Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-27T21:18:43.590Z Has data issue: false hasContentIssue false
  • English
  • Français

Emotional and symptomatic reactivity to stress in individuals at ultra-high risk of developing psychosis

Published online by Cambridge University Press:  09 November 2011

J. E. Palmier-Claus ,
G. Dunn  and
S. W. Lewis
J. E. Palmier-Claus*
Affiliation:
School of Community Based Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
G. Dunn
Affiliation:
School of Community Based Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
S. W. Lewis
Affiliation:
School of Community Based Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
*
*Address for correspondence: J. E. Palmier-Claus, Room 3.309, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The stress–vulnerability model of psychosis continues to be influential. The aim of this study was to compare emotional and symptomatic responses to stress in individuals at ultra-high risk (UHR) of developing psychosis, in age- and gender-matched healthy controls, and in patients with non-affective psychosis.

Method

A total of 27 UHR, 27 psychotic and 27 healthy individuals completed the experience sampling method, an ambulant diary technique, where they were required to fill in self-assessment questions about their emotions, symptoms and perceived stress at semi-random times of the day for 6 days. Quesionnaire and interview assessments were also completed.

Results

Multilevel regression analyses showed that individuals at UHR of developing psychosis reported greater negative emotions in response to stress than the healthy individuals. Against the initial hypotheses, the UHR individuals also experienced greater emotional reactivity to stress when compared with the patient group. No significant differences were observed between the patients and the non-clinical sample. Stress measures significantly predicted the intensity of psychotic symptoms in UHR individuals and patients, but the extent of this did not significantly differ between the groups.

Conclusions

Individuals at UHR of developing psychosis may be particularly sensitive to everyday stressors. This effect may diminish after transition to psychosis is made and in periods of stability. Subtle increases in psychotic phenomena occur in response to stressful events across the continuum of psychosis.

Keywords

Prodromepsychosisschizophreniastressultra-high risk
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 5 , May 2012 , pp. 1003 - 1012
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Altman, DG, Royston, P (2006). The cost of dichotomising continuous variables. British Medical Journal 332, 1080.CrossRefGoogle ScholarPubMed
Bebbington, P, Wilkins, S, Jones, P, Foerster, A, Murray, R, Toone, B, Lewis, S (1993). Life events and psychosis. Initial results from the Camberwell Collaborative Psychosis Study. British Journal of Psychiatry 162, 72–79.Google Scholar
Cohen, S, Kamarck, T, Mermelstein, R (1983). A global measure of perceived stress. Journal of Health and Social Behavior 24, 385–396.CrossRefGoogle ScholarPubMed
Cole, SR (1999). Assessment of differential item functioning in the Perceived Stress Scale-10. Journal of Epidemiology and Community Health 53, 319–320.Google Scholar
Collip, D, Myin-Germeys, I, Van Os, J (2008). Does the concept of “sensitization” provide a plausible mechanism for the putative link between the environment and schizophrenia? Schizophrenia Bulletin 34, 220–225.CrossRefGoogle ScholarPubMed
Csikszentmihalyi, M, Larson, R (1987). Validity and reliability of the Experience-Sampling Method. Journal of Nervous and Mental Disease 175, 526–536.Google Scholar
Delespaul, P (1995). Assessing Schizophrenia in Daily Life: The Experience Sampling Method. Universitaire Pers Maastricht: Maastricht, The Netherlands.Google Scholar
Froot, KA (1989). Consistent covariance matrix estimation with cross-sectional dependence and heteroskedasticity in financial data. Journal of Financial and Quantitative Analysis 24, 333–355.CrossRefGoogle Scholar
Garety, PA, Kuipers, E, Fowler, D, Freeman, D, Bebbington, PE (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine 31, 189–195.CrossRefGoogle ScholarPubMed
Garner, B, Pariante, CM, Wood, SJ, Velakoulis, D, Phillips, L, Soulsby, B, Brewer, WJ, Smith, DJ, Dazzan, P, Berger, GE (2005). Pituitary volume predicts future transition to psychosis in individuals at ultra-high risk of developing psychosis. Biological Psychiatry 58, 417–423.Google Scholar
Glaser, JP, van Os, J, Portegijs, PJM, Myin-Germeys, I (2006). Childhood trauma and emotional reactivity to daily life stress in adult frequent attenders of general practitioners. Journal of Psychosomatic Research 61, 229–236.CrossRefGoogle ScholarPubMed
Hewitt, PL, Flett, GL, Mosher, SW (1992). The Perceived Stress Scale: factor structure and relation to depression symptoms in a psychiatric sample. Journal of Psychopathology and Behavioral Assessment 14, 247–257.CrossRefGoogle Scholar
Huber, PJ (1967). The behaviour of maximum likelihood estimates under nonstandard conditions. In Proceedings of the Fifth Berkeley Symposium on Mathematical Statistics and Probability, vol. 4, pp. 221–223. University of California Press: Berkeley, CA.Google Scholar
Jacobs, N, Myin-Germeys, I, Derom, C, Delespaul, P, Van Os, J, Nicolson, N (2007). A momentary assessment study of the relationship between affective and adrenocortical stress responses in daily life. Biological Psychology 74, 60–66.CrossRefGoogle ScholarPubMed
Johns, LC, van Os, J (2001). The continuity of psychotic experiences in the general population. Clinical Psychology Review 21, 1125–1141.CrossRefGoogle ScholarPubMed
Kapur, S (2003). Psychosis as a state of aberrant salience: a framework linking biology, phenomenology, and pharmacology in schizophrenia. American Journal of Psychiatry 160, 13–23.Google Scholar
Laruelle, M (2000). The role of endogenous sensitization in the pathophysiology of schizophrenia: implications from recent brain imaging studies. Brain Research Reviews 31, 371–384.CrossRefGoogle ScholarPubMed
Lataster, T, Collip, D, Lardinois, M, Van Os, J, Myin-Germeys, I (2010). Evidence for a familial correlation between increased reactivity to stress and positive psychotic symptoms. Acta Psychiatrica Scandinavica 122, 395–404.CrossRefGoogle ScholarPubMed
Lataster, T, Wichers, M, Jacobs, N, Mengelers, R, Derom, C, Thiery, E, Van Os, J, Myin-Germeys, I (2009). Does reactivity to stress cosegregate with subclinical psychosis? A general population twin study. Acta Psychiatrica Scandinavica 119, 45–53.CrossRefGoogle ScholarPubMed
Lazarus, R, Folkman, S (1984). Stress, Appraisal and Coping. Springer: New York.Google Scholar
Lincoln, TM, Lange, J, Burau, J, Exner, C, Moritz, S (2009). The effect of state anxiety on paranoid ideation and jumping to conclusions. An experimental investigation. Schizophrenia Bulletin 29, 1129–1139.Google Scholar
Lobban, F, Barrowclough, C (2009). A Casebook of Family Interventions for Psychosis. John Wiley & Sons: Chichester.Google Scholar
MacCallum, RC, Zhang, S, Preacher, KJ, Rucker, DD (2002). On the practice of dichotomization of quantitative variables. Psychological Methods 7, 19–40.CrossRefGoogle ScholarPubMed
Malla, A, Cortese, L, Shaw, T, Ginsberg, B (1990). Life events and relapse in schizophrenia. Social Psychiatry and Psychiatric Epidemiology 25, 221–224.CrossRefGoogle ScholarPubMed
McGorry, P, Johanessen, J, Lewis, S, Birchwood, M, Malla, A, Nordentoft, M, Addington, J, Yung, A (2010). Early intervention in psychosis: keeping faith with evidence-based health care. Psychological Medicine 40, 399–404.CrossRefGoogle ScholarPubMed
Meichenbaum, DH, Deffenbacher, JL (1988). Stress inoculation training. Counseling Psychologist 16, 69–90.CrossRefGoogle Scholar
Meyer, SE, Bearden, CE, Lu, SR, Gordon, JL, Johnson, JK, O'Brien, MP, Niendam, TA, Loewy, RL, Ventura, J, Cannon, TD (2005). The psychosis prodrome in adolescent patients viewed through the lens of DSM-IV. Journal of Child Adolescent Psychopharmacology 15, 434–451.CrossRefGoogle ScholarPubMed
Mooney, CZ, Duval, RD (1993). Bootstrapping: A Non-Parametric Approach to Statistical Inference. Sage Publications: Newbury Park, CA.CrossRefGoogle Scholar
Morrison, AP (2001). The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy 29, 257–276.CrossRefGoogle Scholar
Morrison, AP, French, P, Walford, L, Lewis, SW, Kilcommons, A, Green, J, Parker, S, Bentall, RP (2004). Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial. British Journal of Psychiatry 185, 291–297.CrossRefGoogle ScholarPubMed
Morrison, AP, Haddock, G, Tarrier, N (1994). Intrusive thoughts and auditory hallucinations: a cognitive approach. Behavioural and Cognitive Psychotherapy 23, 265–280.CrossRefGoogle Scholar
Myin-Germeys, I, Marcelis, M, Krabbendam, L, Delespaul, P, van Os, J (2005). Subtle fluctuations in psychotic phenomena as functional states of abnormal dopamine reactivity in individuals at risk. Biological Psychiatry 58, 105–110.CrossRefGoogle ScholarPubMed
Myin-Germeys, I, Peeters, F, Havermans, R, Nicolson, NA (2003). Emotional reactivity to daily life stress in psychosis and affective disorder: an experience sampling study. Acta Psychiatrica Scandinavica 107, 124–131.CrossRefGoogle ScholarPubMed
Myin-Germeys, I, van Os, J, Schwartz, JE, Stone, AA, Delespaul, PA (2001). Emotional reactivity to daily life stress in psychosis. Archives of General Psychiatry 58, 1137–1144.CrossRefGoogle ScholarPubMed
Nicolo, J-P, Berger, GE, Garner, BA, Velakoulis, D, Markulev, C, Kerr, M, McGorry, PD, Proffitt, T-M, McConchie, M, Pantelis, C, Wood, SJ (2010). The effect of atypical antipsychotics on pituitary gland volume in patients with first-episode psychosis: a longitudinal MRI study. Schizophrenia Research 116, 49–54.CrossRefGoogle ScholarPubMed
Norman, R, Malla, AK (1991). Subjective stress in schizophrenic patients. Social Psychiatry and Psychiatric Epidemiology 26, 212–216.CrossRefGoogle ScholarPubMed
Norman, R, Malla, AK (1994). A prospective study of daily stressors and symptomatology in schizophrenic patients. Social Psychiatry and Psychiatric Epidemiology 29, 244–249.CrossRefGoogle ScholarPubMed
Nuechterlein, KH, Dawson, ME (1984). A heuristic vulnerability/stress model of schizophrenic episodes. Schizophrenia Bulletin 10, 300–312.CrossRefGoogle ScholarPubMed
Palmier-Claus, J, Dunn, G, Morrison, AP, Lewis, S (in press a). The role of metacognitive beliefs in stress sensitisation, self-esteem variability and the generation of paranoia. Cognitive Neuropsychiatry.Google Scholar
Palmier-Claus, J, Myin Germeys, I, Barkus, E, Bentley, L, Udachina, A, Delespaul, P, Lewis, S, Dunn, G (2010). Experience sampling research in individuals with mental illness: reflections and guidance. Acta Psychiatrica Scandinavica 123, 12–20.CrossRefGoogle ScholarPubMed
Palmier-Claus, J, Taylor, PJ, Gooding, P, Dunn, G, Lewis, S (in press b). Affective variability predicts suicidal ideation in individuals at ultra-high risk of developing psychosis: an experience sampling study. British Journal of Clinical Psychology.Google Scholar
Peters, ER, Joseph, SA, Garety, PA (1999). Measurement of delusional ideation in the normal population: introducing the PDI (Peters et al. Delusions Inventory). Schizophrenia Bulletin 25, 553–576.CrossRefGoogle Scholar
Petersen, L, Jeppesen, P, Thorup, A, Abel, MB, Øhlenschlæger, J, Christensen, TØ, Krarup, G, Jørgensen, P, Nordentoft, M (2005). A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness. British Medical Journal 331, 602.CrossRefGoogle ScholarPubMed
Remor, E (2006). Psychometric properties of a European Spanish version of the Perceived Stress Scale (PSS). Spanish Journal of Psychology 9, 86–93.CrossRefGoogle ScholarPubMed
Rogers, WH (1993). Regression standard errors in clustered samples. Stata Technical Bulletin 13, 19–23.Google Scholar
Russell, JA, Carroll, JM (1999). On the bipolarity of positive and negative affect. Psychological Bulletin 125, 3–30.CrossRefGoogle ScholarPubMed
SPSS Inc. (1998). SPSS Base 8.0 for Windows User's Guide. SPSS Inc.: Chicago, IL.Google Scholar
StataCorp LP (2007). Stata Reference Manual, Release 10.0. Stata Press: College Station, TX.Google Scholar
Thompson, KN, Berger, G, Phillips, LJ, Komesaroff, P, Purcell, R, McGorry, PD (2007). HPA axis functioning associated with transition to psychosis: combined DEX/CRH test. Journal of Psychiatric Research 41, 446–450.CrossRefGoogle ScholarPubMed
Varese, F, Udachina, A, Myin-Germeys, I, Oorschot, M, Bentall, RP (2011). The relationship between dissociation and auditory verbal hallucinations in the flow of daily life of patients with psychosis. Psychosis 3, 14–28.CrossRefGoogle Scholar
Wells, A, Matthews, G (1996). Modelling cognition in emotional disorder: the S-REF model. Behaviour Research and Therapy 34, 881–888.CrossRefGoogle ScholarPubMed
White, H (1980). A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity. Econometrica 48, 817–830.Google Scholar
Yung, AR, McGorry, PD, McFarlane, CA, Patton, GC (1995). The PACE Clinic: development of a clinical service for young people at high risk of psychosis. Australasian Psychiatry 3, 345–349.CrossRefGoogle Scholar
Yung, AR, Phillips, LJ, McGorry, PD, McFarlane, CA, Francey, S, Harrigan, S, Patton, GC, Jackson, HJ (1998). Prediction of psychosis: a step towards indicated prevention of schizophrenia. British Journal of Psychiatry 172, 14–20.CrossRefGoogle ScholarPubMed
Yung, AR, Yuen, HP, Berger, G, Francey, S, Hung, TC, Nelson, B, Phillips, L, McGorry, P (2007). Declining transition rate in ultra high risk (prodromal) services: dilution or reduction of risk? Schizophrenia Bulletin 33, 673–681.CrossRefGoogle ScholarPubMed
Yung, AR, Yuen, HP, McGorry, PD, Phillips, LJ, Kelly, D, Dell'Olio, M, Francey, SM, Cosgrave, EM, Killackey, E, Stanford, C, Godfrey, K, Buckby, J (2005). Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Australian and New Zealand Journal of Psychiatry 39, 964–971.Google Scholar
Zubin, J, Spring, B (1977). Vulnerability: a new view of schizophrenia. Journal of Abnormal Psychology 86, 103–126.CrossRefGoogle ScholarPubMed