Hostname: page-component-cd9895bd7-jn8rn Total loading time: 0 Render date: 2024-12-25T06:13:10.290Z Has data issue: false hasContentIssue false

Life Events and Psychosis

Initial Results from the Camberwell Collaborative Psychosis Study

Published online by Cambridge University Press:  03 January 2018

Paul Bebbington*
Affiliation:
Institute of Psychiatry, De Crespigny Park, London SE5 8AF
Soraya Wilkins
Affiliation:
Genetics Section, Institute of Psychiatry, De Crespigny Park, London SE5 8AF
Peter Jones
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry and King's College Hospital, De Crespigny Park, London SE5 8AF
Alice Foerster
Affiliation:
National Institutes of Mental Health, Bethesda, Maryland, USA
Robin Murray
Affiliation:
Institute of Psychiatry and King's College Hospital, De Crespigny Park, London SE5 8AF
Brian Toone
Affiliation:
King's College and Maudsley Hospitals, Denmark Hill, London SE5 9RS
Shôn Lewis
Affiliation:
Academic Department of Psychiatry, Charing Cross and Westminster Medical School, London W6 8RP
*
Correspondence

Abstract

Data from the Camberwell Collaborative Psychosis Study were used to examine the proposition that there is an excess of life events preceding the onset of psychoses of all types. Of 97 patients from the study who had episodes within the past year that were datable, 51 had developed psychotic symptoms from an essentially symptom-free state, 29 had been suffering only from neurotic symptoms, and 17 had experienced a marked exacerbation of psychotic symptoms. DSM–III diagnoses were collapsed into three major groups: 51 cases of schizophrenia; 31 cases of mania; and 14 cases of depressive psychosis. Life-event histories were taken for the six months before onset, and when these were compared with equivalent histories from a psychiatrically healthy sample from the local general population, there was a significant excess of life events, particularly in the three months before onset of psychosis. This was apparent in all groups, and remained even when events were restricted to the independent category. The excess of events began rather earlier than has been found in previous studies. In our view, this study provides some of the strongest evidence for a link between life events and the emergence of psychotic symptoms.

Type
Research Article
Copyright
Copyright © The Royal College of Psychiatrists 

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

Al Khani, M. A. F., Bebbington, P. E., Watson, J. P., et al (1986) Life events and schizophrenia: a Saudi Arabian study. British Journal of Psychiatry, 148, 1222.Google Scholar
Ambelas, A. (1979) Psychologically stressful events in the precipitation of manic episodes. British Journal of Psychiatry, 135, 1521.CrossRefGoogle ScholarPubMed
Ambelas, A. (1987) Life events and mania: a special relationship? British Journal of Psychiatry, 150, 235240.CrossRefGoogle Scholar
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM–III). Washington, DC: APA.Google Scholar
Bebbington, P. E. (1987) Life events and schizophrenia: The WHO collaborative study. Social Psychiatry, 22, 179180.CrossRefGoogle ScholarPubMed
Bebbington, P. E., Tennant, C. & Hurry, J. (1981a) Life events and the nature of psychiatric disorder in the community. Journal of Affective Disorders, 3, 345366.Google Scholar
Bebbington, P. E., Hurry, J., Tennant, C., et al (1981b) The epidemiology of mental disorders in Camberwell. Psychological Medicine, 11, 561580.CrossRefGoogle ScholarPubMed
Bebbington, P. E., Brugha, T., MacCarthy, B., et al (1988) The Camberwell Collaborative Depression Study. I. Depressed probands: adversity and the form of depression. British Journal of Psychiatry, 152, 754765.Google Scholar
Bebbington, P. E. & Kuipers, L. (1992) Social causation of schizophrenia. In Principles of Social Psychiatry (eds Bhugra, D. & Leff, J. P.). Oxford: Blackwells.Google Scholar
Benjaminsen, S. (1981) Primary non-endogenous depression and features attributed to reactive depression. Journal of Affective Disorders, 3, 245259.CrossRefGoogle ScholarPubMed
Brown, G. W. (1974) Meaning, measurement and stress of life events. In Stressful Life Events: Their Nature and Effects (eds Dohrenwend, B. S. & Dohrenwend, B. P.). New York: Wiley.Google Scholar
Brown, G. W. & Birley, J. L. T. (1968) Crises and life changes and the onset of schizophrenia. Journal of Health and Social Behaviour, 9, 203214.Google Scholar
Brown, G. W., Harris, T. O. & Peto, J. (1973) Life events and psychiatric disorders. Part 2: Nature of causal link. Psychological Medicine, 3, 159176.Google Scholar
Brown, G. W. & Harris, T. O. (1978) Social Origins of Depression. London: Tavistock.Google Scholar
Brown, G. W. & Harris, T. O. (1989) Life Events and Illness. London: Unwin Hyman.Google Scholar
Brugha, T. & Conroy, R. (1985) Categories of depression: reported life events in a controlled design. British Journal of Psychiatry, 147, 641646.Google Scholar
Canton, G. & Fraccon, I. G. (1985) Life events and schizophrenia: a replication. Acta Psychiatrica Scandinavica, 71, 211216.Google Scholar
Castle, D. J. & Murray, R. M. (1991) The neurodevelopmental basis of sex differences in schizophrenia. Psychological Medicine, 21, 565576.Google Scholar
Chung, R. K., Langeluddecke, P. & Tennant, C. (1986) Threatening life events in the onset of schizophrenia, schizophreniform psychosis and hypomania. British Journal of Psychiatry, 148, 680686.CrossRefGoogle ScholarPubMed
Clancy, J., Crowe, R., Winokur, G., et al (1973) The Iowa 500: Precipitating factors in schizophrenia and primary affective disorder. Comprehensive Psychiatry, 14, 197202.Google Scholar
Day, R., Neilsen, J. A., Korten, A., et al (1987) Stressful life events preceding the acute onset of schizophrenia: a cross-national study from the World Health Organization. Culture, Medicine and Psychiatry, 11, 123206.CrossRefGoogle ScholarPubMed
Dohrenwend, B. S. & Dohrenwend, B. P. (1974) Overview and prospects for research on stressful life events. In Stressful Life Events: Their Nature and Effects (eds Dohrenwend, B. S. & Dohrenwend, B. P.). New York: Wiley.Google Scholar
Drake, R. E. & Sederer, L. I. (1986) The adverse effects of intensive treatment of chronic schizophrenia. Comprehensive Psychiatry, 27, 313326.Google Scholar
Duncan-Jones, P. (1981) The natural history of neurosis: probability models. In What is a Case? The Problem of Definition in Psychiatric Community Surveys (eds Wing, J. K., Bebbington, P. E. & Robins, L. N.). London: Grant McIntyre.Google Scholar
Dunner, D. L., Patrick, V. & Fieve, R. R. (1979) Life events at the onset of bipolar affective illness. American Journal of Psychiatry, 136, 508511.CrossRefGoogle ScholarPubMed
Glassner, B. & Haldipur, C. V. (1983) Life events and early and late onset of bipolar disorder. American Journal of Psychiatry, 140, 215217.Google Scholar
Goldberg, S. C., Schooler, N. R., Hogarty, G. E., et al (1977) Prediction of relapse in schizophrenic outpatients treated by drug and sociotherapy. Archives of General Psychiatry, 34, 171184.Google Scholar
Hirsch, S. R., Gaind, R., Rohde, P. D., et al (1973) Outpatient maintenance of chronic schizophrenic patients with long acting fluphenazine: a double blind placebo trial. British Medical Journal, i, 633637.Google Scholar
Hudgens, R. W., Morrison, J. R. & Barchka, R. (1967) Life events and onset of primary affective disorders. A study of 40 hospitalised patients and 40 controls. Archives of General Psychiatry, 16, 134145.Google Scholar
Jacobs, S. & Myers, J. (1976) Recent life events and acute schizophrenic psychosis: a controlled study. Journal of Nervous and Mental Disease, 162, 7587.Google Scholar
Jaspers, K. (1963) General Psychopathology (trans. Hoenig, J. & Hamilton, M. W.). Manchester: Manchester University Press.Google Scholar
Katschnig, H. (1984) Commentary to Paul Bebbington, Inferring causes: some constraints in the social psychiatry of depressive disorders. Integrative Psychiatry, 2, 7779.Google Scholar
Katschnig, H., Brandl-Nebehay, A., Fuchs-Robetin, G., et al (1981) Lebensverändernde Ereignisse, Psychoziale Dispositionen und Depressive Verstimmungzustande. Wien: Abteilung für Sozial-psychiatrie und Dokumentation. Psychiatrische Universitatsklinik.Google Scholar
Katschnig, H., Pakesh, G. & Egger-Zeidner, E. (1986) Life stress and subtypes of depression. In Life Events and Psychiatric Disorders: Controversial Issues (ed. Katschnig, H.). Cambridge: Cambridge University Press.Google Scholar
Kennedy, S., Thompson, R., Stancer, H. C., et al (1983) Life events precipitating mania. British Journal of Psychiatry, 142, 398403.CrossRefGoogle ScholarPubMed
Leff, M. H., Roach, J. F. & Bunney, W. E. (1970) Environmental factors preceding the onsets of severe depressions. Psychiatry, 33, 293311.CrossRefGoogle ScholarPubMed
Lloyd, C. (1980) Life events and depressive disorder reviewed: II. Events as precipitating factors. Archives of General Psychiatry, 37, 541548.CrossRefGoogle ScholarPubMed
Malla, A. K., Cortese, L., Shaw, T. S., et al (1990) Life events and relapse in schizophrenia: a one year prospective study. Social Psychiatry and Psychiatric Epidemiology, 25, 221224.CrossRefGoogle ScholarPubMed
Malzacher, M., Mertz, J. & Ebnother, D. (1981) Einschneidende Lebensereignisse im Vorfeld akuter schizophrener Episoden: Erstmals erkrankte Patienten im Vergleich mit einer Normalstichprobe. Archiv für Psychiatrie und Nervenkrankheiten, 230, 227242.Google Scholar
Michaux, W., Gansereit, K., McCabe, O., et al (1967) The psychopathology and measurement of environmental stress. Community Mental Health Journal, 3, 358371.Google Scholar
Nelson, C. J. & Charney, D. S. (1980) Primary affective disorder criteria and the endogenous-reactive distinction. Archives of General Psychiatry, 37, 787793.Google Scholar
Paykel, E. S., Rao, B. M. & Taylor, C. N. (1984) Life stress and symptom pattern in out-patient depression. Psychological Medicine, 14, 559568.Google Scholar
Roy, A., Breier, A., Doran, A. R., et al (1985) Life events and depression: relation to subtypes. Journal of Affective Disorders, 9, 143148.Google Scholar
Schwartz, C. & Myers, J. (1977) Life events and schizophrenia. Parts I and II. Archives of General Psychiatry, 34, 12381248.Google Scholar
Sclare, P. & Creed, F. (1990) Life events and the onset of mania. British Journal of Psychiatry, 156, 508514.Google Scholar
Stevens, B. C. (1973) Evaluation of rehabilitation for psychotic patients in the community. Acta Psychiatrica Scandinavica, 46, 136140.Google Scholar
Tennant, C., Smith, A., Bebbington, P., et al (1979) The contextual threat of life events: the concept and its reliability. Psychological Medicine, 9, 525528.CrossRefGoogle ScholarPubMed
Thompson, K. C. & Hendrie, H. C. (1972) Environmental stress in primary depressive illness. Archives of General Psychiatry, 26, 130132.Google Scholar
Ventura, J., Nuechterlein, K. H., Lukoff, D., et al (1989) A prospective study of stressful life events and schizophrenic relapse. Journal of Abnormal Psychology, 98, 407411.Google Scholar
von Cranach, M., Eberlein, R. & Holl, B. (1981) The concept of onset in psychiatry. In What is a Case? The Problem of Definition in Psychiatric Community Surveys (eds Wing, J. K., Bebbington, P. E. & Robins, L. N.). London: Grant MacIntyre.Google Scholar
Wing, J. K., Bennett, D. H. & Denham, J. (1964) The Industrial Rehabilitation of Long Stay Schizophrenic Patients, Medical Research Council Memo No. 42. London: HMSO.Google ScholarPubMed
Wing, J. K. & Brown, G. W. (1970) Institutionalism and Schizophrenia. A Comparative Study of Three Mental Hospitals 1960–68. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
Wing, J. K., Mann, S. A., Leff, J. P., et al (1978) The concept of a case in psychiatric population surveys. Psychological Medicine, 8, 203217.CrossRefGoogle ScholarPubMed
Zimmerman, M., Coryell, W., Pfohl, B., et al (1986) The validity of four definitions of endogenous depression: II. Clinical, demographic, familial and psychosocial correlates. Archives of General Psychiatry, 43, 234244.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.