The contribution of social factors to the development of schizophrenia: a review of recent findings

Associations between social engagement, internalizing symptoms, and delusional ideation in the general population

BACKGROUND

Delusions are a hallmark feature of psychotic disorders and lead to significant clinical and functional impairment. Internalizing symptoms-such as symptoms of depression, anxiety, and trauma exposure-are commonly cited to be related to delusions and delusional ideation and are often associated with deficits in social functioning. While emerging studies are investigating the impact of low social engagement on psychotic-like experiences, little work has examined the relationship between social engagement, internalizing symptoms, and delusional ideation, specifically.

METHODS

Using general population data from the Nathan Kline Institute-Rockland (NKI-Rockland) database (N = 526), we examined the relationships between self-reported delusional ideation, internalizing symptoms, and social engagement and tested four indirect effect models to understand how these factors interrelate.

RESULTS

Delusional ideation was significantly associated with both increased internalizing symptoms (r = 0.41, p < 0.001) and lower social engagement (r = - 0.14, p = 0.001). Within aspects of social engagement, perceived emotional support showed the strongest relationship with delusional ideation (r = - 0.17, p < 0.001). Lower social engagement was also significantly associated with increased internalizing symptoms (r = - 0.29, p < 0.001). Cross-sectional models suggest that internalizing symptoms have a significant indirect effect on the association between delusional ideation and social engagement.

CONCLUSIONS

These findings reveal that elevated delusional ideation in the general population is associated with lower social engagement. Elevated internalizing symptoms appear to play a critical role in reducing engagement, possibly exacerbating delusional thinking. Future work should examine the causal and temporal relationships between these factors.

Comparative estimation of the effects of antihypertensive medications on schizophrenia occurrence: a multinational observational cohort study

BACKGROUND

The association between antihypertensive medication and schizophrenia has received increasing attention; however, evidence of the impact of antihypertensive medication on subsequent schizophrenia based on large-scale observational studies is limited. We aimed to compare the schizophrenia risk in large claims-based US and Korea cohort of patients with hypertension using angiotensin-converting enzyme (ACE) inhibitors versus those using angiotensin receptor blockers (ARBs) or thiazide diuretics.

METHODS

Adults aged 18 years who were newly diagnosed with hypertension and received ACE inhibitors, ARBs, or thiazide diuretics as first-line antihypertensive medications were included. The study population was sub-grouped based on age (> 45 years). The comparison groups were matched using a large-scale propensity score (PS)-matching algorithm. The primary endpoint was incidence of schizophrenia.

RESULTS

5,907,522; 2,923,423; and 1,971,549 patients used ACE inhibitors, ARBs, and thiazide diuretics, respectively. After PS matching, the risk of schizophrenia was not significantly different among the groups (ACE inhibitor vs. ARB: summary hazard ratio [HR] 1.15 [95% confidence interval, CI, 0.99-1.33]; ACE inhibitor vs. thiazide diuretics: summary HR 0.91 [95% CI, 0.78-1.07]). In the older subgroup, there was no significant difference between ACE inhibitors and thiazide diuretics (summary HR, 0.91 [95% CI, 0.71-1.16]). The risk for schizophrenia was significantly higher in the ACE inhibitor group than in the ARB group (summary HR, 1.23 [95% CI, 1.05-1.43]).

CONCLUSIONS

The risk of schizophrenia was not significantly different between the ACE inhibitor vs. ARB and ACE inhibitor vs. thiazide diuretic groups. Further investigations are needed to determine the risk of schizophrenia associated with antihypertensive drugs, especially in people aged > 45 years.

A qualitative analysis of the documentation of DSM-5 Cultural Formulation Interviews with non-native speaking patients in a Swedish mental health care setting

Introduction

Cultural variety in expressed symptom presentations of mental health problems creates difficulties in transcultural diagnostic assessments. This emphasizes the need of culturally sensitive diagnostic tools like the Cultural Formulation Interview (CFI). Although the CFI is being implemented worldwide there is a lack of studies analyzing what kind of information it provides when used with new patients in routine psychiatric assessments, and how CFI information contributes to diagnostic evaluations. This study aimed to find out what information the CFI questions revealed when used with non-native Swedish speaking patients. We also wanted to understand how the CFI may facilitate identification of psychiatric diagnoses among these patients.

Materials and methods

The CFI was used as part of a routine clinical psychiatric assessment in an outpatient clinic in Sweden. Interpreters were used in the consultations when needed. A qualitative thematic analysis was used to analyze the documented CFI answers from non-native speaking patients.

Results

We found that the CFI information contained contextualized descriptions of dysfunction and current life conditions, as well as expressions of emotions, often described along with somatic terms.

Discussion

Our results indicate that the narrative approach of the CFI, giving contextualized information about distress and functioning, can facilitate clinicians' identification of psychiatric symptoms when language, psychiatric terms and understandings are not shared between patient and clinician.

Psychometric properties of an Arabic translation of the 10-item Connor-Davidson resilience scale (CD-RISC-10), the 8- and 10-item post-traumatic growth inventory-short form (PTGI-SF) scales

BACKGROUND

Given their clinical significance and impact on stress response and their potential malleability, resilience and posttraumatic growth (PTG) should receive greater attention as relevant constructs in clinical and research practice in the Arab context. We aimed through the present study to test the psychometric properties of Arabic translations of the 10-item Connor-Davidson Resilience scale (CD-RISC-10), the 10-item and the 8-item Post-Traumatic Growth Inventory-Short Form (PTGI-SF) in a sample of Lebanese adults from the general population.

METHODS

Three hundred eighty-seven Arabic-speaking participants (mean age = 26.17; 58.4% females) responded to a self-report web-based questionnaire. The forward and backward translation method was applied with the approval of the original developers of the scales.

RESULTS

Confirmatory factor analysis indicated that fit of the one-factor model was acceptable, and all indices suggested that configural, metric, and scalar invariance was supported across gender for all the three scales. The CD-RISC-10, the 10-item and the 8-item PTGI-SF yielded a good internal consistency, with a McDonald's ω of .89, .95, and .93, respectively. Higher resilience and higher PTG were significantly and positively associated with greater cognitive reappraisal and lower emotion suppression, supporting convergent validity.

CONCLUSION

We preliminarily suggest that these Arabic instruments are appropriate for use in Lebanese community adults to assess different positive responses after life crises, identify people with lack or low levels of resilience and growth who might need intervention, and monitor their response to therapy. Further cross-cultural validations should seek to extend their use in broader Arabic-speaking populations and settings.

De-Salazar P, Alegría M. Association of sociocultural stressors with bipolar disorder onset in Puerto Rican youth growing up as members of a minoritized ethnic group: results from the Boricua Youth Longitudinal Study

Background

The development of bipolar disorder is currently explained by a complex interaction of genetic and environmental factors. Less is known regarding the influence of sociocultural factors. This study aims to evaluate the incidence and impact of sociocultural factors on bipolar disorder onset in two comparable samples of youth growing up in different social settings.

Methods

We leveraged data from two urban population-based cohorts representative of Puerto Rican children growing up in either San Juan (Puerto Rico) or the South Bronx (NYC) and followed up for 17 years. Bipolar disorder diagnoses were based on retrospective self-reports on the World Health Organization Composite International Diagnostic Interview. We used a causal inference approach to estimate associations of sociocultural factors with bipolar disorder onset after adjusting for potential confounders.

Findings

We found that South Bronx children, who grew up as a minoritized group, had twice the risk of bipolar disorder onset as young adults, with an incidence rate of 2.22 new cases per 1000 person-years compared to 1.08 new cases in San Juan (incidence rate difference, 1.13; 95% CI, 0.09-1.20). After adjusting for potential confounders, South Bronx children had the same lifetime hazard of bipolar disorder onset compared to San Juan children. However, our analysis demonstrated that caregivers' exposure to societal cultural stress partially explained the increased risk of bipolar disorder onset in the South Bronx, in addition to the potential contribution of genetics.

Interpretation

Our results provide evidence that societal cultural stress can increase the risk of lifetime bipolar disorder onset in youth growing up as a minoritized group. Addressing stress in minoritized groups might reduce the risk of bipolar disorder onset.

Funding

The Boricua Youth Study has been supported by the National Institutes of HealthMH56401, MH098374, DA033172, and AA020191. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the article.

Schizotypal traits in a large sample of high-school and university students from Tunisia: correlates and measurement invariance of the arabic schizotypal personality questionnaire across age and sex

BACKGROUND

The main goal of the present study was to examine the characteristics of schizotypal traits and their correlations with genetic (i.e., family history of mental illness), demographic (i.e., age, sex), environmental (e.g., income, urbanicity, tobacco/alcohol/cannabis use), and psychological (i.e., personal history of mental illness other than psychosis) factors in Tunisian high-school and university students. Our secondary goal was to contribute the literature by examining the factor structure and factorial invariance of the Arabic Schizotypal Personality Questionnaire (SPQ) across sex and age (adolescents [12-18 years] vs. young adults [18-35 years]) groups.

METHOD

This was a cross-sectional study involving 3166 students: 1160 (36.6%) high-school students (53.0% females, aged 14.9 ± 1.8); and 2006 (63.4%) university students (63.9% females, aged 21.8 ± 2.3). All students were asked to complete a paper-and-pencil self-administered questionnaire containing sociodemographic characteristics as well as the Arabic version of the SPQ.

RESULTS

The total sample yielded total SPQ scores of 24.1 ± 16.6 out of 74. The SPQ yielded good composite reliability as attested by McDonald's omega values ranging from .68 to .80 for all nine subscales. Confirmatory Factor Analysis indicated that fit of the 9-factor model of SPQ scores was acceptable. This model is invariant (at the configural, metric and structural levels) across sex and age. Except for "Odd or eccentric behavior", all schizotypy features were significantly higher among female students compared to males. Multivariable analyses showed that female sex, being a university student, lowest family incomes, tobacco use, and having a personal history of psychiatric illness were significantly associated with higher positive, negative and disorganized schizotypy subscales scores.

CONCLUSION

Future research still needs to confirm our findings and investigate the contribution of the identified factors in the development of clinical psychosis. We can also conclude that the Arabic SPQ is appropriate for measuring and comparing schizotypy across age and sex in clinical and research settings. These findings are highly relevant and essential for ensuring the clinical utility and applicability of the SPQ in cross-cultural research.

Effect of a group-based acceptance and commitment therapy (ACT) intervention on self-esteem and psychological flexibility in patients with schizophrenia in remission

The present study explored whether acceptance and commitment therapy (ACT), a cognitive behavioral therapy approach, could improve the symptoms of schizophrenia spectrum disorders among patients with schizophrenia in remission. A pre- and post-treatment design with two evaluation time points was employed. Sixty outpatients with schizophrenia in remission were randomly divided into two groups: the ACT plus treatment as usual (ACT+TAU) and treatment as usual (TAU) groups. The ACT+TAU group participated in 10 group-based ACT interventions and TAU in the hospital, and the TAU group only received TAU interventions. General psycho-pathological symptoms, self-esteem, and psychological flexibility were assessed before intervention (baseline; pre-test) and after intervention (five weeks; post-test). Results indicated that, compared to the TAU group, the ACT+TAU group exhibited a more significant improvement in general psychopathological symptoms, self-esteem, cognitive fusion, and acceptance and action at post-test. ACT intervention could effectively decrease the general psycho-pathological symptoms and increase self-esteem level and psychological flexibility in people with schizophrenia in remission.

Economic strain, parental education and psychotic experiences among college students in the United States: Findings from the Healthy Minds Study 2020

AIM

Socioeconomic status (SES) is linked to psychosis, and much can be learned by examining how various indicators of SES-specifically economic strain and intergenerational transfer of resources-are related to sub-threshold psychotic experiences among college students.

METHODS

Using data from the Healthy Minds Survey (September 2020-December 2020), we used multivariable logistic regression models to examine the associations between five SES indicators and 12-month psychotic experiences, adjusting for age, gender and race/ethnicity. We also examined the count of predictors and psychotic experiences.

RESULTS

Each indicator of economic strain was associated with greater odds of psychotic experiences. In particular, increasing levels of financial stress (current, childhood and pandemic-related) were associated with greater odds of psychotic experiences in a dose-response fashion. Food insecurity was associated with double the odds of psychotic experiences. In terms of intergenerational transfer of resources, having either one or no parents who attended college was associated with significantly greater odds of having psychotic experiences, when compared with having both parents who attended college. Examining all predictors in the same model, only childhood and current financial stress and food insecurity were significantly associated with psychotic experiences. The count of predictors was significantly associated with greater odds of having psychotic experiences in a dose-dependent fashion.

CONCLUSIONS

Among college students, economic strain and intergenerational transfer of resources were associated with recent psychotic experiences, highlighting the importance of economic interventions targeting young adults to influence risk for psychosis.

Impact on routine psychiatric diagnostic practice from implementing the DSM-5 cultural formulation interview: a pragmatic RCT in Sweden

BACKGROUND

Culture and social context affect the expression and interpretation of symptoms of distress, raising challenges for transcultural psychiatric diagnostics. This increases the risk that mental disorders among migrants and ethnic minorities are undetected, diagnosed late or misdiagnosed. We investigated whether adding a culturally sensitive tool, the DSM-5 core Cultural Formulation Interview (CFI), to routine diagnostic procedures impacts the psychiatric diagnostic process.

METHOD

We compared the outcome of a diagnostic procedure that included the CFI with routine diagnostic procedures used at Swedish psychiatric clinics. New patients (n = 256) admitted to a psychiatric outpatient clinic were randomized to a control (n = 122) or CFI-enhanced diagnostic procedure (n = 134) group. An intention-to-treat analysis was conducted and the prevalence ratio and corresponding 95% confidence intervals (CI) were calculated across arms for depressive and anxiety disorder diagnoses, multiple diagnoses, and delayed diagnosis.

RESULTS

The prevalence ratio (PR) of a depressive disorder diagnosis across arms was 1.21 (95% CI = 0.83-1.75), 33.6% of intervention-arm participants vs. 27.9% of controls. The prevalence ratio was higher among patients whose native language was not Swedish (PR =1.61, 95% CI = 0.91-2.86). The prevalence ratio of receiving multiple diagnoses was higher for the CFI group among non-native speaking patients, and lower to a statistically significant degree among native Swedish speakers (PR = .39, 95% CI = 0.18-0.82).

CONCLUSIONS

The results suggest that the implementation of the DSM-5 CFI in routine psychiatric diagnostic practice may facilitate identification of symptoms of certain psychiatric disorders, like depression, among non-native speaking patients in a migration context. The CFI did not result in a reduction of patients with a non-definite diagnosis.

TRIAL REGISTRATION

ISRCTN51527289 , 30/07/2019. The trial was retrospectively registered.

[Metacognitive deficit in schizophrenia: Characteristics and links]

OBJECTIVES

Research indicates that many patients with schizophrenia experience deficits in metacognitive capacity defined as the ability to form complex representations of themselves and others. The aim of the current study was to assess metacognitive deficit in patients with schizophrenia. These variables were collected together with many other sociodemographic, clinical and therapeutic data.

METHODS

We conducted a descriptive and analytical cross-sectional study in the psychiatry department at the Hedi Chaker University Hospital in Sfax (Tunisia). Patients were in a non-acute phase, defined by the absence of any psychiatric symptoms during the last four weeks, also, no changes in medication during the previous month had been required. An informed written consent was obtained, following which patients completed questionnaires assessing sociodemographic and clinical data during structured interviews. Symptoms and severity of the illness were assessed using the Positive and Negative Symptoms Scale (PANSS). Insight was assessed using the Insight Scale (Q8). In addition, the Metacognition Assessment Scale-Abbreviated (MAS-A) was used to assess metacognitive capacities. The MAS-A contains four dimensions: self-reflectivity, awareness of the mind of others, decentration, and mastery. Higher scores reflect an ability to effectively respond to psychological challenges on the basis of psychological knowledge.

RESULTS

We recruited 74 adults with schizophrenia disorder. The diagnosis was with DSM5. Their average age was 45 years (SD=9.84 years) with a sex ratio (M/F) of 1.552. Nineteen patients (25.5%) were married, and low educational level was present in 43% of cases. Forty patients (54%) were unemployed. Metacognitive deficit was detected in all the patients. They had low levels in all four dimensions of metacognition. The most affected dimension in our series was "Mastery". All patients had an overall insight score less than six (the average score was 2.73) with poor awareness in 62% of patients. The main factors correlated with metacognitive deficit were: occupational inactivity (P-0.015), Primary education level (P=0.045), tobacco consumption (P=0.002), low insight (P-0.001), negative symptomatology (P<10-3) and the use of first generation of antipsychotics (P=0.003). The multivariate analysis showed that three factors (occupational inactivity, low insight and the presence of negative symptomatology) were predictors of metacognitive deficits.

CONCLUSION

Based on our results, occupational inactivity, negative symptomatology and low insight are predictors of metacognitive deficit in schizophrenia. Specific therapeutics should be proposed to act on these factors. A metacognitive training program, tailored to this vulnerable population, is a priority to improve their quality of life.

Peer-reported bullying, rejection and hallucinatory experiences in childhood

OBJECTIVE

Psychotic experiences, such as hallucinations, occur commonly in children and have been related to bullying victimization. However, whether bullying perpetration, peer rejection, or peer acceptance are related to hallucinatory experiences has remained under-examined. We used a novel peer nomination method to examine whether (i) bullying perpetration and (ii) social positions within peer networks were associated with future hallucinatory experiences.

METHODS

This prospective study was embedded in the population-based Generation R Study. Bullying perpetration, peer rejection, and peer acceptance were assessed using peer nominations at age 7 years (N = 925). Using a social network analysis, we estimated social positions within peer rejection and acceptance networks. Bullying victimization was assessed using self-reports. Self-reported hallucinatory experiences were assessed at age 10 years. Analyses were adjusted for sociodemographic covariates.

RESULTS

Higher levels of bullying perpetration were prospectively associated with an increased burden of hallucinatory experiences (OR = 1.22, 95% CI 1.05-1.43, p = 0.011). Bullies had a 50% higher, and bully-victims had a 89% higher odds, of endorsing hallucinatory experiences three years later than children who were not involved in bullying (OR_bully = 1.50, 95% CI 1.01-2.24, p = 0.045; OR_bully-victim = 1.89, 95% CI 1.15-3.10, p = 0.012). Unfavorable positions within peer rejection networks, but not peer acceptance networks, were associated with an increased risk for hallucinatory experiences (OR_{peer rejection} = 1.24, 95% CI 1.07-1.44, p_{FDR-corrected} = 0.024).

CONCLUSION

Using peer reports, we observed that bullies and socially rejected children have a higher likelihood to report hallucinatory experiences in pre-adolescence. Children who are both a bully and a victim of bullying (ie, bully-victims) may be particularly vulnerable for psychotic experiences.

Validation of the 10-Item Connor-Davidson Resilience Scale: The Case of Russian Youth

This study validates the 10-item Connor-Davidson Resilience Scale (CD-RISC-10) on a Russian youth sample. A total of 689 respondents participated (M age = 20.22, SD age = 2.08; 526 females). The Warwick-Edinburgh Mental Well-being Scale, the International Positive and Negative Affect Schedule Short-Form, the Centre of Epidemiological Studies-Depression Scale, the Rosenberg Self-Esteem Scale, and the Authenticity Scale were used to examine the content validity of CD-RISC-10. Two hypotheses were examined: that the Russian version of the CD-RISC-10 (1) has structural validity (is unifactorial, as the original version) and (2) has convergent validity (which is proven by positive connections with psychological well-being and negative connections with ill-being). According to confirmatory factor analysis (CFA), it was shown that the scale really had a unifactorial structure; its reliability was satisfactory (α =.85, ω h =.84). No age trends in the CD-RISC-10 scores were detected; in males, the scores were higher than in females. As expected, CD-RISC-10 was positively connected with mental well-being, positive affect, self-esteem, and authentic living while negatively connected with depressive symptoms, negative affect, acceptance of external influence, and self-alienation. The Russian version of CD-RISC-10 seems to be a valid, stable, and reliable instrument which may be recommended for use in various areas of research and practice.

Psychopathology in refugees subjected to the Dublin Regulation: an Italian study

BACKGROUND

Literature shows that migrants-a generic definition for persons who leave their own country of origin-have increased psychopathological vulnerability. Between 2014 and 2017, 976 963 non-European Union (non-EU) people arrived in Italy, of which 30% for humanitarian reasons. This study is aimed at a better understanding of the experience of asylum seekers who transferred to Italy were subjected to the EU Dublin Regulation and most of them suspended in their asylum application.

METHODS

We elaborate a descriptive study based on a population of refugees and asylum seekers who have suffered from social and personal migratory stressful factors. Clinical data was collected between 2011 and 2013 at the "A. Gemelli" General Hospital IRCCS, Rome, Italy. Minors, elderly people, and patients who are unable to declare a voluntary consensus and economic migrants were excluded from the study. Candidates for the status of refugee or asylum seekers were included.

RESULTS

The sample consisted of 180 asylum seekers aged 25.52 ± 5.6 years. Most frequently diagnosis was post-traumatic stress disorder (PTSD) (53%), subthreshold PTSD was reported in 22% of subjects. We found phenomenological patterns highly representative of PTSD of the dissociative subtype. Around 20% of the sample suffered from psychotic symptomatology.

CONCLUSIONS

Loss of the migratory project and the alienation mediated by chronic social defeat paradigm may trigger a psychopathological condition described by the failure to cope with the negative emotional context of social exclusion and solitude. A common and integrated treatment project is needed, with the scope of reintegrating the migrant's personal and narrative identity.

Early childhood social communication deficits in youth at clinical high-risk for psychosis: Associations with functioning and risk

Effective social functioning requires a broad range of social communication skills that are impaired in psychosis populations. However, little is known about early childhood (4- to 5-year period) social communication during the premorbid (pre-illness) stage of psychosis. The present study utilized retrospective parent reports to examine total early childhood social communication deficits, as well as deficits in two distinct domains, reciprocal social interaction (social smiling/eye gaze) and communication (social chat/gesture), in youth at clinical high-risk (CHR) for psychosis (ages 13-21; 37.2% female). Furthermore, associations between early childhood social communication and CHR youth's current functioning (social, academic/work), symptoms (positive/negative), and risk for conversion to psychosis were examined. Compared to healthy controls, CHR individuals had greater deficits in total and communication-specific early childhood social communication. Early childhood total, communication, and reciprocal social interaction deficits were associated with worse current functioning and greater current negative symptom severity (amotivation/anhedonia) in CHR youth. Early childhood total and reciprocal social interaction deficits were also associated with increased risk for conversion. These findings inform the field's understanding of the etiology and pathophysiology of psychosis by extending the current developmental literature on premorbid deficits in psychosis populations to specific domains of social behavior in a critical developmental period.

Plant Fetish: A Creative Challenge to Mental Health Stigma

People of BAMME (Black, Asian, Minority, and Migrant ethnic) heritage in the UK experience various anomalies when engaging with mental health services. Typically concentrated at secondary and secure levels of care, these discrepant experiences interact with a reticence to uptake mental health support at the primary care level. Official, national anti-stigma campaigns often reproduce messages that do not connect with BAMME communities, raising questions about how best to challenge stigma in this context. This research paper describes a case study of an alternative means to address stigma, drawing from a dramatic comedy performance, Plant Fetish, written and performed by an artist who carries a diagnosis of complex post-traumatic stress disorder (Complex PTSD). The study comprised of an individual interview with the artist, audience feedback, and a group discussion conducted after the show. Data were subject to interpretative phenomenological analysis. Findings are discussed in relation to the importance of using creativity to increase public awareness of mental health and inform efforts to reduce stigma. We conclude that such approaches show promise and merit further exploration in a context of growing discursive interest in mental health amidst acknowledged deficiencies of contemporary anti-stigma efforts, especially as they apply to BAMME people, their families, and their communities.

Treating Schizophrenia: Open Conversations and Stronger Relationships Through Psychoeducation and Shared Decision-Making

Integrated pharmacological and psychosocial treatments, such as psychoeducation (PE) and shared decision-making (SDM), have been shown to significantly improve outcomes for people living with schizophrenia (PLWS). Underpinning the success of these interventions is a strong therapeutic relationship between PLWS, their carers, and their healthcare team. While many recognize the value of this relationship, implementation of the interventions necessary to facilitate its construction remain low. In this article, we identify the barriers to developing productive therapeutic relationships and explain how PE and SDM, taking into account cultural difference, can improve adherence to treatment, strengthen therapeutic relationships, and ultimately equip patients to achieve better functional outcomes.

Childhood adversity and clinical and psychosocial outcomes in psychosis

AIMS

Associations between childhood abuse and various psychotic illnesses in adulthood are commonly reported. We aim to examine associations between several reported childhood adverse events (sexual abuse, physical abuse, emotional abuse, neglect and interpersonal loss) among adults with diagnosed psychotic disorders and clinical and psychosocial outcomes.

METHODS

Within a large epidemiological study, the 2010 Australian National Survey of Psychosis (Survey of High Impact Psychosis, SHIP), we used logistic regression to model childhood adverse events (any and specific types) on 18 clinical and psychosocial outcomes.

RESULTS

Eighty percent of SHIP participants (1466/1825) reported experiencing adverse events in childhood (sexual abuse, other types of abuse and interpersonal loss). Participants reporting any form of childhood adversity had higher odds for 12/18 outcomes we examined. Significant associations were observed with all psychosocial outcomes (social dysfunction, victimisation, offending and homelessness within the previous 12 months, and definite psychosocial stressor within 12 months of illness onset), with the strongest association for homelessness (odds ratio (OR) = 2.82). Common across all adverse event types was an association with lifetime depression, anxiety and a definite psychosocial stressor within 12 months of illness onset. When adverse event types were non-hierarchically coded, sexual abuse was associated with 11/18 outcomes, other types of abuse 13/18 and, interpersonal loss occurring in the absence of other forms of abuse was associated with fewer of the clinical and psychosocial outcomes, 4/18. When adverse events types were coded hierarchically (to isolate the effect of interpersonal loss in the absence of abuse), interpersonal loss was associated with lower odds of self-reproach (OR = 0.70), negative syndrome (OR = 0.75) and victimisation (OR = 0.82).

CONCLUSIONS

Adverse childhood experiences among people with psychosis are common, as are subsequent psychosocial stressors. Mental health professionals should routinely enquire about all types of adversities in this group and provide effective service responses. Childhood abuse, including sexual abuse, may contribute to subsequent adversity, poor psychosocial functioning and complex needs among people with psychosis. Longitudinal research to better understand these relationships is needed, as are studies which evaluate the effectiveness of preventative interventions in high-risk groups.

Screening nursing students to identify those at high risk of poor mental health: a cross-sectional survey

OBJECTIVES

This study aimed to identify those at high risk of poor mental health among nursing students and to examine the relationships and consistency among five mental health assessments.

DESIGN

A cross-sectional design with purposive sampling was used. Four mental health screening tools plus previous mental health history/information were conducted during June 2015 to October 2016.

SETTING

A nursing major university in Taiwan.

PARTICIPANTS

A total of 2779 participants aged between 19 and 45 years were recruited.

MAIN OUTCOME MEASURES

Five mental health risks were identified: increased risk for ultra-high risk, putative prepsychosis states, high trait anxiety, high state anxiety with genetic risk and depression.

RESULTS

Out of the 3395 collected questionnaire, 2779 (82%) were found valid and included in the study. 612 (22%) of the participants were identified to be at mental health risk. 12 of them appeared positive in four, 79 in three, 148 in two and 373 in one of the adopted mental health screening tools. 69 participants had the experience of seeking medical help due to mental health issues, and 58% of them were identified to be at risk of mental health during the screening. Trait and state anxiety scored the highest in correlation analysis (r(2620)=0.76, p<0.001). Correlations were observed in the scores on the subscales of Chinese Version of Schizotypal Personality Questionnaire-Brief (CSPQ-B) and those of Brief self-report Questionnaire for Screening Putative Prepsychotic States (BQSPS), and the highest correlation coefficients was (r(2740)=0.70, p<0.001). Although both of the screening tools are used to assess mental illness risk at its prodromal phase, but CSPQ-B in general appeared to have more rigorous screening criteria than BQSPS.

CONCLUSION

For expediting early identification high risk of poor mental health, easy-to-use screening questionnaires can be adopted to assess the mental health state of nursing students whose mental well-being and overall health are of vital importance to the entire healthcare industry.

Evidence for the Influence of Social Dominance Orientation and Intergroup Relations on the Stigma of Schizophrenia

Abstract. The stigma of schizophrenia is an intergroup phenomenon associated with issues of social power. We consider that the concept of stigma power should be extended to include intergroup relations that go beyond the aspect of the relation between “schizophrenic” and “normal.” With the present study, we intend to demonstrate that perceivers hold more stigmatizing attitudes toward a person with schizophrenia belonging to the outgroup and that especially when the perceiver has a higher Social Dominance Orientation (SDO). One hundred and sixty-one participants from the general population participated in our study (50.3% male, Mage = 39.14, SD = 16.36), which was based on a 2 (Sex of Target: male vs. female) × 2 (Sex of Participant: male vs. female) × SDO between-subjects design. The participants read a standardized vignette used in previous research, depicting a person presenting the symptoms of schizophrenia, and were then asked to complete questionnaires about SDO and intention to discriminate against the depicted individual. Our analysis showed the main effect of SDO on discriminating intentions. Simple slope analysis revealed that SDO predicts male participants’ discriminating intentions when the target is a woman, while this relation is not significant when the target is a man. The exact reverse pattern was observed among female participants. Our results suggest intergroup relations and ideological motivations underpin the stigma of schizophrenia. We conclude that different group belongings of individuals with schizophrenia as well as the public’s ideological motivations should be further considered by future research and anti-stigma efforts.

The developing significance of context and function: Neuroscience and law

Neuroscience has already changed the understanding of how intent forms and is acted upon, how an individual's cognitive processes shape behavior, and how bio-psychosocial history and neurodevelopmental approaches provide information that has been largely missing from the assessment of intent. In this paper, we first review the state of forensic assessment of mental condition and intent, focused primarily on the weaknesses of the current approach. In Section 2, we discuss neurobehavioral forensic assessment, which is a neuroscience-based approach. Section 3 focuses on the changing understanding of mental illness and how neuroscience is pushing law towards a functional capacity-and-ability model and away from a diagnostic cut-off model. Finally, in Sections 4 and 5, we turn to the role of social and environmental context in shaping behavior and propose a model of behavioral intent in line with the scientific evidence.

NEURAPRO: a multi-centre RCT of omega-3 polyunsaturated fatty acids versus placebo in young people at ultra-high risk of psychotic disorders-medium-term follow-up and clinical course

This study reports a medium-term follow-up of a randomised, double-blind, placebo-controlled trial of omega-3 polyunsaturated fatty acids (PUFA) in ultra-high risk for psychosis (UHR) patients. Primary outcomes of interest were transition to psychosis and symptomatic and functional outcome. A secondary aim was to investigate clinical predictors of medium-term outcome. Three hundred four UHR participants were recruited across 10 specialised early psychosis services in Australia, Asia, and Europe. The intervention consisted of 1.4 g/daily of omega-3 PUFA or placebo, plus up to 20 sessions of cognitive-behavioural case management (CBCM), over the 6-month study period, with participants receiving further CBCM sessions on basis of need between months 6-12. Mean time to follow-up was 3.4 (median = 3.3; SD = 0.9) years. There was a modest increase in transitions between 12-month and medium-term follow-up (11-13%) and substantial improvement in symptoms and functioning between baseline and follow-up, with no differences between the treatment groups. Most improvement had been achieved by end of the intervention. 55% of the sample received mental health treatment between end of intervention and follow-up. Omega-3 PUFA did not provide additional benefits to good quality psychosocial intervention over the medium term. Although most improvement had been achieved by end of intervention the substantial rates of post-intervention mental health service use indicate longer-term clinical need in UHR patients. The post-intervention phase treatment or the longer-term effect of CBCM, or a combination of the two, may have contributed to maintaining the gains achieved during the intervention phase and prevented significant deterioration after this time.

Staged Treatment in Early Psychosis: A sequential multiple assignment randomised trial of interventions for ultra high risk of psychosis patients

AIM

Previous research indicates that preventive intervention is likely to benefit patients "at risk" of psychosis, in terms of functional improvement, symptom reduction and delay or prevention of onset of threshold psychotic disorder. The primary aim of the current study is to test outcomes of ultra high risk (UHR) patients, primarily functional outcome, in response to a sequential intervention strategy consisting of support and problem solving (SPS), cognitive-behavioural case management and antidepressant medication. A secondary aim is to test biological and psychological variables that moderate and mediate response to this sequential treatment strategy.

METHODS

This is a sequential multiple assignment randomised trial (SMART) consisting of three steps: Step 1: SPS (1.5 months); Step 2: SPS vs Cognitive Behavioural Case Management (4.5 months); Step 3: Cognitive Behavioural Case Management + Antidepressant Medication vs Cognitive Behavioural Case Management + Placebo (6 months). The intervention is of 12 months duration in total and participants will be followed up at 18 months and 24 months post baseline.

CONCLUSION

This paper reports on the rationale and protocol of the Staged Treatment in Early Psychosis (STEP) study. With a large sample of 500 UHR participants this study will investigate the most effective type and sequence of treatments for improving functioning and reducing the risk of developing psychotic disorder in this clinical population.

Social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews

Mental health has been included in the UN Sustainable Development Goals. However, uncertainty exists about the extent to which the major social determinants of mental disorders are addressed by these goals. The aim of this study was to develop a conceptual framework for the social determinants of mental disorders that is aligned with the Sustainable Development Goals, to use this framework to systematically review evidence regarding these social determinants, and to identify potential mechanisms and targets for interventions. We did a systematic review of reviews using a conceptual framework comprising demographic, economic, neighbourhood, environmental events, and social and culture domains. We included 289 articles in the final Review. This study sheds new light on how the Sustainable Development Goals are relevant for addressing the social determinants of mental disorders, and how these goals could be optimised to prevent mental disorders.

Sauna Bathing and Risk of Psychotic Disorders: A Prospective Cohort Study

OBJECTIVE

Sauna bathing has been suggested to promote mental well-being and relaxation, but the evidence is uncertain with respect to mental disorders. We aimed to assess the association of frequency of sauna bathing with risk of psychosis in the Kuopio Ischemic Heart Disease prospective population-based study.

SUBJECTS AND METHODS

Baseline sauna bathing habits were assessed in 2,138 men aged 42-61 years who had no history of psychotic disorders. Participants were classified into three groups based on the frequency of sauna bathing (once, 2-3, and 4-7 times per week).

RESULTS

During a median follow-up of 24.9 years, 203 psychotic disorders were recorded. A total of 537, 1,417, and 184 participants reported having a sauna bath once a week, 2-3 times, and 4-7 times per week, respectively. In Cox regression analysis adjusted for age, compared to men who had 1 sauna session per week, the hazard ratio (95% confidence intervals) of psychosis for 4-7 sauna sessions per week was 0.23 (0.09-0.58). In a multivariable model adjusted for several risk factors and other potential confounders, the corresponding hazard ratio was 0.21 (0.08-0.52). The association was similar after further adjustment for total energy intake, socioeconomic status, physical activity, and C-reactive protein (0.22 [0.09-0.54]) and was unchanged on additional adjustment for duration of a sauna session and temperature of the sauna bath (0.23 [0.09-0.57]).

CONCLUSION

Our study suggests a strong inverse and independent association between frequent sauna bathing and the future risk of psychotic disorders in a general male population.

Patient Characteristics, Length of Stay, and Functional Improvement for Schizophrenia Spectrum Disorders: A Population Study of Inpatient Care in Ontario 2005 to 2015

OBJECTIVES

Schizophrenia and associated illnesses account for a large proportion of mental illness burden and health care expenditures, with the majority of expense involving inpatient care. To date, the literature exploring factors associated with length of stay (LOS) and functional improvement during inpatient care is underdeveloped. In response, this study examined the association between patient characteristics, LOS, and functional improvement using Ontario Mental Health Reporting System (OMHRS) data from 2005 to 2015.

METHODS

The associations of patient characteristics (including key demographics, psychosocial variables, reasons for admission, and service use history) and 2 outcome measures (LOS and Global Assessment of Functioning [GAF]) were analysed with generalised linear mixed modelling (GLMM). From 2005 to 2015, a total of 48,498 episodes for distinct patients from 18 psychiatric hospitals and 57 general hospitals in Ontario were included.

RESULTS

For psychiatric and general hospitals, mean LOS was 96.6 and 20.5 days, and mean GAF improvement was 14.8 and 16.1, respectively. The majority of associations probed demonstrated a high degree of significance with similar patterns across general and tertiary facility contexts. Older age and more recent readmission following a psychiatric discharge were associated with longer LOS and less GAF improvement. Recent experience of adverse life events and substance misuse were associated with shorter LOS.

CONCLUSIONS

While the findings of this exploratory cross-sectional analysis will require further inquiry with respect to validity and reliability, they suggest that a different service pathway is likely required for individuals with greater psychosocial challenge and extensive service use histories.

Stress sensitivity in paranoia: poor-me paranoia protects against the unpleasant effects of social stress

BACKGROUND

The attributional theory of paranoia suggests that paranoid beliefs may protect individuals from low self-esteem and distress (Bentall et al. 2001). The current study tested this theory by investigating a hypothesis that paranoid beliefs in combination with low perceived deservedness of persecution (poor-me beliefs) confer protection against the distress caused by social but not activity related stress.

METHODS

Paranoid symptoms, perceived deservedness of persecution, self-esteem, mood, and stress levels of individuals diagnosed with schizophrenia spectrum disorders (N = 91) and healthy controls (N = 52) were assessed in the context of daily life using the experience sampling method.

RESULTS

Individuals holding poor-me beliefs (poor-me individuals) showed blunted sensitivity to social but not activity stress. In contrast, individuals holding paranoid beliefs in combination with high perceived deservedness of persecution (bad-me individuals) showed heightened sensitivity to social stress. No consistent differences in reactions to activity stress emerged. Although both poor-me and bad-me individuals reported low self-esteem, this disturbance was particularly characteristic of bad-me individuals.

CONCLUSIONS

The results suggest that poor-me paranoid beliefs may protect individuals against the distress associated with unpleasant social situations. The specificity of reactions to social stress is discussed in the context of wider literature. Future directions for research are suggested.

Social exclusion and psychopathology in an online cohort of Moroccan-Dutch migrants: Results of the MEDINA-study

Introduction

Migration is seen as a risk factor for developing psychiatric symptoms and experiencing social exclusion. In the Netherlands, the Moroccan-Dutch population is the second largest migrant group. 70% of all young Moroccan-Dutch people meet each other in the online community www.marokko.nl. Within this community, we investigated the association between experiences of social exclusion and self-reported depressive symptoms and psychotic experiences.

Materials and methods

Participants were recruited via the website www.marokko.nl. They completed an online survey, with screening instruments for depressive symptoms (K10) and psychotic experiences (PQ-16), measures of social exclusion (perceived discrimination, social defeat and social support), and questions about demographical information. With regression analysis the association between social exclusion and psychiatric symptoms was investigated.

Results

We included 267 participants; 87% were female. 27% of the sample has received mental healthcare in the past. Over 50% of these people screened positive for depressive symptoms and psychotic experiences. Perceived discrimination and social defeat were significantly associated with psychotic experiences and social defeat was associated with depressive symptoms. Social support and higher education were associated with less depressive symptoms and psychotic experiences.

Discussion

Our findings suggest that the online environment allows for epidemiological research and early symptom detection. Levels of psychopathology were high in our sample. This suggests that a part of this young ethnic minority population might not get adequate mental healthcare. Since this population can be reached through Internet, the online environment may therefore also offer an appropriate setting for intervention, to increase resilience towards social exclusion.

Assessing the risk for suicide in schizophrenia according to migration, ethnicity and geographical ancestry

BACKGROUND

Suicide is a leading cause of mortality among those afflicted by schizophrenia. Previous studies demonstrated that the stressors associated with immigration may lead to an onset of schizophrenia and suicide separately in susceptible individuals. However, no studies have shown whether immigration may lead to suicidal behaviour for individuals with schizophrenia. Our study proposes that an individual's geographical ancestry, ethnicity or migration status may be predictive of suicide risk in schizophrenia.

METHODS

In a sample of 276 participants with schizophrenia spectrum disorders, we conducted cross-sectional assessments to collect clinical information. Self-identified ethnicity and suicide history were collected through self-report questionnaires and interview-based scales. Ancestry was identified using 292 genetic markers from HapMap. Migrants were classified as those who immigrated to Canada during their lifetime. Using a regression analysis, we tested whether a history of migration, ethnicity or geographical ancestry were predictive of a history of suicide attempts.

RESULTS

Our analysis failed to demonstrate a significant relationship between suicide history and migration, ethnicity or ancestry. However, ethnicity appears to be significantly associated with the number of psychiatric hospitalizations in our sample.

CONCLUSION

Ethnicity and migration history are not predictive of previous suicide attempts. Ethnicity may be an important demographic factor affecting access to mental health resources and frequency of hospitalizations.

Embedding a Recovery Orientation into Neuroscience Research: Involving People with a Lived Experience in Research Activity

This paper highlights the importance and value of involving people with a lived experience of mental ill health and recovery in neuroscience research activity. In this era of recovery oriented service delivery, involving people with the lived experience of mental illness in neuroscience research extends beyond their participation as "subjects". The recovery paradigm reconceptualises people with the lived experience of mental ill health as experts by experience. To support this contribution, local policies and procedures, recovery-oriented training for neuroscience researchers, and dialogue about the practical applications of neuroscience research, are required.

Schizophrenia-Like Phenotype Inherited by the F2 Generation of a Gestational Disruption Model of Schizophrenia

Both environmental and genetic factors contribute to schizophrenia; however, the exact etiology of this disorder is not known. Animal models are utilized to better understand the mechanisms associated with neuropsychiatric diseases, including schizophrenia. One of these involves gestational administration of methylazoxymethanol acetate (MAM) to induce a developmental disruption, which in turn produces a schizophrenia-like phenotype in post-pubertal rats. The mechanisms by which MAM produces this phenotype are not clear; however, we now demonstrate that MAM induces differential DNA methylation, which may be heritable. Here we demonstrate that a subset of both second (F2) and third (F3) filial generations of MAM-treated rats displays a schizophrenia-like phenotype and hypermethylation of the transcription factor, Sp5. Specifically, ventral tegmental area of dopamine neuron activity was examined using electrophysiology as a correlate for the dopamine hyperfunction thought to underlie psychosis in patients. Interestingly, only a subset of F2 and F3 MAM rats exhibited increases in dopamine neuron population activity, indicating that this may be a unique model with a susceptibility to develop a schizophrenia-like phenotype. An increase in dopamine system function in rodent models has been previously associated with decreases in hippocampal GABAergic transmission. In line with these observations, we found a significant correlation between hippocampal parvalbumin expression and dopamine neuron activity in F2 rats. These data therefore provide evidence that offspring born from MAM-treated rats possess a susceptibility to develop aspects of a schizophrenia-like phenotype and may provide a useful tool to investigate gene-environment interactions.

Social class at birth and risk of psychosis

BACKGROUND

Individuals with psychotic disorders are represented more in the lower social classes, yet there is conflicting evidence to whether these individuals drift into the lower social classes or whether lower social class is a risk factor for developing psychosis. The aim of this study was to examine whether the social class at birth is a risk factor for developing psychosis.

METHODS

We included individuals with a first episode of psychosis (FEP) whose social class at birth was determined from birth records. We employed a case-control study design and also compared the distribution of the social classes at birth of the cases to that of the general population.

RESULTS

A total of 380 individuals with an FEP and 760 controls were included in the case-control study. The odds ratio for developing an FEP associated with social class (low vs high) was .62 (95% confidence interval (CI): .46-.85, p < .001), indicating that individuals from a lower social class at birth have a reduced risk of psychosis. Individuals born between 1961 and 1980 with an FEP were more likely to be from a higher social class at birth compared to the general population (60.8% vs 36.7%, χ(2) = 60.85, df = 1, p < .001). However, this association was not observed for those born between 1981 and 1990.

CONCLUSION

A higher social class at birth is associated with a greater risk for developing a psychotic disorder; however, this effect may show temporal variation.

Psychosis, Socioeconomic Disadvantage, and Health Service Use in South Australia: Findings from the Second Australian National Survey of Psychosis

The association between mental illness and poor physical health and socioeconomic outcomes has been well established. In the twenty-first century, the challenge of how mental illnesses, such as psychosis, are managed in the provision of public health services remains complex. Developing effective clinical mental health support and interventions for individuals requires a coordinated and robust mental health system supported by social as well as health policy that places a priority on addressing socioeconomic disadvantage in mental health cohorts. This paper, thus, examines the complex relationship between socioeconomic disadvantage, family/social supports, physical health, and health service utilization in a community sample of 402 participants diagnosed with psychosis. The paper utilizes quantitative data collected from the 2010 Survey of High Impact Psychosis research project conducted in a socioeconomically disadvantaged region of Adelaide, SA, Australia. Participants (42% female) provided information about socioeconomic status, education, employment, physical health, contact with family and friends, and health service utilization. The paper highlights that socioeconomic disadvantage is related to increased self-reported use of emergency departments, decreased use of general practitioners for mental health reasons, higher body mass index, less family contact, and less social support. In particular, the paper explores the multifaceted relationship between socioeconomic disadvantage and poor health confronting individuals with psychosis, highlighting the complex link between socioeconomic disadvantage and poor health. It emphasizes that mental health service usage for those with higher levels of socioeconomic disadvantage differs from those experiencing lower levels of socioeconomic disadvantage. The paper also stresses that the development of health policy and practice that seeks to redress the socioeconomic and health inequalities created by this disadvantage be an important focus for mental health services. Such health policy would provide accessible treatment programs and linked pathways to illness recovery and diminish the pressure on the delivery of health services. Consequently, the development of policy and practice that seeks to redress the socioeconomic and health inequalities created by disadvantage should be an important focus for the improvement of mental health services.

Environmental influence in the brain, human welfare and mental health

The developing human brain is shaped by environmental exposures--for better or worse. Many exposures relevant to mental health are genuinely social in nature or believed to have social subcomponents, even those related to more complex societal or area-level influences. The nature of how these social experiences are embedded into the environment may be crucial. Here we review select neuroscience evidence on the neural correlates of adverse and protective social exposures in their environmental context, focusing on human neuroimaging data and supporting cellular and molecular studies in laboratory animals. We also propose the inclusion of innovative methods in social neuroscience research that may provide new and ecologically more valid insight into the social-environmental risk architecture of the human brain.

New developments in diagnosis and treatment update: Schizophrenia/first episode psychosis in children and adolescents

Childhood onset schizophrenia (COS) is diagnosed before the age of 13 years, and early onset schizophrenia (EOS) is diagnosed before the age of 18 years. EOS is considered extremely rare and its prevalence in comparison to the worldwide prevalence of schizophrenia (1%) has not adequately been studied. Patients who experience the first episode of psychosis need to be treated early and optimally to lessen the morbidity and improve the outcome of the illness. Treatment needs to be a combination of both pharmacological and non-pharmacological modalities. Pharmacological intervention is necessary for remission, improvement of positive symptoms and to aid with the efficacy of psychosocial interventions. There is a lack of efficacy and safety data of the use of antipsychotic medication in children, with most of the information available being extrapolations of adult data. An increased use of atypical antipsychotic drugs in the treatment of EOS has been accompanied by growing concern about the appropriate use and associated side effects in children and adolescents. This update highlights new developments, concepts and treatment trends in EOS.

Patient experienced continuity of care in the psychiatric healthcare system-a study including immigrants, refugees and ethnic danes

Aim: The purpose of this study was to investigate continuity of care in the psychiatric healthcare system from the perspective of patients, including vulnerable groups such as immigrants and refugees. Method: The study is based on 19 narrative interviews conducted with 15 patients with diverse migration backgrounds (immigrants, descendents, refugees, and ethnic Danes). Patients were recruited from a community psychiatric centre situated in an area with a high proportion of immigrants and refugees. Data were analysed through the lens of a theoretical framework of continuity of care in psychiatry, developed in 2004 by Joyce et al., which encompasses four domains: accessibility, individualised care, relationship base and service delivery. Results: Investigating continuity of care, we found issues of specific concern to immigrants and refugees, but also commonalities across the groups. For accessibility, areas pertinent to immigrants and refugees include lack of knowledge concerning mental illness and obligations towards children. In terms of individualised care, trauma, additional vulnerability, and taboo concerning mental illness were of specific concern. In the domain of service delivery, social services included assistance with immigration papers for immigrants and refugees. In the relationship base domain, no differences were identified. Implications for priority area: The treatment courses of patients in the psychiatric field are complex and diverse and the patient perspective of continuity of care provides important insight into the delivery of care. The study highlights the importance of person-centred care irrespective of migration background though it may be beneficial to have an awareness of areas that may be of more specific concern to immigrants and refugees. Conclusions: The study sheds light on concerns specific to immigrants and refugees in a framework of continuity of care, but also commonalities across the patient groups.

Mixed housing with DBA/2 mice induces stress in C57BL/6 mice: implications for interventions based on social enrichment

Several behavioral interventions, based on social enrichment and observational learning are applied in treatment of neuropsychiatric disorders. However, the mechanism of such modulatory effect and the safety of applied methods on individuals involved in social support need further investigation. We took advantage of known differences between inbred mouse strains to reveal the effect of social enrichment on behavior and neurobiology of animals with different behavioral phenotypes. C57BL/6 and DBA/2 female mice displaying multiple differences in cognitive, social, and emotional behavior were group-housed either in same-strain or in mixed-strain conditions. Comprehensive behavioral phenotyping and analysis of expression of several plasticity- and stress-related genes were done to measure the reciprocal effects of social interaction between the strains. Contrary to our expectation, mixed housing did not change the behavior of DBA/2 mice. Nevertheless, the level of serum corticosterone and the expression of glucocorticoid receptor Nr3c1 in the brain were increased in mixed housed DBA/2 as compared with those of separately housed DBA/2 mice. In contrast, socially active C57BL/6 animals were more sensitive to the mixed housing, displaying several signs of stress: alterations in learning, social, and anxiety-like behavior and anhedonia. These behavioral impairments were accompanied by the elevated serum corticosterone and the reduced expression of Nr3c1, as well as the elevated Bdnf levels in the cortex and hippocampus. Our results demonstrate the importance of social factors in modulation of both behavior and the underlying neurobiological mechanisms in stress response, and draw attention to the potential negative impact of social interventions for individuals involved in social support.

Anxiety and depression related to elevated dopamine in a patient with multiple mediastinal paragangliomas

Paragangliomas are rare neuroendocrine tumors. Occasionally they secrete catecholamines in sufficient quantities to cause symptoms. These may include psychiatric symptoms such as anxiety and depression. We describe a patient with multiple mediastinal paragangliomas and persistently elevated dopamine levels who presented with anxiety and depression. She later went on to develop paranoid schizophrenia, which we feel was coincidental. This case illustrates anxiety and depressive symptoms associated with elevated dopamine and the importance of awareness of psychiatric manifestations of neuroendocrine tumors among psychiatrists and physicians.

The neurobiology of social environmental risk for schizophrenia: an evolving research field

INTRODUCTION

Schizophrenia is a severe and complex brain disorder that usually manifests in early adulthood and disturbs a wide range of human functions. More than 100 years after its initial description, the pathophysiology of the disorder is still incompletely understood. Many epidemiological studies strongly suggest a complex interaction between genetic and environmental risk factors for the development of the disorder. While there is considerable evidence for a social environmental component of this risk, the links between adverse social factors and altered brain function have just come into focus.

METHODS

In the present review, we first summarize epidemiological evidence for the significance of social environmental risk factors, outline the role of altered social stress processing in mental illness, and review the latest experimental evidence for the neural correlates of social environmental risk for schizophrenia.

CONCLUSIONS

The studies we have discussed in this review provide a selection of the current work in the field. We suggest that many of the social environmental risk factors may impact on perceived social stress and engage neural circuits in the brain whose functional and structural architecture undergoes detrimental change in response to prolonged exposure. We conclude that multidisciplinary approaches involving various fields and thoroughly constructed longitudinal designs are necessary to capture complex structure of social environmental risks.

Environmental factors during adolescence associated with later development of psychotic disorders - a nested case-control study

Etiologies of psychotic disorders (schizophrenia and bipolar disorder) are conceptualized as interplay between genetic and environmental factors. The adolescent period is characterized by changes in social roles and expectations that may interact with biological changes or psychosocial stressors. Few studies focus on the adolescents' own reports of perceived risk factors. To assess differences at age 16 between persons who later develop psychotic disorders ("Confirmed Psychosis", CP) and their class-mates ("Population Controls", PC) we collected information on: (1) Social support factors (size of social network and expectancies of social support from friends), (2) Cognitive functioning (concentrating in the classroom, actual grades and expectancies of own academic achievements) and (3) Problems and stressors in families (illness or loss of work for parents), and in relationship with others (exposure to bullying, violence or sexual violation). Self-reported data from students at 15-16 years of age were linked to the case-registers from the "Thematically Organized Psychosis (TOP) Study". The CP group reported more economic problems in their families, smaller social network and lower academic expectation than the PC group. The results support the notion that long-term socioeconomic stressors in adolescence may serve as risk factors for the development of psychotic disorders.

ΔFosB induction in prefrontal cortex by antipsychotic drugs is associated with negative behavioral outcomes

ΔFosB, a FosB gene product, is induced in the prefrontal cortex (PFC) by repeated exposure to several stimuli including antipsychotic drugs such as haloperidol. However, the functional consequences of increased ΔFosB expression following antipsychotic treatment have not been explored. Here, we assessed whether ΔFosB induction by haloperidol mediates the positive or negative consequences or clinical-related actions of antipsychotic treatment. We show that individuals with schizophrenia who were medicated with antipsychotic drugs at their time of death display increased ΔFosB levels in the PFC, an effect that is replicated in rats treated chronically with haloperidol. In contrast, individuals with schizophrenia who were medication-free did not exhibit this effect. Viral-mediated overexpression of ΔFosB in the PFC of rodents induced cognitive deficits as measured by inhibitory avoidance, increased startle responses in prepulse inhibition tasks, and increased MK-801-induced anxiety-like behaviors. Together, these results suggest that ΔFosB induction in the PFC by antipsychotic treatment contributes to the deleterious effects of these drugs and not to their therapeutic actions.

Severe bereavement stress during the prenatal and childhood periods and risk of psychosis in later life: population based cohort study

OBJECTIVE

To examine the risk of psychosis associated with severe bereavement stress during the antenatal and postnatal period, between conception to adolescence, and with different causes of death.

DESIGN

Population based cohort study.

SETTING

Swedish national registers including births between 1973 and 1985 and followed-up to 2006.

PARTICIPANTS

In a cohort of 1,045,336 Swedish births (1973-85), offspring born to mothers exposed to severe maternal bereavement stress six months before conception or during pregnancy, or exposed to loss of a close family member subsequently from birth to 13 years of age were followed until 2006. Admissions were identified by linkage to national patient registers.

MAIN OUTCOME MEASURES

Crude and adjusted odds ratios for all psychosis, non-affective psychosis, and affective psychosis.

RESULTS

Maternal bereavement stress occurring preconception or during the prenatal period was not associated with a significant excess risk of psychosis in offspring (adjusted odds ratio, preconception 1.24, 95% confidence interval 0.96 to 1.62; first trimester 0.95, 0.58 to 1.56; second trimester 0.79, 0.46 to 1.33; third trimester 1.14, 0.78 to 1.66). Risks increased modestly after exposure to the loss of a close family member from birth to adolescence for all psychoses (adjusted odds ratio 1.17, 1.04 to 1.32). The pattern of risk was generally similar for non-affective and affective psychosis. Thus estimates were higher after death in the nuclear compared with extended family but remained non-significant for prenatal exposure; the earlier the exposure to death in the nuclear family occurred in childhood (all psychoses: adjusted odds ratio, birth to 2.9 years 1.84, 1.41 to 2.41; 3-6.9 years 1.47, 1.16 to 1.85; 7-12.9 years 1.32, 1.10 to 1.58) and after suicide. Following suicide, risks were especially higher for affective psychosis (birth to 2.9 years 3.33, 2.00 to 5.56; 6.9 years 1.84, 1.04 to 3.25; 7-12.9 years 2.68, 1.84 to 3.92). Adjustment for key confounders attenuated but did not explain associations with risk.

CONCLUSIONS

Postnatal but not prenatal bereavement stress in mothers is associated with an increased risk of psychosis in offspring. Risks are especially high for affective psychosis after suicide in the nuclear family, an effect that is not explained by family psychiatric history. Future studies are needed to understand possible sources of risk and resilience so that structures can be put in place to support vulnerable children and their families.

Migrants Examined for Determinants of psychopathology through INternet Assessment (MEDINA) study: a cross-sectional study among visitors of an Internet community

INTRODUCTION

Migration is a risk factor for the onset of psychopathology. A range of social factors may play a role in the aetiology of psychiatric disorders in migrants. A better understanding of these associations is needed to develop preventive interventions to reduce the disease burden in the migrant population. Research among minority groups is generally time consuming and it is difficult to recruit participants. Internet can offer interesting new possibilities to conduct research among ethnic minorities. This article describes the design of an epidemiological study in the Moroccan-Dutch population, which will be entirely performed online. We investigate the association between social factors and psychopathology.

METHODS AND ANALYSIS

The website Marokko.nl is visited by 70% of the young Moroccan-Dutch population in the Netherlands. This website therefore provides a unique possibility for research within this population. We will conduct a survey with online questionnaires via this website. The online survey consists of several validated short self-report questionnaires, measuring depressive and anxiety symptoms (The Kessler Psychological Distress Scale (K10)), psychotic symptoms (The Prodromal Questionnaire-16 (PQ-16)) and instruments measuring discrimination, social support and social defeat. Furthermore, demographic characteristics are collected. We will use univariate and multivariate methods for analysing the data.

ETHICS AND DISSEMINATION

The local medical ethical committee has assessed the study protocol and judged that the study could be conducted without their approval. Knowledge dissemination will take place through peer-reviewed publication in scientific journals as well as publication for participants on the project website.

DISCUSSION

In this study we further explore the association between psychopathology and social factors within an online Moroccan-Dutch sample. The recruitment of participants via the website Marokko.nl creates a big advantage in collecting a large sample of a specific migrant population. Strengths and limitations of the methodology are discussed. Furthermore, we review the advantages and challenges of online epidemiological research methods.

Neighbourhood-level socio-environmental factors and incidence of first episode psychosis by place at onset in rural Ireland: the Cavan-Monaghan First Episode Psychosis Study [CAMFEPS]

BACKGROUND

Little is known about associations between the social environment and risk for psychosis within rural settings. This study sought to investigate whether such associations exist within a rural context using a prospective dataset of unusual epidemiological completeness.

METHOD

Using the Cavan-Monaghan First Episode Psychosis Study database of people aged 16 years and older, both ecological analyses and multilevel modelling were applied to investigate associations between incidence of psychosis by place at onset and socio-environmental risk factors of material deprivation, social fragmentation and urban-rural classification across electoral divisions.

RESULTS

The primary finding was an association between more deprived social contexts and higher rates of psychotic disorder, after adjustment for age and sex [all psychoses: incidence rate ratio (IRR)=1.12, 95% CI (1.03-1.23)].

CONCLUSIONS

These findings support an association between adverse socio-environmental factors and increase in risk for psychosis by place at onset within a predominantly rural environment. This study suggests that social environmental characteristics may have an impact on risk across the urban-rural gradient.

Prevalence of self-reported childhood abuse in psychosis: a meta-analysis of retrospective studies

There is extensive clinical literature reporting traumatic childhood experiences in patients with psychosis. A quantitative meta-analysis addressing the prevalence of self-reported childhood sexual (CSA), physical (CPA) and emotional abuse (CEA) in psychotic patients has yet to be done. We conducted, a systematic literature search to identify retrospective studies addressing self-reported childhood abuse in patients with DSM/ICD psychosis. Demographic, clinical, and methodological variables were extracted from each publication, or obtained directly from its authors. Quantitative meta-analysis of CSA, CPA, CEA in the sample of patients was performed. Statistical heterogeneity and publication bias were assessed and meta-regressions performed to control for different moderators. Twenty-three studies were retrieved and included a total of 2017 psychotic patients. The prevalence of self-reported CSA, CPA, CEA were respectively of 26%, 39% and 34%. Age, publication year, gender and substance abuse moderated CSA, while age, clinical setting and substance abuse moderated CPA. Results indicated that CEA was moderated by gender and publication year of the study. According to our meta-analysis, psychotic patients have a consistently high self-report of childhood traumatic events which are sexual, physical and emotional in nature. It is our opinion that clinicians should be trained and skilled to carefully investigate childhood abuse in psychosis.