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Baumeister D, Pillinger T, Howes O, Peters E. Psychophysiological stress-reactivity in clinical and non-clinical voice-hearers. Schizophr Res 2021; 235:52-59. [PMID: 34315061 PMCID: PMC8429638 DOI: 10.1016/j.schres.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/09/2020] [Accepted: 07/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Psychosis is associated with dysregulation of psychophysiological stress-reactivity, including in subjective, autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal (HPA) parameters. AIMS This study investigated whether dysregulated psychophysiological stress-reactivity is specifically associated with auditory verbal hallucinations (AVHs) or psychosis more generally by comparing voice-hearers with and without a need for care. METHOD Clinical (n = 20) and non-clinical voice-hearers (n = 23), as well as a healthy control group with no voices (n = 23), were compared on HPA and ANS responses, and subjective reactivity, to a psychophysiological stress paradigm, the socially evaluative cold pressor test. RESULTS Measures of HPA function in both clinical and non-clinical voice-hearers diverged from non-voice-hearing controls. Clinical participants showed a blunted peak response compared to both non-clinical groups (p = 0.02), whilst non-clinical voice-hearers showed, at trend-level, reduced cortisol levels during stress exposure compared to both clinical voice-hearers (p = 0.07) and healthy controls (p = 0.07), who unexpectedly did not differ from each other (p = 0.97). Clinical participants showed greater subjective stress levels than both non-clinical groups (p < 0.001), as well as greater anticipatory stress (p = 0.001) and less recovery. There were no differences between groups on parameters of the ANS (all p > 0.05). CONCLUSIONS Dysregulated psychophysiological stress-function is present in clinical voice-hearers, and partially discriminates them from non-clinical voice-hearers. Overall, the present findings identified specific potential psychophysiological markers of risk and resilience in auditory verbal hallucinations and need for care.
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Affiliation(s)
- David Baumeister
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Department of Psychology, London, UK; Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Germany.
| | - Toby Pillinger
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Department of Psychosis Studies, London, UK
| | - Oliver Howes
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Department of Psychosis Studies, London, UK
| | - Emmanuelle Peters
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, Department of Psychology, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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Associations between physiological responses to social-evaluative stress and daily functioning in first-episode schizophrenia. Schizophr Res 2020; 218:233-239. [PMID: 31948901 PMCID: PMC7299766 DOI: 10.1016/j.schres.2019.12.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 12/28/2019] [Accepted: 12/31/2019] [Indexed: 01/25/2023]
Abstract
Schizophrenia (SZ) is associated with impaired adaptive functioning, including difficulties managing the demands of independent living, work, school, and interpersonal relationships. Prior studies have linked the physiological stress response with less effective coping in daily life. Differences in stress-response tendencies may also support heterogeneity in daily functioning in SZ. The present study examined two established measures of the stress response in patients with first-episode SZ. Salivary cortisol was included as an index of hypothalamic-pituitary-adrenal response. Vagal suppression (VS), a measure of stress-related reduction in heart rate variability, was used to assess parasympathetic flexibility. Greater cortisol response and VS to social-evaluative stress were predicted to be associated with better functioning in SZ over and above relationships with social cognition and neurocognition, two well-established predictors of functional outcome. Thirty-eight first-episode SZ outpatients and 29 healthy comparison subjects (HC) provided social cognitive, neurocognitive, and physiological measurements before and after the Trier Social Stress Test (TSST). Although SZ and HC did not differ on VS to the TSST, patients exhibited significant associations between VS and functioning across all four domains of the Role Functioning Scale. Furthermore, greater VS predicted more effective functioning with friends, beyond the contributions associated with social cognition and neurocognition, and strengthened the positive effects of higher levels of social cognition on independent living/self-care. VS elicited by social-evaluative stress in the laboratory may reflect stress-response tendencies in daily life that are relevant for daily functioning in first-episode SZ.
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Wisner KM, Chiappelli J, Savransky A, Fisseha F, Rowland LM, Kochunov P, Hong LE. Cingulum and abnormal psychological stress response in schizophrenia. Brain Imaging Behav 2020; 14:548-561. [PMID: 31123971 PMCID: PMC6874732 DOI: 10.1007/s11682-019-00120-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Stress is implicated in many aspects of schizophrenia, including heightened distress intolerance. We examined how affect and microstructure of major brain tracts involved in regulating affect may contribute to distress intolerance in schizophrenia. Patients with schizophrenia spectrum disorders (n = 78) and community controls (n = 95) completed diffusion weighted imaging and performed psychological stress tasks. Subjective affect was collected pre and post stressors. Individuals who did not persist during one or both stress tasks were considered distress intolerant (DI), and otherwise distress tolerant (DT). Fractional anisotropy (FA) of the dorsal cingulum showed a significant diagnosis x DT/DI phenotype interaction (p = 0.003). Post-hoc tests showed dorsal cingulum FA was significantly lower in DI patients compared with DI controls (p < 0.001), but not different between DT groups (p = 0.27). Regarding affect responses to stress, irritability showed the largest stress-related change (p < 0.001), but irritability changes were significantly reduced in DI patients compared to DI controls (p = 0.006). The relationship between irritability change and performance errors also differed among patients (ρ = -0.29, p = 0.011) and controls (ρ = 0.21, p = 0.042). Further modeling highlighted the explanatory power of dorsal cingulum for predicting DI even after performance and irritability were taken into account. Distress intolerance during psychological stress exposure is related to microstructural properties of the dorsal cingulum, a key structure for cognitive control and emotion regulation. In schizophrenia, the affective response to psychological stressors is abnormal, and distress intolerant patients had significantly reduced dorsal cingulum FA compared to distress intolerant controls. The findings provide new insight regarding distress intolerance in schizophrenia.
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Affiliation(s)
- Krista M Wisner
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, P.O. Box 21247, Baltimore, MD, 21228, USA.
| | - Joshua Chiappelli
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, P.O. Box 21247, Baltimore, MD, 21228, USA
| | - Anya Savransky
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, P.O. Box 21247, Baltimore, MD, 21228, USA
| | - Feven Fisseha
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, P.O. Box 21247, Baltimore, MD, 21228, USA
| | - Laura M Rowland
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, P.O. Box 21247, Baltimore, MD, 21228, USA
| | - Peter Kochunov
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, P.O. Box 21247, Baltimore, MD, 21228, USA
| | - L Elliot Hong
- Department of Psychiatry, Maryland Psychiatric Research Center, University of Maryland School of Medicine, P.O. Box 21247, Baltimore, MD, 21228, USA
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Behavioral effects of chronic stress in the Fmr1 mouse model for fragile X syndrome. Behav Brain Res 2017; 320:128-135. [PMID: 27939692 DOI: 10.1016/j.bbr.2016.11.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/24/2016] [Accepted: 11/30/2016] [Indexed: 11/21/2022]
Abstract
Fragile X Syndrome (FXS) is a pervasive developmental disorder due to a mutation in the FMR1 X-linked gene. Despite its clear genetic cause, the expression of FXS symptoms is known to be modulated by environmental factors, including stress. Furthermore, several studies have shown disturbances in stress regulatory systems in FXS patients and Fmr1 mice. These studies have mostly focused on the hormonal responses to stress, using the acute exposure to a single type of stressor. Hence, little is known about the behavioral effects of stress in FXS, and the importance of the nature of the stressing procedure, especially in the context of a repeated exposure that more closely resembles real life conditions. Here we evaluated the effects of chronic exposure to different types of stress (i.e., either repeated restraint or unpredictable stress) on the behavioral phenotype of adult Fmr1 mice. Our results demonstrated that chronic stress induced deficits in social interaction and working memory only in WT mice and the impact of stress depended on the type of stressors and the specific behavior tested. Our data suggest that the behavioral sensitivity to stress is dramatically reduced in FXS, opening new views on the impact of gene-environment interactions in this pathology.
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Pruessner M, Cullen AE, Aas M, Walker EF. The neural diathesis-stress model of schizophrenia revisited: An update on recent findings considering illness stage and neurobiological and methodological complexities. Neurosci Biobehav Rev 2017; 73:191-218. [DOI: 10.1016/j.neubiorev.2016.12.013] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 12/09/2016] [Accepted: 12/12/2016] [Indexed: 01/29/2023]
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Calvo P, Fortuny JR, Guzmán S, Macías C, Bowen J, García ML, Orejas O, Molins F, Tvarijonaviciute A, Cerón JJ, Bulbena A, Fatjó J. Animal Assisted Therapy (AAT) Program As a Useful Adjunct to Conventional Psychosocial Rehabilitation for Patients with Schizophrenia: Results of a Small-scale Randomized Controlled Trial. Front Psychol 2016; 7:631. [PMID: 27199859 PMCID: PMC4858645 DOI: 10.3389/fpsyg.2016.00631] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 04/15/2016] [Indexed: 11/25/2022] Open
Abstract
Currently, one of the main objectives of human-animal interaction research is to demonstrate the benefits of animal assisted therapy (AAT) for specific profiles of patients or participants. The aim of this study is to assess the effect of an AAT program as an adjunct to a conventional 6-month psychosocial rehabilitation program for people with schizophrenia. Our hypothesis is that the inclusion of AAT into psychosocial rehabilitation would contribute positively to the impact of the overall program on symptomology and quality of life, and that AAT would be a positive experience for patients. To test these hypotheses, we compared pre-program with post-program scores for the Positive and Negative Syndrome Scale (PANSS) and the EuroQoL-5 dimensions questionnaire (EuroQol-5D), pre-session with post-session salivary cortisol and alpha-amylase for the last four AAT sessions, and adherence rates between different elements of the program. We conducted a randomized, controlled study in a psychiatric care center in Spain. Twenty-two institutionalized patients with chronic schizophrenia completed the 6-month rehabilitation program, which included individual psychotherapy, group therapy, a functional program (intended to improve daily functioning), a community program (intended to facilitate community reintegration) and a family program. Each member of the control group (n = 8) participated in one activity from a range of therapeutic activities that were part of the functional program. In place of this functional program activity, the AAT-treatment group (n = 14) participated in twice-weekly 1-h sessions of AAT. All participants received the same weekly total number of hours of rehabilitation. At the end of the program, both groups (control and AAT-treatment) showed significant improvements in positive and overall symptomatology, as measured with PANSS, but only the AAT-treatment group showed a significant improvement in negative symptomatology. Adherence to the AAT-treatment was significantly higher than overall adherence to the control group's functional rehabilitation activities. Cortisol level was significantly reduced after participating in an AAT session, which could indicate that interaction with the therapy dogs reduced stress. In conclusion, the results of this small-scale RCT suggest that AAT could be considered a useful adjunct to conventional psychosocial rehabilitation for people with schizophrenia.
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Affiliation(s)
- Paula Calvo
- Chair Affinity Foundation Animals and Health, Department of Psychiatry and Forensic Medicine, Universitat Autònoma de BarcelonaBellaterra, Spain
- Hospital del Mar Medical Research InstituteBarcelona, Spain
| | - Joan R. Fortuny
- Centres Assistencials Emili Mira, Institut de Neuropsiquiatria i Addiccions, Parc de Salut MarSanta Coloma de Gramenet, Spain
| | - Sergio Guzmán
- Centres Assistencials Emili Mira, Institut de Neuropsiquiatria i Addiccions, Parc de Salut MarSanta Coloma de Gramenet, Spain
| | - Cristina Macías
- Centres Assistencials Emili Mira, Institut de Neuropsiquiatria i Addiccions, Parc de Salut MarSanta Coloma de Gramenet, Spain
| | - Jonathan Bowen
- Chair Affinity Foundation Animals and Health, Department of Psychiatry and Forensic Medicine, Universitat Autònoma de BarcelonaBellaterra, Spain
- Queen Mother Hospital for Small Animals, The Royal Veterinary CollegeHertfordshire, UK
| | - María L. García
- Centres Assistencials Emili Mira, Institut de Neuropsiquiatria i Addiccions, Parc de Salut MarSanta Coloma de Gramenet, Spain
| | - Olivia Orejas
- Centres Assistencials Emili Mira, Institut de Neuropsiquiatria i Addiccions, Parc de Salut MarSanta Coloma de Gramenet, Spain
| | - Ferran Molins
- Centres Assistencials Emili Mira, Institut de Neuropsiquiatria i Addiccions, Parc de Salut MarSanta Coloma de Gramenet, Spain
| | - Asta Tvarijonaviciute
- Interlab-UMU, Campus de Excelencia Mare Nostrum, Universidad de MurciaMurcia, Spain
- Department of Medicine and Animal Surgery, Universitat Autònoma de BarcelonaBellaterra, Spain
| | - José J. Cerón
- Interlab-UMU, Campus de Excelencia Mare Nostrum, Universidad de MurciaMurcia, Spain
| | - Antoni Bulbena
- Chair Affinity Foundation Animals and Health, Department of Psychiatry and Forensic Medicine, Universitat Autònoma de BarcelonaBellaterra, Spain
- Hospital del Mar Medical Research InstituteBarcelona, Spain
- Centres Assistencials Emili Mira, Institut de Neuropsiquiatria i Addiccions, Parc de Salut MarSanta Coloma de Gramenet, Spain
| | - Jaume Fatjó
- Chair Affinity Foundation Animals and Health, Department of Psychiatry and Forensic Medicine, Universitat Autònoma de BarcelonaBellaterra, Spain
- Hospital del Mar Medical Research InstituteBarcelona, Spain
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