Event attributes and the content of psychotic experiences in first-episode psychosis

BACKGROUND: Previous psychosocial stress research, contemporary cognitive models, and new cognitive behavioural treatments for psychosis converge in suggesting that stressful events influence the content of psychotic experiences. In this paper we test whether the attributes of stressful events preceding the initial onset of psychosis are associated with core themes of the illness. METHOD: Forty-one people who had experienced a first episode of psychosis were assessed on the attributes of stressful events occurring in the year before onset, the themes (persecutory, depressive, and grandiose) associated with their delusions and the content of their auditory hallucinations. RESULTS: Principal component analysis yielded four components accounting for 72% of the variance. As hypothesized, intrusive events were associated with the development of delusions with persecutory themes. Grandiose delusions were negatively associated with loss events. Depressive delusions appear to be associated with danger events rather than loss events. CONCLUSION: There are links between stressful event attributes and core psychotic themes at first-episode psychosis. This has implications for theoretical models of, and early psychological intervention for, psychosis.     

Patterns of attention and experiences of post-traumatic stress symptoms following childbirth: an experimental study

Childbirth for some women can be experienced as a traumatic event whereby it is appraised as threatening to life and associated with feelings of fear, helplessness or horror. These women may develop symptoms consistent with post-traumatic stress disorder or its sub-clinical symptoms (post-traumatic stress, PTS). Cognitive processes such as attentional biases have been identified in individuals with PTS exposed to other traumatic events. This study used an experimental design (the modified Stroop task) to investigate the relationship between attentional biases and PTS symptoms in 50 women who experienced their labour and delivery as stressful and responded with fear, helplessness and horror. Attentional biases away from childbirth words were significantly associated with both symptoms of post-traumatic stress and more negative experiences of childbirth. A negative experience was also associated with more severe symptoms of PTS. Positive experiences were unassociated with attentional biases or symptoms. Post-traumatic stress responses, in this population, may be associated with avoidance, and through influencing cognitive processing, acting as a maintaining factor of distress.     

Codependency as a mediator between stressful events and eating disorders

This study examined the role of codependency in the relationship between stressful events and the development of eating disorders. Ninety-five undergraduate women completed the Codependency Assessment, the Eating Disorder Inventory-2, the Differentiation of Self Scale, and an open-ended questionnaire asking about stressful experiences, including relationships with alcoholic family members. Results supported the hypothesis that women who reported experience with an alcoholic significant other or a chronic stressful situation exhibited higher levels of eating disordered behavior. However, a family history of parental alcohol abuse alone did not result in differences in eating disorder symptoms. Further, women who exhibited more characteristics of codependency (e.g., caretaking, needs for control) also evidenced more eating disorder symptoms. The findings suggest a developmental sequence, whereby codependency mediates the relationship between excessive stress and the development of an eating disorder. © 1997 John Wiley & Sons, Inc.     

Psychopharmacotherapy of posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is a psychiatric disorder that develops after a psychological trauma usually caused by a situation perceived as deeply threatening to a person’s life or integrity. Complex neurobiological changes triggered by such a traumatic and stressful experience may explain a wide range of PTSD symptoms and provide the rationale for psychopharmacological treatment. Selective serotonin-reuptake inhibitors make the first-line treatment of PTSD. Clinical experience has shown that they are more effective than noradrenalin-reuptake inhibitors or tricyclic antidepressants. Antipsychotic drugs, especially atypical ones, have been shown effective in PTSD patients with psychotic characteristics or refractoriness to other treatments. Mood stabilizers seem to reduce mostly autonomous overreactions to stress, whereas the evidence for effectiveness of monoamine oxidase inhibitors is largely inconclusive. Other groups of medications, such as serotonin agonists and antagonists, new antidepressants, dual inhibitors of serotonin- and noradrenalin-reuptake, anticonvulsants, and opiate antagonists are also sometimes used in PTSD treatment. However, as shown in the present review, most clinical studies performed to date to investigate the effectiveness of different psychopharmacological agents in the therapy of PTSD have serious limitations in terms of small sample size, lack of blinding and randomization, and small effect size. More rigorously designed, comparative studies are needed to determine the usefulness, efficacy, tolerability, and safety of particular psychopharmaceutical drugs in the treatment of this therapeutically and functionally challenging disorder.     

Childhood trauma and psychosis: evidence, pathways, and implications

There is currently a growing body of research examining environmental factors in the etiology of psychosis. Much recent interest has focused on the relationship between childhood trauma and the risk of developing psychotic experiences later in life. Numerous studies of psychiatric patients where the majority are diagnosed psychotic indicate that the prevalence of traumatic experiences in this group is high. This body of research now includes many large-scale population-based studies controlling for possible mediating variables, which together provide persuasive evidence of a dose-response association and are indicative of a causal relationship. Several psychological and biological models have been proposed which offer credible accounts of the processes by which trauma may increase risk of psychotic experience. Clinically it is imperative to routinely inquire about traumatic experiences, to respond appropriately and to offer psychosocial treatments to those who report traumatic life events in the context of psychotic experiences.     

Relationship between personality and course and outcome in early psychosis: A review of the literature

The literature relating to the relationship between personality factors and course and outcome for the schizophrenic disorders is reviewed utilizing the approach proposed by Klein, Wonderlich, and Shea (1993). Developed to explicate the relationship between personality and depression, this approach allows for consideration of the contribution of premorbid personality and also of changes in personality occurring secondary to the onset of the psychotic disorder. A model incorporating a developmental understanding of the impact on personality of the potentially traumatic experience of the onset of a schizophrenic disorder in late adolescence is presented. Directions for future research are outlined.     

Psychological aspects of Crohn's disease

This is a critical review of 16 studies reporting a relationship between Crohn's disease and psychological variables. The studies reviewed indicate a relationship between the psychological variables of stressful life events, personality characteristics, and psychopathology and the onset and/or exacerbation of Crohn's symptoms. Personality characteristics such as depression, anxiety, and dependency are frequently reported as are the occurrence of stressful life events and the presence of psychopathology. The nature of the relationship is not explained by the research to date; however, the findings summarized in this report indicate that additional investigation into this association is warranted. A plan for such research is suggested.     

Sociopolitical events and technical innovations may affect the content of delusions and the course of psychotic disorders

The influence of culture on patients with psychiatric disorders has been well documented in the psychiatric literature. The unique emphasis of this paper is the influence of current social and political events on psychotic patients. Current events can be classified into two groups: (1) Communal stressful events that affect everyone (shared stressors), such as earthquakes, wars, etc.; and (2) Public events, highly reported by mass media, but not personally stressful, e.g., elections. This article is devoted to the discussion about the effect of sociopolitical non-traumatic events on persons with psychotic disorders. The author reviewed evidence that sociopolitical events and technical innovations affect patients with psychotic disorders. The author suggests that social events and scientific innovations may change the content of delusions and affect the course of psychotic disorders. The author also suggests that physicians should be sensitive to the clinical impact of sociopolitical events.     

Life Stressors as Risk Factors in Depression

Compelling evidence for an association between major adverse life experience and subsequent major depression is reviewed. Determining individual vulnerability to life stress and the effect of stressors on treatment outcome of depression are highlighted as the next major targets for contemporary stress research. Methodological concerns in the evaluation of stressors are detailed, and available data on variables that may influence the stress-depression relationship are presented. The critical importance of multivariate models in understanding individual vulnerability and outcome is emphasized. As methods for ascertaining stressful life events and chronic stressors continue to be refined, and models addressing the complex relationship of stressors and depression continue to be developed, prediction of stressor effects in onset and outcome of major depression will become increasingly more precise.     

Binary and rate measures of life event experience: their association with illness onset in Edinburgh and London community surveys

This report examines the extent to which a binary stress index (the experience of at least one severe event) and event rate measures were successful in predicting onset of psychiatric disorder amongst 1029 women. Analyses were based upon samples drawn from Edinburgh and London communities. Whilst the binary measures were successful in discriminating cases from non-cases within each sample, they were less powerful than measures based upon the rate at which events (usually severe) had been experienced. The results are discussed in terms of their relevance to issues of the health consequences of experiencing multiple events, and of the duration over which stressful events may have an influence on psychiatric health.     

Health locus of control: a potential moderator variable for the relationship between life stress and psychopathology

Although research indicates that stressful life events commonly precede the onset of a variety of psychological disorders, reported correlations have consistently been only moderately strong. The present study examined the possibility that the health locus of control (HLC) mediates the relationship between life event stress and psychopathology. Subjects were 81 male volunteers between the ages of 21 and 62. The SCL-90-R was utilized to measure psychological symptom status. Subjects' perceptions regarding the desirability and controllability of experienced events were examined. Life events which were perceived to be both undesirable and uncontrollable were significantly correlated with the indices of psychopathology only for subjects who were external in HLC. Externals also showed significant correlations between events which were perceived as being undesirable but under personal control and psychological symptoms. The results suggest that externals are more vulnerable to life event stress than internals. Practical implications for health psychologists are discussed.     

Stress-reactivity in psychosis: evidence for an affective pathway to psychosis

This paper will review a series of studies using the Experience Sampling Method that suggest that altered sensitivity to stress is an endophenotype for psychosis. The Experience Sampling Method is a structured diary technique allowing the assessment of emotional reactivity to stressors occurring in normal daily life. Elevated emotional reactivity to stress was found in subjects vulnerable to psychosis, suggesting that affective responses to stressors in the flow of daily life are an indicator of genetic and/or environmental liability to psychosis. Indeed, the small stressors in daily life associated with affective responses also predict more intense moment-to-moment variation of subtle positive psychotic experiences. Increased emotional reactivity was found to be independent from cognitive impairments, and argued to constitute evidence of an affective pathway to psychosis that may underlie a more episodic, reactive, good-outcome type of psychosis. Evidence for this hypothesis was found in data suggesting that the experience of stressful life events and early trauma were associated with increased stress-sensitivity, and that women were more likely to display elevated stress-reactivity. These findings are discussed in the light of recent biological and psychological mechanisms.     

Effects of Border Tensions on Residents of an Israeli Town

Abstract

The effect of three different stressful events on disorders in the individual's behavior are examined: a single event producing severe, long-term stress; a short-term event of mild stress, which repeats itself over a long period of time; and the cumulative effect of stressful events producing severe long-term stress.

The findings suggest that a single event producing severe, long-term stress – a terrorists' attack – is sufficient to cause disturbances in the residents' behavior. The accumulation of milder, short-term stressful events which repeat themselves over many years (bombings) is also responsible for disturbances in the residents' conduct, but these disturbances are less frequent, as well as less severe, than those we found in the former case.

The findings further indicate that those residents who, in addition to their exposure to the border tension, experienced stressful events because of their immigration and readjustment (such as the Eastern born), manifest more disturbances in their behavior as a result of the border tension than those residents whose immigration or adjustment experience was less stressful (such as the European born or the Israeli born). In other words, the accumulation of events producing high stress results in a greater frequency of disturbances in conduct than does a single event.     

Bad luck: an underestimated factor in the development of obsessive-compulsive disorder

Our clinical experience with patients with OCD has shown us that a sizeable proportion of patients report previous experiences such as accidents, very unusual events, or serious mistakes that in some cases may predate the onset of OCD by many years. In some cases these events, often perceived as bad luck, still appear to play a major role in supporting faulty appraisals of obsessional thoughts. In these cases it may be very useful to analyse and correct the specific learning experiences offered by these bad luck events. This article presents a series of case examples where specific events appear to have contributed to the development of faulty appraisals or at the least the patient attributes an important role to the event in the development of the disorder. We will also provide examples of some interventions that were useful in correcting the basis of these interpretations. © 1998 John Wiley & Sons, Ltd.     

Life events and depression. Part 1. Effect of sex, age and civil status

This is the first of three articles dealing with some basic aspects of the relationship between life events and depression, and is also one part of a larger study in which the possible impact of stressful events has been studied from a multifactorial point of view. Two-hundred and four patients suffering from a depressive disorder, consecutively admitted to the Department of Psychiatry of the Umeå University have participated in a study of life events carried out by means of a specially constructed life events inventory that was used as a guideline for a semistructured interview.The results of this part of the study show that there are no pronounced differences in the occurrence, or appraisal of life events between male and female patients. The more vulnerable, older patients have experienced significantly fewer life events, even of the fateful type, prior to the onset of depression. No difference was found between patients who were married or lived together with a partner and patients who were unmarried, separated, divorced or widowed except in the categories of events (e.g. ‘conflict’ events) which might have been the very reason for a separation or a divorce. The results are discussed in relation to other findings in the literature.     

Interpersonal relatedness and self-definition: Two prototypes for depression

This paper reviews recent research that indicates the importance of differentiating subtypes of depression based on two types of experiences that lead individuals to become depressed: (a) disruptions of interpersonal relations and (b) threats to self-integrity and self-esteem. We review research with clinical and nonclinical samples that investigated the relationships of these distinctions to the quality of current interpersonal relationships and to differential sensitivity to various types of stressful life events, as well as to aspects of early life experiences, especially the quality of the parent-child relationship. We also evaluate research evidence that considers the role of these two dimensions in clinical depression. In addition to proposing an etiologic model about aspects of the onset and recurrence of depression based on the interaction between personality predispositions and types of stressful life events, we place these observations about depression in a broad theoretical context of contemporary personality theory which defines two primary dimensions of personality development and psychopathology.     

Stress and other psychosocial characteristics of patients with psychogenic nonepileptic seizures

Research on psychogenic nonepileptic seizures (PNES) has focused on childhood abuse, but less is known about other stressors and psychosocial risk factors. The authors compared 25 patients with PNES with 33 control subjects with epilepsy on stressful life events and other risk factors for somatoform disorders. Compared with control subjects, patients with PNES reported significantly more prevalent and stressful negative life events (including adulthood abuse) and more current rumination, stress-related diseases, somatic symptoms, bodily awareness, and marginally more anxiety and depression. However, the relationship of many of these variables to PNES was accounted for by life stress. Groups did not differ on illness worry, alexithymia, or psychotic symptoms. The results suggest that PNES are part of a larger pattern of somatic symptoms responses to a wide range of negative events, including stress in adulthood.     

The stress sensitization hypothesis: understanding the course of bipolar disorder

BACKGROUND: The influence of psychosocial stress on the course of bipolar disorder has been increasingly recognized. The authors tested hypotheses about both stress and early adversity "sensitization" on the course of bipolar disorder over a one-year period. METHODS: The participants were 58 adults (29 male and 29 female) with a diagnosis of bipolar I disorder. They were evaluated every three months for one year. Stressful life events and the presence of early adversity were assessed by structured interview. RESULTS: There was no significant interaction between stress and episode number in the prediction of bipolar recurrence. The interaction of early adversity severity and stressful life events significantly predicted recurrence in a manner consistent with the sensitization hypothesis. Participants with early adversity reported lower levels of stress prior to recurrence than those without early adversity. Individuals with early adversity also had a significantly younger age of bipolar onset. LIMITATIONS: The sample size was small and the number of past episodes was determined retrospectively, mainly through self-report. CONCLUSIONS: Severe early adversity may result in a greater effect of stress on bipolar recurrence and earlier onset of bipolar disorder, suggesting the need for further studies of stress mechanisms in bipolar disorder and of treatments designed to intervene early among those at risk.     

Life events and hemodynamic stress reactivity in the middle-aged and elderly

Recent versions of the reactivity hypothesis, which consider it to be the product of stress exposure and exaggerated hemodynamic reactions to stress that confers cardiovascular disease risk, assume that reactivity is independent of the experience of stressful life events. This assumption was tested in two substantial cohorts, one middle-aged and one elderly. Participants had to indicate from a list of major stressful life events up to six they had experienced in the previous 2 years. They were also asked to rate how disruptive and stressful they were, at the time of occurrence and now. Blood pressure and pulse rate were measured at rest and in response to acute mental stress. Those who rated the events as highly disruptive at the time of exposure and now exhibited blunted systolic blood pressure reactions to acute stress. The present results suggest that acute stress reactivity may not be independent of stressful life events experience.     

甲亢患者病前应激性生活事件研究

目的：探讨甲亢患者病前经历的应激性生活事件的特点及与疾病的联系。方法：采用事件量表（ＬＥＳ）对８２例初发的甲亢患者进行测定,并与正常对照比较。结果：甲亢患者病前经历有影响的负性生活事件频数及总生活事件频数、负性生活紧张值及总生活事件紧张值显著高于对照组（Ｐ〈０．０５）,男性患者正性生活事件紧张值显著高于女性患者。结论：提示患病前经历较多负性生活事件的应激可能与发病有一定联系。