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Zhuo C, Zhou C, Cai Z, Chen J, Yang L, Li Q, Zhang Q, Fang T, Tian H, Lin C, Song X. Electrical stimulus combined with venlafaxine and mirtazapine improves brain Ca 2+ activity, pre-pulse inhibition, and immobility time in a model of major depressive disorder in schizophrenia. J Affect Disord 2022; 319:610-617. [PMID: 36162671 DOI: 10.1016/j.jad.2022.09.037] [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: 01/07/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The prevalence of major depressive disorder in patients with schizophrenia (SZ-MDD) has been reported to be about 32.6 %, but it varies considerably depending on the stage (early or chronic) and state (acute or post-psychotic) of schizophrenia. The exploration of ideal strategies for the treatment of major depressive disorder in the context of schizophrenia is urgently needed. Thus, the present study was conducted to investigate the treatment effects of clozapine, electrical stimulation (ECS; the mouse model equivalent of electroconvulsive therapy for humans), venlafaxine, and mirtazapine for SZ-MDD. METHODS A mouse model of SZ-MDD was established with MK801 administration and chronic unpredictable mild stress exposure. Clozapine and ECS, alone and with mirtazapine and/or venlafaxine, were used as treatment strategies. In-vivo two-photon imaging was performed to visualize Ca2+ neural activity in the prefrontal cortex (PFC). Mouse performance on behavioral assays was taken to reflect acute treatment effects. RESULTS ECS + venlafaxine + mirtazapine performed significantly better than other treatments in alleviating major depressive disorder, as reflected by PFC Ca2+ activity and behavioral assay performance. Clozapine + venlafaxine + mirtazapine did not have an ideal treatment effect. Brain Ca2+ activity alterations did not correlate with behavioral expression in any treatment group. CONCLUSIONS In this mouse model of SZ-MDD, ECS + venlafaxine + mirtazapine improved brain Ca2+ activity, pre-pulse inhibition, and immobility time. These findings provide useful information for the further exploration of treatment methods for patients with SZ-MDD, although the mechanisms underlying this comorbidity needed to be investigated further.
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Affiliation(s)
- Chuanjun Zhuo
- Key Laboratory of Real Time Tracing Brain Circuits of Nerology and Psychiatry (RTBNP_Lab), Tianjin Medical University Affiliated Tianjin Fourth Center Hospital, Tianjin Fourth Center Hospital, Tianjin 300140, China; the key Laboratory of Psychiatric-Neuroimaging-Genetics and Comorbidity (PNGC_Lab) of Tianjin Anding Hospital, Tianjin Mental Health Center of Tianjin Medical University, Tianjin 300222, China; Brain Micro-imaging Center of Psychiatric Animal Model, Wenzhou Seventh Peoples Hospital, Wenzhou 325000, China; Department of Psychiatry, the First Affiliated Hospital/Zhengzhou University, Zhengzhou, China.
| | - Chunhua Zhou
- Department of Pharmacology, The First Hospital of Hebei Medical University, Shijiazhuang 05000, China
| | - Ziyao Cai
- Key Laboratory of the Macro-Brain Neuroimaging Center of Animal Model, Wenzhou Seventh Peoples Hospital, Wenzhou 325000, China
| | - Jiayue Chen
- Key Laboratorary of Multiple Organs Damage in the Patients with Mental Illness (MODPM_Lab) of Tianjin Fourth Center Hospital, Tianjin 100140, China
| | - Lei Yang
- Key Laboratorary of Multiple Organs Damage in the Patients with Mental Illness (MODPM_Lab) of Tianjin Fourth Center Hospital, Tianjin 100140, China
| | - Qianchen Li
- Key Laboratorary of Multiple Organs Damage in the Patients with Mental Illness (MODPM_Lab) of Tianjin Fourth Center Hospital, Tianjin 100140, China
| | - Qiuyu Zhang
- Key Laboratorary of Multiple Organs Damage in the Patients with Mental Illness (MODPM_Lab) of Tianjin Fourth Center Hospital, Tianjin 100140, China
| | - Tao Fang
- Key Laboratorary of Multiple Organs Damage in the Patients with Mental Illness (MODPM_Lab) of Tianjin Fourth Center Hospital, Tianjin 100140, China
| | - Hongjun Tian
- Key Laboratorary of Multiple Organs Damage in the Patients with Mental Illness (MODPM_Lab) of Tianjin Fourth Center Hospital, Tianjin 100140, China.
| | - Chongguang Lin
- Key Laboratory of the Macro-Brain Neuroimaging Center of Animal Model, Wenzhou Seventh Peoples Hospital, Wenzhou 325000, China.
| | - Xueqin Song
- Department of Psychiatry, the First Affiliated Hospital/Zhengzhou University, Zhengzhou, China; Biological Psychiatry International Joint Laboratory of Henan/Zhengzhou University, Zhengzhou 045000, China.
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Straup ML, Prothro K, Sweatt A, Shamji JF, Jenkins SR. Coping Strategies and Trauma-Related Distress of College Students During Covid-19. JOURNAL OF COLLEGE STUDENT RETENTION: RESEARCH, THEORY & PRACTICE 2022. [PMCID: PMC9483133 DOI: 10.1177/15210251221126162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Present-day college students are particularly impacted by the disconcerting
effects of Covid-19 because of their vulnerability towards mental health
struggles. The current study identified coping strategies used by students in
the United States and how those strategies are associated with trauma-related
distress. Results showed acceptance, emotional processing, and social support
were the most commonly used coping strategies. Furthermore, avoidance coping
related to higher distress than more helpful approaches (e.g., humor).
Demographic findings revealed that Black students used more religious coping
than did White and Asian students. Additionally, older and upper-year students
used substances to cope more than did other students, including those with
higher grade point averages. Our discussion focuses on how the findings of the
present study can be used to enhance student support, resiliency, academic
performance, and retention.
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Tsang A, Bucci S, Branitsky A, Kaptan S, Rafiq S, Wong S, Berry K, Varese F. The relationship between appraisals of voices (auditory verbal hallucinations) and distress in voice-hearers with schizophrenia-spectrum diagnoses: A meta-analytic review. Schizophr Res 2021; 230:38-47. [PMID: 33667857 DOI: 10.1016/j.schres.2021.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/05/2021] [Accepted: 02/14/2021] [Indexed: 02/01/2023]
Abstract
Cognitive-behavioural models of auditory verbal hallucinations (voices) predict that the interpretation of voices determines the levels of distress experienced by voice-hearers. Examining the contribution of these voice appraisals is central to the delivery of effective psychological interventions for the management of distressing psychotic symptoms. This meta-analysis synthesised evidence from studies that tested the relationship between a range of appraisals and several distress measures (voice-related and emotional distress) in individuals with schizophrenia-spectrum diagnoses. A database search (PsycINFO, PubMed and Web of Science) was conducted for articles published up to August 2020. Twenty-eight eligible studies, comprising of 1497 clinical participants examined the association between eight voice appraisals and distress. Moderate to large summary effects (r ranging between 0.30 and 0.50) were observed in several analyses focusing on 'maladaptive' appraisals and beliefs about voices (malevolence, power, metaphysical beliefs, beliefs about loss of control, voice intrusiveness), with voice dominance having a large summary effect, r = 0.58, 95% CI [0.43, 0.69]. Positive appraisals and beliefs had small negative summary effects on distress. The magnitude of the observed effects was similar across subgroup analyses considering measures of voice-related distress, anxiety and depression. The findings of this evidence synthesis broadly corroborate cognitive-behavioural models of distressing voices, but suggested that factors other than voice appraisals may also predict the distress and impairment caused by hallucinatory experiences in people with schizophrenia-spectrum disorders. Nonetheless, our findings confirm that voice appraisals are an important and meaningful target for treatment in help-seeking voice hearers with psychosis.
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Affiliation(s)
- Anthony Tsang
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester. 2(nd) Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester. 2(nd) Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, UK; Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Alison Branitsky
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Safa Kaptan
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester. 2(nd) Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, UK
| | - Sonya Rafiq
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester. 2(nd) Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, UK
| | - Samantha Wong
- Salford Royal NHS Foundation Trust Unit, Manchester Academic Health Science Centre, Salford, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester. 2(nd) Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, UK; Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester. 2(nd) Floor, Zochonis Building, Brunswick Street, Manchester M13 9PL, UK; Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
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A systematic review of PTSD to the experience of psychosis: prevalence and associated factors. BMC Psychiatry 2021; 21:9. [PMID: 33413179 PMCID: PMC7789184 DOI: 10.1186/s12888-020-02999-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 12/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychosis can be a sufficiently traumatic event to lead to post-traumatic stress disorder (PTSD). Previous research has focussed on the trauma of first episode psychosis (FEP) and the only review to date of PTSD beyond the first episode period was not systematic and is potentially outdated. METHODS We searched electronic databases and reference lists using predetermined inclusion criteria to retrieve studies that reported prevalence rates and associated factors of psychosis-related PTSD across all stages of the course of psychosis. Studies were included if they measured PTSD specifically related to the experience of psychosis. Risk of bias was assessed using an adapted version of the Newcastle Ottawa Scale. Results were synthesised narratively. RESULTS Six papers met inclusion criteria. Prevalence estimates of psychosis-related PTSD varied from 14 to 47%. Studies either assessed first-episode samples or did not specify the number of episodes experienced. Depression was consistently associated with psychosis-related PTSD. Other potential associations included treatment-related factors, psychosis severity, childhood trauma, and individual psychosocial reactions to trauma. CONCLUSIONS Psychosis-related PTSD is a common problem in people with psychosis. There is a lack of published research on this beyond first episode psychosis. Further research is needed on larger, more generalizable samples. Our results tentatively suggest that prevalence rates of psychosis-related PTSD have not reduced over the past decade despite ambitions to provide trauma-informed care. Prospero registration number: CRD42019138750.
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Effect of childhood physical abuse on social anxiety is mediated via reduced frontal lobe and amygdala-hippocampus complex volume in adult clinical high-risk subjects. Schizophr Res 2021; 227:101-109. [PMID: 32461085 DOI: 10.1016/j.schres.2020.05.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/22/2020] [Accepted: 05/16/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Childhood adverse experiences (CAE) are associated with clinical psychiatric disorders and symptoms, and with volumetric abnormalities in the amygdala-hippocampus complex (AmHiC) and frontal lobe (FroL) in adulthood. AIM To study whether CAE are associated with reduced AmHiC and FroL and whether these structures mediate the effect of CAE on social anxiety and depression. METHOD In seven European centres, 374 patients with recent onset of psychosis (n = 127), clinical high-risk to psychosis (n = 119) or recent onset of depression (n = 128) were scanned with MRI and their FroL and AmHiC volumes were measured. They all completed self-report scales for assessment of CAE, social anxiety and depression. RESULTS Of the CAE domains, physical abuse was associated specifically with reduced grey and white matter volumes of FroL and AmHiC in psychotic and high-risk patients. After controlling intracranial volume, PhyAb associated significantly with FroL and its grey matter volume in high-risk patients only. In mediation analyses, the effect of physical abuse on social anxiety was mediated via reduced FroL grey mater volume in high-risk patients. In them, when the effects of AmHiC and depression were controlled, the effect of physical abuse on social anxiety was mediated via FroL grey matter volume reduction. CONCLUSIONS Childhood physical abuse is associated with reduced frontal lobe and amygdala-hippocampus complex volume in adult subjects with psychotic symptoms. Reduced frontal lobe and amygdala-hippocampus complex volume mediate the effect of physical abuse on social anxiety in high-risk patients. The effect of physical abuse on depression-independent social anxiety is mediated via reduced frontal lobe.
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Perlini C, Bellani M, Rossetti MG, Rossin G, Zovetti N, Rossi A, Bressi C, Piccolo LD, Brambilla P. Mindfulness-based interventions in the early phase of affective and non-affective psychoses: Special Section on "Translational and Neuroscience Studies in Affective Disorders" Section Editor, Maria Nobile MD, PhD. J Affect Disord 2020; 263:747-753. [PMID: 31630830 DOI: 10.1016/j.jad.2019.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/12/2019] [Accepted: 10/08/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND In the last 10 years, psychological approaches based on mindfulness techniques have been proposed for the management of psychotic experiences. METHOD In this brief review we summarized, to our knowledge for the first time, published studies on mindfulness-based interventions (MBIs) applied to the early phase of major psychoses (affective and non-affective). RESULTS Despite the great variability in terms of MBIs protocols, available studies on young people at risk to develop or with a first episode of psychosis suggest MBIs as a feasible, well-tolerated and effective approach in ameliorating symptoms, functioning, emotion regulation, and finally reducing the psychological distress associated with the onset of mania and/or psychotic experience. LIMITATIONS The small sample size and inconsistencies between studies in terms of design, MBIs protocols and outcome measures suggest being cautious in interpreting and generalizing results. Moreover, specific guidelines are missing for the adaptation of MBIs to youth at risk of developing affective psychoses. CONCLUSIONS Preliminary findings show that MBIs may be considered a promising adjunctive therapy for the treatment of major psychoses in the early phases of the illness. However, the conduct of further studies in larger samples and with a more rigorous methodology is warranted to confirm the beneficial effect of MBIs in the early stages of major psychoses.
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Affiliation(s)
- Cinzia Perlini
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Marcella Bellani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy.
| | - Maria Gloria Rossetti
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy; Department of Neuroscience and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giulia Rossin
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Niccolò Zovetti
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Alberto Rossi
- Department of Mental Health, ULSS9 Scaligera, Verona, Italy
| | - Cinzia Bressi
- Department of Neuroscience and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lidia Del Piccolo
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Clinical Psychology, University of Verona, Verona, Italy
| | - Paolo Brambilla
- Department of Neuroscience and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Psychiatry and Behavioural Sciences, University of Texas at Houston Medical School, Houston, TX, USA.
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7
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Abstract
Delirium is a significant medical condition that is common in hospitalized patients. Beyond the increased risk of mortality, patients who experience an episode of delirium often go on to develop long-term psychiatric disturbance, including symptoms of post-traumatic stress disorder (PTSD). While there is a growing interest in understanding the complex relationship between delirium and PTSD, the existing literature is sparse and lacking harmony. Thus, this review seeks to develop a unified and thorough description of the cognitive and psychiatric underpinnings of post-delirium PTSD with the aims of promoting awareness of this condition amongst clinicians in medical settings, improving patient care, and sparking further research on this topic. While specific underlying mechanisms are yet unclear, PTSD was found to be associated with delirium in that delirious patients may have decreased factual recall of hospital events and increased hallucinations/delusions of a traumatic nature. Several potential interventions were identified, as well as suggestions for future research and clinical practice.
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8
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Le Trouble Stress Post-Traumatique secondaire à l’expérience de la psychose : une revue de littérature. Encephale 2019; 45:506-512. [DOI: 10.1016/j.encep.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/25/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
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MacDougall AG, Price E, Vandermeer MRJ, Lloyd C, Bird R, Sethi R, Shanmugalingam A, Carr J, Anderson KK, Norman RMG. Youth-focused group mindfulness-based intervention in individuals with early psychosis: A randomized pilot feasibility study. Early Interv Psychiatry 2019; 13:993-998. [PMID: 30318868 DOI: 10.1111/eip.12753] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 09/12/2018] [Accepted: 09/22/2018] [Indexed: 01/18/2023]
Abstract
AIM To assess the feasibility of a randomized pilot trial that evaluated the acceptability and potential clinical utility of the Mindfulness Ambassador Program (MAP), a unique, standardized 12-session facilitated group mindfulness-based intervention (MBI) for youth experiencing early psychosis. METHODS Twenty-one patients of an early psychosis intervention program were randomized to receive MAP (n = 11) or treatment as usual (n = 10). Acceptability was measured by group attendance rate and client satisfaction; feasibility of the study design was measured by the recruitment and retention rate. The means, standard deviations, and 95% confidence intervals were described for outcomes of interest. RESULTS MAP is associated with a high degree of acceptability and has beneficial effects for depression and fatigue. The randomized trial design is feasible. CONCLUSIONS This study provides important pilot data supporting a larger randomized trial of effectiveness for MAP as a group MBI for early psychosis. Details of MAP and study limitations are discussed.
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Affiliation(s)
- Arlene G MacDougall
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Prevention and Early Intervention Program for Psychoses, London Health Sciences Centre, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | | | | | - Chantelle Lloyd
- Lawson Health Research Institute, London, Ontario, Canada.,Prevention and Early Intervention Program for Psychoses, London Health Sciences Centre, London, Ontario, Canada
| | - Richelle Bird
- Lawson Health Research Institute, London, Ontario, Canada.,Prevention and Early Intervention Program for Psychoses, London Health Sciences Centre, London, Ontario, Canada
| | - Rickinder Sethi
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Aturan Shanmugalingam
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Jason Carr
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Ross M G Norman
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Prevention and Early Intervention Program for Psychoses, London Health Sciences Centre, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Bögle S, Boden Z. ‘It was like a lightning bolt hitting my world’: Feeling shattered in a first crisis in psychosis. QUALITATIVE RESEARCH IN PSYCHOLOGY 2019. [DOI: 10.1080/14780887.2019.1631418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sarah Bögle
- London South Bank University, Division of Psychology, School of Applied Science, London, UK
| | - Zoë Boden
- University of Brighton, School of Applied Social Science, Brighton, UK
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Abstract
BACKGROUND The anticipation of threat or victimization is a core feature of paranoia. Cognitive theories of paranoia suggest that paranoid thoughts may arise as a psychological response to trauma exposure, which likewise may lead to greater anticipation of subsequent victimization. Little is known, however, about the relation between paranoid beliefs and anticipated victimization when accounting for past victimization experience. The present study aimed to address whether the experiences of past victimization contribute to the link between paranoid beliefs and the anticipation of threat or victimization, with a particular focus on exposure to police violence. METHODS Data were collected through the Survey of Police-Public Encounters (N=1615), a cross-sectional, general population survey study conducted in four Eastern U.S. cities. Associations between paranoia and anticipated victimization were assessed using linear regression models, with and without adjustment for past victimization exposure. RESULTS Paranoid beliefs were positively associated with police victimization expectations (β=0.19, p<0.001), but these associations were statistically better explained by past exposures to similar victimization such that paranoia was no longer associated with anticipated victimization in adjusted models (β=0.02, p=0.451). To assess for the specificity of past exposures to victimization, adjusting for past exposure to intimate partner violence (as a control condition) did not eliminate the association between paranoia and expected police victimization. CONCLUSIONS The overall findings are consistent with cognitive theories of paranoia in which paranoid beliefs may be a severe but normative reaction to past victimization exposures in some cases.
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12
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McGinty J, Sayeed Haque M, Upthegrove R. Depression during first episode psychosis and subsequent suicide risk: A systematic review and meta-analysis of longitudinal studies. Schizophr Res 2018; 195:58-66. [PMID: 28982553 DOI: 10.1016/j.schres.2017.09.040] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/12/2017] [Accepted: 09/24/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Evidence suggests first episode psychosis (FEP) is associated with suicide, and the influence of depression on suicidal behaviour in cross sectional studies is clear. However the influence of depression during FEP on longer-term mortality is not certain. Existing evidence was synthesised to understand the influence of depressive symptoms during FEP on subsequent suicidal behaviour. METHODS Medline, Embase, PsycINFO, Cochrane Library, Web of Science, OpenGrey, and NICE Evidence were searched from inception to Jan 25, 2017. Longitudinal observational studies assessing the relationship between depressive symptoms during FEP with a measure of s at a specified follow-up time were included. Summary estimates were extracted. The Downs and Black Instrument was used to appraise study quality. Odds ratio (OR) of suicidal behaviour were calculated using random effects meta-analyses. The study protocol was registered with PROSPERO (CRD42017055881). RESULTS Of 4210 articles found, 23 fulfilled eligibility criteria. 13 were included in meta-analysis (n=3002). 428 participants demonstrated suicidal behaviour in the study periods. Odds of suicidal behaviour during follow-up were significantly higher among patients with depressive symptoms during FEP compared to those without (OR=1.59, 95% CI 1.14-2.21; I2=50.0%, p=0.02). Meta-regression demonstrated no evidence of influence of length of follow-up on results. CONCLUSIONS Depressive symptoms during FEP are associated with increased longer-term risk of suicidal behaviour. This association should be acknowledged during early management planning. Large-scale clinical trials are needed to identify efficacious management of depression during FEP.
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Affiliation(s)
- Jessica McGinty
- University of Birmingham, College of Medical and Dental Sciences, United Kingdom
| | - M Sayeed Haque
- University of Birmingham, College of Medical and Dental Sciences, United Kingdom; University of Birmingham, Institute of Mental Health, United Kingdom
| | - Rachel Upthegrove
- University of Birmingham, College of Medical and Dental Sciences, United Kingdom; University of Birmingham, Institute of Mental Health, United Kingdom; Forward Thinking Birmingham, United Kingdom.
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Rodrigues R, Anderson KK. The traumatic experience of first-episode psychosis: A systematic review and meta-analysis. Schizophr Res 2017; 189:27-36. [PMID: 28214175 DOI: 10.1016/j.schres.2017.01.045] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/23/2017] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
Abstract
INTRODUCTION A psychotic episode may be sufficiently traumatic to induce symptoms of post-traumatic stress disorder (PTSD), which could impact outcomes in first-episode psychosis (FEP). The objectives of this systematic review and meta-analysis were to estimate the prevalence of PTSD symptoms in relation to psychosis in FEP and to identify risk factors for the development of PTSD symptoms. METHODS We searched electronic databases and conducted manual searching of reference lists and tables of contents to identify relevant studies. Quantitative studies were included if the population was experiencing FEP and if PTSD was measured in relation to psychosis. Prevalence of PTSD symptoms and diagnoses were meta-analyzed using a random effects model. Potential risk factors for PTSD symptoms were summarized qualitatively. RESULTS Thirteen studies were included. Eight studies assessed PTSD symptoms, three studies assessed full PTSD, and two studies assessed both. The pooled prevalence of PTSD symptoms was 42% (95% CI 30%-55%), and the pooled prevalence of a PTSD diagnosis was 30% (95% CI 21%-40%). Exploratory subgroup analyses suggest that prevalence may be higher in affective psychosis and inpatient samples. Evidence from included studies implicate depression and anxiety as potential risk factors for PTSD symptoms. CONCLUSIONS Approximately one in two people experience PTSD symptoms and one in three experience full PTSD following a first psychotic episode. Evidence-based interventions to treat PTSD symptoms in the context of FEP are needed to address this burden and improve outcomes after the first psychotic episode. Further studies are needed to clarify the associated risk factors.
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Affiliation(s)
- Rebecca Rodrigues
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada; Department of Psychiatry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.
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14
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Tully S, Wells A, Morrison AP. An exploration of the relationship between use of safety-seeking behaviours and psychosis: A systematic review and meta-analysis. Clin Psychol Psychother 2017. [PMID: 28636201 DOI: 10.1002/cpp.2099] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Safety-seeking behaviours are responses employed to protect against perceived threat. In relation to anxiety disorders, safety-seeking behaviours have been implicated in both the formation and maintenance of distress. Several studies have highlighted similar findings in relation to psychosis; however, this literature has not yet been synthesized. This review is, therefore, being conducted in order to synthesize the literature on safety seeking in people with psychosis to increase the understanding of this relationship. A systematic search identified and included 43 studies comprising 2,592 participants, published between 1995 and 2015. The results indicated that people experiencing psychosis commonly respond to their experiences with behavioural and cognitive strategies intended to manage their difficulties. In relation to safety seeking, avoidance, and resistance, there was a pattern that these responses are associated with increased distress and appraisals of threat. The results relating to engagement response styles showed the opposite pattern. These results provide support for cognitive models of safety seeking and psychosis with many of the meta-analyses reported here showing a clear pattern of association between behavioural responses and distress. However, the results reported within individual studies are mixed. This appears to be particularly true with the response style of distraction, with our analyses unable to clarify this relationship. It is possible that the mixed results could reflect the complexities in defining safety seeking and distinguishing it from coping in this population. The clinical implications of this are discussed.
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Affiliation(s)
- Sarah Tully
- The University of Manchester, Manchester, UK.,The Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Prestwich, UK
| | | | - Anthony P Morrison
- The University of Manchester, Manchester, UK.,The Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Prestwich, UK
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15
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Upthegrove R, Marwaha S, Birchwood M. Depression and Schizophrenia: Cause, Consequence, or Trans-diagnostic Issue? Schizophr Bull 2017; 43:240-244. [PMID: 27421793 PMCID: PMC5605248 DOI: 10.1093/schbul/sbw097] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The presence of depression in schizophrenia has been a challenge to the Kraepelinian dichotomy, with various attempts to save the fundamental distinction including evoking and refining diagnoses such as schizoaffective disorder. But the tectonic plates are shifting. Here we put forward a summary of recent evidence regarding the prevalence, importance, possible aetiological pathways and treatment challenges that recognizing depression in schizophrenia bring. Taken together we propose that depression is more than comorbidity and that increased effective therapeutic attention to mood symptoms will be needed to improve outcomes and to support prevention.
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Affiliation(s)
- Rachel Upthegrove
- Institute of Clinical Sciences, School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK;,Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Steven Marwaha
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK;,Affective Disorder Service, Coventry and Warwickshire Partnership Trust, Coventry, UK
| | - Max Birchwood
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
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16
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Sin J, Spain D, Furuta M, Murrells T, Norman I. Psychological interventions for post-traumatic stress disorder (PTSD) in people with severe mental illness. Cochrane Database Syst Rev 2017; 1:CD011464. [PMID: 28116752 PMCID: PMC6464771 DOI: 10.1002/14651858.cd011464.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Increasing evidence indicates that individuals who develop severe mental illness (SMI) are also vulnerable to developing post-traumatic stress disorder (PTSD), due to increased risk of exposure to traumatic events and social adversity. The effectiveness of trauma-focused psychological interventions (TFPIs) for PTSD in the general population is well-established. TFPIs involve identifying and changing unhelpful beliefs about traumatic experiences, processing of traumatic memories, and developing new ways of responding to cues associated with trauma. Little is known about the potential feasibility, acceptability and effectiveness of TFPIs for individuals who have a SMI and PTSD. OBJECTIVES To evaluate the effectiveness of psychological interventions for PTSD symptoms or other symptoms of psychological distress arising from trauma in people with SMI. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Study-Based Register (up until March 10, 2016), screened reference lists of relevant reports and reviews, and contacted trial authors for unpublished and/or specific outcome data. SELECTION CRITERIA We included all relevant randomised controlled trials (RCTs) which investigated TFPIs for people with SMI and PTSD, and reported useable data. DATA COLLECTION AND ANALYSIS Three review authors (DS, MF, IN) independently screened the titles and abstracts of all references identified, and read short-listed full text papers. We assessed risk of bias in each case. We calculated the risk ratio (RR) and 95% confidence interval (CI) for binary outcomes, and the mean difference (MD) and 95% CI for continuous data, on an intention-to-treat basis. We assessed quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and created 'Summary of findings' tables. MAIN RESULTS Four trials involving a total of 300 adults with SMI and PTSD are included. These trials evaluated three active intervention therapies: trauma-focused cognitive behavioural therapy (TF-CBT), eye movement desensitisation and reprocessing (EMDR), and brief psychoeducation for PTSD, all delivered via individual sessions. Our main outcomes of interest were PTSD symptoms, quality of life/well-being, symptoms of co-morbid psychosis, anxiety symptoms, depressive symptoms, adverse events and health economic outcomes. 1. TF-CBT versus usual care/waiting list Three trials provided data for this comparison, however, continuous outcome data available were more often found to be skewed than unskewed, leading to the necessity of conducting analyses separately for the two types of continuous data. Using the unskewed data only, results showed no significant differences between TF-CBT and usual care in reducing clinician-rated PTSD symptoms at short term (1 RCT, n =13, MD 13.15, 95% CI -4.09 to 30.39,low-quality evidence). Limited unskewed data showed equivocal results between groups in terms of general quality of life (1 RCT, n = 39, MD -0.60, 95% CI -4.47 to 3.27, low-quality evidence), symptoms of psychosis (1 RCT, n = 9, MD -6.93, 95% CI -34.17 to 20.31, low-quality evidence), and anxiety (1 RCT, n = 9, MD 12.57, 95% CI -5.54 to 30.68, very low-quality evidence), at medium term. The only available data on depression symptoms were skewed and were equivocal across groups at medium term (2 RCTs, n = 48, MD 3.26, 95% CI -3.66 to 10.18, very low-quality evidence). TF-CBT was not associated with more adverse events (1 RCT, n = 100, RR 0.44, 95% CI 0.09 to 2.31, low-quality evidence) at medium term. No data were available for health economic outcomes. Very limited data for PTSD and other symptoms were available over the long term. 2. EMDR versus waiting listOne trial provided data for this comparison. Favourable effects were found for EMDR in terms of PTSD symptom severity at medium term but data were skewed (1 RCT, n = 83, MD -12.31, 95% CI -22.72 to -1.90, very low-quality evidence). EMDR was not associated with more adverse events (1 RCT, n = 102, RR 0.21, 95% CI 0.02 to 1.85, low-quality evidence). No data were available for quality of life, symptoms of co-morbid psychosis, depression, anxiety and health economics.3. TF-CBT versus EMDROne trial compared TF-CBT with EMDR. PTSD symptom severity, based on skewed data (1 RCT, n = 88, MD -1.69, 95% CI -12.63 to 9.23, very low-quality evidence) was similar between treatment groups. No data were available for the other main outcomes.4. TF-CBT versus psychoeducationOne trial compared TF-CBT with psychoeducation. Results were equivocal for PTSD symptom severity (1 RCT, n = 52, MD 0.23, 95% CI -14.66 to 15.12, low-quality evidence) and general quality of life (1 RCT, n = 49, MD 0.11, 95% CI -0.74 to 0.95, low-quality evidence) by medium term. No data were available for the other outcomes of interest. AUTHORS' CONCLUSIONS Very few trials have investigated TFPIs for individuals with SMI and PTSD. Results from trials of TF-CBT are limited and inconclusive regarding its effectiveness on PTSD, or on psychotic symptoms or other symptoms of psychological distress. Only one trial evaluated EMDR and provided limited preliminary evidence favouring EMDR compared to waiting list. Comparing TF-CBT head-to-head with EMDR and brief psychoeducation respectively, showed no clear effect for either therapy. Both TF-CBT and EMDR do not appear to cause more (or less) adverse effects, compared to waiting list or usual care; these findings however, are mostly based on low to very low-quality evidence. Further larger scale trials are now needed to provide high-quality evidence to confirm or refute these preliminary findings, and to establish which intervention modalities and techniques are associated with improved outcomes, especially in the long term.
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Affiliation(s)
- Jacqueline Sin
- King's College LondonHealth Service & Population Research Department, Institute of Psychiatry, Psychology & NeuroscienceDavid Goldberg Centre16 de Crespigny Park, Denmark HillLondonUKSW5 8AF
| | - Debbie Spain
- King's College LondonMRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience16 de Crespigny Park, Denmark HillLondonUKSE5 8AF
| | - Marie Furuta
- Graduate School of Medicine, Kyoto UniversityDepartment of Human Health Sciences53 Kawara‐cho,Shogo‐in, Sakyo‐kuKyotoKyotoJapan606‐8507
| | - Trevor Murrells
- King's College LondonFlorence Nightingale Faculty of Nursing and MidwiferyJames Clark Maxwell Building, 57 Waterloo RoadLondonUKSE1 8WA
| | - Ian Norman
- King's College LondonFlorence Nightingale Faculty of Nursing and MidwiferyJames Clark Maxwell Building, 57 Waterloo RoadLondonUKSE1 8WA
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17
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Fornells-Ambrojo M, Gracie A, Brewin CR, Hardy A. Narrowing the focus on the assessment of psychosis-related PTSD: a methodologically orientated systematic review. Eur J Psychotraumatol 2016; 7:32095. [PMID: 27679976 PMCID: PMC5040819 DOI: 10.3402/ejpt.v7.32095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/03/2016] [Accepted: 08/27/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) in response to psychosis and associated experiences (psychosis-related PTSD, or PR-PTSD) is the subject of a growing field of research. However, a wide range of PR-PTSD prevalence rates has been reported. This may be due to definitional and methodological inconsistencies in the assessment of PR-PTSD. OBJECTIVE The focus of the review is two-fold. (1) To identify factors that enhance, or detract from, the robustness of PR-PTSD assessment and (2) to critically evaluate the evidence in relation to these identified criteria, including the impact on PR-PTSD prevalence rates. METHOD Four quality criteria, whose development was informed by mainstream PTSD research, were selected to evaluate findings on PR-PTSD prevalence. Two criteria related to assessment of psychosis-related stressors (participant identification of worst moments of discrete threat events; psychometrically robust trauma measure) and two focussed on PR-PTSD symptom measurement (adequate time elapsed since trauma; use of validated PTSD interview) in the context of psychosis. RESULTS Twenty-one studies of PR-PTSD, with prevalence rates ranging from 11 to 51%, were evaluated. Fourteen studies (67%) used robust PTSD measures but PR-trauma was not specifically defined or assessed with validated measures. Eleven studies (52%) assessed PTSD before sufficient time had elapsed since the trauma. Due to significant methodological limitations, it was not possible to review PR-PTSD rates and provide a revised estimate of prevalence. CONCLUSIONS Methodological limitations are common in existing studies of PR-PTSD prevalence. Specific recommendations for improving assessment of psychosis-related trauma are made to guide the development of this new and emerging field. The review concludes with a proposed conceptualisation of PR-PTSD in the context of current diagnostic systems. The utility of the PR-PTSD term and its theoretical underpinnings are discussed.
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Affiliation(s)
- Miriam Fornells-Ambrojo
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK;
| | - Alison Gracie
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Chris R Brewin
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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18
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Dunkley JE, Bates GW, Findlay BM. Understanding the trauma of first-episode psychosis. Early Interv Psychiatry 2015; 9:211-20. [PMID: 24252059 DOI: 10.1111/eip.12103] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 09/22/2013] [Indexed: 11/28/2022]
Abstract
AIM This study examined the distress of first-episode psychosis (FEP) beyond the acute episode. It focused on how people understand the experience of FEP and its negative impact and how this relates to the traumagenic phenomena. METHODS This research was a longitudinal qualitative study including interpretative phenomenological analysis of interview data. Ten people who had experienced FEP were interviewed 3-6 months following their psychotic episode (time one) and again 3 months after their initial interview (time two). Clinicians and significant others were interviewed at time two. RESULTS Interpretative phenomenological analysis of the interview data supported a conceptualization of recovery from FEP within a broad trauma framework. The traumatic nature of FEP was found to be extended beyond the acute episode and was not linked to symptoms of post-traumatic stress disorder (PTSD) but included impact on identity, relationships and worldview. CONCLUSIONS The diagnosis of PTSD does not appear to capture all aspects of the distress of FEP. Traumagenic distress appears explained by incorporating a range of negative emotions, viewing the impact of FEP as ongoing rather than contained to the acute episode, and recognizes disruption of the individual's views of the self, others and the world.
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Affiliation(s)
- Jane E Dunkley
- Faculty of Life and Social Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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19
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Abstract
PURPOSE OF REVIEW Co-occurrence of psychotic symptoms with symptoms typically thought of as posttraumatic stress disorder (PTSD) is well known, and there has been considerable debate whether this represents a psychotic subtype or a comorbid psychotic disorder. RECENT FINDINGS Psychotic symptoms typical of schizophrenia occur with a higher than expected frequency in PTSD. A large genome-wide association study (GWAS) has identified a collection of genes associated with PTSD, and these genes overlap with those identified as increasing the risk of developing schizophrenia. SUMMARY Up to 70% of returning veterans experience symptoms of PTSD. These individuals also fall within the peak age range for the onset of schizophrenia. PTSD with psychosis may occur for several reasons: trauma increases one's risk for schizophrenia and PTSD; patients with schizophrenia have a higher incidence of PTSD and may present with characteristic psychotic symptoms overlapping with psychosis in schizophrenia. Secondary to symptom overlap, there may be substantial misdiagnosis of psychotic disorders as PTSD, or nonidentification of a comorbid psychotic disorder. This overlap calls into question traditional diagnostic boundaries with implications for initial and long-term treatment of PTSD and psychosis. This review will discuss the recent literature relating to the association of PTSD with schizophrenia.
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20
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Upthegrove R, Chard C, Jones L, Gordon-Smith K, Forty L, Jones I, Craddock N. Adverse childhood events and psychosis in bipolar affective disorder. Br J Psychiatry 2015; 206:191-7. [PMID: 25614532 DOI: 10.1192/bjp.bp.114.152611] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There has been increasing interest in the association between childhood trauma and psychosis. Proposals for potential mechanisms involved include affective dysregulation and cognitive appraisals of threat. AIMS To establish if, within bipolar disorder, childhood events show a significant association with psychosis, and in particular with symptoms driven by dysregulation of mood or with a persecutory content. METHOD Data on lifetime-ever presence of psychotic symptoms were determined by detailed structured interview with case-note review (n = 2019). Childhood events were recorded using a self-report questionnaire and case-note information. RESULTS There was no relationship between childhood events, or childhood abuse, and psychosis per se. Childhood events were not associated with an increased risk of persecutory or other delusions. Significant associations were found between childhood abuse and auditory hallucinations, strongest between sexual abuse and mood congruent or abusive voices. These relationships remain significant even after controlling for lifetime-ever cannabis misuse. CONCLUSIONS Within affective disorder, the relationship between childhood events and psychosis appears to be relatively symptom-specific. It is possible that the pathways leading to psychotic symptoms differ, with delusions and non-hallucinatory symptoms being influenced less by childhood or early environmental experience.
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Affiliation(s)
- Rachel Upthegrove
- Rachel Upthegrove, MRCPsych, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, Bipolar Disorder Research Network and Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham; Christine Chard, BMedSc, Lisa Jones, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham and Bipolar Disorder Research Network; Katherine Gordon-Smith, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK; Liz Forty, PhD, Ian Jones, MRCPsych, PhD, Nick Craddock, FRCPsych, PhD, FMedSci, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK
| | - Christine Chard
- Rachel Upthegrove, MRCPsych, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, Bipolar Disorder Research Network and Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham; Christine Chard, BMedSc, Lisa Jones, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham and Bipolar Disorder Research Network; Katherine Gordon-Smith, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK; Liz Forty, PhD, Ian Jones, MRCPsych, PhD, Nick Craddock, FRCPsych, PhD, FMedSci, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK
| | - Lisa Jones
- Rachel Upthegrove, MRCPsych, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, Bipolar Disorder Research Network and Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham; Christine Chard, BMedSc, Lisa Jones, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham and Bipolar Disorder Research Network; Katherine Gordon-Smith, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK; Liz Forty, PhD, Ian Jones, MRCPsych, PhD, Nick Craddock, FRCPsych, PhD, FMedSci, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK
| | - Katherine Gordon-Smith
- Rachel Upthegrove, MRCPsych, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, Bipolar Disorder Research Network and Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham; Christine Chard, BMedSc, Lisa Jones, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham and Bipolar Disorder Research Network; Katherine Gordon-Smith, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK; Liz Forty, PhD, Ian Jones, MRCPsych, PhD, Nick Craddock, FRCPsych, PhD, FMedSci, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK
| | - Liz Forty
- Rachel Upthegrove, MRCPsych, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, Bipolar Disorder Research Network and Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham; Christine Chard, BMedSc, Lisa Jones, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham and Bipolar Disorder Research Network; Katherine Gordon-Smith, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK; Liz Forty, PhD, Ian Jones, MRCPsych, PhD, Nick Craddock, FRCPsych, PhD, FMedSci, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK
| | - Ian Jones
- Rachel Upthegrove, MRCPsych, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, Bipolar Disorder Research Network and Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham; Christine Chard, BMedSc, Lisa Jones, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham and Bipolar Disorder Research Network; Katherine Gordon-Smith, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK; Liz Forty, PhD, Ian Jones, MRCPsych, PhD, Nick Craddock, FRCPsych, PhD, FMedSci, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK
| | - Nick Craddock
- Rachel Upthegrove, MRCPsych, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, Bipolar Disorder Research Network and Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham; Christine Chard, BMedSc, Lisa Jones, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham and Bipolar Disorder Research Network; Katherine Gordon-Smith, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK; Liz Forty, PhD, Ian Jones, MRCPsych, PhD, Nick Craddock, FRCPsych, PhD, FMedSci, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK
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Khoury B, Lecomte T, Comtois G, Nicole L. Third-wave strategies for emotion regulation in early psychosis: a pilot study. Early Interv Psychiatry 2015; 9:76-83. [PMID: 24112303 DOI: 10.1111/eip.12095] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 08/18/2013] [Indexed: 01/14/2023]
Abstract
AIM Emerging evidence supports the priority of integrating emotion regulation strategies in cognitive behaviour therapy for early psychosis, which is a period of intense distress. Therefore, we developed a new treatment for emotional regulation combining third-wave strategies, namely compassion, acceptance, and mindfulness (CAM) for individuals with early psychosis. The purpose of this study was to examine the acceptability, feasibility and potential clinical utility of CAM. METHOD A non-randomized, non-controlled prospective follow-up study was conducted. Outpatients from the First Psychotic Episode Clinic in Montreal were offered CAM, which consisted of 8-week 60-75 min weekly group sessions. Measures of adherence to medication, symptoms, emotional regulation, distress, insight, social functioning and mindfulness were administered at baseline, post-treatment and at 3-month follow up. A short feedback interview was also conducted after the treatment. RESULTS Of the 17 individuals who started CAM, 12 (70.6%) completed the therapy. Average class attendance was 77%. Post-treatment feedback indicated that participants found the intervention acceptable and helpful. Quantitative results suggest the intervention was feasible and associated with a large increase in emotional self-regulation, a decrease in psychological symptoms, especially anxiety, depression, and somatic concerns, and improvements in self-care. CONCLUSION Overall results support the acceptability, feasibility and potential clinical utility of the new developed treatment. A significant increase in emotional self-regulation and a decrease in affective symptoms were found. No significant changes were observed on measures of mindfulness, insight, distress and social functioning. Controlled research is warranted to validate the effectiveness of the new treatment.
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Affiliation(s)
- Bassam Khoury
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
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