Psychosocial stress, interpersonal sensitivity, and social withdrawal in clinical high risk for psychosis: a systematic review

The day-to-day influence of trauma exposure and sleep dysfunction on everyday stress in youth at familial high-risk for psychotic disorders

Cumulative research finds that exposure to childhood trauma, sleep dysfunction, and high stress levels are prevalent in youth diagnosed with and at-risk for psychotic disorders. However, few studies have investigated the association between nightly sleep and moment-to-moment stress in youth who are at familial high-risk (FHR) for psychotic disorders with varying levels of exposure to childhood trauma. The current study examined the day-to-day associations between trauma severity, nightly sleep duration, and next-day momentary stress in 19 FHR and 19 non-psychiatric youth (ages 13-19 years, 66 % girls). Ecological Momentary Assessment was used to assess these variables across three longitudinal timepoints (baseline, 6-months, and 12-months). The FHR group reported greater trauma severity and shorter sleep duration than the non-psychiatric group. In the whole sample, trauma severity and reduced sleep duration were associated with next-day momentary stress. While group status did not moderate the association between sleep duration and next-day momentary stress, group status did moderate the positive association between trauma severity and next-day momentary stress, showing that the association was specific to the non-psychiatric group. Lastly, the effect of nightly sleep duration on next-day momentary stress was significant and negative, but only at low levels of trauma severity for the whole sample. Findings offer preliminary insights into the associations between trauma severity, sleep duration, and momentary stress. Furthermore, this design can provide a foundation for future research examining environmental and psychosocial risk factors that contribute to symptom progression and prognosis of youth who are genetically vulnerable to psychosis.

The Values-Based Psychopathology of Antoni Kępiński (1918-1972)

BACKGROUND

The question of the role of personal values in the constitution of and recovery from mental illness is a divisive subject discussed in contemporary psychopathology. This article critically examines the psychopathological theories and contributions of Antoni Kępiński - a seminal yet internationally under-recognized Polish psychiatrist.

SUMMARY

Drawing upon a multilayered framework incorporating biological, affective-emotional, and sociocultural dimensions, Kępiński posited mental disorders as disturbances in the energy and information metabolism with the environment leading to an increase in entropy. Kępiński's work also contributes to a richer understanding of schizophrenia (whose essence he metaphorically described as the plasma membrane rupture) and the complexities inherent in the decision-making processes of patients. In a quasi-phenomenological vein, Kępiński encouraged to re-evaluate delusions and hallucinations as opportunities to access unfiltered insights into reality. He also argued for the potential for moral growth within psychiatric treatment.

KEY MESSAGES

Kępiński's theories anticipated many concepts now foundational in neuroscientific research and clinical psychiatry, showcasing his role as a forward-thinking figure in the history of the profession.

Molecular evidence of altered stress responsivity related to neuroinflammation in the schizophrenia midbrain

Stress and inflammation are risk factors for schizophrenia. Chronic psychosocial stress is associated with subcortical hyperdopaminergia, a core feature of schizophrenia. Hyperdopaminergia arises from midbrain neurons, leading us to hypothesise that changes in stress response pathways may occur in this region. To identify whether transcriptional changes in glucocorticoid and mineralocorticoid receptors (NR3C1/GR, NR3C2/MR) or other stress signalling molecules (FKBP4, FKBP5) exist in schizophrenia midbrain, we measured gene expression in the human brain (N = 56) using qRT-PCR. We assessed whether alterations in these mRNAs were related to previously identified high/low inflammatory status. We investigated relationships between stress-related transcripts themselves, and between FKBP5 mRNA, dopaminergic, and glial cell transcripts in diagnostic and inflammatory subgroups. Though unchanged by diagnosis, GR mRNA levels were reduced in high inflammatory compared to low inflammatory schizophrenia cases (p = 0.026). We found no effect of diagnosis or inflammation on MR mRNA. FKBP4 mRNA was decreased and FKBP5 mRNA was increased in schizophrenia (p < 0.05). FKBP5 changes occurred in high inflammatory (p < 0.001), whereas FKBP4 changes occurred in low inflammatory schizophrenia cases (p < 0.05). The decrease in mRNA encoding the main stress receptor (GR), as well as increased transcript levels of the stress-responsive negative regulator (FKBP5), may combine to blunt the midbrain response to stress in schizophrenia when neuroinflammation is present. Negative correlations between FKBP5 mRNA and dopaminergic transcripts in the low inflammatory subgroup suggest higher levels of FKBP5 mRNA may also attenuate dopaminergic neurotransmission in schizophrenia even when inflammation is absent. We report alterations in GR-mediated stress signalling in the midbrain in schizophrenia.

Impact of psychosocial stress on facial emotion recognition in schizophrenia and controls: an experimental study in a forensic sample

Introduction

Psychotic disorders have been associated with dysregulated stress reactions and adaptation. Little is known about the neuroendocrine responses to psychosocial stress in justice-involved individuals with schizophrenia.

Methods

Using an experimental research design, the present study aims to examine differences in the subjective and neuroendocrine responses to psychosocial stress and its impact on facial emotion recognition (FER) and performance on an arithmetic task in chronically ill justice-involved individuals with schizophrenia (PAT) and a healthy control group. PAT undergoing treatment in forensic psychiatric inpatient wards (n = 17) and a healthy control group (n = 17) were assessed regarding sociodemographic and clinical characteristics. Additionally, salivary cortisol levels, measured before and after performing a psychosocial stress task [Montreal Imaging Stress Task (MIST)], and performance on an arithmetic problem-solving task and two FER tasks were recorded. Two participants dropped out, one from each group. Therefore, the final sample consisted of 32 individuals.

Results

Significant group differences in FER were recorded. There was a significant rise in subjective perception of momentary strain relating to the induction of psychosocial stress in both groups. Notably, the pre-stress level of subjective strain was higher in the PAT group than controls. Acute psychosocial stress induced an increase in FER performance in a sub-task related to naming emotions in individuals with schizophrenia spectrum disorder.

Discussion

The results underline the importance of psychosocial and therapeutic interventions aimed at strengthening stress resilience in individuals with schizophrenia spectrum disorders.

β1-adrenoceptor expression on GABAergic interneurons in primate dorsolateral prefrontal cortex: potential role in stress-induced cognitive dysfunction

Uncontrollable stress exposure impairs working memory and reduces the firing of dorsolateral prefrontal cortex (dlPFC) "Delay cells", involving high levels of norepinephrine and dopamine release. Previous work has focused on catecholamine actions on dlPFC pyramidal cells, but inhibitory interneurons may contribute as well. The current study combined immunohistochemistry and multi-scale microscopy with iontophoretic physiology and behavioral analyses to examine the effects of beta1-noradrenergic receptors (β1-ARs) on inhibitory neurons in layer III dlPFC. We found β1-AR robustly expressed on different classes of inhibitory neurons labeled by the calcium-binding proteins calbindin (CB), calretinin (CR), and parvalbumin (PV). Immunoelectron microscopy confirmed β1-AR expression on the plasma membrane of PV-expressing dendrites. PV interneurons can be identified as fast-spiking (FS) in physiological recordings, and thus were studied in macaques performing a working memory task. Iontophoresis of a β1-AR agonist had a mixed effect, increasing the firing of a subset and decreasing the firing of others, likely reflecting loss of firing of the entire microcircuit. This loss of overall firing likely contributes to impaired working memory during stress, as pretreatment with the selective β1-AR antagonist, nebivolol, prevented stress-induced working memory deficits. Thus, selective β1-AR antagonists may be helpful in treating stress-related disorders.

A phenomenological comparison of auditory hallucinations between borderline personality disorder and schizophrenia: A systematic review

OBJECTIVE

Borderline personality disorder (BPD) with auditory hallucinations (AHs) may inadvertently be misdiagnosed with a primary psychotic disorder, such as schizophrenia (SZ). This misidentification can lead to challenges in providing effective psychological treatment. This review therefore aims to identify the phenomenological characteristics of AHs in BPD in comparison to SZ, as well as psychological interventions that explicitly target AHs in BPD.

METHODS

A systematic review was conducted to summarise the existing evidence base regarding the phenomenological similarities and differences of AHs in BPD and SZ, along with the identification of psychological interventions for AHs in BPD.

RESULTS

Eighteen studies were eligible for inclusion. Compared to the SZ group, BPD clients were characterised by more persistent and repetitive AHs, significantly more voice-related distress and appraisals of omnipotence, and an earlier age of onset of AHs. The BPD group also reported more severe depression and anxiety, a higher incidence of childhood trauma, and more negative self-schema. Cognitive Behaviour Therapy Coping Strategy Enhancement (CBT-CSE) might be a promising intervention to reduce AH-related distress in BPD, although further studies are required to determine its effectiveness.

CONCLUSION

In order to prevent misdiagnosis of AHs in BPD, the DSM-5 may need to acknowledge the broader and more frequent occurrence of psychosis symptoms in BPD clients. Such clarification may enhance diagnostic practices and facilitate more timely access to treatment. There is also a need to develop and trial psychological interventions that explicitly target AHs in BPD.

Conceptualizing a less paranoid schizophrenia

Schizophrenia stands as one of the most studied and storied disorders in the history of clinical psychology; however, it remains a nexus of conflicting and competing conceptualizations. Patients endure great stigma, poor treatment outcomes, and condemnatory prognosis. Current conceptualizations suffer from unstable categorical borders, heterogeneity in presentation, outcome and etiology, and holes in etiological models. Taken in aggregate, research and clinical experience indicate that the class of psychopathologies oriented toward schizophrenia are best understood as spectra of phenomenological, cognitive, and behavioral modalities. These apparently taxonomic expressions are rooted in normal human personality traits as described in both psychodynamic and Five Factor personality models, and more accurately represent explicable distress reactions to biopsychosocial stress and trauma. Current categorical approaches are internally hampered by axiomatic bias and systemic inertia rooted in the foundational history of psychological inquiry; however, when such axioms are schematically decentralized, convergent cross-disciplinary evidence outlines a more robust explanatory construct. By reconceptualizing these disorders under a dimensional and cybernetic model, the aforementioned issues of instability and inaccuracy may be resolved, while simultaneously opening avenues for both early detection and intervention, as well as for more targeted and effective treatment approaches.

Effects of Workplace Ostracism on Pro-Job Unethical Behavior: The Role of Moral Disengagement, Interpersonal Sensitivity and Self-Serving Political Will

Drawing on social cognition theory, this study aims to investigate the impact of workplace ostracism on pro-job unethical behavior by studying the mediating function of moral disengagement and the moderating function of interpersonal sensitivity and self-serving political will. Data were congregated from 527 Chinese employees. A positive effect of workplace ostracism on pro-job unethical behavior was found, which was partially mediated by moral disengagement. In addition, interpersonal sensitivity strengthened the connection between workplace ostracism and moral disengagement, and self-serving political will strengthened the connection between moral disengagement and pro-job unethical behavior. Both theoretical and practical value are discussed in the study.