Relatives' attachment anxiety mediates the association between perceived loss and expressed emotion in early psychosis

A common reaction experienced by family members of patients with psychosis is grief for the loss of their healthy relative. Importantly, high levels of perceived loss have been related to the manifestation of high expressed emotion (EE), which includes the negative attitudes expressed by relatives toward an ill family member. However, the mechanisms underlying the relationship between relatives' perceived loss and EE attitudes in the early stages of psychosis are still not fully understood. In this regard, attachment theory has been suggested as a useful framework for understanding this link. The current study aimed to examine: (1) whether relatives' perceived loss was associated with relatives' EE dimensions (i.e., criticism and emotional over-involvement (EOI)), and (2) whether such associations were mediated by relatives' attachment dimensions (i.e., anxiety and avoidance). Seventy-eight relatives of patients with early psychosis completed the Mental Illness Version of the Texas Inventory of Grief for the assessment of loss reactions. Attachment dimensions and EE attitudes were assessed by the Psychosis Attachment Measure and the Family Questionnaire, respectively. Findings indicated that relatives' perceived loss was associated with EE dimensions. Relatives' attachment anxiety, but not avoidance, mediated the relationship of perceived loss with both criticism and EOI. Findings highlight the importance of examining the role of relatives' attachment characteristics for understanding how perceptions of loss might impact the manifestation of EE attitudes in the early stages of psychosis. Family interventions aimed at assisting relatives to improve their management of negative emotional reactions to loss are fundamental to prevent impairing loss reactions and the entrenchment of high-EE attitudes

Self-Schemas and Self-Esteem Discrepancies in Subclinical Paranoia : The Essential Role of Depressive Symptoms

Self-concepts are being intensively investigated in relation to paranoia, but research has shown some contradictory findings. Studying subclinical phenomena in a non-clinical population should allow for a clearer understanding given that clinical confounding factors are avoided. We explored self-esteem, self-schemas, and implicit/explicit self-esteem discrepancies in three non-clinical groups with different psychopathological traits and a control group. Methods: Participants with elevated trait-paranoia (n = 41), depressive symptoms (n = 34), a combination of both traits (n = 32), and a control group (n = 71) were assessed on implicit and explicit self-esteem, self-schemas, depression, and paranoia. A dimensional approach with the total sample (n = 208) was also used to complement the information provided by the group approach. Results: All groups presented similar and positive levels of implicit self-esteem. Trait-paranoia participants had similar levels of explicit self-esteem and self-schemas compared with the control group. However, the group with a combination of trait-paranoia and depressive symptoms showed the lowest levels of positive self-schemas and self-esteem. Furthermore, this group and the control group displayed implicit/explicit self-esteem discrepancies, although in opposite directions and with different implications. The dimensional approach revealed associations of trait-paranoia and depressive symptoms with poor explicit self-esteem and self-schemas but not with implicit self-esteem. Conclusions: Trait-paranoia participants showed different self-representations depending on whether depressive symptoms were present or not. The interaction between subclinical neurotic and psychotic traits entailed a detrimental self-representation that might increase the risk for psychopathology

Comparison of self-reported attachment in young adults from Spain and the United States

Background: Previous studies have provided mixed evidence in support of the structure of Bartholomew's attachment framework. The current study examined the comparability of the correlations among the attachment prototypes as well as the underlying factor structure of the Relationship Questionnaire in independent samples of Spanish and American young adults. Method: Participants were 547 students from the Universitat Autònoma de Barcelona and 1425 from the University of North Carolina at Greensboro who completed the Relationship Questionnaire. Results: Secure attachment was negatively correlated with fearful attachment, as was preoccupied attachment with dismissing attachment. The secure-fearful association in the American sample represented a medium effect size, whereas the remaining correlations represented small effect sizes. Except for the secure-fearful association, the correlations among prototypes were comparable in magnitude across samples. A principal components analysis yielded two factors that explained similar amounts of variance in the two samples. The pattern of loadings was relatively comparable in both samples; however, it was not entirely consistent with the theoretical model. Conclusions: The findings provided only partial support to the structure of the theoretical framework invoked. We discuss an alternative interpretation of the two factors, as well as further measurement considerations and directions for future researchAntecedentes: investigaciones previas han arrojado datos inconsistentes sobre la estructura del modelo de apego de Bartholomew. Este estudio investigó la comparabilidad de las correlaciones entre los prototipos de apego y la estructura factorial del Cuestionario de Relación en muestras independientes de jóvenes españoles y americanos. Método: un total de 547 estudiantes de la Universitat Autònoma de Barcelona y 1.425 de la University of North Carolina, Greensboro, completaron el Cuestionario de Relación. Resultados: el apego seguro y el temeroso correlacionaron negativamente, al igual que el preocupado y el rechazante. La asociación seguro-temeroso en la muestra americana representó un tamaño de efecto mediano, mientras que el resto de correlaciones representaron un tamaño de efecto pequeño. A excepción de la asociación seguro-temeroso, la magnitud de las correlaciones entre prototipos fue comparable en ambas muestras. El análisis de componentes principales arrojó dos factores que explicaron porcentajes similares de la varianza en las dos muestras. El patrón de cargas factoriales fue relativamente comparable en ambas muestras, pero no del todo consistente con lo esperado teóricamente. Conclusiones:los resultados proporcionaron apoyo parcial a la estructura del modelo teórico. Se presenta una interpretación alternativa de los factores, así como consideraciones de medición y direcciones para futuras investigacione

Impact of Adverse Childhood Experiences on Psychotic-Like Symptoms and Stress Reactivity in Daily Life in Nonclinical Young Adults

Background: There is increasing interest in elucidating the association of different childhood adversities with psychosis-spectrum symptoms as well as the mechanistic processes involved. This study used experience sampling methodology to examine (i) associations of a range of childhood adversities with psychosis symptom domains in daily life; (ii) whether associations of abuse and neglect with symptoms are consistent across self-report and interview methods of trauma assessment; and (iii) the role of different adversities in moderating affective, psychotic-like, and paranoid reactivity to situational and social stressors. Method: A total of 206 nonclinical young adults were administered self-report and interview measures to assess childhood abuse, neglect, bullying, losses, and general traumatic events. Participants received personal digital assistants that signaled them randomly eight times daily for one week to complete questionnaires about current experiences, including symptoms, affect, and stress. Results: Self-reported and interview-based abuse and neglect were associated with psychotic-like and paranoid symptoms, whereas only self-reported neglect was associated with negative-like symptoms. Bullying was associated with psychotic-like symptoms. Losses and general traumatic events were not directly associated with any of the symptom domains. All the childhood adversities were associated with stress reactivity in daily life. Interpersonal adversities (abuse, neglect, bullying, and losses) moderated psychotic-like and/or paranoid reactivity to situational and social stressors, whereas general traumatic events moderated psychotic-like reactivity to situational stress. Also, different interpersonal adversities exacerbated psychotic-like and/or paranoid symptoms in response to distinct social stressors. Discussion: The present study provides a unique examination of how childhood adversities impact the expression of spectrum symptoms in the real world and lends support to the notion that stress reactivity is a mechanism implicated in the experience of reality distortion in individuals exposed to childhood trauma. Investigating the interplay between childhood experience and current context is relevant for uncovering potential pathways to the extended psychosis phenotype

Interaction of both positive and negative daily-life experiences with FKBP5 haplotype on psychosis risk

Altres ajuts: Fundació La Marató de TV3 (091110)There is limited research on the interaction of both positive and negative daily-life environments with stress-related genetic variants on psychotic experiences (PEs) and negative affect (NA) across the extended psychosis phenotype. This study examined whether the FK506 binding protein 51 (FKBP5) variability moderates the association of positive and negative experiences in the moment with PEs and NA in participants with incipient psychosis and their nonclinical counterparts. A total of 233 nonclinical and 86 incipient psychosis participants were prompted for a 1-week period to assess their day-to-day experiences. Participants were genotyped for four FKBP5 single nucleotide polymorphisms (rs3800373, rs9296158, rs1360780, and rs9470080). Multilevel analyses indicated that, unlike the risk haplotype, the protective FKBP5 haplotype moderated all the associations of positive experiences with diminished PEs and NA in incipient psychosis compared with nonclinical group. Participants with incipient psychosis showed symptomatic improvement when reporting positive appraisals in the interpersonal domain, which suggests that these act as a powerful coping mechanism. The fact that this occurred in daily-life underscores the clinical significance of this finding and pinpoints the importance of identifying protective mechanisms. In addition, results seem to concur with the vantage sensitivity model of gene-environment interaction, which poses that certain genetic variants may enhance the likelihood of benefiting from positive exposures

The genome-wide associated candidate gene ZNF804A and psychosis-proneness : evidence of sex-modulated association

BACKGROUND: The Zinc finger protein 804A (ZNF804A) is a promising candidate gene for schizophrenia and the broader psychosis phenotype that emerged from genome-wide association studies. It is related to neurodevelopment and associated to severe symptoms of schizophrenia and alterations in brain structure, as well as positive schizotypal personality traits in non-clinical samples. Moreover, a female-specific association has been observed between ZNF804A and schizophrenia. AIM: The present study examined the association of two ZNF804A polymorphisms (rs1344706 and rs7597593) with the positive dimension of schizotypy and psychotic-like experiences in a sample of 808 non-clinical subjects. Additionally, we wanted to explore whether the sexual differences reported in schizophrenia are also present in psychosis-proneness. RESULTS: Our results showed an association between rs7597593 and both schizotypy and psychotic-like experiences. These associations were driven by females, such those carrying the C allele had higher scores in the positive dimension of both variables compared to TT allele homozygotes. CONCLUSION: The findings of the present study support the inclusion of ZNF804 variability in studies of the vulnerability for the development of psychopathology in non-clinical samples and consideration of sex as a moderator of this associatio

Attachment style predicts affect, cognitive appraisals, and social functioning in daily life

Altres ajuts: Fundació la Marató de TV3 (091110)The way in which attachment styles are expressed in the moment as individuals navigate their real-life settings has remained an area largely untapped by attachment research. The present study examined how adult attachment styles are expressed in daily life using experience sampling methodology (ESM) in a sample of 206 Spanish young adults. Participants were administered the Attachment Style Interview (ASI) and received personal digital assistants that signaled them randomly eight times per day for 1 week to complete questionnaires about their current experiences and social context. As hypothesized, participants' momentary affective states, cognitive appraisals, and social functioning varied in meaningful ways as a function of their attachment style. Individuals with an anxious attachment, as compared with securely attached individuals, endorsed experiences that were congruent with hyperactivating tendencies, such as higher negative affect, stress, and perceived social rejection. By contrast, individuals with an avoidant attachment, relative to individuals with a secure attachment, endorsed experiences that were consistent with deactivating tendencies, such as decreased positive states and a decreased desire to be with others when alone. Furthermore, the expression of attachment styles in social contexts was shown to be dependent upon the subjective appraisal of the closeness of social contacts, and not merely upon the presence of social interactions. The findings support the ecological validity of the ASI and the person-by-situation character of attachment theory. Moreover, they highlight the utility of ESM for investigating how the predictions derived from attachment theory play out in the natural flow of real lif

The role of stress-regulation genes in moderating the association of stress and daily-life psychotic experiences

The interaction of single nucleotide polymorphisms with both distal and proximal environmental factors across the extended psychosis phenotype is understudied. This study examined (i) the interaction of relevant SNPs with both early-life adversity and proximal (momentary) stress on psychotic experiences (PEs) in an extended psychosis sample; and (ii) differences between early-psychosis and non-clinical groups for these interactions. Two hundred and forty-two non-clinical and 96 early-psychosis participants were prompted randomly eight times daily for 1 week to complete assessments of current experiences, including PEs and stress. Participants also reported on childhood trauma and were genotyped for 10 SNPs on COMT, RGS4, BDNF, FKBP5, and OXTR genes. Unlike genetic variants, distal and proximal stressors were associated with PEs in both samples and were more strongly associated with PEs in the early-psychosis than in the non-clinical group. The RGS4 TA and FKBP5 CATT haplotypes interacted with distal stress, whereas the A allele of OXTR (rs2254298) interacted with proximal stress, increasing momentary levels of PEs in the early-psychosis group. No interactions emerged with COMT or BDNF variants. Individual differences in relevant stress-regulation systems interact with both distal and proximal psychosocial stressors in shaping the daily-life manifestation of PEs across the psychosis continuum

The salience of relational experiences: linking childhood interpersonal adversity, attachment style, and the subclinical psychosis phenotype

El objetivo principal de la presente tesis doctoral fue investigar el papel de la adversidad interpersonal en la infancia y los estilos de apego adulto con respecto a la esquizotipia y otros fenotipos del espectro esquizofrénico en población no clínica. El cuerpo de la tesis se compone de siete capítulos que abordan cuestiones relacionadas con la evaluación y validez de los estilos de apego y las dimensiones de esquizotipia, las asociaciones entre estos constructos y el potencial efecto mediador del apego inseguro en la relación entre la adversidad interpersonal y el fenotipo psicótico subclínico. El capítulo 1 presenta la adaptación española y las propiedades psicométricas de la Psychosis Attachment Measure. Se encontró que la adaptación española es conceptual y semánticamente equivalente a la versión original, que es apropiada para usarse en personas que presentan síntomas psicóticos y que sus propiedades psicométricas son adecuadas. El capítulo 2 examina la expresión de los estilos de apego en la vida diaria utilizando el método de “muestreo de experiencias”. Se encontró que las experiencias momentáneas de afecto, cognición y funcionamiento social variaron de forma teóricamente coherente en función del estilo de apego—proporcionando evidencia de la validez ecológica de los estilos de apego. El capítulo 3 investiga la validez de la esquizotipia positiva y negativa. La esquizotipia positiva predijo el estado mental de alto riesgo/umbral de psicosis y ambas dimensiones predijeron la presencia de trastornos de la personalidad del espectro esquizofrénico. Además, la esquizotipia positiva se asoció con síntomas positivos y paranoides y con esquemas cognitivos negativos, mientras que la esquizotipia negativa se asoció con síntomas esquizoides y con niveles bajos de esquemas cognitivos positivos. El capítulo 4 investiga la relación entre el apego y la esquizotipia en un estudio transcultural comparando muestras de España y Estados Unidos. Se encontró que en las dos muestras el apego preocupado estaba asociado con la esquizotipia positiva, el evitativo con la esquizotipia negativa y el temeroso con ambas dimensiones de esquizotipia. El capítulo 5 presenta una revisión de la investigación sobre los factores ambientales asociados con la vulnerabilidad a la psicosis y de los mecanismos que podrían explicar dichas asociaciones. Los dos últimos capítulos describen estudios que investigaron la hipótesis de que el apego inseguro tiene un efecto mediador en la relación entre la adversidad y el fenotipo psicótico. El estudio presentado en el capítulo 6 (el cual utilizó cuestionarios autoaplicados) encontró que el trauma físico/emocional estaba asociado con la esquizotipia, la suspicacia y las experiencias psicóticas y que el apego temeroso actuaba como mecanismo mediador. El estudio descrito en el capítulo 7 (el cual utilizó entrevistas semi-estructuradas) encontró que dos formas de adversidad en el ámbito de la falta de cuidado parental estaban asociadas con la fenomenología psicótica subclínica (síntomas positivos y negativos y rasgos de personalidad paranoides y esquizotípicos) y que los estilos de apego ansioso y enojado-rechazante actuaban como mecanismos mediadores. Como conclusión, los estudios de esta tesis contribuyen a esclarecer cómo las experiencias interpersonales adversas y los estilos de apego están relacionados con la expresión de la esquizotipia y otras manifestaciones subclínicas de la psicosis. Los resultados indican que centrarse en las experiencias interpersonales y en cómo son internalizadas es importante para mejorar nuestra comprensión de la vulnerabilidad a la psicopatología del espectro esquizofrénico. Por otra parte, los resultados apoyan la noción de que el estudio de las expresiones subclínicas puede facilitar la identificación de factores de riesgo relevantes para la psicosis clínica. En su conjunto, los resultados contribuyen a ampliar y afinar los actuales modelos psicosociales de vulnerabilidad a la psicosis y podrían informar el diseño de estrategias preventivas y de tratamiento.Attachment theory has been suggested as a useful framework for understanding the development and persistence of schizophrenia-spectrum features. The main aim of this thesis was to examine the role of childhood interpersonal adversity and attachment styles in relation to schizotypy and other schizophrenia-spectrum phenotypes in nonclinical young adults. The body of the thesis includes seven chapters investigating issues related to the assessment and validity of attachment styles and schizotypy dimensions, the associations between these constructs, and the role of insecure attachment styles as potential mechanisms underlying the adversity-psychosis link. Chapter 1 presents the adaptation process and psychometric properties of the Spanish version of the Psychosis Attachment Measure. The findings indicated that the Spanish version of the scale is semantically and conceptually equivalent to the original English version, that it is appropriate for use with individuals experiencing psychotic symptoms, and that its psychometric properties are comparable to those reported for the English version. Chapter 2 describes a study investigating the real-life expression of attachment styles using the Experience Sampling Method. It was found that daily life experiences of affect, cognition, and social functioning varied in theoretically meaningful ways across different attachment styles, thus providing evidence of ecological validity of the attachment styles. Furthermore, the differential expression of attachment styles in social contexts was found to be dependent upon the subjective appraisal, and not the mere presence, of social contacts. Chapter 3 presents a study examining the validity of the positive and negative schizotypy dimensions. It was found that positive schizotypy predicted the ultra high-risk or psychosis threshold status and that both dimensions predicted the presence of schizophrenia-spectrum personality disorders. Moreover, positive schizotypy was associated with psychotic-like experiences, positive and paranoid symptoms, and negative self- and other-schemas, whereas negative schizotypy was associated with schizoid symptoms and diminished positive self- and other-schemas. Chapter 4 examines the associations between attachment styles and schizotypy dimensions in a cross-cultural study using samples from Spain and the United States. The results showed a cross-culturally consistent pattern of associations in which preoccupied attachment was related to positive schizotypy, dismissing attachment to negative schizotypy, and fearful attachment to both schizotypy dimensions. Chapter 5 presents an overview of the environmental factors that have been associated with psychosis-proneness and reviews research on the plausible mechanisms that may explain these associations. The last two chapters present studies investigating the hypothesis that insecure attachment provides a pathway from childhood adversity to psychotic phenomena. Chapter 6 describes a self-report study that found that physical/emotional childhood trauma was associated with schizotypy, suspiciousness, and psychotic-like experiences and that these associations were mediated by the fearful attachment style. Chapter 7 presents an interview study that found that two forms of poor childhood care, namely parental antipathy and role reversal, were associated with subclinical symptoms of psychosis as well as with paranoid and schizotypal personality disorder traits. Furthermore, the angry-dismissive and enmeshed attachment styles were mediators of associations between poor childhood care and schizophrenia-spectrum phenomenology. In conclusion, the studies presented in this thesis provide new insights into the way childhood interpersonal adversities and attachment styles are related to the expression of positive and negative schizotypy and other schizophrenia-spectrum phenotypes in nonclinical individuals. The findings indicate that focusing on relational experiences and the ways they are internalized is important for refining our understanding of the vulnerability for schizophrenia-spectrum psychopathology. Moreover, they support the notion that investigating subclinical expressions may facilitate the identification of risk factors and mechanistic pathways relevant to clinical psychosis. Overall, this work contributes to expand and refine current psychosocial models of psychosis vulnerability and may ultimately inform the development of prophylactic and treatment strategies