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SUBCLINICAL PSYCHOTIC EXPERIENCES AND AFFECTIVE DYSREGULATION IN ADOLESCENTS AND YOUNG ADULTS
Abstracts of the 3rd Biennial Schizophrenia International Research Conference / Schizophrenia Research 136, Supplement 1 (2012) S1–S375
disorders (e.g. early traumatic experiences, dysfunctional parental bonding) may create a vulnerability for the emergence of emotional problems during adolescence and into psychosis. Important clinical implications for early intervention and treatment of affective dysfunction in psychosis will be discussed.
AN INVESTIGATION OF SOCIAL ANXIETY DISORDER IN PEOPLE WITH FIRST-EPISODE PSYCHOSIS AND THOSE AT ULTRA HIGH RISK Maria Michail Division of Nursing, School of Nursing, Midwifery & Physiotherapy, University of Nottingham, Nottingham, United Kingdom Psychosis and depression are associated across the full spectrum of the extended psychosis phenotype. Although commonly viewed as interrelated, the exact relationship between subclinical psychosis and depression is unclear. The developmental pathway from subclinical psychotic experiences to clinical disorder is mediated by the persistence of subclinical psychotic experiences. The two studies presented here show the role of affective dysregulation as a factor that is likely associated with this persistence. The first study describes the bi-directional longitudinal relationship between subclinical psychosis and depression across and over time in an adolescent population seeking help for non-psychotic disorders (N=138), measured four times over two years. Subclinical psychosis and depression were related to each other at every cross-sectional measurement, but did not predict each other over time. Subclinical psychotic experiences and depressive symptom levels were highest at baseline, when participants presented to the clinical service. In addition, the relationship between them was also strongest at baseline and decreased significantly over time. The results suggest that psychosis and depression are interrelated phenomena that strongly co-occur in time, but longitudinally, one does not predict change in the other. Both psychopathological dimensions should be addressed in treatment. The second study describes different developmental trajectories of subclinical psychotic experiences in a large adolescent general population sample (N=881) assessed three times between ages 15 and 18 years. Four developmental patterns of psychotic experiences were identified: 1) strongly decreasing; 2) moderately decreasing; 3) persistently low; and 4) persistently high levels of subclinical psychotic experiences. The level of depression differed between the four developmental trajectories in a dose-response fashion and “mirrored” the level of subclinical psychotic experiences over time. For example, decreasing levels of psychotic experiences were associated with decreasing levels of depression. Furthermore, the developmental patterns of psychotic experiences over time were associated with different coping styles. Decreasing levels of psychotic experiences were associated with increasing use of Task-oriented (adaptive) coping. Persistence of psychotic experiences was associated with proportionally higher use of Emotion-oriented (non-adaptive) coping. Thus, Emotion-oriented coping may form a “vicious cycle” with psychotic experiences. These results suggest that opportunities for intervention may already be present at the level of subclinical psychosis. Taken together, these studies show that affective dysregulation is closely associated with subclinical psychotic experiences in young people from the general population and individuals enriched in risk for psychiatric disorders. The nature of this association, whether caused by a common underlying factor or by means of mutual influence, needs more research.
DEVELOPMENTAL VULNERABILITIES AND AFFECTIVE DYSREGULATION IN PSYCHOSIS CONTINUUM Ruchika Gajwani Birmingham & Solihull Mental Health Foundation Trust, Birmingham, United Kingdom Social Anxiety Disorder (SAD) is often associated with Psychotic-Like Experiences (PLEs) and is a frequent diagnosis in the prodromal phases of psychotic disorders. Conversely, the majority of SAD patients will not develop PLEs or psychotic disorder. We investigated whether psychopathological factors could discriminate which subjects with SAD are more likely to develop clinically significant psychotic experiences. Method: The study was conducted on a sample of 139 young adults with
S65
SAD and 30 matched healthy controls. PLEs were evaluated using theCommunity Assessment of Psychic Experiences. Psychopathology was explored using the Intolerance to Uncertainty Scale,Beck Anxiety Inventory, Beck Depression Inventory-II and General Health Questionaire-12. Results: Significantly higher prevalence of PLEs was found in the SAD group (24%) compared to the control group (5%). The clinical sample was split into two subsamples according to the presence of clinically relevant PLEs (SAD with PLEs = 33 and SAD without PLEs = 97). The SAD+PLEs showed significant higher level of anxiety, depression and intolerance of uncertainty. Conclusions: In a group of patients with SAD, the presence of clinically significant PLEs is related to higher levels of depression, anxiety and intolerance of uncertainty. The current findings are consistent with hypotheses suggesting that cognitive disturbances, together with social anxiety, may result in anomalous experiences. In combination with affective dysregulation, these may lead to the development of clinically significant psychotic experiences.
SUBCLINICAL PSYCHOTIC EXPERIENCES AND AFFECTIVE DYSREGULATION IN ADOLESCENTS AND YOUNG ADULTS Johanna Wigman Department of Interdisciplinary Social Science, University of Utrecht, Utrecht, Netherlands Factor analytic studies of psychosis symptoms point to an independent affective dimension (e.g. depression) in non-affective psychosis. Affective disturbances are very prevalent not only during the course of the illness but even before symptom formation and after psychosis symptoms subside. Social anxiety disorder is among the most commonly reported and disabling of these disturbances. However, its nature and origins are not well understood. It is also unclear whether it is a by-product of paranoia and persecutory thinking. The aim of this study is to investigate the prevalence and phenomenology of social anxiety disorder in individuals at risk of developing psychosis and those diagnosed with a first-episode psychosis. We will also explore the relationship between social anxiety and positive symptoms, particularly paranoia and persecutory delusions. Two groups of participants, aged 16-35, were recruited: a) young people at ultra high risk (UHR) of developing psychosis and b) individuals with first-episode psychosis (FEP). Measures of social anxiety, avoidance, depression and psychosis symptoms were administered. A group 51 UHR people and a group of 80 people with FEP were recruited to the study. 60% of the UHR sample and 25% of the FEP sample reported clinically significant levels of social anxiety and phobic avoidance. Social anxiety was accompanied by high rates of depression in both groups. No significant differences in severity levels of social anxiety, avoidance and depression were reported between the UHR and the FEP group. Social anxiety was unrelated to positive psychotic symptoms, particularly paranoia, in people with psychosis. However, in the UHR sample, levels of social phobia were associated with ongoing suspiciousness/persecution. Social anxiety is a significant comorbidity in people with psychosis and those at risk of developing psychosis. Previous studies have identified social anxiety as a risk factor for transition. The presence of social anxiety and avoidance in people with first-episode psychosis does not appear to be linked to the presence or severity of psychosis symptoms including formal persecutory delusions. The link between social phobia and persecution reported in those at high risk suggests that the nature and processes underlying the development and maintenance of social anxiety might differ depending on the phase of the illness. Three causal pathways will be proposed for the understanding of the mechanisms underlying the relationship between social anxiety and persecutory delusions across the psychosis continuum.
PREVALENCE OF PSYCHOTIC-LIKE EXPERIENCES IN YOUNG ADULTS WITH SOCIAL ANXIETY DISORDER AND CORRELATIONS WITH AFFECTIVE DYSREGULATION Marco Armando Department of Psychiatry, Sapienza University, Rome, Italy Childhood traumatic experience and dysfunctional attachment influence
disorders (e.g. early traumatic experiences, dysfunctional parental bonding) may create a vulnerability for the emergence of emotional problems during adolescence and into psychosis. Important clinical implications for early intervention and treatment of affective dysfunction in psychosis will be discussed.
AN INVESTIGATION OF SOCIAL ANXIETY DISORDER IN PEOPLE WITH FIRST-EPISODE PSYCHOSIS AND THOSE AT ULTRA HIGH RISK Maria Michail Division of Nursing, School of Nursing, Midwifery & Physiotherapy, University of Nottingham, Nottingham, United Kingdom Psychosis and depression are associated across the full spectrum of the extended psychosis phenotype. Although commonly viewed as interrelated, the exact relationship between subclinical psychosis and depression is unclear. The developmental pathway from subclinical psychotic experiences to clinical disorder is mediated by the persistence of subclinical psychotic experiences. The two studies presented here show the role of affective dysregulation as a factor that is likely associated with this persistence. The first study describes the bi-directional longitudinal relationship between subclinical psychosis and depression across and over time in an adolescent population seeking help for non-psychotic disorders (N=138), measured four times over two years. Subclinical psychosis and depression were related to each other at every cross-sectional measurement, but did not predict each other over time. Subclinical psychotic experiences and depressive symptom levels were highest at baseline, when participants presented to the clinical service. In addition, the relationship between them was also strongest at baseline and decreased significantly over time. The results suggest that psychosis and depression are interrelated phenomena that strongly co-occur in time, but longitudinally, one does not predict change in the other. Both psychopathological dimensions should be addressed in treatment. The second study describes different developmental trajectories of subclinical psychotic experiences in a large adolescent general population sample (N=881) assessed three times between ages 15 and 18 years. Four developmental patterns of psychotic experiences were identified: 1) strongly decreasing; 2) moderately decreasing; 3) persistently low; and 4) persistently high levels of subclinical psychotic experiences. The level of depression differed between the four developmental trajectories in a dose-response fashion and “mirrored” the level of subclinical psychotic experiences over time. For example, decreasing levels of psychotic experiences were associated with decreasing levels of depression. Furthermore, the developmental patterns of psychotic experiences over time were associated with different coping styles. Decreasing levels of psychotic experiences were associated with increasing use of Task-oriented (adaptive) coping. Persistence of psychotic experiences was associated with proportionally higher use of Emotion-oriented (non-adaptive) coping. Thus, Emotion-oriented coping may form a “vicious cycle” with psychotic experiences. These results suggest that opportunities for intervention may already be present at the level of subclinical psychosis. Taken together, these studies show that affective dysregulation is closely associated with subclinical psychotic experiences in young people from the general population and individuals enriched in risk for psychiatric disorders. The nature of this association, whether caused by a common underlying factor or by means of mutual influence, needs more research.
DEVELOPMENTAL VULNERABILITIES AND AFFECTIVE DYSREGULATION IN PSYCHOSIS CONTINUUM Ruchika Gajwani Birmingham & Solihull Mental Health Foundation Trust, Birmingham, United Kingdom Social Anxiety Disorder (SAD) is often associated with Psychotic-Like Experiences (PLEs) and is a frequent diagnosis in the prodromal phases of psychotic disorders. Conversely, the majority of SAD patients will not develop PLEs or psychotic disorder. We investigated whether psychopathological factors could discriminate which subjects with SAD are more likely to develop clinically significant psychotic experiences. Method: The study was conducted on a sample of 139 young adults with
S65
SAD and 30 matched healthy controls. PLEs were evaluated using theCommunity Assessment of Psychic Experiences. Psychopathology was explored using the Intolerance to Uncertainty Scale,Beck Anxiety Inventory, Beck Depression Inventory-II and General Health Questionaire-12. Results: Significantly higher prevalence of PLEs was found in the SAD group (24%) compared to the control group (5%). The clinical sample was split into two subsamples according to the presence of clinically relevant PLEs (SAD with PLEs = 33 and SAD without PLEs = 97). The SAD+PLEs showed significant higher level of anxiety, depression and intolerance of uncertainty. Conclusions: In a group of patients with SAD, the presence of clinically significant PLEs is related to higher levels of depression, anxiety and intolerance of uncertainty. The current findings are consistent with hypotheses suggesting that cognitive disturbances, together with social anxiety, may result in anomalous experiences. In combination with affective dysregulation, these may lead to the development of clinically significant psychotic experiences.
SUBCLINICAL PSYCHOTIC EXPERIENCES AND AFFECTIVE DYSREGULATION IN ADOLESCENTS AND YOUNG ADULTS Johanna Wigman Department of Interdisciplinary Social Science, University of Utrecht, Utrecht, Netherlands Factor analytic studies of psychosis symptoms point to an independent affective dimension (e.g. depression) in non-affective psychosis. Affective disturbances are very prevalent not only during the course of the illness but even before symptom formation and after psychosis symptoms subside. Social anxiety disorder is among the most commonly reported and disabling of these disturbances. However, its nature and origins are not well understood. It is also unclear whether it is a by-product of paranoia and persecutory thinking. The aim of this study is to investigate the prevalence and phenomenology of social anxiety disorder in individuals at risk of developing psychosis and those diagnosed with a first-episode psychosis. We will also explore the relationship between social anxiety and positive symptoms, particularly paranoia and persecutory delusions. Two groups of participants, aged 16-35, were recruited: a) young people at ultra high risk (UHR) of developing psychosis and b) individuals with first-episode psychosis (FEP). Measures of social anxiety, avoidance, depression and psychosis symptoms were administered. A group 51 UHR people and a group of 80 people with FEP were recruited to the study. 60% of the UHR sample and 25% of the FEP sample reported clinically significant levels of social anxiety and phobic avoidance. Social anxiety was accompanied by high rates of depression in both groups. No significant differences in severity levels of social anxiety, avoidance and depression were reported between the UHR and the FEP group. Social anxiety was unrelated to positive psychotic symptoms, particularly paranoia, in people with psychosis. However, in the UHR sample, levels of social phobia were associated with ongoing suspiciousness/persecution. Social anxiety is a significant comorbidity in people with psychosis and those at risk of developing psychosis. Previous studies have identified social anxiety as a risk factor for transition. The presence of social anxiety and avoidance in people with first-episode psychosis does not appear to be linked to the presence or severity of psychosis symptoms including formal persecutory delusions. The link between social phobia and persecution reported in those at high risk suggests that the nature and processes underlying the development and maintenance of social anxiety might differ depending on the phase of the illness. Three causal pathways will be proposed for the understanding of the mechanisms underlying the relationship between social anxiety and persecutory delusions across the psychosis continuum.
PREVALENCE OF PSYCHOTIC-LIKE EXPERIENCES IN YOUNG ADULTS WITH SOCIAL ANXIETY DISORDER AND CORRELATIONS WITH AFFECTIVE DYSREGULATION Marco Armando Department of Psychiatry, Sapienza University, Rome, Italy Childhood traumatic experience and dysfunctional attachment influence