interventions. We also link, via the framework of computational models, the patient's experiences and response to interventions to putative neurobiology.
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Affiliation(s)
- David Benrimoh
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Andrew Sheldon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Ely Sibarium
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Albert R Powers
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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