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Cowan HR, McAdams DP, Ouellet L, Jones CM, Mittal VA. Self-concept and Narrative Identity in Youth at Clinical High Risk for Psychosis. Schizophr Bull 2024; 50:848-859. [PMID: 37816626 PMCID: PMC11283199 DOI: 10.1093/schbul/sbad142] [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] [Indexed: 10/12/2023]
Abstract
BACKGROUND AND HYPOTHESIS Disturbances of the narrative self and personal identity accompany the onset of psychotic disorders in late adolescence and early adulthood (a formative developmental stage for self-concept and personal narratives). However, these issues have primarily been studied retrospectively after illness onset, limiting any inferences about their developmental course. STUDY DESIGN Youth at clinical high risk for psychosis (CHR) (n = 49) and matched healthy comparison youth (n = 52) completed a life story interview (including self-defining memory, turning point, life challenge, and psychotic-like experience) and questionnaires assessing self-esteem, self-beliefs, self-concept clarity, and ruminative/reflective self-focus. Trained raters coded interviews for narrative identity themes of emotional tone, agency, temporal coherence, context coherence, self-event connections, and meaning-making (intraclass correlations >0.75). Statistical analyses tested group differences and relationships between self-concept, narrative identity, symptoms, and functioning. STUDY RESULTS CHR participants reported more negative self-esteem and self-beliefs, poorer self-concept clarity, and more ruminative self-focus, all of which related to negative symptoms. CHR participants narrated their life stories with themes of negative emotion and passivity (ie, lack of personal agency), which related to positive and negative symptoms. Reflective self-focus and autobiographical reasoning were unaffected and correlated. Autobiographical reasoning was uniquely associated with preserved role functioning. CONCLUSIONS This group of youth at CHR exhibited some, but not all, changes to self-concept and narrative identity seen in psychotic disorders. A core theme of negativity, uncertainty, and passivity ran through their semantic and narrative self-representations. Preserved self-reflection and autobiographical reasoning suggest sources of resilience and potential footholds for cognitive-behavioral and metacognitive interventions.
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Affiliation(s)
- Henry R Cowan
- Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Dan P McAdams
- Psychology, Northwestern University, Evanston, IL, USA
| | - Leah Ouellet
- Human Development and Social Policy, Northwestern University, Evanston, IL, USA
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2
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Üçok A, Noyan H, Gülöksüz S, Saka MC, Alptekin K, Atbaşoğlu C, Akturan E, Karadayı G, Baran Tatar Z, Akdede B, Binbay T, Altınyazar V, Ulaş H, Yalınçetin B, Gümüş-Akay G, Cihan B, Soygür H, Şahin Cankurtaran E, Ulusoy Kaymak S, Rutten BPF, van Os J. The relationship between childhood trauma, psychotic symptoms, and cognitive schemas in patients with schizophrenia, their siblings, and healthy controls: results from the EU-GEI study. Psychol Med 2024:1-12. [PMID: 38606591 DOI: 10.1017/s0033291724000540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUND The relationship between childhood trauma (CT) and psychotic symptoms in patients with schizophrenia (SCZ), and subthreshold psychotic experiences in non-clinical populations is well-established. However, little is known about the relationship between subtypes of trauma and specific symptoms in patients, their siblings, and controls. It is also not clear which variables mediate the relationship between trauma and psychotic symptoms. METHODS Seven hundred and forty-two patients with SCZ, 718 of their unaffected siblings and 1039 controls from three EU-GEI sites were assessed for CT, symptom severity, and cognitive schemas about self/others. CT was assessed with the Childhood Trauma Questionnaire, and cognitive schemas were assessed by The Brief Core Schema Scale. RESULTS Patients with psychosis were affected by CT more than their siblings and controls in all domains. Childhood emotional abuse and neglect were more common in siblings than controls. CT was related to negative cognitive schemas toward self/others in patients, siblings, and controls. We found that negative schemas about self-mediated the relationship between emotional abuse and thought withdrawal and thought broadcasting. Approximately 33.9% of the variance in these symptoms was explained by the mediator. It also mediated the relationship between sexual abuse and persecutory delusions in SCZ. CONCLUSIONS Our findings suggest that childhood abuse and neglect are more common in patients with schizophrenia than their siblings and healthy controls, and have different impacts on clinical domains which we searched. The relationship between CT and positive symptoms seems to be mediated by negative cognitive schemas about self in schizophrenia.
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Affiliation(s)
- Alp Üçok
- Psychotic Disorders Research Program, Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Handan Noyan
- Psychotic Disorders Research Program, Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
- Department of Psychology, Faculty of Social Sciences, Beykoz University, Istanbul, Turkey
| | - Sinan Gülöksüz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Meram Can Saka
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
- Ankara University Brain Research Center, Ankara University, Ankara, Turkey
| | - Köksal Alptekin
- Department of Psychiatry, School of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Cem Atbaşoğlu
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
- Ankara University Brain Research Center, Ankara University, Ankara, Turkey
| | - Elçin Akturan
- Psychotic Disorders Research Program, Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Gülşah Karadayı
- Psychotic Disorders Research Program, Department of Psychiatry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zeynep Baran Tatar
- Department of Psychiatry, Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Berna Akdede
- Department of Psychiatry, School of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Tolga Binbay
- Department of Psychiatry, School of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Vesile Altınyazar
- Department of Psychiatry, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Halis Ulaş
- Department of Psychiatry, School of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Berna Yalınçetin
- Department of Neuroscience, Health Sciences Institute, Dokuz Eylül University, Izmir, Turkey
| | - Güvem Gümüş-Akay
- Department of Psychiatry, School of Medicine, Ankara University, Ankara, Turkey
- Ankara University Brain Research Center, Ankara University, Ankara, Turkey
| | - Burçin Cihan
- Department of Psychology, Middle East Technical University, Ankara, Turkey
| | - Haldun Soygür
- Turkish Federation of Schizophrenia Associations, Ankara, Turkey
- Department of Psychology, Faculty of Humanities and Social Sciences, Okan University, Istanbul, Turkey
| | | | | | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, the Netherlands
- King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK
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3
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Addington J, Chao A, Braun A, Miller M, Farris MS. Patient-Reported Outcome Measures in Clinical High Risk for Psychosis: A Systematic Review. SCHIZOPHRENIA BULLETIN OPEN 2023; 4:sgad006. [PMID: 37025755 PMCID: PMC10069322 DOI: 10.1093/schizbullopen/sgad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
A key issue in both research and clinical work with youth at clinical high risk (CHR) of psychosis is that there are clearly heterogenous clinical outcomes in addition to the development of psychosis. Thus, it is important to capture the psychopathologic outcomes of the CHR group and develop a core outcomes assessment set that may help in dissecting the heterogeneity and aid progress toward new treatments. In assessing psychopathology and often poor social and role functioning, we may be missing the important perspectives of the CHR individuals themselves. It is important to consider the perspectives of youth at CHR by using patient-reported outcome measures (PROMs). This systematic review of PROMs in CHR was conducted based on a comprehensive search of several databases and followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Sixty-four publications were included in the review examining PROMs for symptoms, functioning, quality of life, self-perceptions, stress, and resilience. Typically, PROMs were not the primary focus of the studies reviewed. The PROMs summarized here fit with results published elsewhere in the literature based on interviewer measures. However, very few of the measures used were validated for CHR or for youth. There are several recommendations for determining a core set of PROMs for use with CHR.
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Affiliation(s)
- Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Amanda Chao
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Amy Braun
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Madeline Miller
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Megan S Farris
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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4
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Interactions between the cortical midline structures and sensorimotor network track maladaptive self-beliefs in clinical high risk for psychosis. SCHIZOPHRENIA 2022; 8:74. [PMID: 36114173 PMCID: PMC9481626 DOI: 10.1038/s41537-022-00279-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022]
Abstract
Individuals at clinical high risk for psychosis (CHR) report a maladaptive self-concept—with more negative and less positive self-beliefs—linked to clinical symptoms and functional impairment. Alterations have also been reported in brain networks associated with intrinsic (cortical midline structures, CMS) and extrinsic (sensorimotor network, SMN) self-processing. Theoretical accounts of multiple levels of self-experience in schizophrenia suggest that interactions between these networks would be relevant for self-beliefs. This study tested whether self-beliefs related to resting-state functional connectivity within and between the CMS and SMN. Participants were 56 individuals meeting CHR criteria and 59 matched healthy community participants (HC). Pearson correlations examined potential mediators and outcomes. The CHR group reported more negative and less positive self-beliefs. Greater resting-state functional connectivity between the posterior CMS (posterior cingulate cortex) and the SMN was associated with less positive self-beliefs in CHR, but more positive self-beliefs in HC. Attenuated negative symptoms and poorer social functioning were associated with CMS-SMN connectivity (trend level after FDR-correction) and self-beliefs. Reduced connectivity between the left and right PCC was associated with lower positive self-beliefs in CHR, although this effect was specific to very low levels of positive self-beliefs. Left-right PCC connectivity did not correlate with outcomes. Dynamic interactions between intrinsic and extrinsic self-processing supported positive self-beliefs in typically developing youth while undermining positive self-beliefs in CHR youth. Implications are discussed for basic self-fragmentation, narrative self-related metacognition, and global belief updating. Interventions for self-processing may be beneficial in the CHR syndrome.
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5
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Crowter L, Banerjee R, Berry C, Fowler D. Schematic beliefs, negative affect and paranoia in at-risk youth. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:1038-1051. [PMID: 35762490 DOI: 10.1111/bjc.12373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/08/2022] [Accepted: 05/03/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Attenuated symptoms of psychosis are a core feature of At-Risk Mental States. However, subthreshold levels of paranoia are also common among nonpsychosis populations. At present, little is known about whether the processes underpinning the experience of paranoid ideation in high-risk youth differ as a consequence of meeting At-Risk Mental States (ARMS) for psychosis criteria. METHODS This study utilized path analysis techniques to examine the relationships between schematic beliefs, negative affect and the experience of paranoia for two groups: a group meeting criteria for ARMS (n = 133) and a group presenting with emerging complex mental health difficulties who did not meet the criteria for ARMS (n = 137). RESULTS While the ARMS group displayed significantly greater maladaptive schematic beliefs and more severe symptomatology, the associations between schematic beliefs, symptoms of negative affect and paranoia did not differ as a consequence of ARMS status. CONCLUSIONS While meeting the ARMS criteria is associated with experiencing more maladaptive cognitions and more negative symptomatology among at-risk youth, the associations between these cognitive beliefs and symptoms may be similar for youth who do not meet ARMS. These findings have implications for broadening the scope of at-risk/high-risk and for developing effective interventions for young people presenting with emerging difficulties.
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Affiliation(s)
| | | | - Clio Berry
- Brighton and Sussex Medical School, Sussex, UK
| | - David Fowler
- University of Sussex, Sussex, UK.,Sussex Partnership NHS Foundation Trust, Sussex, UK
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6
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Patton HN, Cowan HR, Mittal VA. Changes in core beliefs over time predict symptoms and functioning in clinical high risk for psychosis. Early Interv Psychiatry 2022; 16:311-315. [PMID: 33938147 DOI: 10.1111/eip.13156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/23/2021] [Indexed: 11/30/2022]
Abstract
AIM The current study examined whether changes in core beliefs over time predict positive symptoms, negative symptoms, social functioning, and role functioning within individuals at clinical high risk for psychosis (CHR). METHODS CHR participants (N = 73) completed the Brief Core Schemas Scale (BCSS) at baseline, with a subset of participants (n = 54) completing study procedures at a 12-month follow-up. Attenuated psychotic symptoms, social, and role functioning were assessed at both timepoints. RESULTS Hierarchical regression analyses showed that changes in self-beliefs between baseline and follow-up predicted worsening social and role functioning at 12-month follow-up, with trends suggesting they also predicted negative and positive symptoms at 12-month follow-up. The independent effect of an increase in negative self-beliefs marginally or significantly predicted all outcomes of interest. CONCLUSIONS The current study shows incremental validity of self-beliefs from a novel perspective. It suggests that worsening self-beliefs have a clinically meaningful impact within CHR populations.
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Affiliation(s)
| | - Henry R Cowan
- Psychology, Northwestern University, Evanston, Illinois, USA
| | - Vijay A Mittal
- Psychology, Psychiatry, Medical Social Sciences, Northwestern University, Evanston, Illinois, USA
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7
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Faustino B. Maladaptive and Adaptive Cognitions About the Self and Others: Confirmatory Factor Analysis of the Brief Core Schemas Scales. Psychol Rep 2022; 126:1445-1460. [PMID: 35015611 DOI: 10.1177/00332941211063602] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The presence of dysfunctional cognitions about how individuals see themselves and others is a hallmark of psychopathology. The Brief Core Schemas Scale (BCSS) was developed to evaluate adaptive and dysfunctional beliefs about the self and others. This study describes the first psychometric analysis of the BCSS in the Portuguese population. Participants were recruited from community (N = 320, Mage=27.31, DP = 12.75). Confirmatory factor analysis (CFA) was used to confirm the BCSS factorial structure. Four-factor model revealed moderate to adequate goodness-of-fit indices (χ2/df = 717.1, (246) p = .01; SRMR = .044; RMSEA = .077; CFI/TLI < .90). Negative views of the self and others correlated positively with early maladaptive schemas, distress, and symptomatology and correlated negatively with psychological well-being. An inversed correlational pattern was found with the positive views of the self and others. Despite the model's moderate adherence to the data, results suggest that the BCSS may be an asset in the assessment of dysfunctional and adaptive cognitions about the self and others. Further analysis is required to deepen the psychometric properties of the BCSS in the Portuguese population.
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Affiliation(s)
- Bruno Faustino
- Faculdade de Psicologia da 37809Universidade de Lisboa, Lisboa, Portugal
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8
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Gleeson JFM, Eleftheriadis D, Santesteban-Echarri O, Koval P, Bastian B, Penn DL, Lim MH, Ryan RM, Alvarez-Jimenez M. Positive and meaningful lives: Systematic review and meta-analysis of eudaimonic well-being in first-episode psychosis. Early Interv Psychiatry 2021; 15:1072-1091. [PMID: 33037789 DOI: 10.1111/eip.13049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/13/2020] [Accepted: 09/26/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND First-episode psychosis typically has its onset during adolescence. Prolonged deficits in social functioning are common in FEP and yet often variance in functioning remains unexplained. Developmental psychology frameworks may be useful for understanding these deficits. Eudaimonic well-being (EWB), or positive self-development, is a developmental psychology construct that has been shown to predict mental health outcomes across multiple populations but has not been systematically reviewed in FEP. AIM Our aim was to systematically review the evidence for: the predictors of EWB, the effectiveness of EWB interventions and to examine the quality of this research in FEP. METHODS Selected studies measured either composite or components of EWB. A systematic search produced 2876 abstracts and 122 articles were identified for full screening which produced 17 final papers with 2459 participants. RESULTS Studies comprised six RCTs, eight prospective follow-up studies and three case-controlled studies. Self-esteem and self-efficacy were the most commonly measured components. A meta-analysis of RCTs revealed no statistically significant effect of interventions on self-esteem. The extant research indicates that character strengths may be associated with higher EWB. Self-esteem may be lower in FEP compared with age matched controls but not different from ultra-high risk patients. Self-esteem appears to be associated with poorer insight and improved therapeutic alliance. Significant problems with both external and internal validity of reviewed studies were apparent. CONCLUSIONS The hypotheses that lowered EWB is a risk factor for both onset of FEP and for poorer functional outcomes warrant further investigation. There is currently no evidence for effective interventions for EWB in FEP.
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Affiliation(s)
- John F M Gleeson
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Dina Eleftheriadis
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia.,Orygen, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Olga Santesteban-Echarri
- Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Peter Koval
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Brock Bastian
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - David L Penn
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia.,Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michelle H Lim
- Centre for Mental Health & Iverson Health Research Innovation Institute, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Richard M Ryan
- Department of Psychology, University of Rochester, Rochester, New York, USA.,Institute for Positive Psychology and Education, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Mario Alvarez-Jimenez
- Orygen, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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9
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Bemrose HV, Akande IO, Cullen AE. Self-esteem in individuals at ultra-high risk for psychosis: A systematic review and meta-analysis. Early Interv Psychiatry 2021; 15:775-786. [PMID: 32860493 DOI: 10.1111/eip.13034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/22/2020] [Accepted: 08/02/2020] [Indexed: 11/27/2022]
Abstract
AIM Low self-esteem (LSE) has been reported among individuals with psychosis and is hypothesized to act as a risk and maintenance factor for the disorder. However, the extent to which LSE also characterizes individuals deemed at ultra-high risk (UHR) for psychosis (who present features consistent with the prodromal phase of illness), has yet to be quantified using meta-analysis. This is important given that LSE is a potentially modifiable target for early intervention services aiming to reduce the risk of psychosis transition in this population. METHODS We searched Medline, Embase, PsycINFO and Web of Science Core Collection for studies examining self-esteem in UHR and healthy individuals. Random-effects models were used to examine group differences in self-esteem (Hedges'g) with exploratory meta-regression analyses employed to investigate the effect of study characteristics (mean age of UHR group, the proportion of male participants in the UHR group and study quality) on standardized mean differences. RESULTS Six studies were eligible for inclusion. Significant differences in self-esteem were observed, with individuals at UHR showing reduced self-esteem relative to healthy controls (g = -1.33 [-1.73 to -0.94] P < .001).However, there was evidence of substantial heterogeneity (I2 = 75%). Exploratory meta-regression analyses indicated a significant effect of the mean age of the UHR group on effect sizes (B = -0.26, P = .02). CONCLUSIONS UHR youth present with lower levels of self-esteem than healthy individuals, a difference that appears to be more pronounced with advancing age. We discuss clinical implications and provide recommendations for future studies.
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Affiliation(s)
- Holly V Bemrose
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Isaac O Akande
- Outreach and Support in South London (OASIS), South London and Maudsley NHS Foundation Trust, London, UK
| | - Alexis E Cullen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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10
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Cowan HR, Mittal VA, McAdams DP. Narrative identity in the psychosis spectrum: A systematic review and developmental model. Clin Psychol Rev 2021; 88:102067. [PMID: 34274799 DOI: 10.1016/j.cpr.2021.102067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/31/2021] [Accepted: 07/06/2021] [Indexed: 01/19/2023]
Abstract
Individuals with schizophrenia-spectrum disorders face profound challenges as they attempt to maintain identity through the course of illness. Narrative identity-the study of internalized, evolving life stories-provides a rich theoretical and empirical perspective on these challenges. Based on evidence from a systematic review of narrative identity in the psychosis spectrum (30 studies, combined N = 3859), we argue that the narrative identities of individuals with schizophrenia-spectrum disorders are distinguished by three features: disjointed structure, a focus on suffering, and detached narration. Psychotic disorders typically begin to emerge during adolescence and emerging adulthood, which are formative developmental stages for narrative identity, so it is particularly informative to understand identity disturbances from a developmental perspective. We propose a developmental model in which a focus on suffering emerges in childhood; disjointed structure emerges in middle and late adolescence; and detached narration emerges before or around the time of a first psychotic episode. Further research with imminent risk and early course psychosis populations would be needed to test these predictions. The disrupted life stories of individuals on the psychosis spectrum provide multiple rich avenues for further research to understand narrative self-disturbances.
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Affiliation(s)
| | - Vijay A Mittal
- Psychology, Psychiatry, Medical and Social Sciences, Institute for Policy Research, Northwestern University, United States
| | - Dan P McAdams
- Psychology, School of Education and Social Policy, Northwestern University, United States
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11
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Monsonet M, Ballespí S, Sheinbaum T, Valiente C, Espinosa R, Kwapil TR, Barrantes-Vidal N. Self-Schemas and Self-Esteem Discrepancies in Subclinical Paranoia: The Essential Role of Depressive Symptoms. Front Psychiatry 2021; 12:623755. [PMID: 33790815 PMCID: PMC8005540 DOI: 10.3389/fpsyt.2021.623755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background : Self-concepts are being intensively investigated in relation to paranoia, but research has shown some contradictory findings. Studying subclinical phenomena in a non-clinical population should allow for a clearer understanding given that clinical confounding factors are avoided. We explored self-esteem, self-schemas, and implicit/explicit self-esteem discrepancies in three non-clinical groups with different psychopathological traits and a control group. Methods: Participants with elevated trait-paranoia (n = 41), depressive symptoms (n = 34), a combination of both traits (n = 32), and a control group (n = 71) were assessed on implicit and explicit self-esteem, self-schemas, depression, and paranoia. A dimensional approach with the total sample (n = 208) was also used to complement the information provided by the group approach. Results: All groups presented similar and positive levels of implicit self-esteem. Trait-paranoia participants had similar levels of explicit self-esteem and self-schemas compared with the control group. However, the group with a combination of trait-paranoia and depressive symptoms showed the lowest levels of positive self-schemas and self-esteem. Furthermore, this group and the control group displayed implicit/explicit self-esteem discrepancies, although in opposite directions and with different implications. The dimensional approach revealed associations of trait-paranoia and depressive symptoms with poor explicit self-esteem and self-schemas but not with implicit self-esteem. Conclusions: Trait-paranoia participants showed different self-representations depending on whether depressive symptoms were present or not. The interaction between subclinical neurotic and psychotic traits entailed a detrimental self-representation that might increase the risk for psychopathology.
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Affiliation(s)
- Manel Monsonet
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Sergi Ballespí
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Tamara Sheinbaum
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
| | - Carmen Valiente
- School of Psychology, Complutense University of Madrid, Pozuelo de Alarcón, Spain
| | - Regina Espinosa
- Department of Psychology, University of Camilo José Cela, Villanueva de la Cañada, Spain
| | - Thomas Richard Kwapil
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain.,Sant Pere Claver - Fundació Sanitària, Barcelona, Spain.,Centre for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
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12
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Monsonet M, Kwapil TR, Barrantes-Vidal N. Deconstructing the relationships between self-esteem and paranoia in early psychosis: an experience sampling study. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 59:503-523. [PMID: 32862467 PMCID: PMC7693052 DOI: 10.1111/bjc.12263] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/21/2020] [Indexed: 12/27/2022]
Abstract
Background No studies have examined the association between self‐esteem and paranoia developmentally across the critical stages of psychosis emergence. The present study fills this gap and extends previous research by examining how different dimensions, measures, and types of self‐esteem relate to daily‐life paranoia across at‐risk mental states for psychosis (ARMS) and first episode of psychosis (FEP) stages. Furthermore, the moderation effects of momentary anxiety and momentary perceived social support on the association between momentary self‐esteem and paranoia were examined. Design This study used a multilevel, cross‐sectional design. Methods One‐hundred and thirteen participants (74 ARMS and 39 FEP) were assessed repeatedly over seven consecutive days on levels of momentary paranoia, self‐esteem, anxiety and perceived social support using experience sampling methodology. Measures of trait and implicit self‐esteem were also collected. Results Global momentary and trait self‐esteem, and their positive and negative dimensions, were related to daily‐life paranoia in both ARMS and FEP groups. Conversely, implicit self‐esteem was not associated with daily‐life paranoia in either group. Anxiety negatively moderated the association between positive self‐esteem and lower paranoia, whereas both feeling close to others and feeling cared for by others strengthened this association. However, only feeling cared for by others moderated the association between negative self‐esteem and higher paranoia. Conclusions Different types, measures and dimensions of self‐esteem are differentially related to paranoia in early psychosis and are influenced by contextual factors in daily‐life. This yields a more complex picture of these associations and offers insights that might aid psychological interventions. Practitioner points Different measures (trait and momentary) and dimensions (positive and negative) of explicit self‐esteem are distinctly related to paranoia across risk and first‐episode stages of psychosis. Explicit, but not implicit, self‐esteem is associated with real‐life paranoia in incipient psychosis. Anxiety boosted the association of poor self‐esteem and paranoia ideation in daily‐life. Social closeness, but feeling cared for by others in particular, interacts with self‐esteem tempering the expression of paranoia in real life.
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Affiliation(s)
- Manel Monsonet
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Thomas R Kwapil
- Department of Psychology, University of Illinois at Urbana-Champaign, USA
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain.,Sant Pere Claver - Fundació Sanitària, Barcelona, Spain.,Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
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13
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Müller H, de Millas W, Gaebel W, Herrlich J, Hasan A, Janssen B, Juckel G, Karow A, Kircher T, Kiszkenow-Bäker S, Klingberg S, Klosterkötter J, Krüger-Özgürdal S, Lambert M, Lautenschlager M, Maier W, Michel TM, Mehl S, Müller BW, Pützfeld V, Rausch F, Riedel M, Sartory G, Schneider F, Wagner M, Wiedemann G, Wittorf A, Wobrock T, Wölwer W, Zink M, Bechdolf A. Negative schemata about the self and others and paranoid ideation in at-risk states and those with persisting positive symptoms. Early Interv Psychiatry 2018; 12:1157-1165. [PMID: 28524542 DOI: 10.1111/eip.12433] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 12/13/2016] [Accepted: 01/19/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND The objective of this study is to test the conflicting theories concerning the association of negative self and other schemata and paranoid ideation. METHODS A risk-based approach, including risk stratification, is used to gain insight into the association of the negative self and other schemata that may be shared by individuals or differentiate between individuals at clinical high risk (CHR) for a first-episode psychosis and those with full-blown psychosis. The dataset includes a sample of individuals at CHR (n = 137) and a sample of individuals with persisting positive symptoms (PPS, n = 211). The CHR sample was subdivided according to a prognostic index yielding 4 CHR sub-classes with increasing risk for transition to psychosis. RESULTS Negative beliefs about the self were associated with paranoid ideation in CHR and a lower risk state. In the highest risk state and full-blown psychosis, there is an association with negative beliefs about others. CONCLUSION These findings are in line with theories suggesting a switch from a predominantly activated negative self-schema to a malevolent others-schema in association with paranoid ideation along the risk-continuum. However, due to methodological limitations these results should be replicated by future studies.
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Affiliation(s)
- Hendrik Müller
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Walter de Millas
- Department of Psychiatry and Psychotherapy, Charité University Medicine Campus Mitte, Berlin, Germany
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Jutta Herrlich
- Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe-University of Frankfurt am Main, Frankfurt am Main, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Birgit Janssen
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy, and Preventive Medicine, Ruhr University Bochum, Bochum, Germany
| | - Anne Karow
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Stefanie Kiszkenow-Bäker
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, Eberhard-Karls-University of Tuebingen, Tuebingen, Germany
| | | | - Seza Krüger-Özgürdal
- Department of Psychiatry, Psychotherapy, and Preventive Medicine, Ruhr University Bochum, Bochum, Germany
| | - Martin Lambert
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Marion Lautenschlager
- Department of Psychiatry and Psychotherapy, Charité University Medicine Campus Mitte, Berlin, Germany
| | - Wolfgang Maier
- Department of Psychiatry and Psychotherapy, Rhineland Friedrich Wilhelms University of Bonn, Bonn, Germany
| | - Tanja Maria Michel
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen, Aachen, Germany
| | - Stefanie Mehl
- Department of Psychiatry and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Bernhard W Müller
- Department for Psychiatry and Psychotherapy, LVR-Clinic Essen, Faculty of Medicine, University of Duisburg-Essen, Duisburg, Germany
| | - Verena Pützfeld
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Franziska Rausch
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Michael Riedel
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Gudrun Sartory
- Department of Clinical Psychology, University of Wuppertal, Wuppertal, Germany
| | - Frank Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen, Aachen, Germany
| | - Michael Wagner
- Department of Psychiatry and Psychotherapy, Rhineland Friedrich Wilhelms University of Bonn, Bonn, Germany
| | - Georg Wiedemann
- Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe-University of Frankfurt am Main, Frankfurt am Main, Germany
| | - Andreas Wittorf
- Department of Psychiatry and Psychotherapy, Eberhard-Karls-University of Tuebingen, Tuebingen, Germany
| | - Thomas Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University Goettingen, Goettingen, Germany
| | - Wolfgang Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Mathias Zink
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Andreas Bechdolf
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Clinic am Urban and Vivantes Clinic im Friedrichshain, Academic Hospital Charité, Berlin, Germany
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14
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Metacognitive beliefs as psychological predictors of social functioning: An investigation with young people at risk of psychosis. Psychiatry Res 2018; 262:520-526. [PMID: 28942953 PMCID: PMC5884305 DOI: 10.1016/j.psychres.2017.09.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 05/24/2017] [Accepted: 09/12/2017] [Indexed: 11/30/2022]
Abstract
Poor social functioning has been found to be present in those at risk for psychosis. This study aimed to examine metacognitive beliefs as potential predictors of structured activity (measure of social functioning) in those with an At Risk Mental State (ARMS). Regression and correlation analyses were conducted. The sample included 109 young people. Age was found to be positively correlated to structured activity. Metacognitive beliefs concerning uncontrollability and danger of worry were found to negatively predict structured activity. This was after controlling for age, gender, treatment allocation, cognitive schemas, positive symptom severity, social anxiety, and depression. Metacognitive danger items were most important. Age was the only control variable found to be an independent predictor of structured activity in the regression model, despite negative bi-variate relationships with structured activity found across three cognitive schema subscales and social anxiety. This is the first study to find that higher negative metacognitive beliefs about uncontrollability and danger predict lower social functioning in an ARMS sample, and that the perception of thoughts being dangerous was of particular importance. Psychological interventions should consider targeting this metacognitive dimension to increase social functioning. Future longitudinal research is required to strengthen findings in this area.
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15
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Core beliefs in healthy youth and youth at ultra high-risk for psychosis: Dimensionality and links to depression, anxiety, and attenuated psychotic symptoms. Dev Psychopathol 2018; 31:379-392. [PMID: 29506584 DOI: 10.1017/s0954579417001912] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cognitive theory posits that core beliefs play an active role in developing and maintaining symptoms of depression, anxiety, and psychosis. This study sought to comprehensively examine core beliefs, their dimensionality, and their relationships to depression, anxiety, and attenuated psychotic symptoms in two groups of community youth: a group at ultrahigh risk for psychosis (UHR; n = 73, M age = 18.7) and a matched healthy comparison group (HC; n = 73, M age = 18.1). UHR youth reported significantly more negative beliefs about self and others, and significantly less positive beliefs about self and others. HC youth rarely endorsed negative self-beliefs. Exploratory factor analyses found that HC negative self-beliefs did not cohere as a single factor. We hypothesized specific links between core beliefs and symptoms based on cognitive models of each disorder, and tested these links through regression analyses. The results in the HC group were consistent with the proposed models of depression and anxiety. The results in the UHR group were consistent with proposed models of depression and negative psychotic symptoms, somewhat consistent with a proposed model of positive psychotic symptoms, and not at all consistent with a proposed model of anxiety. These findings add to a growing developmental literature on core beliefs and psychopathology, with important clinical implications.
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16
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Jaya ES, Ascone L, Lincoln TM. Social Adversity and Psychosis: The Mediating Role of Cognitive Vulnerability. Schizophr Bull 2017; 43:557-565. [PMID: 27451429 PMCID: PMC5463978 DOI: 10.1093/schbul/sbw104] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Social adversity is a risk factor for psychosis, but the translating mechanisms are not well understood. This study tests whether the relationship between social adversity and psychosis is mediated by cognitive vulnerability in the form of low perceived social rank, negative schemas related to self and other, and loneliness and whether the putative mediations are specific to psychosis or are largely explained by depression. METHODS The study was a survey in a community sample (N = 2350) from Germany (n = 786), Indonesia (n = 844), and the United States (n = 720). Mediation path analysis with structural equation modeling was used to test for the specificity of the hypothesized paths to psychosis controlling for depression. RESULTS Social adversity had a significant medium to large effect on positive (R2 = .20) and negative symptoms (R2 = .38). Social rank, negative schemas, and loneliness significantly mediated the relationship between social adversity and negative symptoms and the models explained a large amount of the variance (R2 = .43-.44). For positive symptoms, only negative schemas were a significant mediator (R2 = .27). DISCUSSION The results emphasize the role of social adversity in psychosis and support the assumption that cognitive vulnerability is a relevant translating mechanism as postulated by the social defeat hypothesis and cognitive models of psychosis. This underlines the relevance of the clinical practice of targeting beliefs in cognitive interventions for psychosis. It also indicates that targeting cognitive vulnerability in people experiencing social adversity could be a promising approach to prevention.
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Affiliation(s)
- Edo S. Jaya
- Clinical Psychology and Psychotherapy, Institute of Psychology, University of Hamburg, Hamburg, Germany
| | - Leonie Ascone
- Clinical Psychology and Psychotherapy, Institute of Psychology, University of Hamburg, Hamburg, Germany
| | - Tania M. Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, University of Hamburg, Hamburg, Germany
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17
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Appiah-Kusi E, Fisher HL, Petros N, Wilson R, Mondelli V, Garety PA, Mcguire P, Bhattacharyya S. Do cognitive schema mediate the association between childhood trauma and being at ultra-high risk for psychosis? J Psychiatr Res 2017; 88:89-96. [PMID: 28103519 DOI: 10.1016/j.jpsychires.2017.01.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 12/09/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Abstract
Exposure to childhood trauma has been associated with psychotic symptoms, being at ultra-high risk for psychosis (UHR), and psychotic disorders such as schizophrenia. Negative self-beliefs have been shown to partially mediate the relationship between childhood trauma and paranoia and have been shown to be characteristic of patients with psychosis. However, whether the association between childhood trauma and being at high risk of developing psychosis (e.g., UHR) and paranoia symptoms is mediated by altered cognitive schema is unknown and warrants investigation to inform preventive interventions. Data was collected on 30 UHR patients from Outreach and Support in South London about exposure to childhood trauma, cognitive schema, paranoia and cannabis use. Relative to healthy controls (n = 38), UHR patients were significantly more likely to report exposure to various types of childhood trauma (emotional and sexual abuse, and emotional and physical neglect), had more negative schema and less positive schema about themselves and others, and were more likely to use cannabis more than once a month. Emotional neglect was found to be significantly associated with UHR status even after controlling for the effects of previous exposure to cannabis use (b = 0.262, 95% CI: 0.115-0.408), and this association was partially mediated by negative self-schema (b = 0.045, 95% CI: 0.004-0.159). Similarly, emotional neglect was significantly associated with paranoia (b = 1.354, 95% CI: 0.246-2.462), and this association was partially mediated by negative self-schema (b = 0.988, 95% CI: 0.323-1.895). These findings provide preliminary evidence about the cognitive mechanisms that may underlie the association between childhood trauma and later risk for psychosis.
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Affiliation(s)
- E Appiah-Kusi
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 67, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - H L Fisher
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 80, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - N Petros
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 67, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - R Wilson
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 67, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - V Mondelli
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 92, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - P A Garety
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 77, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - P Mcguire
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 67, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - S Bhattacharyya
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 67, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
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18
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So SHW, Tang V, Leung PWL. Dimensions of Delusions and Attribution Biases along the Continuum of Psychosis. PLoS One 2015; 10:e0144558. [PMID: 26640897 PMCID: PMC4671671 DOI: 10.1371/journal.pone.0144558] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/19/2015] [Indexed: 01/12/2023] Open
Abstract
This study compared delusional dimensions and attribution biases along the continuum of psychosis. Participants completed questionnaires on delusion-like beliefs and attributions. Although patients with first-episode psychosis (N = 70) endorsed fewer delusion-like beliefs than non-clinical individuals with psychotic-like experiences (N = 12), they scored highest on delusional conviction, distress and preoccupation, followed by non-clinical individuals with psychotic-like experiences, and then healthy controls (N = 642). Self-serving bias was found in patients and non-clinical individuals with psychotic-like experiences, but not in healthy controls. Personalizing bias for negative events was not significantly different across the three groups. When compared with healthy controls, non-clinical individuals with psychotic-like experiences had an exaggerated self-serving bias, but were not more marked in personalizing bias. Self-serving bias and personalizing bias were both associated with delusional dimensions. However, the association between self-serving bias and number of delusion-like beliefs was stronger among patients than non-clinical participants. Future research could investigate the extent to which self-serving bias, in combination with an appraisal of delusional ideation as convincing, distress, and preoccupying, contributes to the development of clinical delusions.
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Affiliation(s)
- Suzanne Ho-wai So
- Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong Special Administrative Region, China
| | - Venus Tang
- Department of Clinical Psychology, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, China
| | - Patrick Wing-leung Leung
- Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong Special Administrative Region, China
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19
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Carol EE, Mittal VA. Resting cortisol level, self-concept, and putative familial environment in adolescents at ultra high-risk for psychotic disorders. Psychoneuroendocrinology 2015; 57:26-36. [PMID: 25880698 PMCID: PMC4437835 DOI: 10.1016/j.psyneuen.2015.03.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/20/2015] [Accepted: 03/21/2015] [Indexed: 12/24/2022]
Abstract
A growing body of evidence suggests that resting cortisol levels are elevated in patients with schizophrenia and closely tied to symptom severity. However, there is limited research on the biological stress system during the ultra high-risk (UHR) period immediately preceding the onset of psychosis, and cortisol has not been examined in relation to individual characteristics such as self-concept or potential stressors such as putative familial environment in this critical population. In the present study, salivary cortisol samples were collected on 37 UHR and 42 matched control adolescents, and these individuals were assessed with clinical interviews as well as a measure of self-concept. For a subsection of the sample (23 UHR and 20 control adolescents), a participating relative/caretaker was also assessed with an expressed emotion interview designed to gauge psychosocial environment. Consistent with previous studies, UHR participants exhibited elevated resting cortisol levels when compared with controls. In addition, UHR adolescents exhibited increased negative self-concept and their relatives/caretakers endorsed significantly fewer initial positive statements about the participant. Interestingly, a strong trend in the UHR group suggests that higher cortisol levels are associated with higher rates of critical statements from relatives/caretakers. Furthermore, elevated cortisol levels in the participants were associated with increased negative self-concept as well as fewer initial positive comments from relatives/caretakers. Results suggest that hypothalamic-pituitary-adrenal axis (HPA) dysfunction is closely associated with both individual and environmental-level characteristics. Taken together, these findings support a neural diathesis-stress model of psychosis and future studies, designed to examine causal relationships, stand to inform both our understanding of pathogenic processes in the high-risk period as well as early intervention efforts.
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Affiliation(s)
- Emily E. Carol
- University of Colorado Boulder Department of Psychology and Neuroscience Boulder, Colorado, 80309 United States of America,Corresponding Author: Emily E. Carol University of Colorado at Boulder Department of Psychology and Neuroscience, Center for Neuroscience 345 UCB Boulder, CO 80309-0345 Phone: 303.492-4616
| | - Vijay A. Mittal
- Northwestern University, Department of Psychology, Evanston, IL, 60208, USA
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20
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Bebbington P. Unravelling psychosis: psychosocial epidemiology, mechanism, and meaning. SHANGHAI ARCHIVES OF PSYCHIATRY 2015; 27:70-81. [PMID: 26120255 PMCID: PMC4466846 DOI: 10.11919/j.issn.1002-0829.215027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 02/23/2015] [Indexed: 12/17/2022]
Abstract
This paper reviews a revolution in our understanding of psychosis over the last 20 years. To a
major extent, this has resulted from a process of cross-fertilization between psychosocial epidemiology
and cognitive behavior therapy for psychosis (CBT-p). This encouraged complementary strategies for the
acquisition and analysis of data. These include the use of a range of dependent variables related to psychosis,
and the exploitation of data from cross-sectional and longitudinal epidemiological surveys, virtual reality
experiments, experience sampling methodology, and treatment trials. The key element is to investigate social
and psychological measures in relation to each other. This research has confirmed the role of the external
social world in the development and persistence of psychotic disorder. In addition, several psychological
drivers of psychotic experiences have been identified. There is now persuasive evidence that the influence
of social factors in psychosis is significantly mediated by non-psychotic symptoms, particularly mood
symptoms and other attributes of affect such as insomnia. Psychotic symptoms are also driven by reasoning
biases such as jumping to conclusions and belief inflexibility, though little is known about social influences
on such biases. It is now clear that there are many routes to psychosis and that it takes many forms.
Treatment of all kinds should take account of this: the dependence of CBT-p on a detailed initial formulation
in terms of psychological processes and social influences is an example of the required flexibility. Individual
mediators are now being targeted in specific forms of CBT-p, with good effect. This in turn corroborates the
hypothesized role of non-psychotic symptoms in mediation, and attests to the power of the approaches
described.
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Affiliation(s)
- Paul Bebbington
- Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom
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21
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Abstract
Background: Schema Theory proposes that the development of maladaptive schemas are based on a combination of memories, emotions and cognitions regarding oneself and one's relationship to others. A cognitive model of psychosis suggests that schemas are crucial to the development and persistence of psychosis. Little is known about the impact that schemas may have on those considered to be at clinical high risk (CHR) of developing psychosis. Aims: To investigate schemas over time in a large sample of CHR individuals and healthy controls. Method: Sample included 765 CHR participants and 280 healthy controls. Schemas were assessed at baseline, 6 and 12 months using the Brief Core Schema Scale (BCSS). Baseline schemas were compared to 2-year clinical outcome. Results: CHR participants evidenced stable and more maladaptive schemas over time compared to controls. Schemas at initial contact did not vary amongst the different clinical outcome groups at 2 years although all CHR outcome groups evidenced significantly worse schemas than healthy controls. Although there were no differences on baseline schemas between those who later transitioned to psychosis compared to those who did not, those who transitioned to psychosis had more maladaptive negative self-schemas at the time of transition. Associations between negative schemas were positively correlated with earlier abuse and bullying. Conclusions: These findings demonstrate a need for interventions that aim to improve maladaptive schemas among the CHR population. Therapies targeting self-esteem, as well as schema therapy may be important work for future studies.
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A preliminary investigation of schematic beliefs and unusual experiences in children. Eur Psychiatry 2015; 30:569-75. [PMID: 25591496 DOI: 10.1016/j.eurpsy.2014.12.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 12/13/2014] [Accepted: 12/13/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In cognitive models of adult psychosis, schematic beliefs about the self and others are important vulnerability and maintaining factors, and are therefore targets for psychological interventions. Schematic beliefs have not previously been investigated in children with distressing unusual, or psychotic-like, experiences (UEDs). The aim of this study was firstly to investigate whether a measure of schematic beliefs, originally designed for adults with psychosis, was suitable for children; and secondly, to examine the association of childhood schematic beliefs with internalising and externalising problems and with UEDs. METHOD Sixty-seven children aged 8-14 years, with emotional and behavioural difficulties, completed measures of UEDs, internalising (depression and anxiety), and externalising (conduct and hyperactivity-inattention) problems, together with the Brief Core Schema Scales (BCSS). RESULTS The BCSS was readily completed by participants, and scale psychometric properties were good. Children tended to view themselves and others positively. Internalising and externalising problems and UEDs were all associated with negative schematic beliefs; effect sizes were small to medium. CONCLUSIONS Schematic beliefs in young people can be measured using the BCSS, and negative schematic beliefs are associated with childhood psychopathology and with UEDs. Schematic beliefs may therefore form a useful target in psychological interventions for young people with UEDs.
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