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Heriot-Maitland C, Wykes T, Peters E. Social influences on the relationship between dissociation and psychotic-like experiences. Psychol Med 2024:1-9. [PMID: 38825863 DOI: 10.1017/s0033291724001405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
BACKGROUND Shame is experienced as a threat to social self, and so activates threat-protective responses. There is evidence that shame has trauma-like characteristics, suggesting it can be understood within the same conceptual framework as trauma and dissociation. Evidence for causal links among trauma, dissociation, and psychosis thus warrant the investigation of how shame may influence causal mechanisms for psychosis symptoms. METHODS This study tested the interaction between dissociation and shame, specifically external shame (feeling shamed by others), in predicting psychotic-like experiences (PLEs) six months later in a general population sample (N = 314). It also tested if social safeness moderates these effects. A longitudinal, online questionnaire design tested a moderation model (dissociation-shame) and a moderated moderation model (adding social safeness), using multiple regressions with bootstrap procedures. RESULTS Although there was no direct effect of dissociation on PLEs six months later, there was a significant interaction effect with shame, controlling for PLEs at baseline. There were complex patterns in the directions of effects: For high-shame-scorers, higher dissociation predicted higher PLE scores, but for low-shame-scorers, higher dissociation predicted lower PLE scores. Social safeness was found to significantly moderate these interaction effects, which were unexpectedly more pronounced in the context of higher social safeness. CONCLUSIONS The results demonstrate evidence for an interaction between dissociation and shame on its impact on PLEs, which manifests particularly for those experiencing higher social safeness. This suggests a potential role of social mechanisms in both the etiology and treatment of psychosis, which warrants further testing in clinical populations.
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Affiliation(s)
- Charles Heriot-Maitland
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Til Wykes
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Emmanuelle Peters
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Abstract
PURPOSE This paper outlines the theoretical and empirical basis for compassion focused therapy (CFT) for psychosis, the gaps in the current knowledge and research, as well as some of the challenges for addressing gaps. It will guide the direction of future work and the steps needed to develop and advance this approach. METHOD This paper reviews evidence of how evolutionary models such as social rank theory and attachment theory have greatly contributed to our understanding of psychosis and provide a clear rationale and evidence base for the mechanisms of change in CFT for psychosis. It reviews the evidence for outcomes of compassion training more generally, and early feasibility evaluations of CFT for psychosis. RESULTS The process evidence shows that people with psychosis have highly active social rank and threat systems, and the benefits of switching into attachment and care systems, which can support emotion regulation and integrative mind states. The outcomes evidence shows that compassion training impacts not only psychological outcomes, but also physiological outcomes such as neural circuits, immune system, and the autonomic nervous system. Within the psychosis field, outcomes research is still in the early days, but there are good indications of feasibility and a clear path forward for the next steps. CONCLUSIONS CFT for psychosis is an approach that integrates biopsychosocial processes, an integration that's evidenced across each aspect of the model, from theoretical foundations (evolution-informed) to interventions (e.g., body/breath training and relational techniques), to evaluation. Future RCTs are required to understand the effects on biopsychosocial outcomes for people with psychosis.
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Affiliation(s)
- Charles Heriot-Maitland
- Balanced Minds, London, UK
- King's College London, London, UK
- University of Glasgow, Glasgow, UK
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van Sambeek N, Franssen G, van Geelen S, Scheepers F. Making meaning of trauma in psychosis. Front Psychiatry 2023; 14:1272683. [PMID: 38025479 PMCID: PMC10656619 DOI: 10.3389/fpsyt.2023.1272683] [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: 08/04/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Finding new meaning and identity in the aftermath of trauma has been identified as a key process of mental health recovery. However, research indicates that this meaning-making process is compromised in people with psychosis. Considering the high prevalence, yet under-treatment of trauma in people with psychosis, it is urgent to gain insight into how their meaning-making process can be supported. Aim To gain insight into how people with psychosis make meaning of trauma and identify barriers and facilitators in their meaning-making process. Methods Qualitative inquiry of N = 21 interviews transcripts from the Dutch Psychiatry Storybank. We included interviews of people who (a) lived through multiple psychotic episodes, and (b) spontaneously addressed traumatic experiences in a low-structured interview. Storyline analysis was performed to gain insight into the meaning-making of trauma within their self-stories. Psychosocial conceptualizations of narrative identity were used to inform the analysis. A data-validation session with four experts-by-experience was organized to check and improve the quality of our analysis. Results We identified four different story types: (1) Psychiatry as the wrong setting to find meaning; (2) The ongoing struggle to get trauma-therapy; (3) Exposure to trauma as a threat to a stable life, and (4) Disclosure as the key to resolving alienation. Each story type comprises a different plot, meaning of trauma withing the self-story, (lack of) integration and barriers and facilitators in the meaning-making process. Overall, barriers in the meaning-making process were mostly situated within mental healthcare and stigma-related. People felt particularly hindered by pessimistic ideas on their capacity to develop self-insight and cope with distress, resulting in limited treatment options. Their process of adaptive meaning-making often started with supportive, non-judgmental relationships with individuals or communities that offered them the safety to disclose trauma and motivated them to engage in a process of self-inquiry and growth. Conclusion The outcomes illuminate the social context of the meaning-making challenges that people with psychosis face and illustrate the devastating influence of stigma. Our outcomes offer guidance to remove barriers to adaptive meaning-making in people with psychosis, and can help clinicians to attune to differences in the meaning-making of trauma.
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Affiliation(s)
- Nienke van Sambeek
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Gaston Franssen
- Faculty of Humanities, University of Amsterdam, Amsterdam, Netherlands
| | | | - Floortje Scheepers
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
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Shah DB, Fichadia PA, Shah FH, Patel SS, Jain IN. Acute Psychotic Episode Precipitated by Opioid Withdrawal in a Case of Bipolar I Disorder. Cureus 2023; 15:e45538. [PMID: 37868375 PMCID: PMC10585184 DOI: 10.7759/cureus.45538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Psychosis is a state of mind where an individual loses touch with reality and cannot differentiate between their perceptions and the real world. They experience one or more of the following: delusions, hallucinations, disorganized speech or catatonic behavior. While it can have a sporadic onset, drug-induced psychosis is also very common. When a person consuming large quantities of a particular drug, such as opioids, stops consuming the drug and enters the rehabilitation stage, this is a vulnerable time due to abrupt chemical changes. It can predispose the individual to psychosis due to withdrawal from the drug. Here, we present a 30-year-old Caucasian female who underwent rehabilitation and was treated successfully with buprenorphine/naloxone (Suboxone) for eight months. However, due to a comorbid psychiatric condition, mania, she was not able to adhere to her medication regimen, which led to an abrupt discontinuation of her maintenance medication, and this led to psychotic symptoms, including agitation, hallucinations, delusions, and bizarre behavior surrounding her family and individual health. Later, she restarted on buprenorphine/naloxone, which led to a gradual recovery and disappearance of her psychotic symptoms.
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Affiliation(s)
- Darshini B Shah
- Medicine, GCS Medical College, Hospital & Research Center, Ahmedabad, IND
| | - Palak A Fichadia
- Medicine, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College (MMC), Ahmedabad, IND
| | - Freya H Shah
- Internal Medicine, Landmark Medical Center, Woonsocket, USA
- Internal Medicine, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College (MMC), Ahmedabad, IND
| | - Shirish S Patel
- Psychiatry, Windsor University School of Medicine, Cayon, KNA
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Kim D, Kim D, Kim EK. Dissociation mediates association between childhood trauma and distress from trauma research participation: analysis of pooled clinical data. PSYCHOSIS 2023. [DOI: 10.1080/17522439.2023.2176536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Affiliation(s)
- Dongjoo Kim
- Department of Psychiatry, College of Medicine, Hanyang University, Seoul, South Korea
| | | | - Eun Kyoung Kim
- Department of Premedicine, Hanyang University, Seoul, South Korea
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Chemsex and Psychosis: A Systematic Review. Behav Sci (Basel) 2022; 12:bs12120516. [PMID: 36546999 PMCID: PMC9774634 DOI: 10.3390/bs12120516] [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: 11/16/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Chemsex is presented as a major challenge in public health, with numerous physical and mental consequences. The general objective of this review was to analyze the relationship between the practice of chemsex and the development of psychosis. A mixed systematic review model was chosen. PubMed, PsycINFO, and Web of Science databases were searched following a predetermined search strategy. The studies were selected, and their information was extracted following a systematic method. A total of 10 articles were included. Psychotic symptoms ranged from 6.7% to 37.2%, being one of the most frequent psychiatric diagnoses. Slamsex, polydrug use and smoked methamphetamine posed up to a 3-fold increased risk of psychosis within this practice. The risk factors found were foreign or ethnic minority status, location in large cities, stress and anxiety, trauma, loneliness, sexually transmitted infections (STIs), hepatitis, and previous psychotic history. In conclusion, chemsex is associated with psychosis development; we found numerous converging risk factors and a clear mediating role of drugs. It is important, in approaching the prevention and treatment of this addiction, to take into account motivations and psychosocial circumstances.
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Lazaridou FB, Schubert SJ, Ringeisen T, Kaminski J, Heinz A, Kluge U. Racism and psychosis: an umbrella review and qualitative analysis of the mental health consequences of racism. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01468-8. [PMID: 36001139 PMCID: PMC9400567 DOI: 10.1007/s00406-022-01468-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
Black people and People of Color are disproportionately affected by racism and show increased rates of psychosis. To examine whether racialized migrant groups are particularly exposed to racism and therefore have higher risks for psychosis, this paper (1) systematically assesses rates of psychosis among racialized migrant groups concerning the country of origin, and (2) analyzes interviews regarding the association of racism experiences with psychosis-related symptoms in racialized Black people and People of Color populations in Germany. We present an umbrella review of meta-analyses that report the incidence of positive symptoms (e.g., hallucinations and delusions) and negative symptoms (e.g., apathy and incoherent speech) of diagnosed schizophrenia, other non-affective psychotic disorders (e.g., schizoaffective disorder) or first-episode psychosis among migrants by country of origin. We also report 20 interviews with first- and second-generation migrants racialized as Black and of Color in Germany to capture and classify their experiences of racism as well as racism-associated mental health challenges. In the umbrella review, psychosis risk was greatest when migration occurred from developing countries. Effect size estimates were even larger among Caribbean and African migrants. In the qualitative study, the application of the constant comparative method yielded four subordinate themes that form a subclinical psychosis symptomatology profile related to experiences of racism: (1) a sense of differentness, (2) negative self-awareness, (3) paranoid ideation regarding general persecution, and (4) self-questioning and self-esteem instability. We here provide converging evidence from a quantitative and qualitative analysis that the risk of poor mental health and psychotic experiences is related to racism associated with minority status and migration.
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Affiliation(s)
- Felicia Boma Lazaridou
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Campus Mitte, Berlin, Germany. .,National Discrimination and Racism Monitor, German Institute for Integration and Migration Research - DeZIM, Berlin, Germany. .,Department of Migration, Mental and Physical Health and Health Promotion, Berlin Institute of Integration and Migration Research (BIM), Humboldt University, Berlin, Germany.
| | | | | | - Jakob Kaminski
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Campus Mitte, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Campus Mitte, Berlin, Germany ,Department of Migration, Mental and Physical Health and Health Promotion, Berlin Institute of Integration and Migration Research (BIM), Humboldt University, Berlin, Germany ,Department of Psychiatry and Psychotherapy, Charité University Medicine, Alexianer St. Hedwig-Hospital, Berlin, Germany
| | - Ulrike Kluge
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Campus Mitte, Berlin, Germany ,Department of Migration, Mental and Physical Health and Health Promotion, Berlin Institute of Integration and Migration Research (BIM), Humboldt University, Berlin, Germany
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