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Salaminios G, Barrantes-Vidal N, Luyten P, Debbané M. Editorial: Mentalization in the psychosis continuum: current knowledge and new directions for research and clinical practice. Front Psychiatry 2024; 15:1447937. [PMID: 38988739 PMCID: PMC11233753 DOI: 10.3389/fpsyt.2024.1447937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 07/12/2024] Open
Affiliation(s)
- George Salaminios
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Research Department, British Association for Counselling and Psychotherapy, Lutterworth, United Kingdom
| | - Neus Barrantes-Vidal
- Department of Clinical and Health Psychology, Autonomous University of Barcelona, Barcelona, Spain
- CIBER de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Martin Debbané
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
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2
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Sanz P, Tur N, Lana F. Mentalization-based approach for schizophrenia spectrum disorders: a psychotherapeutic proposal for evolved schizophrenic trajectories and serious mental disorders. Front Psychiatry 2024; 15:1240393. [PMID: 38779549 PMCID: PMC11109361 DOI: 10.3389/fpsyt.2024.1240393] [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: 06/14/2023] [Accepted: 04/16/2024] [Indexed: 05/25/2024] Open
Abstract
There is a growing interest in psychotherapeutic approaches to pre-psychotic high-risk states or first-episode psychosis, where mentalization-based treatment has shown its utility. This article presents a mentalization-based approach for the treatment of those individuals diagnosed with an evolved schizophrenia spectrum disorder, whose characteristics make them especially inaccessible to reflective psychotherapeutic treatment. A synthesis of the conceptual frameworks that justify the needs for technical modification of the mentalization-based treatment foundational techniques is carried out, followed by the proposal of adaptations, with a focus in self-agency and patient-therapist dyad. Therapeutic interventions are outlined, including illustrative examples. The mentalizing approach presented here holds promise for future research and treatment opportunities for patients with evolved schizophrenia and other serious mental disorders.
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Affiliation(s)
- Pedro Sanz
- Programa de Trastorno Mental Grave, Area de Gestión Clínica de Psiquiatria y Salud Mental (AGCPSM), Hospital 12 de Octubre, Madrid, Spain
| | - Nuria Tur
- Servicio de Psiquiatria, Unidad del Niño y Adolescente, Hospital Clínico San Carlos, Madrid, Spain
| | - Fernando Lana
- Instituto de Neuropsiquiatría y Adiciones (INAD), Centro Emili Mira y Hospital del Mar, Parc de Salut Mar, Barcelona, Centro de Investigación en Red de Salud Mental (CIBERSAM), Departamento de Psiquiatría, Universidad Autónoma de Barcelona, EspañaIMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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Luyten P, Campbell C, Moser M, Fonagy P. The role of mentalizing in psychological interventions in adults: Systematic review and recommendations for future research. Clin Psychol Rev 2024; 108:102380. [PMID: 38262188 DOI: 10.1016/j.cpr.2024.102380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 12/20/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
Mentalizing is the human capacity to understand actions of others and one's own behavior in terms of intentional mental states, such as feelings, wishes, goals and desires. Mentalizing is a transtheoretical and transdiagnostic concept that has been applied to understanding vulnerability to psychopathology and has attracted considerable research attention over the past decades. This paper reports on a pre-registered systematic review of evidence concerning the role of mentalizing as a moderator and mediator in psychological interventions in adults. Studies in adults were reviewed that address the following questions: (a) does pre-treatment mentalizing predict treatment outcome; (b) do changes in mentalizing across treatment predict outcome; (c) does adherence to the principles or protocol of mentalization-based treatment predict outcome; and (d) does strengthening in-session mentalizing impact the therapeutic process via improved alliance, alleviated symptoms, or improved interpersonal functioning? Results suggest that mentalizing might be a mediator of change in psychotherapy and may moderate treatment outcome. However, the relatively small number of studies (n = 33 papers based on 29 studies, totaling 3124 participants) that could be included in this review, and the heterogeneity of studies in terms of design, measures used, disorders included, and treatment modalities, precluded a formal meta-analysis and limited the ability to draw strong conclusions. Therefore, theoretical and methodological recommendations for future research to improve the quality of existing research in this area are formulated.
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Affiliation(s)
- Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, Pobox 3722, Leuven 3000, Belgium; Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
| | - Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Max Moser
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
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Qiao Z, Lafit G, Lecei A, Achterhof R, Kirtley OJ, Hiekkaranta AP, Hagemann N, Hermans KSFM, Boets B, Reininghaus U, Myin-Germeys I, van Winkel R. Childhood Adversity and Emerging Psychotic Experiences: A Network Perspective. Schizophr Bull 2024; 50:47-58. [PMID: 37318106 PMCID: PMC10754171 DOI: 10.1093/schbul/sbad079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND HYPOTHESIS Childhood adversity is associated with a myriad of psychiatric symptoms, including psychotic experiences (PEs), and with multiple psychological processes that may all mediate these associations. STUDY DESIGN Using a network approach, the present study examined the complex interactions between childhood adversity, PEs, other psychiatric symptoms, and multiple psychological mediators (ie, activity-related and social stress, negative affect, loneliness, threat anticipation, maladaptive cognitive emotion regulation, attachment insecurity) in a general population, adolescent sample (n = 865, age 12-20, 67% female). STUDY RESULTS Centrality analyses revealed a pivotal role of depression, anxiety, negative affect, and loneliness within the network and a bridging role of threat anticipation between childhood adversity and maladaptive cognitive emotion regulation. By constructing shortest path networks, we found multiple existing paths between different categories of childhood adversity and PEs, with symptoms of general psychopathology (ie, anxiety, hostility, and somatization) as the main connective component. Sensitivity analyses confirmed the robustness and stability of the networks. Longitudinal analysis in a subsample with Wave 2 data (n = 161) further found that variables with higher centrality (ie, depression, negative affect, and loneliness) better predicted follow-up PEs. CONCLUSIONS Pathways linking childhood adversity to PEs are complex, with multifaceted psychological and symptom-symptom interactions. They underscore the transdiagnostic, heterotypic nature of mental ill-health in young people experiencing PEs, in agreement with current clinical recommendations.
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Affiliation(s)
- Zhiling Qiao
- Department of Neurosciences, Research Group Psychiatry, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium
| | - Ginette Lafit
- Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
- Department of Psychology, Group on Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | - Aleksandra Lecei
- Department of Neurosciences, Research Group Psychiatry, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium
| | - Robin Achterhof
- Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Olivia J Kirtley
- Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Anu P Hiekkaranta
- Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Noëmi Hagemann
- Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Karlijn S F M Hermans
- Strategy and Academic Affairs, Administration and Central Services, Leiden University, Leiden, The Netherlands
| | - Bart Boets
- Department of Neurosciences, Research Group Psychiatry, Center for Developmental Psychiatry, KU Leuven, Leuven, Belgium
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Baden-Württemberg, Germany
- ESRC Centre for Society and Mental Health and Social Epidemiology Research Group, King’s College London, London, UK
| | - Inez Myin-Germeys
- Department of Neurosciences, Research Group Psychiatry, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
| | - Ruud van Winkel
- Department of Neurosciences, Research Group Psychiatry, Center for Clinical Psychiatry, KU Leuven, Leuven, Belgium
- University Psychiatric Center (UPC), KU Leuven, Leuven, Belgium
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5
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Strachan LP, Paulik G, Preece DA, McEvoy PM. Pathways from trauma to unusual perceptual experiences: Modelling the roles of insecure attachment, negative affect, emotion regulation and dissociation. Psychol Psychother 2023; 96:934-951. [PMID: 37493351 DOI: 10.1111/papt.12486] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND A range of traumas have been linked to voices (auditory verbal hallucinations) and unusual perceptual experiences (UPEs) in other perceptual-sensory domains. Models of PTSD and positive symptoms of psychosis are insufficient in explaining the relationship between trauma and voices. The trauma-related voices (TRV) model was developed to generate novel research in this area. AIMS This study aimed to investigate pathways from trauma to the frequency of UPEs based on a subset of hypothesised relationships in the TRV model. MATERIALS The PTSD Diagnostic Scale for DSM-5, State Adult Attachment Measure, Depression Anxiety and Stress Scales-21, Perth Emotion and Regulation Competency Inventory, Dissociative Experiences Measure Oxford, and Multi-modality Unusual Perceptual Experiences Questionnaire. METHODS We used path analysis in a non-clinical sample (N = 528) to model indirect effects from diverse trauma experiences to the frequency of multi-sensory UPEs via a subset of mediators within the TRV model: insecure attachment, emotion regulation deficits, negative affect and dissociation. RESULTS Our model was an excellent fit to the data and accounted for 37.1% of variance in UPE frequency, and all direct (βs = .14-.61) and indirect pathways (βs = .01-.08) were significant (ps < .001). DISCUSSION Our findings suggest that insecure attachment may link diverse trauma experiences to emotion regulation deficits and negative affect, which are linked to UPE frequency via dissociation. CONCLUSION Our findings provide preliminary evidence for a subset of relationships within the TRV model. Future studies are needed to gather stronger evidence of temporality and causation between these factors, and to test broader pathways within the TRV model.
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Affiliation(s)
- Laura P Strachan
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Georgie Paulik
- School of Psychology, Murdoch University, Perth, Western Australia, Australia
- Perth Voices Clinic, Perth, Western Australia, Australia
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - David A Preece
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Peter M McEvoy
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
- Centre for Clinical Interventions, Perth, Western Australia, Australia
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Costa-Cordella S, Soto-Icaza P, Borgeaud K, Grasso-Cladera A, Malberg NT. Towards a comprehensive approach to mentalization-based treatment for children with autism: integrating attachment, neurosciences, and mentalizing. Front Psychiatry 2023; 14:1259432. [PMID: 38098626 PMCID: PMC10719951 DOI: 10.3389/fpsyt.2023.1259432] [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: 07/17/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
Autism spectrum disorder (ASD) is diagnosed based on socio-communicative difficulties, which are believed to result from deficits in mentalizing, mainly evidenced by alterations in recognizing and responding to the mental states of others. In recent years, efforts have been made to develop mentalization-based treatment (MBT) models for this population. These models focus on enhancing individuals' ability to understand and reflect on their own mental states, as well as those of others. However, MBT approaches for people with ASD are limited by their existing theoretical background, which lacks a strong foundation grounded in neuroscience-based evidence properly integrated with attachment, and mentalizing. These are crucial aspects for understanding psychological processes in autism, and as such, they play a pivotal role in shaping the development of tailored and effective therapeutic strategies for this specific population. In this paper we review evidence related to the neurobiological, interpersonal, and psychological dimensions of autism and their implications for mentalizing processes. We also review previous mentalization-based frameworks on the psychosis continuum to provide a comprehensive understanding of attachment, neurobiology, and mentalization domains in therapeutic approaches for autism. After presenting a synthesis of the literature, we offer a set of clinical strategies for the work with children with autism. Finally, we provide recommendations to advance the field towards more robust models that can serve as a basis for evidence-based therapeutic strategies.
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Affiliation(s)
- Stefanella Costa-Cordella
- Centro de Estudios en Psicología Clínica y Psicoterapia, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
- Centro de Estudios en Neurociencia y Neuropsicología Humana, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
- Millennium Institute for Depression and Personality Research (MIDAP), Santiago, Chile
| | - Patricia Soto-Icaza
- Laboratorio de Neurociencia Social y Neuromodulación (neuroCICS), Centro de Investigación en Complejidad Social (CICS), Facultad de Gobierno, Universidad del Desarrollo, Santiago, Chile
| | | | - Aitana Grasso-Cladera
- Centro de Estudios en Neurociencia y Neuropsicología Humana, Facultad de Psicología, Universidad Diego Portales, Santiago, Chile
- Institute of Cognitive Science, Universität Osnabrück, Osnabrück, Germany
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Benfante A, Cisarò F, Ribaldone DG, Castelli L, Sandroni N, Romeo A. Inflammatory Bowel Disease and Irritable Bowel Syndrome: What Differences in Mentalization Abilities? A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7125. [PMID: 38063555 PMCID: PMC10706729 DOI: 10.3390/ijerph20237125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/18/2023]
Abstract
Mentalization is a psychological process that enables individuals to understand the self and others in terms of intentional mental states. The aim of this scoping review was to provide an overview of the findings on mentalization in patients with inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). A literature search, in line with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols extension for Scoping Review guidelines, was conducted in the following bibliographic databases: PubMed, PsycINFO, and Scopus. Databases were queried using the following strings (with Boolean operators): ("mentaliz*" OR "metacogniti*" OR "theory of mind" OR "ToM" OR "reflective function*") AND ("irritable bowel syndrome" OR "IBS" OR "inflammatory bowel disease" OR "IBD"). In line with the eligibility criteria, seven articles were included. Results showed that no significant differences in metacognitive ability were found between patients in the IBD and IBS groups. This review revealed the mentalizing difficulties for patients with IBD and IBS. These results should be interpreted with caution since they are based on a few studies that used different instruments to assess mentalizing processes. Future studies are needed to clarify the role of mentalization in patients with these gastrointestinal conditions.
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Affiliation(s)
- Agata Benfante
- Department of Psychology, University of Turin, 10124 Turin, Italy; (L.C.); (N.S.); (A.R.)
| | - Fabio Cisarò
- Division of Digestive Endoscopy, Città della Salute e della Scienza University-Hospital, 10126 Turin, Italy;
| | - Davide Giuseppe Ribaldone
- Division of Gastroenterology, Città della Salute e della Scienza University-Hospital, 10126 Turin, Italy;
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Lorys Castelli
- Department of Psychology, University of Turin, 10124 Turin, Italy; (L.C.); (N.S.); (A.R.)
| | - Nikolas Sandroni
- Department of Psychology, University of Turin, 10124 Turin, Italy; (L.C.); (N.S.); (A.R.)
| | - Annunziata Romeo
- Department of Psychology, University of Turin, 10124 Turin, Italy; (L.C.); (N.S.); (A.R.)
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Nonweiler J, Torrecilla P, Kwapil TR, Ballespí S, Barrantes-Vidal N. I don't understand how I feel: mediating role of impaired self-mentalizing in the relationship between childhood adversity and psychosis spectrum experiences. Front Psychiatry 2023; 14:1268247. [PMID: 38098634 PMCID: PMC10719857 DOI: 10.3389/fpsyt.2023.1268247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Childhood adversity is associated with the severity of multiple dimensions of psychosis, but the mechanisms underpinning the close link between the two constructs is unclear. Mentalization may underlie this relationship, as impaired mentalizing is found in various stages of the psychosis continuum. Nonetheless, the differential roles of self- and other-mentalizing in psychosis are not well understood. Methods Parallel multiple mediation was conducted for the relationship between a diverse range of childhood adversity types, including intentional and nonintentional harm, and schizotypy (positive, negative, disorganized), psychotic-like experiences (PLE) and paranoia via self-mentalizing (attention to emotions and emotional clarity) and other-mentalizing in n = 1,156 nonclinically ascertained young adults. Results Significant parallel multiple mediation models were found for all psychotic outcomes except negative schizotypy. The associations between intentionally harmful childhood adversity and psychotic outcomes were significantly mediated by increased attention to emotions for most models and decreased emotional clarity for some models. No significant mediation was found for parental loss. Paternal abuse was only mediated by attention to emotions whereas the effects of maternal abuse were mediated by attention to emotions and emotional clarity. Other-mentalizing only showed mediating effects on one of thirty models tested. Conclusion Results highlight the mediating role of impaired self-mentalizing in the association between childhood adversity and psychosis. This is consistent with disturbances of self-concept and self-boundary characterizing, in particular, the positive dimension of psychosis. Maternal versus paternal figures may contribute differentially to the development of mentalizing. These results could inform future preventative interventions, focusing on the development and maintenance of self-mentalizing.
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Affiliation(s)
- Jacqueline Nonweiler
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pilar Torrecilla
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Thomas R. Kwapil
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Sergi Ballespí
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBER de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain
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Salaminios G, Sprüngli-Toffel E, Michel C, Morosan L, Eliez S, Armando M, Fonseca-Pedrero E, Derome M, Schultze-Lutter F, Debbané M. The role of mentalizing in the relationship between schizotypal personality traits and state signs of psychosis risk captured by cognitive and perceptive basic symptoms. Front Psychiatry 2023; 14:1267656. [PMID: 37810595 PMCID: PMC10557948 DOI: 10.3389/fpsyt.2023.1267656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Objective Schizotypal traits and disturbances in mentalizing (the capacity to understand the mental states driving one's own and others' behaviors) have been implicated in increased vulnerability for psychosis. Therefore, we explored the associations linking schizotypal traits, mentalizing difficulties and their interactions to clinical high-risk for psychosis (CHR-P), as captured by the Basic Symptoms (BS) approach, during adolescence and young adulthood. Methods Eighty-seven adolescents and young adults from the general population (46% male, 44% female; age: 14-23 years) were assessed with the Schizophrenia Proneness Interview (SPI-CY/A) for 11 perceptive and cognitive BS, with the Schizotypal Personality Questionnaire (SPQ) for schizotypal traits, and with the Reflective Functioning Questionnaire (RFQ) for self-reported mentalizing abilities. The RFQ evaluates the level of certainty (RFQc scale) and uncertainty (RFQu scale) with which individuals use mental state information to explain their own and others' behaviors. Results Logistic regression models showed significant positive effects of the SPQ disorganization scale on perceptive BS and of the SPQ interpersonal scale on cognitive BS. Post-hoc analyses revealed that schizotypal features pertaining to odd speech and social anxiety, respectively, were associated with perceptive and cognitive BS. Furthermore, higher scores on the RFQu scale and lower scores on the RFQc scale independently explained the presence of cognitive BS. Finally, significant interaction effects between RFQc and SPQ odd speech on perceptive BS, and between RFQc and SPQ social anxiety on cognitive BS were found. Conclusion Our findings suggest that schizotypal traits and mentalizing significantly relate both independently and through their interactions to the presence of cognitive and perceptive BS included in CHR-P criteria. Furthermore, mentalizing dysfunction may contribute in the relation between schizotypal traits and early state signs of CHR-P. Mentalizing may support both detection and early treatment of CHR-P among adolescents and young adults who present with trait risk for psychosis.
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Affiliation(s)
- George Salaminios
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Research Department, British Association for Counselling and Psychotherapy, Lutterworth, United Kingdom
| | - Elodie Sprüngli-Toffel
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Developmental Imaging and Psychopathology Lab, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
- Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Chantal Michel
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Larisa Morosan
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Developmental Imaging and Psychopathology Lab, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
| | - Stephan Eliez
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Marco Armando
- Department of Psychiatry, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | | | - Melodie Derome
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
- Department of Psychology, Faculty of Psychology, Airlangga University, Surabaya, Indonesia
| | - Martin Debbané
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Developmental Imaging and Psychopathology Lab, Department of Psychiatry, University of Geneva School of Medicine, Geneva, Switzerland
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Awhangansi S, Okewole A, Archard PJ, O’Reilly M. Perspective on clinical high-risk for psychosis in Africa. Front Psychiatry 2023; 14:1226012. [PMID: 37743999 PMCID: PMC10514491 DOI: 10.3389/fpsyt.2023.1226012] [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: 05/20/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
Clinical High Risk for Psychosis has evolved in recent years as a conceptual and clinical entity, representing a shift in focus from the syndromal psychosis state to a recognition of the pre-psychotic state as a period of potential preventive intervention. Much existing evidence has been generated from well-resourced countries, with a more limited body of literature available from Africa and other Majority World countries. Against a backdrop of prevailing systemic challenges, it is necessary to appraise the state of knowledge on Clinical High Risk for Psychosis in Africa. In this perspective article, we cover epidemiology, risk factors, predictors of psychosis conversion, as well as an overview of sociocultural factors, notably stigma, and the barriers to mental health services in African settings. We discuss existing and promising assessment approaches and reflect on preventive and early intervention strategies. We conclude with recommendations including the need for more clinical, longitudinal, and collaborative research anchored in an integrative transdisciplinary approach. We highlight the need for more culturally valid assessment tools and strategies to improve access to and utilization of services while also reducing stigma.
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Affiliation(s)
| | - Adeniran Okewole
- Neuropsychiatric Hospital Aro, Abeokuta, Nigeria
- Pembroke College, University of Cambridge, Cambridge, United Kingdom
| | - Philip John Archard
- Leicestershire Partnership NHS Trust, Leicester, United Kingdom
- University of Leicester, Leicester, United Kingdom
- Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | - Michelle O’Reilly
- Leicestershire Partnership NHS Trust, Leicester, United Kingdom
- University of Leicester, Leicester, United Kingdom
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Weijers JG, van Kaam F, Selten JP, de Winter RFP, ten Kate C. Diverging effects of mentalization based treatment for patients with borderline personality disorder and schizophrenia: an explorative comparison. Front Psychiatry 2023; 14:1226507. [PMID: 37692309 PMCID: PMC10485774 DOI: 10.3389/fpsyt.2023.1226507] [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: 05/21/2023] [Accepted: 08/01/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction There is robust evidence that both patients with schizophrenia (SCZ) and borderline personality disorder (BPD) display mentalizing difficulties. Less is known however about differences in the way mentalization based treatment (MBT) impacts mentalizing capacity in SCZ and BPD patients. This study compares the impact of MBT on mentalizing capacity in individuals with SCZ and BPD. Method The thematic apperception test was used to measure mentalizing capacity. It was administered at the beginning and end of treatment to 26 patients with SCZ and 28 patients with BPD who enrolled in an 18-month long MBT program. For comparison a sample of 28 SCZ patients who did not receive MBT was also included. Using the social cognition and object-relations system, these narratives were analyzed and scored. Missing data was imputed and analyzed using intention-to-treat ANCOVAs with post-treatment measures of mentalizing capacity as dependent variables, group type as independent variable and baseline mentalizing capacities as covariates. Results Results showed that patients with BPD showed significantly more improvement on several measures of mentalizing, including complexity of representation (ηp2 = 0.50, ppooled < 0.001), understanding of social causality (ηp2 = 0.41, ppooled < 0.001) and emotional investment in relationships (ηp2 = 0.41, ppooled < 0.001) compared to patients with SCZ who received MBT. No differences were found regarding affect-tone of relationships (ηp2 = 0.04, ppooled = 0.36). SCZ patients who received MBT showed greater performance on understanding of social causality (ηp2 = 0.12, ppooled = 0.01) compared to SCZ patients who did not receive MBT, but no differences were observed on complexity of representations, capacity for emotional investment or affect-tone of relationships. Discussion Patients with BPD performed better after receiving MBT on three dimensions of mentalizing capacity than SCZ patients who received MBT. Remarkably, SCZ patients who received MBT performed better on one dimension of mentalizing capacity compared to SCZ patients who did not receive MBT. Whereas MBT for BPD clearly involves improvement on most aspects of mentalizing, MBT for SCZ seems to thwart a further decline of other-oriented, cognitive mentalizing. Treatment goals should be adapted toward these disorder-specific characteristics.
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Affiliation(s)
- Jonas G. Weijers
- GGZ Rivierduinen, Institute for Mental Health Care, Leiden, Netherlands
| | - Fleur van Kaam
- GGZ Rivierduinen, Institute for Mental Health Care, Leiden, Netherlands
| | - Jean-Paul Selten
- GGZ Rivierduinen, Institute for Mental Health Care, Leiden, Netherlands
- MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Remco F. P. de Winter
- GGZ Rivierduinen, Institute for Mental Health Care, Leiden, Netherlands
- MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
- Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Coriene ten Kate
- GGZ Rivierduinen, Institute for Mental Health Care, Leiden, Netherlands
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12
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Hennig-Fast K, Meissner D, Steuwe C, Dehning S, Blautzik J, Eilert DW, Zill P, Müller N, Meindl T, Reiser M, Möller HJ, Falkai P, Driessen M, Buchheim A. The Interplay of Oxytocin and Attachment in Schizophrenic Patients: An fMRI Study. Brain Sci 2023; 13:1125. [PMID: 37626482 PMCID: PMC10452454 DOI: 10.3390/brainsci13081125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/02/2023] [Accepted: 07/18/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Attachment theory offers an important framework for understanding interpersonal interaction experiences. In the present study, we examined the neural correlates of attachment patterns and oxytocin in schizophrenic patients (SZP) compared to healthy controls (HC) using fMRI. We assumed that male SZP shows a higher proportion of insecure attachment and an altered level of oxytocin compared to HC. On a neural level, we hypothesized that SZP shows increased neural activation in memory and self-related brain regions during the activation of the attachment system compared to HC. METHODS We used an event-related design for the fMRI study based on stimuli that were derived from the Adult Attachment Projective Picture System to examine attachment representations and their neural and hormonal correlates in 20 male schizophrenic patients compared to 20 male healthy controls. RESULTS A higher proportion of insecure attachment in schizophrenic patients compared to HC could be confirmed. In line with our hypothesis, Oxytocin (OXT) levels in SZP were significantly lower than in HC. We found increasing brain activations in SZP when confronted with personal relevant sentences before attachment relevant pictures in the precuneus, TPJ, insula, and frontal areas compared to HC. Moreover, we found positive correlations between OXT and bilateral dlPFC, precuneus, and left ACC in SZP only. CONCLUSION Despite the small sample sizes, the patients' response might be considered as a mode of dysregulation when confronted with this kind of personalized attachment-related material. In the patient group, we found positive correlations between OXT and three brain areas (bilateral dlPFC, precuneus, left ACC) and may conclude that OXT might modulate within this neural network in SZP.
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Affiliation(s)
- Kristina Hennig-Fast
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
- Department of Psychiatry and Psychotherapy, University of Bielefeld, 33615 Bielefeld, Germany
| | - Dominik Meissner
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Carolin Steuwe
- Department of Psychiatry and Psychotherapy, University of Bielefeld, 33615 Bielefeld, Germany
| | - Sandra Dehning
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Janusch Blautzik
- Department of Radiology, Ludwig-Maximilians University, 81377 Munich, Germany
| | - Dirk W. Eilert
- Department of Psychology, University Innsbruck, 6020 Innsbruck, Austria
| | - Peter Zill
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Norbert Müller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Thomas Meindl
- Department of Radiology, Ludwig-Maximilians University, 81377 Munich, Germany
| | - Maximilian Reiser
- Department of Radiology, Ludwig-Maximilians University, 81377 Munich, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy, University of Bielefeld, 33615 Bielefeld, Germany
| | - Anna Buchheim
- Department of Psychology, University Innsbruck, 6020 Innsbruck, Austria
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13
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Fekih-Romdhane F, Stambouli M, Malaeb D, Farah N, Cheour M, Obeid S, Hallit S. Insomnia and distress as mediators on the relationship from cyber-victimization to self-reported psychotic experiences: a binational study from Tunisia and Lebanon. BMC Psychiatry 2023; 23:524. [PMID: 37475011 PMCID: PMC10360279 DOI: 10.1186/s12888-023-05019-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND While expansive research has accumulated concerning the association between traditional, face-to-face peer victimization and psychosis, a paucity of empirical research has been undertaken so far to investigate these associations with experiences of new and evolving ways of victimization through the digital world. Exploring these associations is highly relevant and timely, given that emerging adults are heavy users of digital technologies, highly exposed to online risks, and are at the peak age of onset of psychosis. This study aimed to test the hypothesis that psychological distress and insomnia symptoms have a significant indirect mediating effect on the association between cyber-victimization and self-reported positive psychotic experiences (SRPEs) in a binational sample of Tunisian and Lebanese community adults. METHOD The total sample was composed of 3766 participants; 3103 were from Lebanon (Mean age: 21.73 ± 3.80 years, 63.6% females) and 663 from Tunisia (Mean age: 26.32 ± 4.86 years, 59.9% females). Online anonymous self-report questionnaires were administered to all participants. RESULTS Higher SRPEs were found in Lebanese participants compared to Tunisians, in single participants compared to married ones, in those with a university level of education compared to secondary or less, in those who live in rural areas compared to urban, in those who do not smoke, do not drink alcohol and do not use marijuana or any other illegal drug. Furthermore, more cyber-victimization, a higher insomnia severity and psychological distress were significantly associated with higher SRPEs. After adjusting for potential confounders, mediation analysis demonstrated that higher cyber-victimization was significantly associated with more insomnia severity/psychological distress; which were, in turn, significantly associated with greater SRPEs. Finally, more cyber-victimization was significantly and directly associated with more positive dimension. CONCLUSION Identifying insomnia and distress as mediators could provide novel insight for psychosis prevention efforts and intervention targets for cyber-victimized individuals prone to experience subclinical psychotic symptoms.
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Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry “Ibn Omrane”, Razi hospital, Manouba, 2010 Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Manel Stambouli
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry “Ibn Omrane”, Razi hospital, Manouba, 2010 Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Nour Farah
- Faculty of Science, Lebanese University, Fanar, Lebanon
| | - Majda Cheour
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry “Ibn Omrane”, Razi hospital, Manouba, 2010 Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
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14
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Bröcker AL, von Haebler D, Lempa G, Montag C. Mentalizing in the context of Mentzos' dilemma-on the use of implicit work in the treatment of non-affective psychosis. Front Psychiatry 2023; 14:1229113. [PMID: 37529074 PMCID: PMC10389263 DOI: 10.3389/fpsyt.2023.1229113] [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: 05/25/2023] [Accepted: 06/27/2023] [Indexed: 08/03/2023] Open
Abstract
Current approaches to the treatment of non-affective psychosis include elements of mentalization-based treatment and the potential in enhancing mentalizing capacity in this patient group has been widely emphasized. This article presents the "psychotic identity dilemma", a concept by Stavros Mentzos, and a therapeutic approach considering this concept as a valuable complementary addition to these treatments. The idea of a dilemma between closeness and distance, which in itself cannot be represented mentally at first, helps to respond to specific needs of patients with psychotic disorders by placing the treatment focus on fundamental interpersonal processes. Following this train of thought, this article attempts to shed light on the importance of the "real relationship" between therapist and patient as well as the exploration of the "here and now", especially at the beginning of psychotherapeutic treatment. Two treatment modes are suggested, one characterized by the experience of interpersonality within the therapeutic relationship and a second one characterized by the reflection of interpersonal phenomena. These modes are framed by Stavros Mentzos' concept of an identity dilemma. We describe how mentalizing first needs to be addressed implicitly in a tolerable, exemplary relationship in which closeness and distance are regulated based on the therapist's countertransference, then explicitly. A series of interventions are described, which allow for moments of shared attention, promote intentionality and contingency and, later in the course of therapy, help to integrate experiences into narratives.
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Affiliation(s)
- Anna-Lena Bröcker
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Dorothea von Haebler
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- International Psychoanalytic University Berlin, Berlin, Germany
| | | | - Christiane Montag
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
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15
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Georgiades A, Almuqrin A, Rubinic P, Mouhitzadeh K, Tognin S, Mechelli A. Psychosocial stress, interpersonal sensitivity, and social withdrawal in clinical high risk for psychosis: a systematic review. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:38. [PMID: 37330526 DOI: 10.1038/s41537-023-00362-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/28/2023] [Indexed: 06/19/2023]
Abstract
Stress has repeatedly been implicated in the onset and exacerbation of positive symptoms of psychosis. Increasing interest is growing for the role of psychosocial stress in the development of psychosis symptoms in individuals at Clinical High Risk (CHR) for psychosis. A systematic review was therefore conducted to summarize the existing evidence base regarding psychosocial stress, interpersonal sensitivity, and social withdrawal in individuals at CHR for psychosis. An electronic search of Ovid (PsychINFO, EMBASE, MEDLINE, and GLOBAL HEALTH) was conducted until February 2022. Studies that examined psychosocial stress in CHR were included. Twenty-nine studies were eligible for inclusion. Psychosocial stress, interpersonal sensitivity, and social withdrawal were higher in CHR individuals compared to healthy controls and there was some evidence of their association with positive symptoms of psychosis. Two types of psychosocial stressors were found to occur more frequently with CHR status, namely daily stressors, and early and recent trauma, while significant life events did not appear to be significant. Greater exposure to psychosocial stress, emotional abuse, and perceived discrimination significantly increased risk of transition to psychosis in CHR. No studies examined the role of interpersonal sensitivity on transition to psychosis in CHR. This systematic review provides evidence for the association of trauma, daily stressors, social withdrawal, and interpersonal sensitivity with CHR status. Further studies investigating the impact of psychosocial stress on psychosis symptom expression in individuals at CHR and its effects on transition to psychosis are therefore warranted.
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Affiliation(s)
- A Georgiades
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK.
- Brent Early Intervention Service, CNWL, NHS Foundation Trust, 27-29 Fairlight Avenue, London, NW10 8AL, UK.
| | - A Almuqrin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - P Rubinic
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - K Mouhitzadeh
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - S Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - A Mechelli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
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16
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Bucci S, Varese F, Quayle E, Cartwright K, Machin M, Whelan P, Chitsabesan P, Richards C, Green V, Norrie J, Schwannauer M. A Digital Intervention to Improve Mental Health and Interpersonal Resilience in Young People Who Have Experienced Technology-Assisted Sexual Abuse: Protocol for a Nonrandomized Feasibility Clinical Trial and Nested Qualitative Study. JMIR Res Protoc 2023; 12:e40539. [PMID: 36943343 PMCID: PMC10131936 DOI: 10.2196/40539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 10/14/2022] [Accepted: 10/29/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND No evidence-based support has been offered to young people (YP) who have experienced technology-assisted sexual abuse (TASA). Interventions aimed at improving mentalization (the ability to understand the mental states of oneself and others) are increasingly being applied to treat YP with various clinical issues. Digital technology use among YP is now common. A digital intervention aimed at improving mentalization in YP who have experienced TASA may reduce the risk of revictimization and future harm and make YP more resilient and able to manage distress that might result from TASA experiences. OBJECTIVE In this paper, we describe a protocol for determining the feasibility of the i-Minds trial and the acceptability, safety, and usability of the digital intervention (the i-Minds app) and explore how to best integrate i-Minds into existing routine care pathways. METHODS This is a mixed methods nonrandomized study aimed to determine the feasibility, acceptability, safety, and usability of the intervention. Participants aged between 12 and 18 years who report distress associated with TASA exposure will be recruited from the United Kingdom from the National Health Service (NHS) Trust Child and Adolescent Mental Health Services, sexual assault referral centers, and a web-based e-therapy provider. All participants will receive the i-Minds app for 6 weeks. Coproduced with YP and a range of stakeholders, the i-Minds app focuses on 4 main topics: mentalization, TASA and its impact, emotional and mental health, and trauma. A daily prompt will encourage YP to use the app, which is designed to be used in a stand-alone manner alongside routine care. We will follow participants up after the intervention and conduct interviews with stakeholders to explore the acceptability of the app and trial procedures and identify areas for improvement. Informed by the normalization process theory, we will examine barriers and enablers relevant to the future integration of the intervention into existing care pathways, including traditional clinic-based NHS and NHS e-therapy providers. RESULTS This study was approved by the Research Ethics Board of Scotland. We expect data to be collected from up to 60 YP. We expect to conduct approximately 20 qualitative interviews with participants and 20 health care professionals who referred YP to the study. The results of this study have been submitted for publication. CONCLUSIONS This study will provide preliminary evidence on the feasibility of recruiting YP to a trial of this nature and on the acceptability, safety, and usability of the i-Minds app, including how to best integrate it into existing routine care. The findings will inform the decision to proceed with a powered efficacy trial. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number Registry (ISRCTN) ISRCTN43130832; https://www.isrctn.com/ISRCTN43130832. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40539.
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Affiliation(s)
- Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Ethel Quayle
- School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom
| | - Kim Cartwright
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Matthew Machin
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science, The University of Manchester, Manchester, United Kingdom
| | - Pauline Whelan
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science, The University of Manchester, Manchester, United Kingdom
| | - Prathiba Chitsabesan
- Pennine Care NHS Foundation Trust, Greater Manchester, United Kingdom
- University College London, London, United Kingdom
| | | | | | - John Norrie
- Population Health Sciences, Usher Institute, Centre for Population Health Sciences, Edinburgh Clinical Trials Unit, Edinburgh, United Kingdom
| | - Matthias Schwannauer
- School of Health in Social Science, The University of Edinburgh, Edinburgh, United Kingdom
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17
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Christy A, Cavero D, Navajeeva S, Murray-O’Shea R, Rodriguez V, Aas M, Trotta G, Moudiab S, Garrido N, Zamora B, Sideli L, Wrobel AL, Salazar de Pablo G, Alameda L. Association Between Childhood Adversity and Functional Outcomes in People With Psychosis: A Meta-analysis. Schizophr Bull 2023; 49:285-296. [PMID: 36107860 PMCID: PMC10016406 DOI: 10.1093/schbul/sbac105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND AND HYPOTHESIS Despite the accepted link between childhood adversity (CA) and psychotic disorders, evidence on the relationship between CA and poor functional outcome remains less consistent and has never been reviewed quantitatively. The aim of this meta-analysis was to systematically examine the association between CA and functional outcomes in people with psychotic disorders. STUDY DESIGN The study protocol was registered on the International Prospective Register of Systematic Reviews (CRD42021254201). A search was conducted across EMBASE, MEDLINE, PsycINFO, and Cochrane Libraries (CENTRAL) using search terms related to psychosis; CA (general, sexual abuse, physical abuse, emotional abuse, physical neglect, and emotional neglect); and functional outcomes (social, occupational, and general functioning [GF]). We conducted random-effects models, sensitivity and heterogeneity analyses, meta-regressions, and we assessed quality. STUDY RESULTS Our meta-analysis comprised 35 studies, including 10 568 cases with psychosis. General CA was negatively associated with GF (28 studies; r = -0.109, 95%CI = -0.161 to -0.05, P < .001), with greater effects in prospective data (10 studies; r = -0.151, 95% CI = -0.236 to -0.063, P = .001). General CA was also associated with social functioning (r = -0.062, 95% CI = -0.120 to -0.004, P = .018) but not occupational outcomes. All CA subtypes except sexual abuse were significantly associated with GF, with emotional and physical neglect showing the largest magnitudes of effect (ranging from r = -0.199 to r = -0.250). CONCLUSIONS This meta-analysis provides evidence for a negative association between general CA, specific subtypes, and general and social functional outcomes in people with psychosis.
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Affiliation(s)
- Angeline Christy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Daniela Cavero
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sujeena Navajeeva
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Rachel Murray-O’Shea
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Victoria Rodriguez
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Monica Aas
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK
- NORMENT, Centre for Research on Mental Disorders, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Giulia Trotta
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King’s College London, London, UK
| | - Socayna Moudiab
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Nathalia Garrido
- Departamento de Psiquiatría, Centro Investigación Biomedica en Red de Salud Mental (CIBERSAM), Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain
| | - Blanca Zamora
- Universidad Internacional de la Rioja (UNIR), Logroño, Spain
| | - Lucia Sideli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Department of Human Science, LUMSA University, Rome, Italy
| | - Anna L Wrobel
- IMPACT – The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
- Orygen, Parkville, Victoria, Australia
| | - Gonzalo Salazar de Pablo
- Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s CollegeLondon, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Luis Alameda
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Departamento de Psiquiatría, Centro Investigación Biomedica en Red de Salud Mental (CIBERSAM), Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain
- TiPP Program Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Gori A, Topino E. Exploring and Deepening the Facets of Mentalizing: The Integration of Network and Factorial Analysis Approaches to Verify the Psychometric Properties of the Multidimensional Mentalizing Questionnaire (MMQ). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4744. [PMID: 36981653 PMCID: PMC10049311 DOI: 10.3390/ijerph20064744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
Mentalization is a complex and multifaceted trans-theoretical and trans-diagnostic construct that has found increasing application in the clinical context. This research aimed at deepening the psychometric properties of the Multidimensional Mentalizing Questionnaire (MMQ), a 33-item theoretically based self-report questionnaire allowing for a comprehensive assessment of mentalizing, by integrating factor analysis and network analysis approaches. A sample of 1640 participants (Mage = 33 years; SD = 13.28) was involved in the research. The six-factor structure was confirmed for the MMQ, and both the total and the subdimensions demonstrated good reliability. The network analysis has further enriched these results, showing the central role of the items attributable to Emotional Dysregulation or Reflexivity in influencing the network as well as the contribution of aspects related to Relational Discomfort in managing the flow of communication flow. Such findings may have useful clinical implications and emphasize the usefulness of the MMQ in both research and clinical practice.
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Affiliation(s)
- Alessio Gori
- Department of Health Sciences, University of Florence, Via di San Salvi 12, Pad. 26, 50135 Florence, Italy
- Integrated Psychodynamic Psychotherapy Institute (IPPI), Via Ricasoli 32, 50122 Florence, Italy
| | - Eleonora Topino
- Department of Human Sciences, LUMSA University of Rome, Via della Traspontina 21, 00193 Rome, Italy
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19
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Constantinides P, Dauphin J. Mentalization Psychotherapy for Patients Presenting with a Psychotic Personality Structure: A Contemporary Approach. Psychodyn Psychiatry 2023; 51:76-97. [PMID: 36867182 DOI: 10.1521/pdps.2023.51.1.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Overt psychotic symptoms, currently understood as resulting from both neurobiological and developmental etiological factors, are also associated with deficits in mentalization in a subgroup of patients presenting with psychotic personality structure. Neurodevelopmental and traumatic impairments seen in this subtype of psychotic disorders create a pressure or need for what has been called a transformational mentalizing process. This specific form of mental elaboration focuses explicitly on finding words and images that help patients to grasp their emotional and mental states. It thus differs from mainstream mentalization treatment, which puts a greater emphasis on reflective functioning. A psychodynamically informed mentalization-based individual and group psychotherapy for this subgroup of patients was developed, aiming at augmenting the patient's psychological resources through explicit transformational mentalization, rather than primarily targeting symptom reduction. This program stimulates curiosity about one's mental states, progressively aiming to give shape to and explore affectively charged mental states, and is integrated with other treatment modalities. This article presents a psychological model of psychotic personality structure and its psychotherapeutic implications, as well as clinical illustrations. Preliminary findings from a pilot study provide encouraging support for the model, including emerging reflective capacities and symptom reduction, as well as overall improvement of social and occupational functioning.
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Affiliation(s)
- Prometheas Constantinides
- Institut Universitaire en Santé Mentale de Montréal; Department of Psychiatry, University of Montreal
| | - Julie Dauphin
- Institut Minerve, Montréal; Department of Psychology, University of Montreal
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20
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Burra N, Vrtička P. Association between attachment anxiety and the gaze direction-related N170. Attach Hum Dev 2023; 25:181-198. [PMID: 35924946 DOI: 10.1080/14616734.2022.2091337] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Attachment theory suggests that interindividual differences in attachment security versus insecurity (anxiety and avoidance) contribute to the ways in which people perceive social emotional signals, particularly from the human face. Among different facial features, eye gaze conveys crucial information for social interaction, with a straight gaze triggering different cognitive and emotional processes as compared to an averted gaze. It remains unknown, however, how interindividual differences in attachment associate with early face encoding in the context of a straight versus averted gaze. Using electroencephalography (EEG) and recording event-related potentials (ERPs), specifically the N170 component, the present study (N = 50 healthy adults) measured how the characteristics of attachment anxiety and avoidance relate to the encoding of faces with respect to gaze direction and head orientation. Our findings reveal a significant relationship between gaze direction (irrespective of head orientation) and attachment anxiety on the interhemispheric (i.e. right) asymmetry of the N170 and thus provide evidence for an association between attachment anxiety and eye gaze processing during early visual face encoding.
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Affiliation(s)
- Nicolas Burra
- Faculté de Psychologie et des Sciences de l'Education, Université de Genève, Geneva, Switzerland
| | - Pascal Vrtička
- Department of Psychology, University of Essex, Colchester, UK
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21
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Bröcker AL, Zimmermann J, Stuke F, Just S, Bayer S, Mielau J, Bertram G, Funcke J, Maaßen E, Hadzibegovic J, Lempa G, von Haebler D, Montag C. Exploring the Latent Structure and Convergent and Incremental Validity of the Metacognition Assessment Scale - Abbreviated in a Sample of Patients with Non-Affective Psychosis. J Pers Assess 2023; 105:100-110. [PMID: 35363095 DOI: 10.1080/00223891.2022.2048843] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Synthetic metacognition is a heterogeneous construct related to psychotic disorders. One important tool to assess this construct is the Metacognition Assessment Scale - Abbreviated (MAS-A). In this study, we investigated the latent structure as well as the interrater reliability and convergent and incremental validity of the MAS-A in a sample of patients with non-affective psychosis. Analyses indicated that the scale might be one-dimensional. Interrater reliability of the MAS-A total score was good. In terms of convergent validity, correlational analyses showed significant associations of MAS-A metacognition with the Operationalized Psychodynamic Diagnosis Level of Structural Integration Axis (OPD-LSIA) and the Levels of Emotional Awareness Scale (LEAS). In terms of construct validity, a significant association was observed between MAS-A metacognition and a short version of the International Classification of Functioning, Disability and Health (MINI-ICF), which persisted after self-report measures of impairments in structural capacities (Structure Questionnaire of Operationalized Psychodynamic Diagnosis [OPD-SQS]) and mentalizing abilities (Mentalization Questionnaire [MZQ]) were included as covariates, but not after symptom dimensions were included. There was a significant correlation with the current living situation, but not with other external criteria like diagnosis or duration of illness. Future studies should explore alternative outcomes and replicate results in longitudinal designs.
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Affiliation(s)
- Anna-Lena Bröcker
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany
| | | | - Frauke Stuke
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany
| | - Sandra Just
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany
| | - Samuel Bayer
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany
| | - Juliane Mielau
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany
| | - Gianna Bertram
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany
| | - Jakob Funcke
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany
| | - Eva Maaßen
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany
| | - Jasmina Hadzibegovic
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany
| | | | - Dorothea von Haebler
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany.,International Psychoanalytic University, Berlin, Germany
| | - Christiane Montag
- Department of Psychiatry and Neurosciences, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt - Universität zu Berlin, Germany
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22
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Buitrago Ramírez F, Ciurana Misol R, Fernández Alonso MDC, Tizón JL. [Prevention of mental health disorders in primary care: Children of single-parent families. Pregnancy in adolescence]. Aten Primaria 2022; 54 Suppl 1:102445. [PMID: 36435588 PMCID: PMC9705223 DOI: 10.1016/j.aprim.2022.102445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Francisco Buitrago Ramírez
- Medicina Familiar y Comunitaria, Centro de Salud Universitario La Paz, Servicio Extremeño de Salud, Badajoz, España.
| | | | | | - Jorge L Tizón
- Psiquiatría y Neurología, Psicología y Psicoanálisis, Institut Universitaria de Salut Mental, Universitat Ramon Llull, Barcelona, España
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23
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Rogeau A, Nordio G, Veronese M, Brown K, Nour MM, Osugo M, Jauhar S, Howes OD, McCutcheon RA. The relationship between glutamate, dopamine, and cortical gray matter: A simultaneous PET-MR study. Mol Psychiatry 2022; 27:3493-3500. [PMID: 35546633 PMCID: PMC9708555 DOI: 10.1038/s41380-022-01596-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 11/09/2022]
Abstract
Prefrontal cortex has been shown to regulate striatal dopaminergic function via glutamatergic mechanisms in preclinical studies. Concurrent disruption of these systems is also often seen in neuropsychiatric disease. The simultaneous measurement of striatal dopamine signaling, cortical gray matter, and glutamate levels is therefore of major interest, but has not been previously reported. In the current study, twenty-eight healthy subjects underwent 2 simultaneous [11C]-( + )-PHNO PET-MRI scans, once after placebo and once after amphetamine in a double-blind randomized cross-over design, to measure striatal dopamine release, striatal dopamine receptor (D2/3R) availability, anterior cingulate glutamate+glutamine (Glx) levels, and cortical gray matter volumes at the same time. Voxel-based morphometry was used to investigate associations between neurochemical measures and gray matter volumes. Whole striatum D2/3R availability was positively associated with prefrontal cortex gray matter volume (pFWE corrected = 0.048). This relationship was mainly driven by associative receptor availability (pFWE corrected = 0.023). In addition, an interaction effect was observed between sensorimotor striatum D2/3R availability and anterior cingulate Glx, such that in individuals with greater anterior cingulate Glx concentrations, D2/3R availability was negatively associated with right frontal cortex gray matter volumes, while a positive D2/3R-gray matter association was observed in individuals with lower anterior cingulate Glx levels (pFWE corrected = 0.047). These results are consistent with the hypothesis that the prefrontal cortex is involved in regulation of striatal dopamine function. Furthermore, the observed associations raise the possibility that this regulation may be modulated by anterior cingulate glutamate concentrations.
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Affiliation(s)
- Antoine Rogeau
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Nuclear Medicine, Lille University Hospitals, Lille, France
| | - Giovanna Nordio
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mattia Veronese
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Kirsten Brown
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Matthew M Nour
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, UK
| | - Martin Osugo
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - Sameer Jauhar
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - Oliver D Howes
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, Imperial College London, London, UK
| | - Robert A McCutcheon
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
- Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK.
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, Imperial College London, London, UK.
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24
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Török E, Kéri S. The Relationship Among Mentalization, Mindfulness, Working Memory, and Schizotypal Personality Traits in the General Population. Front Psychol 2022; 13:682889. [PMID: 35586232 PMCID: PMC9108540 DOI: 10.3389/fpsyg.2022.682889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/12/2022] [Indexed: 11/24/2022] Open
Abstract
Individuals with high schizotypal traits are less able to observe, describe, and monitor inner feelings, thoughts, and experiences, commonly referred to as mindfulness and mentalization. High schizotypy is also associated with impaired working memory (WM). However, the relationship among mindfulness, mentalization, WM, and schizotypal traits is unknown. Three hundred individuals from the community (mean age: 38.0 years, SD = 10.5; 49.3% women) completed questionnaires examining schizotypal traits, mindfulness, and mentalization and performed working memory tasks. Results revealed that mentalization was a general predictor of schizotypal traits, including unusual experiences, cognitive disorganization, introverted anhedonia, and impulsive nonconformity, when the effect of mindfulness and working memory was controlled. We also found a positive correlation between mindfulness and mentalization. Low mindfulness and mentalization performances were associated with high schizotypy. However, poor working memory was only weakly linked to cognitive disorganization and introverted anhedonia. These findings suggest that weak mentalization is a core feature of schizotypy independent of mindfulness and working memory.
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Affiliation(s)
- Edina Török
- Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary
| | - Szabolcs Kéri
- Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary
- Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary
- Department of Physiology, University of Szeged, Szeged, Hungary
- *Correspondence: Szabolcs Kéri, ;
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25
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Stramecki F, Misiak B, Gawęda Ł, Prochwicz K, Kłosowska J, Samochowiec J, Samochowiec A, Pawlak E, Szmida E, Skiba P, Cechnicki A, Frydecka D. The Moderating Role of the FKBP5 Gene Polymorphisms in the Relationship between Attachment Style, Perceived Stress and Psychotic-like Experiences in Non-Clinical Young Adults. J Clin Med 2022; 11:jcm11061614. [PMID: 35329940 PMCID: PMC8953491 DOI: 10.3390/jcm11061614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022] Open
Abstract
Numerous studies have reported that stressful life experiences increase the risk of psychosis and psychotic-like experiences (PLEs). Common variations of the FKBP5 gene have been reported to impact the risk of psychosis by moderating the effects of environmental exposures. Moreover, anxious and avoidant attachment styles have been shown to increase both the level of perceived stress and the risk for psychosis development. In the present cross-sectional study, we aimed to investigate whether variants of the FKBP5 gene moderate the effects of attachment styles and the level of perceived stress on the development of PLEs. A total of 535 non-clinical undergraduates were genotyped for six FKBP5 single nucleotide polymorphisms (SNPs) (rs3800373, rs9470080, rs4713902, rs737054, rs1360780 and rs9296158). The Psychosis Attachment Measure (PAM), the Perceived Stress Scale-10 (PSS-10) and the Prodromal Questionnaire 16 (PQ-16) were administered to assess attachment styles, the level of perceived stress and PLEs, respectively. Anxious attachment style, lower levels of perceived self-efficacy and higher levels of perceived helplessness were associated with a significantly higher number of PLEs. The main effects of attachment style on the severity of PLEs were significant in models testing for the associations with perceived self-efficacy and three FKBP5 SNPs (rs1360780, rs9296158 and rs9470080). The main effect of rs38003733 on the number of PLEs was observed, with GG homozygotes reporting a significantly higher number of PLEs in comparison to T allele carriers. In individuals with dominant anxious attachment style, there was a significant effect of the interaction between the FKBP5 rs4713902 SNP and self-efficacy on the severity of PLEs. Among rs4713902 TT homozygotes, a low level of perceived self-efficacy was associated with higher severity of PLEs. In subjects with non-dominant anxious attachment, a low level of perceived self-efficacy was associated with a higher number of PLEs, regardless of the genotype. Our results indicate that the FKBP5 gene might moderate the relationship between attachment, perceived stress and PLEs.
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Affiliation(s)
- Filip Stramecki
- Department of Psychiatry, Wroclaw Medical University, Pasteur Street 10, 50-367 Wroclaw, Poland;
| | - Błażej Misiak
- Department of Psychiatry, Division of Consultation Psychiatry and Neuroscience, Wroclaw Medical University, Pasteur Street 10, 50-367 Wroclaw, Poland;
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Jaracza Street 1, 00-378 Warsaw, Poland;
| | - Katarzyna Prochwicz
- Institute of Psychology, Jagiellonian University, Ingardena 6 Street, 30-060 Krakow, Poland; (K.P.); (J.K.)
| | - Joanna Kłosowska
- Institute of Psychology, Jagiellonian University, Ingardena 6 Street, 30-060 Krakow, Poland; (K.P.); (J.K.)
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-457 Szczecin, Poland;
| | - Agnieszka Samochowiec
- Institute of Psychology, Department of Clinical Psychology, University of Szczecin, 71-017 Szczecin, Poland;
| | - Edyta Pawlak
- Department of Experimental Therapy, Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Weigla Street 12, 53-114 Wroclaw, Poland;
| | - Elżbieta Szmida
- Department of Genetics, Wroclaw Medical University, Marcinkowskiego 1 Street, 50-368 Wroclaw, Poland; (E.S.); (P.S.)
| | - Paweł Skiba
- Department of Genetics, Wroclaw Medical University, Marcinkowskiego 1 Street, 50-368 Wroclaw, Poland; (E.S.); (P.S.)
| | - Andrzej Cechnicki
- Department of Community Psychiatry, Medical College Jagiellonian University, Sikorskiego Place 2, 31-115 Krakow, Poland;
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Pasteur Street 10, 50-367 Wroclaw, Poland;
- Correspondence:
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26
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Degnan A, Berry K, Humphrey C, Bucci S. The role of attachment and dissociation in the relationship between childhood interpersonal trauma and negative symptoms in psychosis. Clin Psychol Psychother 2022; 29:1692-1706. [PMID: 35218114 PMCID: PMC9790513 DOI: 10.1002/cpp.2731] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/17/2022] [Accepted: 02/23/2022] [Indexed: 12/30/2022]
Abstract
Negative symptoms have an adverse impact on quality of life and functioning in psychosis. Service users with psychosis have identified negative symptoms as a priority for their recovery. Despite this, there is a lack of effective and targeted psychological interventions for negative symptoms and their underlying mechanisms remain poorly understood. Childhood trauma is a robust risk factor for positive symptoms in psychosis, but the association with negative symptoms is less well established. Our aim was to examine the association between childhood interpersonal trauma and negative symptoms and the psychological mediators of this relationship. Two hundred and forty participants experiencing psychosis completed validated self-report measures of childhood trauma, attachment, dissociation, compartmentalization, and symptoms. Mediation analyses showed that disorganized attachment and dissociative experiences mediated the association between childhood trauma and negative symptoms, when analysed individually and in a combined model. Models adjusted for age and positive and depressive symptoms. Avoidant attachment and compartmentalization were independently associated with negative symptoms but not childhood trauma and thus were not significant mediators. Childhood trauma was not independently associated with negative symptoms. This paper is the first to present empirical data to support a model implicating attachment and dissociation as important psychological processes in the link between childhood trauma and negative symptoms. These exploratory findings suggest that it may be beneficial to consider these relationships in trauma-informed formulations and interventions. Further longitudinal research is required to establish causality and test theoretical models of mechanisms in the pathway to negative symptoms.
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Affiliation(s)
- Amy Degnan
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthManchester Academic Health Sciences Centre, The University of ManchesterManchesterUK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthManchester Academic Health Sciences Centre, The University of ManchesterManchesterUK
| | - Charlotte Humphrey
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthManchester Academic Health Sciences Centre, The University of ManchesterManchesterUK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthManchester Academic Health Sciences Centre, The University of ManchesterManchesterUK
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27
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Weijers J, Ten Kate C, Viechtbauer W, Rampaart LJA, Eurelings EHM, Selten JP. Mentalization-based treatment for psychotic disorder: a rater-blinded, multi-center, randomized controlled trial. Psychol Med 2021; 51:2846-2855. [PMID: 32466811 PMCID: PMC8640364 DOI: 10.1017/s0033291720001506] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/29/2020] [Accepted: 05/06/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Impaired mentalizing ability - an impaired ability to understand one's own and other people's behavior in terms of mental states - is associated with social dysfunction in non-affective psychotic disorder (NAPD). We tested whether adding mentalization-based treatment for psychotic disorder (MBTp) to treatment as usual (TAU) results in greater improvement in social functioning. METHODS Multicenter, rater-blinded, randomized controlled trial. Eighty-four patients with NAPD were assigned to TAU or MBTp plus TAU. Patients in the MBTp group received 18 months of MBTp, consisting of weekly group sessions and one individual session per 2 weeks. Social functioning was measured using the Social Functioning Scale. We conducted ANCOVAs to examine the difference between treatment conditions directly after treatment and at 6-month follow-up and performed moderation and mediation analyses. RESULTS Intention-to-treat analyses showed no significant differences between groups post-treatment (p = 0.31) but revealed the MBTp group to be superior to TAU at follow-up (p = 0.03). Patients in the MBTp group also seemed to perform better on measures of mentalizing ability, although evidence of a mediation effect was limited (p = 0.06). Lastly, MBTp treatment was less effective in chronic patients than in recent-onset patients (p = 0.049) and overall symptoms at baseline were mild, which may have reduced the overall effectiveness of the intervention. CONCLUSION The results suggest that MBTp plus TAU may lead to more robust improvements in social functioning compared to TAU, especially for patients with a recent onset of psychosis.
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Affiliation(s)
- J. Weijers
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
| | - C. Ten Kate
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, The Netherlands
| | - W. Viechtbauer
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
| | - L. J. A. Rampaart
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, The Netherlands
| | - E. H. M. Eurelings
- Department of Clinical Psychology, Health, and Neuropsychology, Leiden University, Wassenaarseweg 52, 2333 AKLeiden, The Netherlands
| | - J. P. Selten
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
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28
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Caretti V, Franquillo AC, Guccione C, Cuzzocrea G, Pecora R, Trani L, Carpentieri R, Cantiano A, Cinelli F, Betti E, Fontana A, Sideli L, Panaccione I, Brogna P, Caprì C, Di Cesare G, Ducci G. Integrating Psychophysiology within Clinical Practice: A Pilot Cross-sectional Study on Prodromal Symptoms of Schizophrenia, Emotion Regulation, and Personality Functioning. CLINICAL NEUROPSYCHIATRY 2021; 18:334-338. [PMID: 35096080 PMCID: PMC8785423 DOI: 10.36131/cnfioritieditore20210607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the association between prodromal symptoms of schizophrenia, autonomic activity, and personality functioning. METHOD 10 adolescents underwent semi-structured interviews assessing prodromal symptoms of schizophrenia and personality functioning. Cardiac activity was recorded at baseline, during the clinical interviews, and at recovery to assess concurrent changes in autonomic functioning. RESULTS During the assessment of prodromal symptoms of schizophrenia, participants increased sympathetic activation compared to the recovery condition, and reduced vagal activation compared to the assessment of interpersonal functioning. CONCLUSIONS The findings highlight the importance of integrating the autonomic assessment in clinical psychiatric and psychological practice.
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Affiliation(s)
- Vincenzo Caretti
- Department of Human Sciences, LUMSA University, Rome, Italy
- Consorzio Universitario Humanitas, Rome, Italy
| | - Anna Chiara Franquillo
- Department of Human Sciences, LUMSA University, Rome, Italy
- Consorzio Universitario Humanitas, Rome, Italy
| | - Camilla Guccione
- Department of Human Sciences, LUMSA University, Rome, Italy
- Consorzio Universitario Humanitas, Rome, Italy
| | - Gaia Cuzzocrea
- Department of Human Sciences, LUMSA University, Rome, Italy
| | | | - Lucrezia Trani
- Department of Human Sciences, LUMSA University, Rome, Italy
| | | | | | | | - Eleonora Betti
- Department of Human Sciences, LUMSA University, Rome, Italy
| | - Andrea Fontana
- Department of Human Sciences, LUMSA University, Rome, Italy
| | - Lucia Sideli
- Department of Human Sciences, LUMSA University, Rome, Italy
| | | | | | - Chiara Caprì
- Department of Mental Health, PIPSM, ASL Roma 1, Rome, Italy
| | | | - Giuseppe Ducci
- Department of Mental Health, PIPSM, ASL Roma 1, Rome, Italy
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29
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Cristina ME, Josep PG. Attachment Dimensions predict Social Functioning in persons with Schizophrenia-Spectrum Disorders, regardless of Symptom Severity. ACTAS ESPANOLAS DE PSIQUIATRIA 2021; 49:269-281. [PMID: 34734642 PMCID: PMC9335082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022]
Abstract
Attachment patterns and early-life adversities are relevant to understand the role of psychosocial factors in the vulnerability and the development of psychosis. The first aim of the study was to test whether a dimensional attachment instrument, the CAMIR (from French; Cartes: Modèles Individuels de Relation), may differentiate attachment styles by comparing a group of psychotic patients with a non-clinical sample. Also, we hypothesised that attachment dimensions would predict Social Functioning (SF) within the clinical group.
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Affiliation(s)
| | - Pena-Garijo Josep
- Universidad Jaume I, Castellón de la Plana, España
Unidad de Salud Mental, Hospital Universitario Doctor Peset, Valencia, España
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30
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Rolli NJ. Mentalizing in Clinical Practice: Working with Children Whose Mother is Suffering from Psychotic Symptoms. BRITISH JOURNAL OF PSYCHOTHERAPY 2021. [DOI: 10.1111/bjp.12655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Carvalho D, Marques CC, Pinto AM, Martins MJ, Leal I, Castilho P. Fears of compassion scales in psychosis: confirmatory factor analysis and psychometric properties. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01979-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Salaminios G, Morosan L, Toffel E, Tanzer M, Eliez S, Badoud D, Armando M, Debbané M. Associations between schizotypal personality features, mentalizing difficulties and thought problems in a sample of community adolescents. Early Interv Psychiatry 2021; 15:705-715. [PMID: 32573985 DOI: 10.1111/eip.13011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 04/02/2020] [Accepted: 05/24/2020] [Indexed: 12/01/2022]
Abstract
AIM Schizotypal trait expression and mentalizing impairments represent key factors associated with increased vulnerability for schizophrenia. In the current study, we analysed the nature of associations linking specific schizotypal personality features to mentalizing difficulties during adolescence. Furthermore, we examined the extent to which mentalizing difficulties mediate the relationship between schizotypal trait features and self-reported thought problems. METHODS One hundred and five community adolescents (Mage = 15.72; SD = 1.91) completed a recently developed self-report measure of mentalizing (Reflective Functioning Questionnaire [RFQ]), evaluating the degree of certainty (RFQc-scale) and uncertainty (RFQu-scale) with which individuals utilize mental state information to understand their own and others' behaviour. High scores on the RFQu-scale reflect poor usage of mental state information, while high scores on the RFQc-scale capture adaptive levels of certainty about mental states. Self-report questionnaires were also used to assess schizotypal trait expression, thought problems and symptoms of anxiety/depression. RESULTS Linear regression models indicated that schizotypal features of social anxiety and odd speech accounted for increased RFQu scores, while odd speech also accounted for reduced RFQc scores. RFQu partially mediated the effects of social anxiety and odd speech on the level of thought problems in the sample. CONCLUSIONS Present findings suggest that schizotypal features that impede interpersonal communication during adolescence are linked to difficulties in mental state understanding. Our study also provides original data suggesting that the effects of social anxiety and odd speech on psychosis-risk may partially depend upon the level of mentalizing uncertainty. Mentalizing difficulties may constitute important clinical assessment and early prevention treatment targets in adolescents who demonstrate schizotypal features.
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Affiliation(s)
- George Salaminios
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Larisa Morosan
- Developmental Clinical Psychology Unit, Faculty of Psychology, University of Geneva, Geneva, Switzerland.,Department of Psychiatry, Developmental Imaging and Psychopathology Lab, Office Medico-Pédagogique, University of Geneva 1 rue David-Dufour, Geneva, Switzerland
| | - Elodie Toffel
- Developmental Clinical Psychology Unit, Faculty of Psychology, University of Geneva, Geneva, Switzerland
| | - Michal Tanzer
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Stephan Eliez
- Department of Psychiatry, Developmental Imaging and Psychopathology Lab, Office Medico-Pédagogique, University of Geneva 1 rue David-Dufour, Geneva, Switzerland
| | - Deborah Badoud
- Developmental Clinical Psychology Unit, Faculty of Psychology, University of Geneva, Geneva, Switzerland.,Department of Psychiatry, Developmental Imaging and Psychopathology Lab, Office Medico-Pédagogique, University of Geneva 1 rue David-Dufour, Geneva, Switzerland
| | - Marco Armando
- Department of Psychiatry, Developmental Imaging and Psychopathology Lab, Office Medico-Pédagogique, University of Geneva 1 rue David-Dufour, Geneva, Switzerland
| | - Martin Debbané
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Developmental Clinical Psychology Unit, Faculty of Psychology, University of Geneva, Geneva, Switzerland.,Department of Psychiatry, Developmental Imaging and Psychopathology Lab, Office Medico-Pédagogique, University of Geneva 1 rue David-Dufour, Geneva, Switzerland
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Varela LF, Wong KHT, Shergill SS, Fett AKJ. Attachment styles moderate Theory of Mind differences between persons with schizophrenia, first-degree relatives and controls. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 60:339-356. [PMID: 34036577 DOI: 10.1111/bjc.12308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Theory of Mind (ToM) plays a role in social functioning and is impaired in patients with schizophrenia and to a lesser degree in first-degree relatives, compared to healthy controls. This study investigates whether attachment styles moderate these observed group differences in ToM. METHODS This cross-sectional study included a sample of 51 patients, 23 first-degree relatives, and 49 controls who completed assessments of anxious and avoidant attachment (Psychosis Attachment Measure), ToM (Reading the Mind in the Eyes Test), and estimated cognitive ability. Patients' symptoms were assessed with the Positive and Negative Syndrome Scale. RESULTS Patients differed from controls and relatives in ToM performance but not in attachment avoidance or attachment anxiety. Attachment anxiety showed an interaction with group over ToM. The interaction was significant only between patients and controls but not between patients and relatives or relatives and controls. Post-hoc analysis showed that patients and controls showed differential ToM performance at average and high attachment anxiety. In patients, symptom levels did not moderate the association between attachment and ToM. CONCLUSIONS Attachment anxiety is related to poorer levels of ToM in patients, suggesting this may have a contributory role in schizophrenia. The findings stress the need for longitudinal research into the directionality of the relationship between ToM and attachment anxiety. PRACTITIONER POINTS Relationships with significant others might be a factor that influences the way in which social information is processed by persons with a diagnosis of a psychotic disorder. In patients, higher levels of attachment anxiety - that is, low self-worth, fear of abandonment and rejection, continuous vigilance of threat-related cues - were associated with a lower ability to understand the mental states of others. However, at lower levels of attachment anxiety, their ToM performance was comparable to that of relatives and controls. This effect was not influenced by symptom severity. Further research is required to confirm the potential influence of attachment insecurity on ToM ability as the latter is strongly related to patient's functional outcomes.
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Affiliation(s)
- Luis F Varela
- Unidad de Psiquiatría, Escuela de Medicina, Facultad de Medicina, Universidad Andres Bello, Santiago, Chile.,Servicio de Psiquiatría y Salud Mental, Hospital CRS El Pino, Servicio de Salud Metropolitano Sur, Santiago, Chile.,Cognition, Schizophrenia and Imaging Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Katie H T Wong
- Cognition, Schizophrenia and Imaging Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Sukhi S Shergill
- Cognition, Schizophrenia and Imaging Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Anne-K J Fett
- Cognition, Schizophrenia and Imaging Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,Department of Psychology, School of Arts and Social Sciences, City, University of London, UK
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Mertens YL, Racioppi A, Sheinbaum T, Kwapil T, Barrantes-Vidal N. Dissociation and insecure attachment as mediators of the relation between childhood emotional abuse and nonclinical paranoid traits. Eur J Psychotraumatol 2021; 12:1888539. [PMID: 33968322 PMCID: PMC8079066 DOI: 10.1080/20008198.2021.1888539] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Research suggests dissociation and insecure attachment serve as explanatory mechanisms in the pathway from childhood trauma to paranoia. However, past work has not examined these mechanisms concurrently in nonclinical populations. Objective: The current study sought to examine dissociation and insecure attachment as parallel mediators of the association between childhood emotional abuse and paranoid traits. Furthermore, a serial mediation model with insecure attachment preceding dissociation in the explanatory pathway was explored. Methods: Eighty-nine nonclinically ascertained young adults were assessed for childhood emotional abuse, dissociation, attachment styles, and paranoid traits. Parallel and serial mediation models were tested. Results: The association of childhood emotional abuse with both interview-based and self-reported paranoid traits was significantly mediated by dissociation and preoccupied attachment. Fearful attachment was a significant mediator in the model for self-reported paranoid traits. No evidence for a serial mediation effect was found. Conclusions: The present findings extend support for dissociation and attachment insecurity as mechanisms underlying the link between childhood emotional maltreatment and paranoid traits. Longitudinal research is needed to inform whether insecure attachment contributes to dissociation along the pathways to paranoid traits.
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Affiliation(s)
- Yoki Linn Mertens
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Anna Racioppi
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona (Edifici B), Barcelona, Spain
| | - Tamara Sheinbaum
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Thomas Kwapil
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA.,Department of Clinical Psychology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona (Edifici B), Barcelona, Spain.,Departament de Salut Mental, Sant Pere Claver - Fundació Sanitària, Barcelona, Spain.,Center for Biomedical Research in Mental Health (CIBERSAM), Madrid, Spain
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Dzirlo L, Richter F, Steinmair D, Löffler-Stastka H. Reflective Functioning in Patients with Irritable Bowel Syndrome, Non-Affective Psychosis and Affective Disorders-Differences and Similarities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052780. [PMID: 33803368 PMCID: PMC7967285 DOI: 10.3390/ijerph18052780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 02/07/2023]
Abstract
Irritable bowel syndrome (IBS), as part of the functional somatic syndromes, is frequent in the general population. Medical care and morbidity costs are high, and so is the psychological and somatic strain. The etiopathogenesis of IBS is still poorly understood; it is assumed to be multifactorial and to include biopsychosocial factors. Links between the intestine, psyche, nervous system (e.g., via the hypothalamic-pituitary-adrenal axis (HPA-Axis/neurotransmitters) and with the microbiome, the immune system have lately been investigated. Factors such as personality traits, mentalization, and early attachment strategies (deactivating and hyperactivating) have been suggested to influence IBS with relevance for treatment regimens. At this time, data on reflective functioning (RF) is lacking. Within a cross-sectional, we examined the mentalizing capacity of a clinical sample (n = 90) consisting of patients with IBS (n = 30), affective disorders (AD; n = 28), and non-affective psychosis (NAP; n = 32). The reflective functioning scale was used based on the brief reflective function interview (BRFI). The results revealed severe impairment in patients with IBS concerning their mentalizing ability, which was comparable to patients with affective disorders. Patients with non-affective-psychosis showed the lowest mentalizing ability. Thus, psychotherapeutic treatment with a focus on mentalization could be a promising approach.
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Affiliation(s)
- Larisa Dzirlo
- Department of Internal Medicine and Psychosomatics, Krankenhaus der Barmherzigen Schwestern, 1060 Vienna, Austria;
| | - Felix Richter
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria; (F.R.); (D.S.)
| | - Dagmar Steinmair
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria; (F.R.); (D.S.)
- Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
| | - Henriette Löffler-Stastka
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria; (F.R.); (D.S.)
- Correspondence: ; Tel.: +43-(0)1-40400-30700
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Tanzer M, Salaminios G, Morosan L, Campbell C, Debbané M. Self-Blame Mediates the Link between Childhood Neglect Experiences and Internalizing Symptoms in Low-Risk Adolescents. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2021; 14:73-83. [PMID: 33692873 PMCID: PMC7900265 DOI: 10.1007/s40653-020-00307-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Childhood neglect is the most common type of maltreatment, ranging from minor isolated incidents to consistent failures in emotional/physical caregiving. It has been associated with developmental impairments and considered a risk factor for the emergence of psychopathology, particularly internalizing disorders. This study aimed to explore individual differences in response to the continuum of severity of neglect in community adolescents, as well as the role of specific cognitive emotion regulation strategies (CERSs) as mediators between childhood neglect and current internalizing symptoms. Low-risk adolescents (12-19 years old; M age 15.88 years; N = 123; 64 Females) completed questionnaires assessing these experiences. We employed a regression model and a simple mediation analyses. Findings indicate a positive association between childhood neglect, internalizing behaviors, and the adoption of self-blame as CERS. Moreover, the use of self-blame in response to everyday stress partially mediated the relationship between neglect and internalizing behaviors (effect size: .28). Findings support the hypothesis that even in a low risk sample, neglect is associated with internalizing symptoms, and highlight the importance of assessing individual differences in the experience of neglect. Moreover, the mediation effect of the CERSs of self-blame might serve as a potential target for psychotherapeutic interventions aimed at reducing internalizing symptoms.
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Affiliation(s)
- Michal Tanzer
- Psychoanalysis Unit, Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - George Salaminios
- Psychoanalysis Unit, Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Larisa Morosan
- Developmental Clinical Psychology Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Chloe Campbell
- Psychoanalysis Unit, Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Martin Debbané
- Psychoanalysis Unit, Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
- Developmental Clinical Psychology Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
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Pipkin A, Hogg L, Armitage S. 'Someone on my level': A Meta-Ethnographic Review of Therapeutic Relationships in Cognitive Behavioural Therapy for Psychosis. Clin Psychol Psychother 2021; 28:1297-1313. [PMID: 33605515 DOI: 10.1002/cpp.2578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Cognitive Behavioural Therapy for Psychosis (CBTp) demonstrates variable and at times mild to moderate effect sizes; thus, its therapeutic processes are important to explore. Establishing a secure therapeutic relationship is one such key process where barriers may exist, including those related to psychotic symptoms and associated stigma. This review synthesizes the available qualitative research pertaining to the experience of the therapeutic relationship from the perspective of those experiencing psychosis. METHODS A systematic review was undertaken using PRISMA guidelines. Search terms included variants of 'psychosis', 'therapy' and 'qualitative'. PsycInfo, CINAHL, EmBase, MedLine and Web of Science were searched, and reference lists were hand-scanned. Yardley's quality appraisal tool was utilized and Noblit and Hare's seven-stage process for conducting a meta-ethnographic review. A line-of-argument synthesis is presented. RESULTS Fourteen papers were identified using inclusion and exclusion criteria. Twelve papers were deemed to have satisfactory quality. The line-of-argument synthesis used attachment theory to propose four semi-distinct stages to establishing a therapeutic relationship: beginning; safety, hope and trust; the practicalities of therapy; and branching out. Findings suggest that the therapist's persona and use of CBTp techniques such as collaboration and shared agency over the process were important in establishing for the patient a sense of self as normal, equal and worthwhile. CONCLUSIONS Attachment security may be an important strand of CBTp and warrants further research and clinical investigation as a process and an outcome. Future research can benefit from increased transparency regarding researcher positionality as a potential source of bias.
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Affiliation(s)
- Alastair Pipkin
- Senior Clinical Psychologist, Northamptonshire Gender Service, Northamptonshire Healthcare NHS Foundation Trust, Northamptonshire, UK
| | - Lorna Hogg
- Deputy Director and Consultant Clinical Psychologist, Oxford Institute of Clinical Psychology Training, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Sarah Armitage
- Clinical Psychologist, Berkshire Early Intervention in Psychosis Service, Berkshire Healthcare NHS Foundation Trust, Bracknell, UK
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Emotional Comprehension Is Not Related to Duration of Distress from Daily Life Events. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020459. [PMID: 33430055 PMCID: PMC7827275 DOI: 10.3390/ijerph18020459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/04/2020] [Accepted: 12/30/2020] [Indexed: 11/21/2022]
Abstract
The main aim of this paper is to analyze to what extent insight (i.e., mentalization referring to one’s own mental state) moderates recovering from daily life events. A total of 110 participants (84.5% women; mean age: M = 21.5; SD = 3.2) filled in the Trait Meta-Mood Scale (TMMS-24) and the Eysenck Personality Questionnaire (EPQ-R), and were interviewed about impairment derived from daily life events (everyday life stresses) during the past year. Multivariate regression models were adjusted for neuroticism, sex, and socioeconomic status to analyze whether different degrees of insight moderated the relationship between the intensity and the duration of emotional distress. Results showed that the global measure of insight did not moderate recovering from daily-life distress. Regarding the subdimensions, attention to emotional reactions was related to an increased duration of distress. Results showed that, against our hypothesis, deeper comprehension of emotional reactions, operationalized here as “true insight”, was not associated to faster recovery. Limitations and recommendations for further studies are discussed considering these results.
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Heriot-Maitland C, Wykes T, Peters E. Trauma and Social Pathways to Psychosis, and Where the Two Paths Meet. Front Psychiatry 2021; 12:804971. [PMID: 35082703 PMCID: PMC8785245 DOI: 10.3389/fpsyt.2021.804971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/17/2021] [Indexed: 12/17/2022] Open
Abstract
The pathways from trauma-via dissociation-to psychosis have been thoroughly tested and evidenced, but what has received less attention has been the social pathways-via dissociation-to psychosis. Often social factors are more commonly linked to other influences, e.g., to appraisals and the creation of negative schema in cognitive models, or to unsupportive caregiving experiences where there is high "expressed emotion." However, evidence is now emerging that negative social rank experiences, such as being excluded or shamed, may themselves have dissociative properties, which poses intriguing questions as to how trauma pathways and social pathways might interact. This article reviews the state of knowledge in trauma and social pathways to psychosis and then considers the potential mechanisms and the relationships between them, specifically (i) dissociation, (ii) attachment, and (iii) social rank. Recommendations are suggested for future modeling and testing of three-way interactions (dissociation × attachment × social rank) in the pathway from trauma to psychosis.
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Affiliation(s)
- Charles Heriot-Maitland
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.,Institute of Health and Wellbeing, Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom
| | - Til Wykes
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Emmanuelle Peters
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Ciocca G, Jannini TB, Ribolsi M, Rossi R, Niolu C, Siracusano A, Jannini EA, Di Lorenzo G. Sexuality in Ultra-High Risk for Psychosis and First-Episode Psychosis. A Systematic Review of Literature. Front Psychiatry 2021; 12:750033. [PMID: 34777053 PMCID: PMC8579023 DOI: 10.3389/fpsyt.2021.750033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022] Open
Abstract
A considerable body of literature reports that individuals with psychotic disorders often suffer from sexual dysfunctions (SDs), with these representing a major unmet need. Long-term antipsychotic drug treatment may be the main cause for SDs in psychotic patients, through a plethora of different mechanisms, including prolactin dyscrasia, histamine-mediated sedation, and serotonin-induced sexual demotivation. However, a few pieces of evidence treat sexuality in patients at risk or the onset of psychosis. For this purpose, we systematically reviewed literature of the last 10 years in order to investigate sexuality in ultra-high risk (UHR) for psychosis and first-episode psychosis (FEP). We included in our review 34 articles fitting our research criteria on SDs in UHR and FEP. Evidence of SDs in the transition from UHR to FEP emerges through the selected studies. In FEP, sexuality is affected by the severity of the psychotic symptoms and, in some cases, by the iatrogenic effects of psychopharmacological treatment. Further experimental and clinical studies should systematically investigate the role of sexual functioning in the transition from UHR to FEP and, consequently, clarify whether or not SDs could be considered a possible marker for the onset of psychosis in at-risk populations. Moreover, psychiatrists and clinical psychologists should take into consideration the role of sexual life in young people with prodromal mental symptoms or at the onset of psychosis. Focusing on a thorough sexual evaluation might be a major challenge that could break down barriers of mental health promotion among young people with schizophrenia-spectrum disorders and therefore achieve better clinical outcomes.
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Affiliation(s)
- Giacomo Ciocca
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Tommaso B Jannini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Michele Ribolsi
- Unit of Neurology, Neurobiology, Neurophysiology and Psychiatry, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Cinzia Niolu
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS - Fondazione Santa Lucia, Rome, Italy
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Buitrago Ramírez F, Ciurana Misol R, Fernández Alonso MDC, Tizón JL. [COVID-19 pandemic and mental health: Initial considerations from spanish primary health care]. Aten Primaria 2021; 53:89-101. [PMID: 32747166 PMCID: PMC7346833 DOI: 10.1016/j.aprim.2020.06.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 11/18/2022] Open
Abstract
An approach is made to the psychological and psychosocial characteristics that the COVID-19 pandemic is acquiring in the countries of our socio-cultural environment. The scarcity of research in this regard and the necessary acceptance of uncertainty to face the situation, both socially, as well as health and psychological, are discussed. Consequently, a series of reflections and recommendations are proposed for the psychological care of the population, health workers and social organization based on: 1) The existence of psychological and psychosocial research into connected fields and 2) In the new neuroscientific perspectives on emotions and their elaboration in crisis situations.
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Rek-Owodziń K, Tyburski E, Waszczuk K, Samochowiec J, Mak M. Neurocognition and Social Cognition- Possibilities for Diagnosis and Treatment in Ultra-High Risk for Psychosis State. Front Psychiatry 2021; 12:765126. [PMID: 34880793 PMCID: PMC8645604 DOI: 10.3389/fpsyt.2021.765126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/27/2021] [Indexed: 11/13/2022] Open
Abstract
In recent decades, clinicians have developed the construct of ultra-high risk (UHR) for psychosis to characterize the prodromal phase of psychosis or classify people with weakly expressed psychotic symptoms. In this conceptual analysis, we have gathered up-to-date data about the clinical picture of neurocognition and social cognition in people at UHR for psychosis. We also discuss treatment options. A well-chosen therapeutic approach can help to deal with difficulties and delay or even prevent the development of full-blown psychotic disorders in the UHR group. Despite much evidence supporting the benefits of therapy, early interventions are still not as widely used as they should be. Thus, a better understanding of the UHR state is very important for all healthcare workers.
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Affiliation(s)
- Katarzyna Rek-Owodziń
- Department of Health Psychology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Ernest Tyburski
- Department of Health Psychology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Katarzyna Waszczuk
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Monika Mak
- Department of Health Psychology, Pomeranian Medical University in Szczecin, Szczecin, Poland
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Buitrago Ramírez F, Ciurana Misol R, Fernández Alonso MDC, Tizón García JL. [Mental health in epidemics: A perspective from the Spanish Primary Health Care]. Aten Primaria 2020; 52 Suppl 2:93-113. [PMID: 33388120 PMCID: PMC7801217 DOI: 10.1016/j.aprim.2020.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/09/2020] [Indexed: 11/22/2022] Open
Abstract
The pandemic of the disease known as COVID-19 (acronym for coronavirus disease-2019), which was first detected in the Chinese city of Wuhan in December 2019, has led to an international public health emergency. This due to several reasons (threat to the lives of many people, unprecedented health and socioeconomic crisis, cessation of school and work activities, or the need to adopt extraordinary measures, including quarantining entire cities or countries). The PAPPS Mental Health Group has considered it important to observe, reflect and investigate the phenomena that are occurring, and will occur, in what has possibly been one of the most extensive and radical public health interventions in recent history. This work makes an approach to the psychological and psychosocial characteristics that the COVID-19 pandemic is acquiring in the countries of our socio-cultural environment, and proposes a series of reflections and recommendations for the psychological care of the population, health workers, and social organisation.
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Affiliation(s)
| | - Ramon Ciurana Misol
- Medicina Familiar y Comunitaria, Centro de Salud La Mina, Sant Adrià del Besòs, Barcelona, España
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Boldrini T, Pontillo M, Tanzilli A, Giovanardi G, Di Cicilia G, Salcuni S, Vicari S, Lingiardi V. An attachment perspective on the risk for psychosis: Clinical correlates and the predictive value of attachment patterns and mentalization. Schizophr Res 2020; 222:209-217. [PMID: 32513546 DOI: 10.1016/j.schres.2020.05.052] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/07/2020] [Accepted: 05/19/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND In a longitudinal design, the present study examined: (a) the nature of attachment patterns and reflective functioning (RF) in individuals at ultra-high risk for psychosis (UHR); (b) the association between RF and subclinical psychotic symtoms; and (c) the psychosis-predictive value of attachment patterns, RF, and the interaction between these factors. METHOD The sample comprised 57 UHR subjects and 53 clinical controls (non-UHR). UHR subjects were followed over a mean period of 14 months (SD = 2.7; range 11-19), during which time 11.5% developed psychosis. Attachment patterns and RF were measured. Hierarchical logistic regression was used to examine the predictive value of variables in the transition to psychosis. RESULTS At baseline, significant differences were found between groups in secure attachment patterns and RF. RF was negatively associated with the attenuated psychotic symptoms described by the Unusual Thought Content/Delusional Ideas, Suspiciousness/Persecutory Ideas, and Disorganized Communication subscales. Moreover, poor mentalization was related to an increased likelihood of developing a psychotic disorder (OR = 0.427, 95% CI [0.188, 0.970]); conversely, no predictive effects of the attachment variables and their interaction with RF on the transition to psychosis were found. Notably, an optimal threshold value of RF = 1.25 was found to distinguish UHR subjects who made the transition to psychosis from those who did not develop this pathology. CONCLUSION The results suggest that aberrant mentalizing patterns can predict the development of psychosis. Clinical implications of these results for the development of preventive treatments are discussed.
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Affiliation(s)
- Tommaso Boldrini
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185 Rome, Italy; Department of Developmental Psychology and Socialization, University of Padua, Via Venezia, 8, 35131 Padua, Italy.
| | - Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy.
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185 Rome, Italy.
| | - Guido Giovanardi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185 Rome, Italy; Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico, 31, 81100 Caserta, Italy.
| | - Giuseppe Di Cicilia
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185 Rome, Italy.
| | - Silvia Salcuni
- Department of Developmental Psychology and Socialization, University of Padua, Via Venezia, 8, 35131 Padua, Italy.
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Piazza Sant'Onofrio 4, 00100 Rome, Italy.
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli, 1, 00185 Rome, Italy.
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Luyten P, Campbell C, Allison E, Fonagy P. The Mentalizing Approach to Psychopathology: State of the Art and Future Directions. Annu Rev Clin Psychol 2020; 16:297-325. [DOI: 10.1146/annurev-clinpsy-071919-015355] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Mentalizing is the capacity to understand others and oneself in terms of internal mental states. It is assumed to be underpinned by four dimensions: automatic–controlled, internally–externally focused, self–other, and cognitive–affective. Research suggests that mental disorders are associated with different imbalances in these dimensions. Addressing the quality of mentalizing as part of psychosocial treatments may benefit individuals with various mental disorders. We suggest that mentalizing is a helpful transtheoretical and transdiagnostic concept to explain vulnerability to psychopathology and its treatment. This review summarizes the mentalizing approach to psychopathology from a developmental socioecological evolutionary perspective. We then focus on the application of the mentalizing approach to personality disorders, and we review studies that have extended this approach to other types of psychopathology, including depression, anxiety, and eating disorders. We summarize core principles of mentalization-based treatments and preventive interventions and the evidence for their effectiveness. We conclude with recommendations for future research.
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Affiliation(s)
- Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, B-3000 Leuven, Belgium
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom
| | - Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom
| | - Elizabeth Allison
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 7HB, United Kingdom
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Long M, Verbeke W, Ein-Dor T, Vrtička P. A functional neuro-anatomical model of human attachment (NAMA): Insights from first- and second-person social neuroscience. Cortex 2020; 126:281-321. [DOI: 10.1016/j.cortex.2020.01.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/14/2019] [Accepted: 01/20/2020] [Indexed: 12/14/2022]
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Montag C, Schöner J, Speck LG, Just S, Stuke F, Rentzsch J, Gallinat J, Majić T. Peripheral oxytocin is inversely correlated with cognitive, but not emotional empathy in schizophrenia. PLoS One 2020; 15:e0231257. [PMID: 32255800 PMCID: PMC7138301 DOI: 10.1371/journal.pone.0231257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/19/2020] [Indexed: 12/05/2022] Open
Abstract
Endogenous oxytocin has been associated with different aspects of social cognition in healthy subjects and patients with schizophrenia. In this pilot study, we investigated the relationship between plasma oxytocin and oxytocin level changes induced by empathy-eliciting, attachment-related movie scenes with correlates of cognitive and emotional empathy in patients and healthy controls. The Multifaceted Empathy Test (MET) and the Interpersonal Reactivity Index (IRI) were administered to patients with schizophrenia (N = 35, 12 females) and healthy controls (N = 35, 12 females) to estimate dimensions of cognitive and emotional empathy. Peripheral basal oxytocin concentrations and oxytocin responses to movie-based emotional stimuli were assessed using radioimmunoassay with sample extraction. In patients, induced oxytocin level changes were inversely correlated with MET cognitive empathy regarding negative emotional states. Controlling for non-social cognition and age revealed a significant negative association between basal oxytocin levels and MET cognitive empathy for positive emotions. In healthy subjects, oxytocin reactivity was inversely correlated with the IRI subscale "fantasy". Oxytocin was not related to any measure of emotional empathy. A hyper-reactive oxytocin system might be linked to impaired cognitive empathy as a part of a dysfunctional regulative circuit of attachment-related emotions and interpersonal stressors or threats by attribution of meaning. Healthy adults with a disposition to identify with fictional characters showed lower oxytocin reactivity, possibly indicating familiarity with movie-based stimuli. The oxytocinergic system may be involved in maladaptive coping mechanisms in the framework of impaired mentalizing and associated dysfunctional responses to interpersonal challenges in schizophrenia.
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Affiliation(s)
- Christiane Montag
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Johanna Schöner
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Lucas Guilherme Speck
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Sandra Just
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Frauke Stuke
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Johannes Rentzsch
- Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg Medical School ‘Theodor Fontane’, Neurupppin, Germany
| | - Jürgen Gallinat
- Clinic and Policlinic for Psychiatry and Psychotherapy, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Tomislav Majić
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte, Berlin, Germany
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Henssler J, Brandt L, Müller M, Liu S, Montag C, Sterzer P, Heinz A. Migration and schizophrenia: meta-analysis and explanatory framework. Eur Arch Psychiatry Clin Neurosci 2020; 270:325-335. [PMID: 31161262 DOI: 10.1007/s00406-019-01028-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 05/28/2019] [Indexed: 12/14/2022]
Abstract
Systematic reviews and meta-analyses suggest that there are increased rates of schizophrenia and related psychoses in first- and second-generation migrants and refugees. Here, we present a meta-analysis on the incidence of non-affective psychotic disorders among first- and second-generation migrants. We found substantial evidence for an increased relative risk of incidence among first- and second-generation migrants compared to the native population. As heterogeneity of included studies was high, effect estimates should be interpreted with caution and as guiding values rather than exact risk estimates. We interpret our findings in the context of social exclusion and isolation stress, and provide an explanatory framework that links cultural differences in verbal communication and experienced discrimination with the emergence of psychotic experiences and their neurobiological correlates. In this context, we discuss studies observing stress-dependent alterations of dopamine neurotransmission in studies among migrants versus non-migrants as well as in subjects with psychotic disorders. We suggest that social stress effects can impair contextualization of the meaning of verbal messages, which can be accounted for in Bayesian terms by a reduced precision of prior beliefs relative to sensory data, causing increased prediction errors and resulting in a shift towards the literal or "concrete" meaning of words. Compensatory alterations in higher-level beliefs, e.g., in the form of generalized interpretations of ambiguous interactions as hostile behavior, may contribute to psychotic experiences in migrants. We thus suggest that experienced discrimination and social exclusion is at the core of increased rates of psychotic experiences in subjects with a migration background.
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Affiliation(s)
- Jonathan Henssler
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Lasse Brandt
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute of Health Economics and Clinical Epidemiology, University Hospital of Cologne, Cologne, Germany
| | - Shuyan Liu
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Philipp Sterzer
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Berlin School of Mind and Brain, Berlin, Germany.,Bernstein Center of Computational Neuroscience Berlin, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,Berlin School of Mind and Brain, Berlin, Germany. .,Bernstein Center of Computational Neuroscience Berlin, Berlin, Germany.
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Bröcker AL, Bayer S, Stuke F, Just S, Bertram G, Funcke J, Grimm I, Lempa G, von Haebler D, Montag C. Levels of Structural Integration Mediate the Impact of Metacognition on Functioning in Non-affective Psychosis: Adding a Psychodynamic Perspective to the Metacognitive Approach. Front Psychol 2020; 11:269. [PMID: 32153475 PMCID: PMC7047329 DOI: 10.3389/fpsyg.2020.00269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/04/2020] [Indexed: 12/12/2022] Open
Abstract
Synthetic metacognition is defined by integrative and contextualizing processes of discrete reflexive moments. These processes are supposed to be needed to meet intrapsychic as well as interpersonal challenges and to meaningfully include psychotic experience in a personal life narrative. A substantial body of evidence has linked this phenomenon to psychosocial functioning and treatment options were developed. The concept of synthetic metacognition, measured with the Metacognition Assessment Scale-Abbreviated (MAS-A), rises hope to bridge gaps between therapeutic orientations and shares valuable parallels to modern psychodynamic constructs, especially the 'levels of structural integration' of the Operationalized Psychodynamic Diagnosis (OPD-2). As theoretical distinctions remain, aim of this study was to compare the predictive value of both constructs with regard to psychosocial functioning of patients with non-affective psychoses, measured with the International Classification of Functioning, Disability and Health (MINI-ICF-APP). It was further explored if levels of structural integration (OPD-LSIA) would mediate the impact of metacognition (MAS-A) on function (MINI-ICF-APP). Expert ratings of synthetic metacognition (MAS-A), the OPD-2 'levels of structural integration' axis (OPD-LSIA), psychosocial functioning (MINI-ICF-APP) and assessments of general cognition and symptoms were applied to 100 individuals with non-affective psychoses. Whereas both, MAS-A and OPD-LSIA, significantly predicted MINI-ICF-APP beyond cognition and symptoms, OPD-LSIA explained a higher share of variance and mediated the impact of MAS-A on MINI-ICF-APP. Levels of structural integration, including the quality of internalized object representations and unconscious interpersonal schemas, might therefore be considered as valuable predictors of social functioning and as one therapeutic focus in patients with non-affective psychoses. Structural integration might go beyond and form the base of a person's actual reflexive and metacognitive capabilities. Psychotherapeutic procedures specific for psychoses may promote and challenge a patient's metacognitive capacities, but should equally take the need for maturing structural skills into account. Modern psychodynamic approaches to psychosis are shortly presented, providing concepts and techniques for the implicit regulation of interpersonal experience and aiming at structural integration in this patient group.
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Affiliation(s)
- Anna-Lena Bröcker
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Samuel Bayer
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Frauke Stuke
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sandra Just
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Gianna Bertram
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jakob Funcke
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Imke Grimm
- International Psychoanalytic University Berlin, Berlin, Germany
| | | | - Dorothea von Haebler
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
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Mentalization and Psychosis: A Rationale for the Use of Mentalization Theory to Understand and Treat Non-affective Psychotic Disorder. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2020. [DOI: 10.1007/s10879-019-09449-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractSocial functioning can be severely impaired in non-affective psychotic disorder (NAPD). Current models of psychosis pathogenesis do not tend to focus on social dysfunction and pharmacological treatment fails to ameliorate it. In this article, we propose that mentalization theory provides a valuable contribution to the understanding and treatment of NAPD. Impaired mentalizing may contribute to both positive and negatives symptoms as well as social dysfunction observed in NAPD. Furthermore, impaired mentalizing may help explain the relation between childhood abuse, insecure attachment and psychosis. Mentalization based treatment may contribute to the functional recovery of NAPD patients as it targets the social cognitive processes underlying social interaction. The article includes a description of the principles of MBT in general, specific characteristics of using MBT with patients with NAPD and a clinical vignette to illustrate these principles.
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