August 21, 2018

status: publishe

Do loneliness and social exclusion breed paranoia? An experience sampling investigation across the psychosis continuum

Background The role of loneliness and social exclusion in the development of paranoia is largely unexplored. Negative affect may mediate potential associations between these factors. We investigated the temporal relationships of daily-life loneliness, felt social exclusion, negative affect, and paranoia across the psychosis continuum. Method Seventy-five participants, including 29 individuals with a diagnosis of non-affective psychosis, 20 first-degree relatives, and 26 controls used an Experience Sampling Method (ESM) app to capture the fluctuations in loneliness, feelings of social exclusion, paranoia, and negative affect across a 1-week period. Data were analysed with multilevel regression analyses. Results In all groups, loneliness and feelings of social exclusion were independent predictors of paranoia over time (b = 0.05, p < .001 and b = 0.04, p < .05, respectively). Negative affect predicted paranoia (b = 0.17, p < .001) and partially mediated the associations between loneliness, social exclusion, and paranoia. It also predicted loneliness (b = 0.15, p < .0001), but not social exclusion (b = 0.04, p = .21) over time. Paranoia predicted social exclusion over time, with more pronounced effects in controls (b = 0.43) than patients (b = 0.19; relatives: b = 0.17); but not loneliness (b = 0.08, p = .16). Conclusion Paranoia and negative affect worsen in all groups following feelings of loneliness and social exclusion. This highlights the importance of a sense of belonging and being included for mental well-being. Loneliness, feeling socially excluded, and negative affect were independent predictors of paranoid thinking, suggesting they represent useful targets in its treatment

The expression of positive and negative schizotypy in daily life: an experience sampling study

Background. Psychometrically identified positive schizotypy and negative schizotypy are differentially related to psychopathology, personality and social functioning. However, little is known about the experience and expression of schizotypy in daily life and the psychological mechanisms that trigger psychotic-like experiences. Method. The present study employed experience sampling methodology (ESM) to assess positive and negative schizotypy in daily life in a non-clinical sample of 412 young adults. ESM is a structured diary technique in which participants are prompted at random times during the day to complete assessments of their current experiences. Results. As hypothesized, positive schizotypy was associated with increased negative affect, thought impairment, suspiciousness, negative beliefs about current activities and feelings of rejection, but not with social disinterest or decreased positive affect. Negative schizotypy, on the other hand, was associated with decreased positive affect and pleasure in daily life, increased negative affect, and decreases in social contact and interest. Both positive schizotypy and negative schizotypy were associated with the desire to be alone when with others. However, this was moderated by anxiety in positive schizotypy and by diminished positive affect in negative schizotypy. Conclusions. The results support the construct validity of a multidimensional model of schizotypy and the ecological validity of the positive and negative schizotypy dimensions. ESM appears to be a promising method for examining the daily life experiences of schizotypic individuals

A comparison of affective-cognitive states in daily life between emerging adults with and without past-year non-suicidal self-injury

Although the literature suggests trait-like differences in affective and cognitive vulnerabilities between individuals with and without a history of non-suicidal self-injury (NSSI), little is known about how these dispositional differences are experienced in the natural environment. The present study compares the intensity, inertia, interaction, and variability of affective (negative and positive affect) and cognitive states (rumination, self-criticism) in the everyday lives of individuals who do and do not engage in NSSI. Using experience sampling methodology (ESM), 60 emerging adults (ages=18-22 years) with and without past-year NSSI (equally distributed) completed eight questionnaires per day for 12 days (in total, 96 questionnaires per participant), resulting in 4,587 assessments (median compliance=83.3%; IQR=71.9-91.7). In a dynamic structural equation modeling framework, dynamic parameters (i.e., mean intensity, carryover effects, spillover effects, and within-person variability) were evaluated using multilevel vector autoregressive models. Emerging adults who engage in NSSI experience higher intensity and greater variability of negative affect, rumination, and self-criticism, whereas lower intensity and greater variability of positive affect. In addition, past-year NSSI predicted stronger affective-cognitive interactions over time, with stronger spillover effects of negative and positive affect on subsequent rumination and self-criticism in individuals who engage in NSSI. Depressive symptoms and trait levels of emotion dysregulation and self-criticism partially negated these differences. Our findings provide evidence that emerging adults who self-injure experience more negative affective-cognitive states in daily life and point to the potential relevance of boosting positive emotions to buffer negative cognitions

Evidence That Transition from Health to Psychotic Disorder Can Be Traced to Semi-Ubiquitous Environmental Effects Operating against Background Genetic Risk

Background: In order to assess the importance of environmental and genetic risk on transition from health to psychotic disorder, a prospective study of individuals at average (n=462) and high genetic risk (n=810) was conducted.Method: A three-year cohort study examined the rate of transition to psychotic disorder. Binary measures indexing environmental exposure (combining urban birth, cannabis use, ethnicity and childhood trauma) and proxy genetic risk (high-risk sibling status) were used to model transition.Results: The majority of high-risk siblings (68%) and healthy comparison subjects (60%) had been exposed to one or more environmental risks. The risk of transition in siblings (n=9, 1.1%) was higher than the risk in healthy comparison subjects (n=2, 0.4%; ORadj=2.2,95% CI: 5-10.3). All transitions (100%) were associated with environmental exposure, compared to 65% of non-transitions (p=0.014), with the greatest effects for childhood trauma (ORadj=34.4,95% CI: 4.4-267.4), cannabis use (OR=4.1,95% CI: 1.1, 15.4), minority ethnic group (OR=3.8,95% CI: 1.2,12.8) and urban birth (OR=3.7,95% CI: 0.9,15.4). The proportion of transitions in the population attributable to environmental and genetic risk ranged from 28% for minority ethnic group, 45% for urban birth, 57% for cannabis use, 86% for childhood trauma, and 50% for high-risk sibling status. Nine out of 11 transitions (82%) were exposed to both genetic and environmental risk, compared to only 43% of non-transitions (p=0.03).Conclusion: Environmental risk associated with transition to psychotic disorder is semi-ubiquitous regardless of genetic high risk status. Careful prospective documentation suggests most transitions can be attributed to powerful environmental effects that become detectable when analysed against elevated background genetic risk, indicating gene-environment interaction.</p

Depressive symptoms are associated with (sub)clinical psychotic symptoms in patients with non-affective psychotic disorder, siblings and healthy controls

Background. Depression is a clinically relevant dimension, associated with both positive and negative symptoms, in patients with schizophrenia. However, in siblings it is unknown whether depression is associated with subclinical positive and negative symptoms. Method. Depressive symptoms and their association with positive and negative symptoms were examined in 813 healthy siblings of patients with a non-affective psychotic disorder, 822 patients and 527 healthy controls. Depressive episodes meeting DSM-IV-TR criteria (lifetime) and depressed mood (lifetime) were assessed with the Comprehensive Assessment of Symptoms and History (CASH) in all three groups. In the patient group, the severity of positive and negative psychosis symptoms was assessed with the CASH. In the siblings and healthy controls, the severity of subclinical psychosis symptoms was assessed with the Community Assessment of Psychic Experiences (CAPE). Results. Patients reported more lifetime depressed mood and more depressive episodes than both siblings and controls. Siblings had a higher chance of meeting lifetime depressive episodes than the controls; no significant differences in depressed mood were found between siblings and controls. In all three groups the number and duration of depressive symptoms were associated with (sub) clinical negative symptoms. In the patients and siblings the number of depressive symptoms was furthermore associated with (sub) clinical positive symptoms. Finally, lifetime depressed mood showed familial clustering but this clustering was absent for lifetime depressive episodes. Conclusions. These findings suggest that a co-occurring genetic vulnerability for both depressive and psychotic symptomatology exists on a clinical and a subclinical level