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Merritt SH, Zak PJ. Continuous remote monitoring of neurophysiologic Immersion accurately predicts mood. Front Digit Health 2024; 6:1397557. [PMID: 39157805 PMCID: PMC11327156 DOI: 10.3389/fdgth.2024.1397557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/10/2024] [Indexed: 08/20/2024] Open
Abstract
Mental health professionals have relied primarily on clinical evaluations to identify in vivo pathology. As a result, mental health is largely reactive rather than proactive. In an effort to proactively assess mood, we collected continuous neurophysiologic data for ambulatory individuals 8-10 h a day at 1 Hz for 3 weeks (N = 24). Data were obtained using a commercial neuroscience platform (Immersion Neuroscience) that quantifies the neural value of social-emotional experiences. These data were related to self-reported mood and energy to assess their predictive accuracy. Statistical analyses quantified neurophysiologic troughs by the length and depth of social-emotional events with low values and neurophysiologic peaks as the complement. Participants in the study had an average of 2.25 (SD = 3.70, Min = 0, Max = 25) neurophysiologic troughs per day and 3.28 (SD = 3.97, Min = 0, Max = 25) peaks. The number of troughs and peaks predicted daily mood with 90% accuracy using least squares regressions and machine learning models. The analysis also showed that women were more prone to low mood compared to men. Our approach demonstrates that a simple count variable derived from a commercially-available platform is a viable way to assess low mood and low energy in populations vulnerable to mood disorders. In addition, peak Immersion events, which are mood-enhancing, may be an effective measure of thriving in adults.
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Affiliation(s)
- Sean H. Merritt
- Center for Neuroeconomics Studies, Claremont Graduate University, Claremont, CA, United States
| | - Paul J. Zak
- Center for Neuroeconomics Studies and Drucker School of Management, Claremont Graduate University, Claremont, CA, United States
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Bogudzińska B, Jaworski A, Zajdel A, Skrzypek K, Misiak B. The experience sampling methodology in psychosis risk states: A systematic review. J Psychiatr Res 2024; 175:34-41. [PMID: 38704979 DOI: 10.1016/j.jpsychires.2024.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/03/2024] [Accepted: 04/25/2024] [Indexed: 05/07/2024]
Abstract
The experience sampling method (ESM) is a structured diary technique, which is used to assess thoughts, mood and appraise subjective experiences in daily life. It has been recognized as a useful tool for understanding the characteristics, dynamics, and underlying mechanisms of prodromal symptoms of psychosis. The present systematic review aimed to provide a qualitative synthesis of findings provided by the ESM studies conducted in people with psychosis risk states. A systematic review of the MEDLINE, ERIC, Academic Search Ultimate, and Health Source: Nursing/Academic Edition databases, utilizing search terms related to the ESM and the risk of psychosis was conducted. Out of 1069 publication records identified, 77 studies met the inclusion criteria for the review. Data were synthesized around the following topics: 1) assessment of symptoms dynamics and social functioning; 2) assessment of the mechanisms contributing to the emergence of psychotic experiences and 3) assessment of stress sensitivity. The studies have shown that negative emotions are associated with subsequent development of paranoia. The tendency to draw hasty conclusions, aberrant salience, self-esteem, and emotion regulation were the most frequently reported mechanisms associated with the emergence of psychotic experiences. Studies using the ESM also provided evidence for the role of stress sensitivity, in the development of psychotic symptoms. The ESM has widely been applied to studies investigating psychosis risk states, using a variety of protocols. Findings from this systematic review might inform future studies and indicate potential targets for interventions.
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Affiliation(s)
- Bogna Bogudzińska
- Departament of Psychiatry, Wroclaw Medical University, Wroclaw, Poland.
| | | | | | | | - Błażej Misiak
- Departament of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
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Formica MJC, Fuller-Tyszkiewicz M, Reininghaus U, Kempton M, Delespaul P, de Haan L, Nelson B, Mikocka-Walus A, Olive L, Ruhrmann S, Rutten B, Riecher-Rössler A, Sachs G, Valmaggia L, van der Gaag M, McGuire P, van Os J, Hartmann JA. Associations between disturbed sleep and attenuated psychotic experiences in people at clinical high risk for psychosis. Psychol Med 2024:1-10. [PMID: 38450445 DOI: 10.1017/s0033291724000400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND Pre-diagnostic stages of psychotic illnesses, including 'clinical high risk' (CHR), are marked by sleep disturbances. These sleep disturbances appear to represent a key aspect in the etiology and maintenance of psychotic disorders. We aimed to examine the relationship between self-reported sleep dysfunction and attenuated psychotic symptoms (APS) on a day-to-day basis. METHODS Seventy-six CHR young people completed the Experience Sampling Methodology (ESM) component of the European Union Gene-Environment Interaction Study, collected through PsyMate® devices, prompting sleep and symptom questionnaires 10 times daily for 6 days. Bayesian multilevel mixed linear regression analyses were performed on time-variant ESM data using the brms package in R. We investigated the day-to-day associations between sleep and psychotic experiences bidirectionally on an item level. Sleep items included sleep onset latency, fragmentation, and quality. Psychosis items assessed a range of perceptual, cognitive, and bizarre thought content common in the CHR population. RESULTS Two of the seven psychosis variables were unidirectionally predicted by previous night's number of awakenings: every unit increase in number of nightly awakenings predicted a 0.27 and 0.28 unit increase in feeling unreal or paranoid the next day, respectively. No other sleep variables credibly predicted next-day psychotic symptoms or vice-versa. CONCLUSION In this study, the relationship between sleep disturbance and APS appears specific to the item in question. However, some APS, including perceptual disturbances, had low levels of endorsement amongst this sample. Nonetheless, these results provide evidence for a unidirectional relationship between sleep and some APS in this population.
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Affiliation(s)
- M J C Formica
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, Australia
| | - M Fuller-Tyszkiewicz
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, Australia
| | - U Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - M Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, King's College London, London, UK
| | - P Delespaul
- Facalty of Health, Medicine and Life Sciences, Psychiatrie & Neuropsychologie, Maastricht University, Maastricht, The Netherlands
- Mondriaan Mental Health Centre, Maastricht/Heerlen, The Netherlands
| | - L de Haan
- Department of Psychiatry, Early Psychosis, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - B Nelson
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - A Mikocka-Walus
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, Australia
| | - L Olive
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
- Centre for Social and Early Emotional Development, School of Psychology, Deakin University, Geelong, Australia
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Australia
| | - S Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - B Rutten
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience (MHeNS), European Graduate School of Neuroscience (EURON), Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - G Sachs
- Medical University of Vienna, Vienna, Austria
| | - L Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M van der Gaag
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - P McGuire
- Department of Psychiatry, University of Oxford, Warneford Hospital OX3 7JX, UK
| | - J van Os
- Department of Psychiatry, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - J A Hartmann
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Wright AC, Palmer-Cooper E, Cella M, McGuire N, Montagnese M, Dlugunovych V, Liu CWJ, Wykes T, Cather C. Experiencing hallucinations in daily life: The role of metacognition. Schizophr Res 2024; 265:74-82. [PMID: 36623979 DOI: 10.1016/j.schres.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Hallucinations have been linked to failures in metacognitive reflection suggesting an association between hallucinations and overestimation of performance, although the cross-sectional findings are inconsistent. This inconsistency may relate to the fluctuating hallucinatory experiences that are not captured in cross-sectional studies. Ecological Momentary Assessment (EMA) captures in-the-moment experiences over time so can identify causal relationships between variables such as the associations between metacognition and hallucinatory experience in daily life and overcome problems in cross-sectional designs. METHODS Participants (N = 41) experiencing daily hallucinations completed baseline questionnaires and smartphone surveys 7 times per day for 14 days. They were prompted to identify a task they would complete in the next 4 h and to make metacognitive predictions around the likelihood of completing the task, the difficulty of the task, and how well they would complete it (standard of completion). RESULTS 76 % finished the 14-days of assessment with an average of 42.2 % survey completion. Less accurate metacognition was associated with more hallucinations, but less accurate likelihood and standard of completion was associated with fewer hallucinations. Using a cross-lagged analysis, metacognitive predictions around the likelihood of completion (p < .001) and standard of completion (p = .01) predicted hallucination intensity at the following timepoint, and metacognitive predictions regarding likelihood of completion (p = .02) predicted hallucination control at the following timepoint. DISCUSSION Interventions that aim to improve metacognitive ability in-the-moment may serve to reduce the intensity and increase the control of hallucinations.
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Affiliation(s)
- Abigail C Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Emma Palmer-Cooper
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, UK
| | - Matteo Cella
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Nicola McGuire
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Marcella Montagnese
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Chih-Wei Joshua Liu
- Physics of Living Systems Group, Department of Physics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Corinne Cather
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Steenhuis LA, Harms T, Nauta MH, Bartels-Velthuis AA, Albers CJ, Aleman A, Vos M, Pijnenborg GHM, van den Berg D, Palstra EC, Wigman JTW, Booij SH. The dynamics of social activation and suspiciousness in individuals at ultra-high risk for psychosis. Schizophr Res 2023; 262:67-75. [PMID: 37925753 DOI: 10.1016/j.schres.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/25/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Social functioning is often impaired during the ultra-high risk (UHR) phase for psychosis, but group-level studies regarding the role of social functioning in transition to psychosis are inconsistent. Exploring the inter-individual differences which underlie the association between social functioning and psychotic symptoms in this phase could yield new insights. OBJECTIVE To examine the idiographic and dynamic association between social activation and suspiciousness in individuals at UHR for psychosis using time-series analysis. METHODS Twenty individuals at UHR for psychosis completed a diary application every evening for 90 days. Two items on social activation (quantity: 'time spent alone' and quality: 'feeling supported') and two items on suspiciousness ('feeling suspicious' and 'feeling disliked') were used. Time series (T = 90) of each individual were analyzed using vector auto regression analysis (VAR), to estimate the lagged (over 1 day) effect of social activation on suspiciousness, and vice versa, as well as their contemporaneous associations. RESULTS Heterogeneous person-specific associations between social activation and suspiciousness were found in terms of strength, direction and temporal aspects. CONCLUSIONS The association between social activation and suspiciousness differs amongst individuals who are at UHR for psychosis. These findings underline the importance of tailoring psychosocial interventions to the individual. Future studies may examine whether using results of single-subject studies in clinical practice to personalize treatment goals leads to better treatment outcomes.
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Affiliation(s)
- Laura A Steenhuis
- University of Groningen, Faculty of Behavioural and Social Sciences, Department of Clinical and Developmental Neuropsychology, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands; GGZ Drenthe, Department of Psychotic Disorders, Dennenweg 9, 9404 LA Assen, the Netherlands.
| | - Tim Harms
- University of Groningen, Faculty of Behavioural and Social Sciences, Department of Clinical and Developmental Neuropsychology, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands
| | - Maaike H Nauta
- University of Groningen, Faculty of Behavioural and Social Sciences, Department of Clinical and Developmental Neuropsychology, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands
| | - Agna A Bartels-Velthuis
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
| | - Casper J Albers
- University of Groningen, Faculty of Behavioural and Social Sciences, Department of Psychometrics & Statistics, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands
| | - André Aleman
- University of Groningen, Faculty of Behavioural and Social Sciences, Department of Clinical and Developmental Neuropsychology, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Maarten Vos
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
| | - Gerdina H M Pijnenborg
- University of Groningen, Faculty of Behavioural and Social Sciences, Department of Clinical and Developmental Neuropsychology, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands; GGZ Drenthe, Department of Psychotic Disorders, Dennenweg 9, 9404 LA Assen, the Netherlands
| | - David van den Berg
- VU University and Amsterdam Public Health Research, Department of Clinical Psychology, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands; Parnassia Psychiatric Institute, Department of Psychosis Research, Zoutkeetsingel 40, 2512 HN The Hague, the Netherlands
| | - Eline C Palstra
- VU University and Amsterdam Public Health Research, Department of Clinical Psychology, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands; Parnassia Psychiatric Institute, Department of Psychosis Research, Zoutkeetsingel 40, 2512 HN The Hague, the Netherlands
| | - Johanna T W Wigman
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Neuroscience, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands
| | - Sanne H Booij
- University of Groningen, University Medical Center Groningen, Department of Neuroscience, Antonius Deusinglaan 1, 9713 AV, Groningen, the Netherlands
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Lüdtke T, Hedelt KS, Westermann S. Predictors of paranoia in the daily lives of people with non-affective psychosis and non-clinical controls: A systematic review of intensive longitudinal studies. J Behav Ther Exp Psychiatry 2023; 81:101885. [PMID: 37354896 DOI: 10.1016/j.jbtep.2023.101885] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 05/08/2023] [Accepted: 05/27/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND AND OBJECTIVES Worrying, self-esteem, sleep problems, anomalous internal experiences, reasoning biases, and interpersonal sensitivity are associated with paranoia. However, no review has examined whether these variables function as predictors of paranoia in everyday life. The present systematic review of intensive longitudinal studies (e.g., experience sampling) examined contemporaneous and time-lagged associations between paranoia and each candidate mechanism in individuals with non-affective psychosis and controls (pre-registration: https://osf.io/uwr9d). METHODS We searched electronic databases, PsyArXiv, and reference lists for studies published since 1994. RESULTS Of n = 5,918 results, n = 54 fulfilled inclusion criteria (n = 43 datasets). Most studies examined individuals with non-affective psychosis (n = 34). Strong evidence emerged for negative affect (subsumed under 'anomalous internal experiences') and sleep problems. For self-esteem, results suggest contemporaneous and lagged effects on paranoia but associations are likely driven by between-person variance. The low number of studies (n = 2 studies each) allowed no conclusions regarding worrying and reasoning biases. Findings on interpersonal sensitivity, which should be interpreted with caution because of the predictor's conceptual overlap with paranoia, indicate contemporaneous effects whereas time-lagged and within-person associations could not be judged due to insufficient data. LIMITATIONS The present review used a narrative data-synthetization and it did not cover outcomes such as hallucinations. CONCLUSIONS Despite convincing evidence for affect and sleep problems, it remains unclear whether affective states are precursors or also consequences of paranoia (vicious circle), and which of the actigraphy measures (sleep time, -efficiency, -fragmentation, etc.) best predicts paranoia.
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Affiliation(s)
- Thies Lüdtke
- Department of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany.
| | | | - Stefan Westermann
- Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany
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Haslbeck JMB, Ryan O. Recovering Within-Person Dynamics from Psychological Time Series. MULTIVARIATE BEHAVIORAL RESEARCH 2022; 57:735-766. [PMID: 34154483 DOI: 10.1080/00273171.2021.1896353] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Idiographic modeling is rapidly gaining popularity, promising to tap into the within-person dynamics underlying psychological phenomena. To gain theoretical understanding of these dynamics, we need to make inferences from time series models about the underlying system. Such inferences are subject to two challenges: first, time series models will arguably always be misspecified, meaning it is unclear how to make inferences to the underlying system; and second, the sampling frequency must be sufficient to capture the dynamics of interest. We discuss both problems with the following approach: we specify a toy model for emotion dynamics as the true system, generate time series data from it, and then try to recover that system with the most popular time series analysis tools. We show that making straightforward inferences from time series models about an underlying system is difficult. We also show that if the sampling frequency is insufficient, the dynamics of interest cannot be recovered. However, we also show that global characteristics of the system can be recovered reliably. We conclude by discussing the consequences of our findings for idiographic modeling and suggest a modeling methodology that goes beyond fitting time series models alone and puts formal theories at the center of theory development.
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Affiliation(s)
| | - Oisín Ryan
- Department of Methodology and Statistics, Utrecht University
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Wright AC, Browne J, Skiest H, Bhiku K, Baker JT, Cather C. The relationship between conventional clinical assessments and momentary assessments of symptoms and functioning in schizophrenia spectrum disorders: A systematic review. Schizophr Res 2021; 232:11-27. [PMID: 34004382 DOI: 10.1016/j.schres.2021.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 04/09/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Symptoms and functioning are critical dimensions in those with schizophrenia and are typically measured using validated conventional clinical assessments. Researchers and clinicians have begun to use real-time digital methods, such as ecological momentary assessment (EMA), to assess symptoms and functioning in the moment and outside of traditional hospital and laboratory settings, which may yield more naturalistic data. Although digital methods have advantages, it is unclear whether these momentary assessments capture core aspects of symptoms and functioning. OBJECTIVE This systematic literature review aimed to evaluate the association between conventional clinical and momentary-based assessments of functioning and symptoms in individuals with schizophrenia. METHODS Studies were included if they met the following criteria: (1) written or translated into English; (2) peer-reviewed; (3) included primary quantitative data; (4) 60% of the clinical sample included persons with schizophrenia spectrum disorders; (5) included a clinical assessment of functioning and/or symptoms; (6) included active momentary assessment and/or passive data; and (7) assessed the relationship between the momentary and conventional clinical assessments. RESULTS A total of 49 studies (87 analyses) were included. Conventional clinical assessments of functioning and positive, negative, and depressive symptoms were related to momentary assessments of these symptom domains. Passive data was beneficial for assessing negative symptoms, but research is warranted for other domains. CONCLUSIONS The reviewed studies highlight the utility of EMA methodologies to collect detailed data on symptoms and functioning. Such data is being used to develop more sophisticated models of schizophrenia to enhance our understanding of important mechanisms and develop targeted interventions.
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Affiliation(s)
- Abigail C Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA
| | - Hannah Skiest
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Kamila Bhiku
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Justin T Baker
- Harvard Medical School, Boston, MA, USA; Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
| | - Corinne Cather
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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9
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Geraets CNW, Snippe E, van Beilen M, Pot-Kolder RMCA, Wichers M, van der Gaag M, Veling W. Virtual reality based cognitive behavioral therapy for paranoia: Effects on mental states and the dynamics among them. Schizophr Res 2020; 222:227-234. [PMID: 32527676 DOI: 10.1016/j.schres.2020.05.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/31/2020] [Accepted: 05/18/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Negative affective processes may contribute to maintenance of paranoia in patients with psychosis, and vice versa. Successful treatment may break these pathological symptom networks. This study examined whether treatment with virtual reality based cognitive behavioral therapy (VR-CBT) for paranoia influences momentary affective states, and whether VR-CBT changes the adverse interplay between affective states and paranoia. METHODS Patients with a psychotic disorder (n = 91) were randomized to 16-session VR-CBT or treatment as usual (TAU). With the experience sampling method (structured diary technique) mental states were assessed for 6-10 days at baseline, posttreatment and 6-month follow-up. Multilevel analysis were performed to establish treatment effects and time-lagged associations between mental states, that were visualized with networks of mental states. RESULTS Average levels of paranoia (feeling suspicious [b = -032., p = .04], disliked [b = -49., p < .01] and hurt [b = -0.52, p < .01]) and negative affect (anxious [b = -0.37, p = .01], down [b = -0.33, p = .04] and insecure [b = -0.17, p = .03) improved more after VR-CBT than TAU, but positive affect did not. Baseline mental state networks had few significant connections, with most stable connections being autocorrelations of mental states. The interplay between affective states and paranoia did not change in response to treatment. A trend reduction in average intranode connections (autocorrelations) was found after VR-CBT (b = -0.07, p = .08), indicating that mental states reinforce themselves less after treatment. CONCLUSIONS VR-CBT reduced paranoid symptoms and lowered levels of negative affect in daily life, but did not affect the extent to which mental states influenced each other. Findings do suggest that as a result of treatment mental states regain flexibility.
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Affiliation(s)
- Chris N W Geraets
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, the Netherlands.
| | - Evelien Snippe
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), the Netherlands
| | - Marije van Beilen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, the Netherlands
| | - Roos M C A Pot-Kolder
- Parnassia Psychiatric Institute, The Hague, the Netherlands; VU University and Amsterdam Public Mental Health research institute, Department of Clinical Psychology, Amsterdam, the Netherlands
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), the Netherlands
| | - Mark van der Gaag
- Parnassia Psychiatric Institute, The Hague, the Netherlands; VU University and Amsterdam Public Mental Health research institute, Department of Clinical Psychology, Amsterdam, the Netherlands
| | - Wim Veling
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, the Netherlands; Parnassia Psychiatric Institute, The Hague, the Netherlands; Maastricht University, Department of Psychiatry and Neuropsychology, Maastricht, the Netherlands
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Pries L, Klingenberg B, Menne‐Lothmann C, Decoster J, van Winkel R, Collip D, Delespaul P, De Hert M, Derom C, Thiery E, Jacobs N, Wichers M, Cinar O, Lin BD, Luykx JJ, Rutten BPF, van Os J, Guloksuz S. Polygenic liability for schizophrenia and childhood adversity influences daily-life emotion dysregulation and psychosis proneness. Acta Psychiatr Scand 2020; 141:465-475. [PMID: 32027017 PMCID: PMC7318228 DOI: 10.1111/acps.13158] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/23/2020] [Accepted: 02/02/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To test whether polygenic risk score for schizophrenia (PRS-S) interacts with childhood adversity and daily-life stressors to influence momentary mental state domains (negative affect, positive affect, and subtle psychosis expression) and stress-sensitivity measures. METHODS The data were retrieved from a general population twin cohort including 593 adolescents and young adults. Childhood adversity was assessed using the Childhood Trauma Questionnaire. Daily-life stressors and momentary mental state domains were measured using ecological momentary assessment. PRS-S was trained on the latest Psychiatric Genetics Consortium schizophrenia meta-analysis. The analyses were conducted using multilevel mixed-effects tobit regression models. RESULTS Both childhood adversity and daily-life stressors were associated with increased negative affect, decreased positive affect, and increased subtle psychosis expression, while PRS-S was only associated with increased positive affect. No gene-environment correlation was detected. There is novel evidence for interaction effects between PRS-S and childhood adversity to influence momentary mental states [negative affect (b = 0.07, P = 0.013), positive affect (b = -0.05, P = 0.043), and subtle psychosis expression (b = 0.11, P = 0.007)] and stress-sensitivity measures. CONCLUSION Exposure to childhood adversities, particularly in individuals with high PRS-S, is pleiotropically associated with emotion dysregulation and psychosis proneness.
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Affiliation(s)
- L.‐K. Pries
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands
| | - B. Klingenberg
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands
| | - C. Menne‐Lothmann
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands
| | - J. Decoster
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands,Department of NeurosciencesUniversity Psychiatric Centre KU LeuvenKU LeuvenLeuvenBelgium,Brothers of CharityUniversity Psychiatric Centre Sint‐Kamillus BierbeekBierbeekBelgium
| | - R. van Winkel
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands,Department of NeurosciencesUniversity Psychiatric Centre KU LeuvenKU LeuvenLeuvenBelgium
| | - D. Collip
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands
| | - P. Delespaul
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands
| | - M. De Hert
- Department of NeurosciencesUniversity Psychiatric Centre KU LeuvenKU LeuvenLeuvenBelgium,Antwerp Health Law and Ethics Chair – AHLECUniversity AntwerpAntwerpBelgium
| | - C. Derom
- Centre of Human GeneticsUniversity Hospitals LeuvenKU LeuvenLeuvenBelgium,Department of Obstetrics and GynecologyGhent University HospitalsGhent UniversityGhentBelgium
| | - E. Thiery
- Department of NeurologyGhent University HospitalGhent UniversityGhentBelgium
| | - N. Jacobs
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands,Faculty of Psychology and Educational SciencesOpen University of the NetherlandsHeerlenThe Netherlands
| | - M. Wichers
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands,Department of PsychiatryInterdisciplinary Center Psychopathology and Emotion Regulation (ICPE)University of GroningenUniversity Medical Center GroningenThe Netherlands
| | - O. Cinar
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands
| | - B. D. Lin
- Department of Translational NeuroscienceUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - J. J. Luykx
- Department of Translational NeuroscienceUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands,Department of PsychiatryUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands,GGNet Mental HealthApeldoornThe Netherlands
| | - B. P. F. Rutten
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands
| | - J. van Os
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands,Department of PsychiatryUMC Utrecht Brain CenterUniversity Medical Center UtrechtUtrecht UniversityUtrechtThe Netherlands,Department of Psychosis StudiesInstitute of PsychiatryKing's Health PartnersKing's College LondonLondonUK
| | - S. Guloksuz
- Department of Psychiatry and NeuropsychologySchool for Mental Health and NeuroscienceMaastricht University Medical CentreMaastrichtThe Netherlands,Department of PsychiatryYale School of MedicineNew HavenCTUSA
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11
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Pignon B, Peyre H, Szöke A, Geoffroy PA, Rolland B, Jardri R, Thomas P, Vaiva G, Roelandt JL, Benradia I, Behal H, Schürhoff F, Amad A. A latent class analysis of psychotic symptoms in the general population. Aust N Z J Psychiatry 2018; 52:573-584. [PMID: 29232967 DOI: 10.1177/0004867417744255] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Individuals with psychotic symptoms may actually correspond to various subgroups, characterized by different patterns of psychotic symptoms as well as specific sociodemographic and clinical correlates. We aimed to identify groups of individuals from the general population with specific patterns of psychotic symptoms. METHODS In a 38,694-subject survey, a latent class analysis was performed to identify subgroups based on the distribution of seven psychotic symptoms taken from the Mini International Neuropsychiatric Interview. The different classes were subsequently compared according to sociodemographic and clinical correlates. RESULTS The best fit was obtained with a four-class solution, including the following: (1) a class with a low prevalence of all psychotic symptoms ('LOW', 85.9%); (2) a class with a high prevalence of all psychotic symptoms ('HAL + DEL', 1.7%); and classes with a high prevalence of (3) hallucinations ('HAL', 4.5%) or (4) delusions ('DEL', 7.9%). The HAL + DEL class displayed higher rates of history of trauma, social deprivation and migrant status, while the HAL and DEL classes displayed intermediate rates between HAL + DEL and LOW. HAL + DEL displayed the highest rates of psychotic and non-psychotic disorders and the use of mental health treatment, while HAL and DEL displayed intermediate rates of these disorders between HAL + DEL and LOW. In comparison to the HAL class, psychotic and substance use disorders were more frequent in the DEL class, while anxiety and mood disorders were less frequent. CONCLUSION These findings support the hypothesis of a continuum model relating the level of psychotic symptoms to the level of global psychopathology.
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Affiliation(s)
- Baptiste Pignon
- 1 AP-HP, DHU PePSY, Hôpitaux universitaires Henri-Mondor, Pôle de Psychiatrie and Inserm, U955, team 15 and Fondation FondaMental and UPEC, Université Paris-Est, Faculté de médecine, Créteil, France
| | - Hugo Peyre
- 2 Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Child and Adolescent Psychiatry Department and Cognitive Sciences and Psycholinguistic Laboratory, Ecole Normale Supérieure, Paris, France
| | - Andrei Szöke
- 1 AP-HP, DHU PePSY, Hôpitaux universitaires Henri-Mondor, Pôle de Psychiatrie and Inserm, U955, team 15 and Fondation FondaMental and UPEC, Université Paris-Est, Faculté de médecine, Créteil, France
| | - Pierre A Geoffroy
- 3 Inserm, U1144 and Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, and AP-HP, GH Saint-Louis-Lariboisière-F. Widal, Pôle de Psychiatrie et de Médecine Addictologique, Fondation FondaMental, Créteil, France
| | - Benjamin Rolland
- 4 Service Universitaire d'Addictologie, Pôle UP-MOPHA, CH Le Vinatier, Univ. Lyon and CRNL Inserm U1028/CNRS UMR5292-CH Le Vinatier, Bron, France
| | - Renaud Jardri
- 5 Univ. Lille, CNRS UMR 9193-PsyCHIC-SCALab, & CHU Lille, Pôle de Psychiatrie, Unité CURE, Lille, France
| | - Pierre Thomas
- 5 Univ. Lille, CNRS UMR 9193-PsyCHIC-SCALab, & CHU Lille, Pôle de Psychiatrie, Unité CURE, Lille, France.,6 Fédération régionale de recherche en santé mentale (F2RSM) Nord-Pas-de-Calais, Lille, France
| | - Guillaume Vaiva
- 5 Univ. Lille, CNRS UMR 9193-PsyCHIC-SCALab, & CHU Lille, Pôle de Psychiatrie, Unité CURE, Lille, France.,6 Fédération régionale de recherche en santé mentale (F2RSM) Nord-Pas-de-Calais, Lille, France
| | - Jean-Luc Roelandt
- 7 EPSM Lille Métropole and Centre Collaborateur de l'Organisation Mondiale de la Santé pour la recherche et la formation en santé mentale and Equipe Eceve Inserm UMR 1123, Lille, France
| | - Imane Benradia
- 7 EPSM Lille Métropole and Centre Collaborateur de l'Organisation Mondiale de la Santé pour la recherche et la formation en santé mentale and Equipe Eceve Inserm UMR 1123, Lille, France
| | - Hélène Behal
- 8 Univ. Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Department of biostatistics, Lille, France
| | - Franck Schürhoff
- 1 AP-HP, DHU PePSY, Hôpitaux universitaires Henri-Mondor, Pôle de Psychiatrie and Inserm, U955, team 15 and Fondation FondaMental and UPEC, Université Paris-Est, Faculté de médecine, Créteil, France
| | - Ali Amad
- 5 Univ. Lille, CNRS UMR 9193-PsyCHIC-SCALab, & CHU Lille, Pôle de Psychiatrie, Unité CURE, Lille, France.,6 Fédération régionale de recherche en santé mentale (F2RSM) Nord-Pas-de-Calais, Lille, France.,9 Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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12
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Lecomte T, Leclerc C, Wykes T. Symptom fluctuations, self-esteem, and cohesion during group cognitive behaviour therapy for early psychosis. Psychol Psychother 2018; 91:15-26. [PMID: 28707407 DOI: 10.1111/papt.12139] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/08/2017] [Indexed: 01/23/2023]
Abstract
UNLABELLED Group cohesion has been linked to positive changes in self-esteem and in symptoms during group psychotherapy in people with psychosis. These changes may be linked to changes in symptoms as fluctuations in self-esteem have been linked to symptom fluctuations. OBJECTIVE We aimed to determine the relationship between these three factors - group cohesion, self-esteem, and symptoms - during group cognitive behaviour therapy for psychosis (GCBTp). We hypothesized that group cohesion would precede changes in symptoms and self-esteem and that improvements in self-esteem would precede improvements in symptoms. DESIGN This is an uncontrolled longitudinal study recruiting from a convenience sample within two early psychosis clinics. METHODS Sixty-six individuals from first episode of psychosis treatment programmes participated in this study and received 24 sessions of a validated GCBTp protocol. Participants answered a brief questionnaire at the end of each session, measuring their group cohesion, self-esteem, and perception of their symptoms as worse, same, or better than usual. RESULTS Orthogonal polynomial contrasts for time effects were estimated with a mixed model for repeated measures with a random cluster effect and revealed a quartic trend regarding changes in symptoms over the 24 sessions. Self-esteem, symptoms, and group cohesion were strongly linked during a given session. Also, self-esteem changes predicted changes in symptoms up to two sessions later, and symptoms changes predicted self-esteem changes at the next session. Group cohesion preceded improvements in both self-esteem and symptoms; self-esteem also predicted improvements in group cohesion. CONCLUSION These results suggest that self-esteem and symptoms influence each other during therapy, with improvements in one leading to improvements in the other. Group cohesion also appears to be an essential prerequisite to positive changes in self-esteem and symptoms during GCBTp. PRACTITIONER POINTS This study emphasizes the interrelation between self-esteem improvements and symptom improvements, with improvements in one leading to improvements in the other, during group CBT for psychosis. Group cohesion, in this study, is a predictor of self-esteem and symptom improvements, suggesting that a special attention should be given to developing a strong alliance and group cohesion early on during CBT for psychosis.
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Affiliation(s)
- Tania Lecomte
- Department of Psychology, CRIUSMM, University of Montreal, Québec, Canada
| | - Claude Leclerc
- School of Nursing, University of Quebec at Trois-Rivieres, Québec, Canada
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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13
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van Nierop M, Lecei A, Myin-Germeys I, Collip D, Viechtbauer W, Jacobs N, Derom C, Thiery E, van Os J, van Winkel R. Stress reactivity links childhood trauma exposure to an admixture of depressive, anxiety, and psychosis symptoms. Psychiatry Res 2018; 260:451-457. [PMID: 29272730 DOI: 10.1016/j.psychres.2017.12.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 12/06/2017] [Accepted: 12/07/2017] [Indexed: 12/18/2022]
Abstract
Childhood trauma exposure has been associated with a clinically relevant mixed phenotype of psychopathology composed of depressive, anxiety, and psychosis symptoms, across healthy and clinical samples. Altered stress-reactivity after exposure to childhood trauma may be a plausible underlying mechanism explaining this association. In a general population sample of female twins (T0 = 564; T1 = 483), associations between childhood trauma exposure and symptom profile (no symptoms, isolated symptoms, or a mixed phenotype) on the one hand, and daily life stress reactivity on the other were investigated. Daily life stress reactivity was measured using the Experience Sampling Method (ESM), and was defined as negative affect reactivity to minor daily life stressors. Individuals exposed to childhood trauma who reported a mixed phenotype of psychopathology showed a significant increase in emotional reactivity to daily life stress (activity and social stress), compared with trauma-exposed individuals without a mixed phenotype. In the trauma-exposed mixed phenotype group, increased emotional reactivity to event-stress predicted more severe symptoms at ± 14 month follow-up. This study found evidence that may link heightened emotional reactivity to stress in individuals with a trauma history to the risk for later comorbid psychopathology.
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Affiliation(s)
- Martine van Nierop
- KU Leuven, Department of Neuroscience, Research group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium.
| | - Aleksandra Lecei
- KU Leuven, Department of Neuroscience, Research group Psychiatry, Center for Clinical Psychiatry, Belgium
| | - Inez Myin-Germeys
- KU Leuven, Department of Neuroscience, Research group Psychiatry, Center for Contextual Psychiatry, Leuven, Belgium
| | - Dina Collip
- Maastricht University Medical Center, Dept. of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, Maastricht, The Netherlands
| | - Wolfgang Viechtbauer
- Maastricht University Medical Center, Dept. of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, Maastricht, The Netherlands
| | - Nele Jacobs
- Maastricht University Medical Center, Dept. of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, Maastricht, The Netherlands; Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, The Netherlands
| | - Catherine Derom
- Centre of Human Genetics, University Hospital Leuven, Dept. of Human Genetics, Leuven, Belgium; Department of Obstetrics and Gynaecology, Ghent University, Ghent, Belgium
| | - Evert Thiery
- Dept. of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Jim van Os
- Maastricht University Medical Center, Dept. of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, Maastricht, The Netherlands; King's College London, King's Health Partners, Dept. of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
| | - Ruud van Winkel
- University Psychiatric Center KU Leuven, Leuvensesteenweg 517, 3070 Kortenberg, Belgium; KU Leuven, Department of Neuroscience, Research group Psychiatry, Center for Clinical Psychiatry, Belgium
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14
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Booij SH, Wichers M, de Jonge P, Sytema S, van Os J, Wunderink L, Wigman JTW. Study protocol for a prospective cohort study examining the predictive potential of dynamic symptom networks for the onset and progression of psychosis: the Mapping Individual Routes of Risk and Resilience (Mirorr) study. BMJ Open 2018; 8:e019059. [PMID: 29358438 PMCID: PMC5781162 DOI: 10.1136/bmjopen-2017-019059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/25/2017] [Accepted: 11/09/2017] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Our current ability to predict the course and outcome of early psychotic symptoms is limited, hampering timely treatment. To improve our understanding of the development of psychosis, a different approach to psychopathology may be productive. We propose to reconceptualise psychopathology from a network perspective, according to which symptoms act as a dynamic, interconnected system, impacting on each other over time and across diagnostic boundaries to form symptom networks. Adopting this network approach, the Mapping Individual Routes of Risk and Resilience study aims to determine whether characteristics of symptom networks can predict illness course and outcome of early psychotic symptoms. METHODS AND ANALYSIS The sample consists of n=100 participants aged 18-35 years, divided into four subgroups (n=4×25) with increasing levels of severity of psychopathology, representing successive stages of clinical progression. Individuals representing the initial stage have a relatively low expression of psychotic experiences (general population), whereas individuals representing the end stage are help seeking and display a psychometric expression of psychosis, putting them at ultra-high risk for transition to psychotic disorder. At baseline and 1-year follow-up, participants report their symptoms, affective states and experiences for three consecutive months in short, daily questionnaires on their smartphone, which will be used to map individual networks. Network parameters, including the strength and directionality of symptom connections and centrality indices, will be estimated and associated to individual differences in and within-individual progression through stages of clinical severity and functioning over the next 3 years. ETHICS AND DISSEMINATION The study has been approved by the local medical ethical committee (ABR no. NL52974.042.15). The results of the study will be published in (inter)national peer-reviewed journals, presented at research, clinical and general public conferences. The results will assist in improving and fine-tuning dynamic models of psychopathology, stimulating both clinical and scientific progress. TRIAL REGISTRATION NUMBER NTR6205 ; Pre-results.
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Affiliation(s)
- Sanne H Booij
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Research and Education, Friesland Mental Health Services, Groningen, The Netherlands
| | - Marieke Wichers
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter de Jonge
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Developmental Psychology, Research Program Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Sjoerd Sytema
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, King's Health Partners, London, UK
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lex Wunderink
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Research and Education, Friesland Mental Health Services, Groningen, The Netherlands
| | - Johanna T W Wigman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Research and Education, Friesland Mental Health Services, Groningen, The Netherlands
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15
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van Os J, Verhagen S, Marsman A, Peeters F, Bak M, Marcelis M, Drukker M, Reininghaus U, Jacobs N, Lataster T, Simons C, Lousberg R, Gülöksüz S, Leue C, Groot PC, Viechtbauer W, Delespaul P. The experience sampling method as an mHealth tool to support self-monitoring, self-insight, and personalized health care in clinical practice. Depress Anxiety 2017; 34:481-493. [PMID: 28544391 DOI: 10.1002/da.22647] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/27/2017] [Accepted: 03/31/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The experience sampling method (ESM) builds an intensive time series of experiences and contexts in the flow of daily life, typically consisting of around 70 reports, collected at 8-10 random time points per day over a period of up to 10 days. METHODS With the advent of widespread smartphone use, ESM can be used in routine clinical practice. Multiple examples of ESM data collections across different patient groups and settings are shown and discussed, varying from an ESM evaluation of a 6-week randomized trial of mindfulness, to a twin study on emotion dynamics in daily life. RESULTS Research shows that ESM-based self-monitoring and feedback can enhance resilience by strengthening the capacity to use natural rewards. Personalized trajectories of starting or stopping medication can be more easily initiated and predicted if sensitive feedback data are available in real time. In addition, personalized trajectories of symptoms, cognitive abilities, symptoms impacting on other symptoms, the capacity of the dynamic system of mental health to "bounce back" from disturbance, and patterns of environmental reactivity yield uniquely personal data to support shared decision making and prediction in clinical practice. Finally, ESM makes it possible to develop insight into previous implicit patterns of thought, experience, and behavior, particularly if rapid personalized feedback is available. CONCLUSIONS ESM enhances clinical practice and research. It is empowering, providing co-ownership of the process of diagnosis, treatment evaluation, and routine outcome measurement. Blended care, based on a mix of face-to-face and ESM-based outside-the-office treatment, may reduce costs and improve outcomes.
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Affiliation(s)
- Jim van Os
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, UK
| | - Simone Verhagen
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne Marsman
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frenk Peeters
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten Bak
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Machteld Marcelis
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, The Netherlands
| | - Marjan Drukker
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ulrich Reininghaus
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nele Jacobs
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, The Netherlands
| | - Tineke Lataster
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Claudia Simons
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,GGzE, Institute for Mental Health Care Eindhoven and De Kempen, Eindhoven, The Netherlands
| | -
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Richel Lousberg
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sinan Gülöksüz
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Carsten Leue
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter C Groot
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wolfgang Viechtbauer
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Philippe Delespaul
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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16
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van Os J, Reininghaus U, Meyer-Lindenberg A. The Search for Environmental Mechanisms Underlying the Expression of Psychosis: Introduction. Schizophr Bull 2017; 43:283-286. [PMID: 28039422 PMCID: PMC5782498 DOI: 10.1093/schbul/sbw178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In this themed issue, a number of articles are presented that investigate environmental mechanisms in psychotic disorder. Below, we describe some of the challenges associated with this research, in terms of phenotypic definition, the nature of environmental impact and associated design and measurement issues.
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Affiliation(s)
- Jim van Os
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Psychosis Studies Department, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | - Ulrich Reininghaus
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
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17
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Wichers M, Wigman JTW, Bringmann LF, de Jonge P. Mental disorders as networks: some cautionary reflections on a promising approach. Soc Psychiatry Psychiatr Epidemiol 2017; 52:143-145. [PMID: 28210750 DOI: 10.1007/s00127-016-1335-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 12/23/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Marieke Wichers
- University of Groningen, Department of Psychiatry (UCP), Interdisciplinary Center for Psychopathology and Emotion Regulation (ICPE), University Medical Centre Groningen (UMCG), Groningen, The Netherlands.
| | - Johanna T W Wigman
- University of Groningen, Department of Psychiatry (UCP), Interdisciplinary Center for Psychopathology and Emotion Regulation (ICPE), University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - Laura F Bringmann
- Department of Psychometrics and Statistics, Faculty of Behavioural and Social Sciences, Heymans Institute, University of Groningen, Groningen, The Netherlands
| | - Peter de Jonge
- Department of Developmental Psychology, Faculty of Behavioural and Social Sciences, Interdisciplinary Center for Psychopathology and Emotion Regulation (ICPE), Heymans Institute, University of Groningen, Groningen, The Netherlands
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Vasconcelos E Sa D, Wearden A, Hartley S, Emsley R, Barrowclough C. Expressed Emotion and behaviourally controlling interactions in the daily life of dyads experiencing psychosis. Psychiatry Res 2016; 245:406-413. [PMID: 27611070 DOI: 10.1016/j.psychres.2016.08.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 07/23/2016] [Accepted: 08/26/2016] [Indexed: 01/11/2023]
Abstract
While research using Experience Sampling Methodology (ESM) suggests that, in general, contact with relatives or friends may be protective for psychotic experiences, contact with high-Expressed Emotion (high-EE) relatives can have adverse consequences for patients. This study investigated whether contact with high-EE relatives, and relatives' behaviourally controlling interactions (BCI) are related to patients' symptoms and to both patients' and relatives' affect when measured using structured diary assessments in the course of everyday life. Twenty-one patients experiencing psychosis and their closest relatives provided synchronized self-reports of symptoms (patients only), affect, dyadic contact and BCI over a 6-days period. Relatives' EE was obtained from Camberwell Family Interviews. Multi-level modeling showed that patients' reports of relatives taking control of them and helping them were associated with increased patient negative affect and symptoms. Relatives' self-reports of nagging, taking control and keeping an eye on the patient were related to fluctuations in relatives' affect. No evidence was found for the moderating effect of EE status on the association between dyadic contact and affect or, in the case of patients, symptoms. When measured using an ecologically valid methodology, momentary behaviourally controlling interactions within dyads experiencing psychosis can impact on patients' affect and symptoms.
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Affiliation(s)
| | - Alison Wearden
- School of Psychological Sciences & Manchester Centre for Health Psychology, The University of Manchester, Manchester, UK
| | - Samantha Hartley
- School of Psychological Sciences, The University of Manchester, Manchester, UK
| | - Richard Emsley
- Centre for Biostatistics, The University of Manchester & Manchester Academic Health Science Centre, Manchester, UK
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Bak M, Drukker M, Hasmi L, van Os J. An n=1 Clinical Network Analysis of Symptoms and Treatment in Psychosis. PLoS One 2016; 11:e0162811. [PMID: 27643994 PMCID: PMC5028060 DOI: 10.1371/journal.pone.0162811] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 08/29/2016] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Dynamic relationships between the symptoms of psychosis can be shown in individual networks of psychopathology. In a single patient, data collected with the Experience Sampling Method (ESM-a method to construct intensive time series of experience and context) can be used to study lagged associations between symptoms in relation to illness severity and pharmacological treatment. METHOD The patient completed, over the course of 1 year, for 4 days per week, 10 daily assessments scheduled randomly between 10 minutes and 3 hours apart. Five a priori selected symptoms were analysed: 'hearing voices', 'down', 'relaxed', 'paranoia' and 'loss of control'. Regression analysis was performed including current level of one symptom as the dependent variable and all symptoms at the previous assessment (lag) as the independent variables. Resulting regression coefficients were printed in graphs representing a network of symptoms. Network graphs were generated for different levels of severity: stable, impending relapse and full relapse. RESULTS ESM data showed that symptoms varied intensely from moment to moment. Network representations showed meaningful relations between symptoms, e.g. 'down' and 'paranoia' fuelling each other, and 'paranoia' negatively impacting 'relaxed'. During relapse, symptom levels as well as the level of clustering between symptoms markedly increased, indicating qualitative changes in the network. While 'hearing voices' was the most prominent symptom subjectively, the data suggested that a strategic focus on 'paranoia', as the most central symptom, had the potential to bring about changes affecting the whole network. CONCLUSION Construction of intensive ESM time series in a single patient is feasible and informative, particularly if represented as a network, showing both quantitative and qualitative changes as a function of relapse.
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Affiliation(s)
- Maarten Bak
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- * E-mail:
| | - Marjan Drukker
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Laila Hasmi
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
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Abstract
The concept of psychosis has been shaped by traditions in the concepts of mental disorders during the last 170 years. The term "psychosis" still lacks a unified definition, but denotes a clinical construct composed of several symptoms. Delusions, hallucinations, and thought disorders are the core clinical features. The search for a common denominator of psychotic symptoms points toward combinations of neuropsychological mechanisms resulting in reality distortion. To advance the elucidation of the causes and the pathophysiology of the symptoms of psychosis, a deconstruction of the term into its component symptoms is therefore warranted. Current research is dealing with the delineation from "normality", the genetic underpinnings, and the causes and pathophysiology of the symptoms of psychosis.
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Affiliation(s)
- Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Jürgen Zielasek
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
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21
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Wigman JTW, van Os J, Borsboom D, Wardenaar KJ, Epskamp S, Klippel A, Viechtbauer W, Myin-Germeys I, Wichers M. Exploring the underlying structure of mental disorders: cross-diagnostic differences and similarities from a network perspective using both a top-down and a bottom-up approach. Psychol Med 2015; 45:2375-2387. [PMID: 25804221 DOI: 10.1017/s0033291715000331] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND It has been suggested that the structure of psychopathology is best described as a complex network of components that interact in dynamic ways. The goal of the present paper was to examine the concept of psychopathology from a network perspective, combining complementary top-down and bottom-up approaches using momentary assessment techniques. METHOD A pooled Experience Sampling Method (ESM) dataset of three groups (individuals with a diagnosis of depression, psychotic disorder or no diagnosis) was used (pooled N = 599). The top-down approach explored the network structure of mental states across different diagnostic categories. For this purpose, networks of five momentary mental states ('cheerful', 'content', 'down', 'insecure' and 'suspicious') were compared between the three groups. The complementary bottom-up approach used principal component analysis to explore whether empirically derived network structures yield meaningful higher order clusters. RESULTS Individuals with a clinical diagnosis had more strongly connected moment-to-moment network structures, especially the depressed group. This group also showed more interconnections specifically between positive and negative mental states than the psychotic group. In the bottom-up approach, all possible connections between mental states were clustered into seven main components that together captured the main characteristics of the network dynamics. CONCLUSIONS Our combination of (i) comparing network structure of mental states across three diagnostically different groups and (ii) searching for trans-diagnostic network components across all pooled individuals showed that these two approaches yield different, complementary perspectives in the field of psychopathology. The network paradigm therefore may be useful to map transdiagnostic processes.
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Affiliation(s)
- J T W Wigman
- Department of Psychiatry,University of Groningen, University Medical Center Groningen,Groningen,The Netherlands
| | - J van Os
- Department of Psychiatry and Psychology,School of Mental Health and Neuroscience, Maastricht University Medical Center,Maastricht,The Netherlands
| | - D Borsboom
- Department of Psychology,University of Amsterdam,Amsterdam,The Netherlands
| | - K J Wardenaar
- Department of Psychiatry,University of Groningen, University Medical Center Groningen,Groningen,The Netherlands
| | - S Epskamp
- Department of Psychology,University of Amsterdam,Amsterdam,The Netherlands
| | - A Klippel
- Department of Psychiatry and Psychology,School of Mental Health and Neuroscience, Maastricht University Medical Center,Maastricht,The Netherlands
| | - W Viechtbauer
- Department of Psychiatry and Psychology,School of Mental Health and Neuroscience, Maastricht University Medical Center,Maastricht,The Netherlands
| | - I Myin-Germeys
- Department of Psychiatry and Psychology,School of Mental Health and Neuroscience, Maastricht University Medical Center,Maastricht,The Netherlands
| | - M Wichers
- Department of Psychiatry,University of Groningen, University Medical Center Groningen,Groningen,The Netherlands
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Wichers M, Wigman JTW, Myin-Germeys I. Micro-Level Affect Dynamics in Psychopathology Viewed From Complex Dynamical System Theory. EMOTION REVIEW 2015. [DOI: 10.1177/1754073915590623] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This article discusses the role of moment-to-moment affect dynamics in mental disorder and aims to integrate recent literature on this topic in the context of complex dynamical system theory. First, we will review the relevance of temporal and contextual aspects of affect dynamics in relation to psychopathology. Related to this, we will discuss recent insights resulting from a network view on affect dynamics in psychopathology. Next, we explore how we can reconcile literature findings from a perspective of complex dynamical system theory. Finally, future directions with regard to personalized assessment of risk and diagnostic use are discussed.
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Affiliation(s)
- M. Wichers
- Department of Psychiatry & Psychology, Maastricht University, The Netherlands
- Department of Psychiatry, University Medical Centre of Groningen, The Netherlands
| | - J. T. W. Wigman
- Department of Psychiatry & Psychology, Maastricht University, The Netherlands
- Department of Psychiatry, University Medical Centre of Groningen, The Netherlands
| | - I. Myin-Germeys
- Department of Psychiatry & Psychology, Maastricht University, The Netherlands
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23
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VAN Os J. The transdiagnostic dimension of psychosis: implications for psychiatric nosology and research. SHANGHAI ARCHIVES OF PSYCHIATRY 2015; 27:82-6. [PMID: 26120256 PMCID: PMC4466847 DOI: 10.11919/j.issn.1002-0829.215041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 04/07/2015] [Indexed: 12/29/2022]
Abstract
If psychosis is a transdiagnostic dimension, the expression of which is governed by a dynamic set of contextual and emotional factors that are amenable to treatment, current approaches in psychiatric nosology and therapeutic research may need to be revised. The dominant approach to date is to clinically and conceptually situate psychotic symptoms in the construct of schizophrenia. However, schizophrenia, which has a lifetime prevalence of 1%, only represents the poor outcome fraction of a much broader spectrum of psychotic disorders which have a lifetime prevalence of 3.5%. Therefore, research findings in schizophrenia may reflect mechanisms of prognosis rather than fundamental associations with psychosis and other symptom domains per se. Similarly, the discovery that up to 30% of individuals with non-psychotic common mental disorders have subthreshold psychotic symptoms that situate them on the transdiagnostic dimension of psychosis - and which impact clinical severity and treatment response - indicates that the rigid separation between 'psychotic' and 'non-psychotic' hampers both clinical practice and research. Diagnostic manuals in psychiatry would benefit from a system of transdiagnostic dimensions, including a transdiagnostic dimension of psychosis. Introduction of transdiagnostic dimensions allows for a system combining a nomothetic (i.e., group-specific) categorical diagnosis with an idiographic (i.e., person-specific) combination of dimensional scores. The advantage of such a system is that it encourages consideration of how symptoms dynamically interact with each other in a network of psychopathology, and of how this network is impacted by the social world.
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Affiliation(s)
- Jim VAN Os
- Maastricht University Medical Centre, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht, The Netherlands King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
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Jeppesen P, Clemmensen L, Munkholm A, Rimvall MK, Rask CU, Jørgensen T, Larsen JT, Petersen L, van Os J, Skovgaard AM. Psychotic experiences co-occur with sleep problems, negative affect and mental disorders in preadolescence. J Child Psychol Psychiatry 2015; 56:558-65. [PMID: 25156482 DOI: 10.1111/jcpp.12319] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND Knowledge on the significance of childhood psychotic symptoms and experiences (PE) is still limited. This study aimed to investigate the prevalence and clinical significance of PE in preadolescent children from the general population by use of in-depth psychopathological interviews and comprehensive diagnostic assessments. METHODS We investigated 1,632 children from the general population-based Copenhagen Child Cohort 2000. PE were measured by semistructured interviews using the K-SADS-PL-items on psychotic and affective symptoms, each symptom scored as not present versus likely or definitely present. The Development and Well-Being Assessment (DAWBA) was used independently to diagnose DSM-IV-mental disorders. Puberty development and sleep disturbance were self-reported. The associations between PE (any lifetime hallucination and/or delusion) and various mental problems and disorders were examined by multivariable binomial regression analyses, adjusting for gender and onset of puberty. RESULTS The weighted life time prevalence of PE at age 11-12 years was 10.9% (CI 9.1-12.7). The majority of children with PE (n = 172) either had a diagnosable DSM-IV-mental disorder (31.4%) or self-reported mental health difficulties in absence of a diagnosis (31.4%). The risk of delusions increased with onset of puberty. The risk of PE increased with emotional and neurodevelopmental disorders, subthreshold depressive symptoms, sleep problems and lack of sleep, regardless of whether PE were expressed as hallucinations and/or delusions. The highest correlations were seen for emotional and multiple disorders. CONCLUSIONS Psychotic experiences are particularly prevalent in the context of affective dysregulation and sleep disturbance, increase with onset of puberty and represent a trans-diagnostic marker of psychopathology.
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Affiliation(s)
- Pia Jeppesen
- Child and Adolescent Mental Health Center, Mental Health Services, the Capital Region of Denmark, Glostrup, Denmark; Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
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25
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van Os J, Delespaul P, Barge D, Bakker RP. Testing an mHealth momentary assessment Routine Outcome Monitoring application: a focus on restoration of daily life positive mood states. PLoS One 2014; 9:e115254. [PMID: 25513813 PMCID: PMC4267819 DOI: 10.1371/journal.pone.0115254] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/18/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Routine Outcome Monitoring (ROM) is used as a means to enrich the process of treatment with feedback on patient outcomes, facilitating patient involvement and shared decision making. While traditional ROM measures focus on retrospective accounts of symptoms, novel mHealth technology makes it possible to collect real life, in-the-moment ambulatory data that allow for an ecologically valid assessment of personalized and contextualized emotional and behavioural adjustment in the flow daily life (mROM). METHOD In a sample of 34 patients with major depressive disorder, treated with antidepressants, the combined effect of treatment and natural course was examined over a period of 18 weeks with Ecological Momentary Assessment (EMA). EMA consisted of repeated, within-subject, mini-measurements of experience (eg positive affect, negative affect, medication side effects) and context (eg stressors, situations, activities) at 10 unselected semi-random moments per day, for a period of six days, repeated three times over the 18-week period (baseline, week 6 and week 18). RESULTS EMA measures of emotional and behavioural adjustment were sensitive to the effects of treatment and natural course over the 18-week period, particularly EMA measures focussing on positive mood states and the ability to use natural rewards (impact of positive events on positive mood states), with standardized effect sizes of 0.4-0.5. EMA measures of activities, social interaction, stress-sensitivity and negative mood states were also sensitive to change over time. CONCLUSION This study supports the use of mROM as a means to involve the patient in the process of needs assessment and treatment. EMA data are meaningful to the patient, as they reflect daily life circumstances. Assessment of treatment response with mROM data allows for an interpretation of the effect of treatment at the level of daily life emotional and social adjustment--as an index of health, obviating the need for an exclusive focus on traditional measures of 'sickness'.
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Affiliation(s)
- Jim van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands
- King’s College London, King’s Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
| | - Philippe Delespaul
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands
| | - Daniela Barge
- Leiden University Medical Centre, Leiden, The Netherlands
| | - Roberto P. Bakker
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, South Limburg Mental Health and Teaching Network, Maastricht, The Netherlands
- Psychiatric Centre GGZ Centraal, Amersfoort, The Netherlands
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26
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Abayomi O, Amato D, Bailey C, Bitanihirwe B, Bowen L, Burshtein S, Cullen A, Fusté M, Herrmann AP, Khodaie B, Kilian S, Lang QA, Manning EE, Massuda R, Nurjono M, Sadiq S, Sanchez-Gutierrez T, Sheinbaum T, Shivakumar V, Simon N, Spiteri-Staines A, Sirijit S, Toftdahl NG, Wadehra S, Wang Y, Wigton R, Wright S, Yagoda S, Zaytseva Y, O'Shea A, DeLisi LE. The 4th Schizophrenia International Research Society Conference, 5-9 April 2014, Florence, Italy: a summary of topics and trends. Schizophr Res 2014; 159:e1-22. [PMID: 25306204 PMCID: PMC4394607 DOI: 10.1016/j.schres.2014.08.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/07/2014] [Accepted: 08/26/2014] [Indexed: 11/26/2022]
Abstract
The 4th Schizophrenia International Research Society Conference was held in Florence, Italy, April 5-9, 2014 and this year had as its emphasis, "Fostering Collaboration in Schizophrenia Research". Student travel awardees served as rapporteurs for each oral session, summarized the important contributions of each session and then each report was integrated into a final summary of data discussed at the entire conference by topic. It is hoped that by combining data from different presentations, patterns of interest will emerge and thus lead to new progress for the future. In addition, the following report provides an overview of the conference for those who were present, but could not participate in all sessions, and those who did not have the opportunity to attend, but who would be interested in an update on current investigations ongoing in the field of schizophrenia research.
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Affiliation(s)
- Olukayode Abayomi
- Ladoke Akintola University of Technology Teaching Hospital, PMB 4007, Ogbomoso, Oyo, Nigeria
| | - Davide Amato
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University of Erlangen-Nuremberg, Ulmenweg 19, 91054 Erlangen, Germany
| | - Candace Bailey
- University of Texas Medical Branch, School of Medicine, 215 Mechanic Street, Apt. M206, Galveston77550, TX, United States
| | - Byron Bitanihirwe
- Laboratory of System and Cell Biology of Neurodegeneration, University of Zurich, Wagistrasse 12, 8952 Schlieren, Zurich, Switzerland
| | - Lynneice Bowen
- Morehouse School of Medicine, 720 Westview Dr. SW, Atlanta, GA 30310, United States
| | | | - Alexis Cullen
- Health Services and Population Research Department, David Goldberg Centre, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - Montserrat Fusté
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, 16 De Crespigny Park, SE5 8AF London, UK
| | - Ana P Herrmann
- Pharmacology Department, Basic Health Sciences Institute, Universidade Federal do Rio Grande do Sul, Rua Sarmento Leite, 500, 90050-170 Porto Alegre, RS, Brazil
| | | | - Sanja Kilian
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Qortni A Lang
- Howard University College of Medicine, 520 W Street, Washington, DC 20059, United States
| | - Elizabeth E Manning
- The Florey Institute of Neuroscience and Mental Health, Kenneth Myer Building, 30 Royal Parade, Parkville 3052, VIC, Australia
| | - Raffael Massuda
- Laboratory of Molecular Psychiatry, INCT for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2350 Santa Cecília, Porto Alegre, RS 90035-903, Brazil
| | - Milawaty Nurjono
- Saw Swee Hock School of Public Health, National University of Singapore, MD3, 16 Medical Drive, Singapore 117597, Singapore
| | - Sarosh Sadiq
- Government College University, 170-S, 19/B, College Road, New Samanabad, Lahore, Pakistan
| | - Teresa Sanchez-Gutierrez
- Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, C/Ibiza, 43 28009, Madrid, Spain
| | - Tamara Sheinbaum
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Edifici B, 08193 Bellaterra, Barcelona, Spain
| | | | - Nicholas Simon
- Department of Neuroscience, A210 Langley Hall, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Anneliese Spiteri-Staines
- Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville 3052, Victoria, Australia
| | - Suttajit Sirijit
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Nanna Gilliam Toftdahl
- Mental Health Centre Copenhagen, Bispebjerg Bakke 23, Entrance 13A, 3rd floor, DK-2400, Copenhagen NV, Denmark
| | - Sunali Wadehra
- Wayne State University School of Medicine, 469 West Hancock, Detroit 48201, MI, United States
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing 100101, China
| | - Rebekah Wigton
- Cognition and Schizophrenia Imaging Laboratory, Institute of Psychiatry, King's College, 16 De Crespigny Park Rd, Denmark Hill, London SE5 8AF, UK
| | - Susan Wright
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Neuroimaging Research Program, P.O. Box 21247, Baltimore, MD 21228, United States
| | - Sergey Yagoda
- Department of Psychiatry, Psychotherapy and Medical Psychology of Stavropol State Medical University, 28b Aivazovsky str, Stavropol 355007, Russia
| | - Yuliya Zaytseva
- Moscow Research Institute of Psychiatry, Russian Federation/Prague Psychiatric Centre affiliated with 3rd Faculty of Medicine, Charles University in Prague, Czech Republic
| | - Anne O'Shea
- Harvard Medical School, Brockton, MA 02301, United States. anne_o'
| | - Lynn E DeLisi
- Department of Psychiatry, Harvard Medical School, 940 Belmont Street, Brockton, MA 02301, United States; VA Boston Healthcare System, 940 Belmont Street, Brockton, MA 02301, United States.
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27
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Affiliation(s)
- Marion Leboyer
- Psychiatry Department, University Paris Est Créteil, INSERM U955, FondaMental Foundation, Creteil, France
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28
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Ronald A, Sieradzka D, Cardno AG, Haworth CMA, McGuire P, Freeman D. Characterization of psychotic experiences in adolescence using the specific psychotic experiences questionnaire: findings from a study of 5000 16-year-old twins. Schizophr Bull 2014; 40:868-77. [PMID: 24062593 PMCID: PMC4059437 DOI: 10.1093/schbul/sbt106] [Citation(s) in RCA: 129] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We aimed to characterize multiple psychotic experiences, each assessed on a spectrum of severity (ie, quantitatively), in a general population sample of adolescents. Over five thousand 16-year-old twins and their parents completed the newly devised Specific Psychotic Experiences Questionnaire (SPEQ); a subsample repeated it approximately 9 months later. SPEQ was investigated in terms of factor structure, intersubscale correlations, frequency of endorsement and reported distress, reliability and validity, associations with traits of anxiety, depression and personality, and sex differences. Principal component analysis revealed a 6-component solution: paranoia, hallucinations, cognitive disorganization, grandiosity, anhedonia, and parent-rated negative symptoms. These components formed the basis of 6 subscales. Correlations between different experiences were low to moderate. All SPEQ subscales, except Grandiosity, correlated significantly with traits of anxiety, depression, and neuroticism. Scales showed good internal consistency, test-retest reliability, and convergent validity. Girls endorsed more paranoia, hallucinations, and cognitive disorganization; boys reported more grandiosity and anhedonia and had more parent-rated negative symptoms. As in adults at high risk for psychosis and with psychotic disorders, psychotic experiences in adolescents are characterized by multiple components. The study of psychotic experiences as distinct dimensional quantitative traits is likely to prove an important strategy for future research, and the SPEQ is a self- and parent-report questionnaire battery that embodies this approach.
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Affiliation(s)
- Angelica Ronald
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK;
| | - Dominika Sieradzka
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
| | - Alastair G. Cardno
- Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, Leeds, UK
| | - Claire M. A. Haworth
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK
| | - Philip McGuire
- Institute of Psychiatry, King’s College London, London, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK
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29
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Marwaha S, Broome MR, Bebbington PE, Kuipers E, Freeman D. Mood instability and psychosis: analyses of British national survey data. Schizophr Bull 2014; 40:269-77. [PMID: 24162517 PMCID: PMC3932088 DOI: 10.1093/schbul/sbt149] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND We used British national survey data to test specific hypotheses that mood instability (1) is associated with psychosis and individual psychotic phenomena, (2) predicts the later emergence of auditory hallucinations and paranoid ideation, and (3) mediates the link between child sexual abuse and psychosis. METHODS We analyzed data from the 2000 and 2007 UK national surveys of psychiatric morbidity (N = 8580 and 7403, respectively). The 2000 survey included an 18-month follow-up of a subsample (N = 2406). Mood instability was assessed from the Structured Clinical Interview for DSM-IV Axis II (SCID-II) questionnaire. Our dependent variables comprised auditory hallucinations, paranoid ideation, the presence of psychosis overall, and a 15-item paranoia scale. RESULTS Mood instability was strongly associated in cross-sectional analyses with psychosis (2000: OR: 7.5; 95% CI: I 4.1-13.8; 2007: OR: 21.4; CI: 9.7-41.2), paranoid ideation (2000: OR: 4.7; CI: 4.1-5.4; 2007: OR: 5.7; CI: 4.9-6.7), auditory hallucinations (2000: OR: 3.4; CI: 2.6-4.4; 2007: OR 3.5; CI: 2.7-4.7), and paranoia total score (2000: Coefficient: 3.6; CI: 3.3-3.9), remaining so after adjustment for current mood state. Baseline mood instability significantly predicted 18-month inceptions of paranoid ideation (OR: 2.3; CI: 1.6-3.3) and of auditory hallucinations (OR: 2.6; CI: 1.5-4.4). Finally, it mediated a third of the total association of child sexual abuse with psychosis and persecutory ideation and a quarter of that with auditory hallucinations. CONCLUSIONS Mood instability is a prominent feature of psychotic experience and may have a role in its genesis. Targeting mood instability could lead to innovative treatments for psychosis.
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Affiliation(s)
- Steven Marwaha
- *To whom correspondence should be addressed; Mental Health Sciences Unit, University College London, 67-73 Riding House St. London W1W 7EJ, UK; tel: +44-20-7679-9465, fax: +44-20-7679-9426, e-mail:
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van Os J, Lataster T, Delespaul P, Wichers M, Myin-Germeys I. Evidence that a psychopathology interactome has diagnostic value, predicting clinical needs: an experience sampling study. PLoS One 2014; 9:e86652. [PMID: 24466189 PMCID: PMC3900579 DOI: 10.1371/journal.pone.0086652] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 12/15/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND For the purpose of diagnosis, psychopathology can be represented as categories of mental disorder, symptom dimensions or symptom networks. Also, psychopathology can be assessed at different levels of temporal resolution (monthly episodes, daily fluctuating symptoms, momentary fluctuating mental states). We tested the diagnostic value, in terms of prediction of treatment needs, of the combination of symptom networks and momentary assessment level. METHOD Fifty-seven patients with a psychotic disorder participated in an ESM study, capturing psychotic experiences, emotions and circumstances at 10 semi-random moments in the flow of daily life over a period of 6 days. Symptoms were assessed by interview with the Positive and Negative Syndrome Scale (PANSS); treatment needs were assessed using the Camberwell Assessment of Need (CAN). RESULTS Psychotic symptoms assessed with the PANSS (Clinical Psychotic Symptoms) were strongly associated with psychotic experiences assessed with ESM (Momentary Psychotic Experiences). However, the degree to which Momentary Psychotic Experiences manifested as Clinical Psychotic Symptoms was determined by level of momentary negative affect (higher levels increasing probability of Momentary Psychotic Experiences manifesting as Clinical Psychotic Symptoms), momentary positive affect (higher levels decreasing probability of Clinical Psychotic Symptoms), greater persistence of Momentary Psychotic Experiences (persistence predicting increased probability of Clinical Psychotic Symptoms) and momentary environmental stress associated with events and activities (higher levels increasing probability of Clinical Psychotic Symptoms). Similarly, the degree to which momentary visual or auditory hallucinations manifested as Clinical Psychotic Symptoms was strongly contingent on the level of accompanying momentary paranoid delusional ideation. Momentary Psychotic Experiences were associated with CAN unmet treatment needs, over and above PANSS measures of psychopathology, similarly moderated by momentary interactions with emotions and context. CONCLUSION The results suggest that psychopathology, represented as an interactome at the momentary level of temporal resolution, is informative in diagnosing clinical needs, over and above traditional symptom measures.
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Affiliation(s)
- Jim van Os
- Dept of Psychiatry and Psychology, Centre of Contextual Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
- King’s College London, King’s Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
- * E-mail:
| | - Tineke Lataster
- Dept of Psychiatry and Psychology, Centre of Contextual Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Philippe Delespaul
- Dept of Psychiatry and Psychology, Centre of Contextual Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Marieke Wichers
- Dept of Psychiatry and Psychology, Centre of Contextual Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Inez Myin-Germeys
- Dept of Psychiatry and Psychology, Centre of Contextual Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
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VAN Os J, Delespaul P, Wigman J, Myin-Germeys I, Wichers M. Psychiatry beyond labels: introducing contextual precision diagnosis across stages of psychopathology. Psychol Med 2013; 43:1563-1567. [PMID: 23769385 DOI: 10.1017/s0033291713000937] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Jim VAN Os
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
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van Os J, Delespaul P, Wigman J, Myin-Germeys I, Wichers M. Beyond DSM and ICD: introducing "precision diagnosis" for psychiatry using momentary assessment technology. World Psychiatry 2013; 12:113-7. [PMID: 23737412 PMCID: PMC3683255 DOI: 10.1002/wps.20046] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Jim van Os
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre6200, MD Maastricht, the Netherlands,Department of Psychosis Studies, Institute of Psychiatry, King's College London, King's Health PartnersDe Crespigny Park, London, SE5 8AF, UK
| | - Philippe Delespaul
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre6200, MD Maastricht, the Netherlands
| | - Johanna Wigman
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre6200, MD Maastricht, the Netherlands
| | - Inez Myin-Germeys
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre6200, MD Maastricht, the Netherlands
| | - Marieke Wichers
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre6200, MD Maastricht, the Netherlands
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