Risk behaviours, victimisation and mental distress among adolescents in different family structures

Background Previous studies have shown an elevated risk with regard to social and behavioural domains in adolescents of single parents. However, the diversity of single parent families concerning gender of the resident parent has seldom been taken into account when investigating the relation between family structure and children’s negative outcomes. Thus, the aim of this study was to investigate risk behaviours, victimisation and mental distress among adolescents in different family structures using more detailed sub-groups of single parents (i.e., single mother, single father and shared physical custody). Methods The sample consisted of 15,428 ninth graders from all municipal and private schools in the county of Stockholm (response rate 83.4%). Risk behaviours included use of alcohol, illicit drugs and smoking. Victimisation was measured by experiences of exposure to bullying and physical violence. Mental distress was assessed with the anxious/depressed and aggressive behaviour syndrome scales in the Youth Self Report (YSR). Bivariate and multivariate logistic regression analyses were used to investigate the associations between family structure and outcome variables. Results Adolescents in single-mother/father families were at higher risk of risk behaviours, victimisation and mental distress than their counterparts in two-parent families. However, after control for possible confounders the associations between victimisation, aggressive behaviour problems and single motherhood were no longer significant, whereas these relations remained for children living with single fathers. Adolescents in shared physical custody run no increased risk of any of the studied outcomes (except drunkenness) after adjustment for covariates. Post hoc analyses revealed that adolescents in single-father families were at higher risk for use of alcohol, illicit drugs, drunkenness, and aggressive behaviour as compared to their peers in single-mother families, whereas no differences were found between adolescents in single-mother families and those in shared physical custody. Conclusions Children of single parents should not be treated as a homogenous group when planning prevention and intervention programmes. Researchers and professionals should be aware of and consider the specific problems of single parent children and that their problems may vary depending on their living arrangements.     

Childhood negative experiences and subclinical psychosis in adolescence: a longitudinal general population study

Background: Accumulating evidence suggests that experiences of trauma and victimization during childhood are associated with an increased risk to develop clinical and subclinical psychosis in adulthood. A recent cross‐sectional study showed a significant association between trauma and psychotic experiences in adolescents. The current study aimed to extend these findings by investigating the longitudinal effects of negative life experiences on the risk for subclinical psychotic symptoms 2 years later in an adolescent general community sample. Methods: Data were derived from the standard health screenings of the Youth Health Care Divisions of the Public Health Services, in the South of the Netherlands. A total of 1129 adolescents filled out a self‐report questionnaire at age 13/14 years and 2 years later (15/16 years), assessing psychotic experiences, as well as experiences of being bullied, sexual trauma, and negative life events. Results: Logistic regression analyses revealed that sexual trauma increased the risk for psychotic symptoms 2 years later. Life events contributed to the risk for psychosis over time and psychosis in turn gave rise to new life events. No significant association with bullying was found after controlling for confounders. Conclusion: The results provide further evidence for an association between childhood environment and psychosis in the crucial developmental period of early adolescence. Early and later psychological stress, if severe, may impact on the risk for psychosis in adolescence through mechanisms of person–environment interaction and correlation.     

Misattribution of self-generated speech in relation to hallucinatory proneness and delusional ideation in healthy volunteers

When patients with hallucinations and delusions encounter their own distorted speech they tend to mistakenly attribute it to someone else. This external misattribution of self-generated material is thought to be associated with 'positive' psychotic symptoms. The aim of the present study was to examine this process in relation to the predisposition to hallucination-like experiences and unusual beliefs in a healthy population. Fifty-seven volunteers completed assessments of hallucination proneness and delusional ideation and performed a source-monitoring task. Participants listened to a series of pre-recorded words for which the source (self/non-self) and acoustic quality (undistorted/distorted) of the speech were varied across trials. Participants indicated whether the words were spoken in their own or another person's voice via a button press. Misattribution errors were greatest when participants made source judgements about their own distorted speech (p < 0.01) and were positively correlated with delusional ideation scores, particularly the level of conviction with which delusional ideas were held (p = 0.03), and there was a trend for a positive correlation with hallucination proneness scores. There was a negative correlation between unsure responses and delusional ideation when participants were processing their own distorted speech (p = -0.03). The misattribution of self-generated speech occurs in healthy individuals with high levels of psychotic-like experiences. This suggests that the same cognitive impairments may underlie psychotic phenomena in healthy individuals as in patients with psychotic disorders, consistent with a continuum model of psychosis.     

Fear of negative evaluation is associated with delusional ideation in non-clinical population and patients with schizophrenia

Purpose

A number of recent studies suggest that delusions may be explained as a continuum from normal beliefs. Fear of negative evaluation from others (FNE) is one of potential factors that might describe this psychological process of delusions.

Methods

In order to examine whether FNE is associated with delusional ideation in both non-clinical population and patients with schizophrenia, two sets of data [from a non-clinical student sample (n?=?282) and from patients with schizophrenia (n?=?117)] were collected to examine whether Brief Fear of Negative Evaluation Scale (BFNE) score and the 21-item Peters Delusions Inventory (PDI-21) score were associated with each other. Linear regression analyses were carried out to assess if the BFNE score still remained associated with the PDI-21 scores once the confounding effects of depression were controlled.

Results

BFNE scores were significantly related to PDI-21 scores in both non-clinical [Pearson product?Cmoment correlation coefficient (r)?=?0.37, 95% confidence Interval (CI)?=?0.25?C0.48] and patient (r?=?0.33, 95% CI?=?0.14?C0.49) samples. These associations were still significant when confounding effects of depression were controlled. Standardised coefficients for the BFNE scores in the linear regression model were 0.21 in the student sample and 0.19 in the clinical sample.

Conclusions

FNE was associated with delusional ideation both in non-clinical population and in patients with schizophrenia. FNE might be a potential target for both pharmacological and psychological interventions for patients with delusions.     

Childhood trauma and hippocampal and amygdalar volumes in first-episode psychosis

Objective: A history of childhood trauma is common in individuals who later develop psychosis. Similar neuroanatomical abnormalities are observed in people who have been exposed to childhood trauma and people with psychosis. However, the relationship between childhood trauma and such abnormalities in psychosis has not been investigated. This study aimed to explore the association between the experience of childhood trauma and hippocampal and amygdalar volumes in a first-episode psychosis (FEP) population. Methods: The study employed an observational retrospective design. Twenty-one individuals, who had previously undergone magnetic resonance imaging procedures as part of the longitudinal Northern Ireland First-Episode Psychosis Study, completed measures assessing traumatic experiences and were included in the analysis. Data were subject to correlation analyses (r and r (pb)). Potential confounding variables (age at FEP and delay to scan from recruitment) were selected a priori for inclusion in multiple regression analyses. Results: There was a high prevalence of lifetime (95%) and childhood (76%) trauma in the sample. The experience of childhood trauma was a significant predictor of left hippocampal volume, although age at FEP also significantly contributed to this model. There was no significant association between predictor variables and right hippocampal volume. The experience of childhood trauma was a significant predictor of right and total amygdalar volumes and the hippocampal/amygdalar complex volume as a whole. Conclusions: The findings indicate that childhood trauma is associated with neuroanatomical measures in FEP. Future research controlling for childhood traumatic experiences may contribute to explaining brain morphology in people with psychosis.     

Testing the Independent and Joint Contribution of Exposure to Neurodevelopmental Adversity and Childhood Trauma to Risk of Psychotic Experiences in Adulthood

Exposure to neurodevelopmental adversity and childhood trauma are both independently associated with psychosis. However, there is little research on the mechanism underlying their relationship with each other. The current study investigated both the independent and joint effects of neurodevelopmental adversity and childhood trauma to better understand the etiology of psychosis. A large population-based cohort (N = 3514) followed from birth was assessed on psychotic experiences (PE) at 24 years. Neurodevelopmental adversity included obstetric complications (birth weight, gestational age, in-utero influenza exposure, resuscitation) and developmental impairment (cognitive and motor impairments). Trauma exposure included caregiver and peer inflicted trauma up to 17 years. Multiple regression models tested their independent and interactive effect on PE, and path analysis estimated the indirect effect of neurodevelopmental adversity on PE via trauma. Neurodevelopmental adversity (OR = 1.32, 95%CI: 1.08–1.62) and trauma (OR = 1.97, 95%CI: 1.65–2.36) independently increased the odds of PE. There was also an indirect relationship between neurodevelopmental adversity and PE via increased exposure to childhood trauma (β = 0.01, 95%CI: 0.004–0.024). In particular, peer bullying mediated the association between developmental impairment to PE (β = 0.02, 95%CI: 0.01–0.03). In conclusion, children with neurodevelopmental adversity, in particular those with developmental impairment, are more likely to be exposed to trauma. This new etiological understanding of psychosis suggests that PE may be partially modifiable through reducing exposure to peer bullying, especially in children with developmental impairment.     

Childhood sexual abuse, early cannabis use, and psychosis: testing an interaction model based on the National Comorbidity Survey

Previous research investigating the etiology of psychosis has identified risk factors such as childhood sexual abuse and cannabis use. This study investigated the multiplicative effect of these variables on clinically assessed diagnoses of psychosis based on a large community sample (the National Comorbidity Survey). Demographic variables (sex, age, urbanicity, ethnicity, education, employment, and living arrangements) and depression were used as predictors in the first block of a binary logistic regression. In the second block, the variables representing early cannabis use, childhood sexual trauma, and the interaction between these variables were entered. There was no significant main effect for early cannabis use or childhood sexual trauma. The interaction was statistically significant (odds ratio [OR] = 6.93, 95% confidence interval [CI] = 1.39-34.63, P = .02). The effect for the sexual trauma variable was statistically significant for those who used cannabis under 16 years (OR = 11.96, 95% CI = 2.10-68.22, P = .01) but not for those who had not used cannabis under 16 years (OR = 1.80, 95% CI = 0.91-3.57, P = .09). Many factors have been shown to be significant in the etiology of psychosis; however, the current research augments previous findings by examining psychosis in terms of an interaction between 2 of these factors.     

The Association Between Childhood Trauma and Memory Functioning in Schizophrenia

Objective: Both neurocognitive impairments and a history of childhood abuse are highly prevalent in patients with schizophrenia. Childhood trauma has been associated with memory impairment as well as hippocampal volume reduction in adult survivors. The aim of the following study was to examine the contribution of childhood adversity to verbal memory functioning in people with schizophrenia. Methods: Eighty-five outpatients with a Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnosis of chronic schizophrenia were separated into 2 groups on the basis of self-reports of childhood trauma. Performance on measures of episodic narrative memory, list learning, and working memory was then compared using multivariate analysis of covariance. Results: Thirty-eight (45%) participants reported moderate to severe levels of childhood adversity, while 47 (55%) reported no or low levels of childhood adversity. After controlling for premorbid IQ and current depressive symptoms, the childhood trauma group had significantly poorer working memory and episodic narrative memory. However, list learning was similar between groups. Conclusion: Childhood trauma is an important variable that can contribute to specific ongoing memory impairments in schizophrenia.     

The use of brief isolation to suppress delusional and hallucinatory speech

Isolation of 15 min duration (time-out, TO) was used to consequate the delusional and hallucinatory speech of a 33-yr-old female, chronic psychotic impatient. Delusional speech was defined as saying any one of 30 false statements; hallucinatory speech was defined as saying any audible verbalization to an unobservable stimulus. Delusional speech was recorded during two different types of conversations: six daily 5 min conversations conducted in a specific locale; 18 daily 1-min conversations conducted at any place on the patient's unit. TO was applied, withdrawn, and then reapplied first to the 5-min conversations and then to any delusional or hallucinatory verbalization emitted everywhere on the unit.Results indicated that TO was effective in suppressing delusional and hallucinatory speech, but the effects did not generalize from the 5-min to the 1-min conversations. When an attempt was made to fade TO from a continuous to an intermittent schedule, delusional speech increased to baseline levels. Additional observations made during the periods of TO indicated that the patient significantly increased the frequency of her delusional and hallucinatory verbalizations. This suggested that TO functioned as a punisher rather than as removal from social reinforcement which had initially been hypothesized as maintaining delusional and hallucinatory speech.     

Neurocognitive and Symptom Correlates of Self-Reported Childhood Sexual Abuse in Schizophrenia Spectrum Disorders

This study examined whether self-reported childhood sexual abuse in schizophrenia spectrum disorders is linked with severity of neurocognitive deficits. The Wisconsin Card Sorting Test, California Verbal Learning Test, and select WAIS III subtests were administered to 15 participants with schizophrenia or schizoaffective disorder who had been sexually abused and to 28 participants with no abuse history. Controlling for age and premorbid IQ, a MANCOVA indicated there were group differences (f(9, 31) = 5.53, p < .001). Subsequent ANCOVA indicated that the sexual abuse group performed more poorly on tests of working memory and information processing speed. Childhood sexual abuse is associated with more severe working memory deficits in adults with schizophrenia spectrum disorders.     

Resilience in the face of peer victimisation and discrimination: The who,when and why in five patterns of adjustment

Victimisation has a negative effect on psychosocial functioning. Based on the resilience theory, and with a sample of 2975 Portuguese students, the present study aims to: i) identify patterns of adjustment in the face of peer victimisation and perceptions of discrimination; ii) explore the association between the patterns of adjustment and the characteristics of participants (the who) and of the victimisation (the when and why). Cluster analysis revealed five patterns of adjustment: Unchallenged; Externally Maladjusted; Internally Maladjusted; Resilient, and At-Risk. The results suggest that there is no complete resilience in the face of social victimisation. Group differences were found regarding: i) gender, type of course, sexual orientation, ethnicity, nationality, parental educational level and religious beliefs; ii) the age at which peer victimisation was more frequent, and; iii) the motives underlying discrimination. Globally considered, peer victimisation is representative of the wider cultural environment and interventions should also target social prejudices.     

Clinical course and outcome of delusional psychosis

The purpose of the study was to examine first-admitted patients with delusional psychosis meaning functional psychosis with paranoid symptoms with respect to clinical course and outcome. The index population comprised 88 patients. At discharge from first admission the patients were classified according to ICD-8 and DSM-III. According to both diagnostic classifications the majority of the patients did not belong to either of the two major psychotic groups, schizophrenia or affective psychosis. During the 2-year observation period half of the patients took psychotropic drugs continuously, and almost half of the patients experienced one or more relapses. One third of the patients were readmitted, and in average the patients stayed in the hospital for 4 months during the observation period including the time of index admission. At follow-up half of the patients revealed positive psychotic symptoms, while two thirds were moderately or severely impaired because of psychotic illness or personality dysfunction. It is concluded that the present aftercare treatment is insufficient to prevent relapse and psychotic symptoms. In consequence of this the existence of delusions at first admission to hospital because of functional psychosis seems for many to predict an unfavourable course and outcome. Further study will search for clinical and social predictors of course and outcome in patients with delusional psychosis.     

Evidence that onset of psychosis in the population reflects early hallucinatory experiences that through environmental risks and affective dysregulation become complicated by delusions

Objective:

To examine the hypothesis that the “natural” combination of delusions and hallucinations in psychotic disorders in fact represents a selection of early subclinical hallucinatory experiences associated with delusional ideation, resulting in need for care and mental health service use.

Methods:

In the Early Developmental Stages of Psychopathology study, a prospective, 10-year follow-up of a representative cohort of adolescents and young adults in Munich, Germany (n = 2524), clinical psychologists assessed hallucinations and delusions at 2 time points (T2 and T3). Analyses compared differences in psychopathology, familial liability for nonpsychotic disorder, nongenetic risk factors, persistence, and clinical outcome between groups characterized by: (1) absence of positive psychotic symptoms, (2) presence of isolated hallucinations, (3) isolated delusions, and (4) both hallucinations and delusions.

Results:

Delusions and hallucinations occurred together much more often (T2: 3.1%; T3: 2.0%) than predicted by chance (T2: 1.0%; T3: 0.4%; OR = 11.0; 95% CI: 8.1, 15.1). Content of delusions was contingent on presence of hallucinations but modality of hallucinations was not contingent on presence of delusions. The group with both hallucinations and delusions, compared to groups with either delusions or hallucinations in isolation, displayed the strongest associations with familial affective liability and nongenetic risk factors, as well as with persistence of psychotic symptoms, comorbidity with negative symptoms, affective psychopathology, and clinical need.

Conclusions:

The early stages of psychosis may involve hallucinatory experiences that, if complicated by delusional ideation under the influence of environmental risks and (liability for) affective dysregulation, give rise to a poor prognosis hallucinatory–delusional syndrome.     

Social course and outcome of delusional psychosis

The purpose of the study was to examine first-admitted patients with delusional psychosis regarding social background, course and outcome. The study was handicapped by the lack of data of social variables as regards population in the catchment area, so comparisons were made with the population in the County and in the Nation. The index population comprised 88 patients. Social variables such as civil state and cohabitation are presented. At admission one-third had been employed continuously during the past year, while one-fourth had had no useful work at all. Significantly more patients were recruited from the lowest social group. Significantly more patients had inadequate social support, and two-thirds met friends less than once a week on an average. Only one-fourth of the patients seemed socially well adjusted and economically self-supporting. At follow-up 2 years later the distribution of the patients as regards useful work, social support, social contacts and social adjustment has significantly changed with more patients now with less useful work and social support, fewer social contacts and increased social maladjustment. The difficulty of interpretation of the findings is stressed but it is concluded that the present psychiatric treatment including social intervention is insufficient to prevent this social downlift mobility during a 2-year observation period as regards patients with delusional psychosis. Further study will search for social predictors of course and outcome.     

Early trauma may increase the risk for psychotic experiences by impacting on emotional response and perception of control

OBJECTIVE: Exposure to early trauma may increase the risk of dysfunctional responses to anomalous psychotic experiences resulting in psychotic symptom formation. METHOD: In a three-wave longitudinal general population study, 4045 never-psychotic individuals exposed and non-exposed to trauma before the age of 16 years, according to baseline interview were interviewed for the onset of psychotic experiences 3 years later (T2). In 36 individuals with incident psychosis at T2, assessments were made, for each psychotic experience, of i) the amount of distress associated with and ii) the degree of coping and subjective control over the experience. RESULTS: In the 16 observations of an incident psychotic experience, in the absence of distress, the baseline rate of early trauma was low (6%), whereas it was much higher in the 21 observations of an incident psychotic experience with distress [43%; odds ratio=10.0, 95% confidence interval (CI): 1.04, 96.3; P=0.046]. Similarly, coping attempts in the context of early trauma was associated with less control (reduction of 2 points on a seven-point scale, 95% CI: -4.0, -0.07). CONCLUSION: Early experience of trauma may create lasting cognitive and affective vulnerabilities to develop clinical symptoms arising out of early, non-clinical psychotic experiences.     

Childhood trauma and psychotic disorders: a systematic, critical review of the evidence

There is controversy over whether childhood trauma (CT) is a causal factor in the development of psychosis. This review aims to identify and critically analyze the association between CT and psychotic disorders. Studies investigating CT and psychotic disorder were identified by searches of electronic databases and manual searches of references lists, and 46 studies were identified. Forty studies had no control group, only psychiatric control groups, or unmatched, nonpopulation control groups and thus had methodologies that were inadequate to determine the relationship between CT and psychosis. Six studies used appropriate control groups. Three studies found an association between CT and psychosis, 2 found potentially real associations that failed to reach statistical significance, and 1 found no association, tentatively suggesting a relationship between CT and psychotic disorders. Several methodological problems were found in the studies in the review, including the highest quality studies, which limit the strength of the conclusions that can be drawn from them. These were lack of statistical power, lack of attention to moderating or mediating variables, the way in which CT was measured, and the use of cross-sectional research designs. These problems, some of which may be unavoidable in CT research, suggest the need for new and innovative methodologies in the investigation of CT and psychosis. Directions for further research are explored.