- Email: [email protected]
TC15D HPA AXIS AND THE STRESS RESPONSE IN PSYCHOSIS
S32
Schizophrenia Research 86 (2006)
Symposium 17: Stress-sensitivity in psychosis: phenomenology and biology Chair: I. Myin-Germeys TC15A BEHAVIOURAL AND DOPAMINE SENSITIZATION TO STRESS IN INDIVIDUALS AT RISK FOR PSYCHOSIS I. Myin-Germeys *, M. Marcelis, P. Delespaul, J. van Os. Maastricht University, Maastricht, Netherlands Presenting author contact: [email protected] Background: Recent neurobiological models (Kapur, 2003) provide a possible mechanism of daily life stress directly affecting the intensity of psychotic experiences in vulnerable individuals. In order to validate such a mechanism, the impact of daily stress on psychosis intensity was investigated in two groups at increased risk of onset (relatives) and relapse (patients) of psychosis. In addition, it was investigated whether the association between daily stress and psychosis was mediated by dopamine-reactivity in drug-na¨ıve subjects (relatives). Methods: Patients in remission (n = 42), relatives (n = 47), and controls (n = 49) were studied with the Experience Sampling Method (a structured diary technique assessing current context and psychopathology in daily life) to assess 1) appraised subjective stress, and 2) intensity of subtle psychotic experiences. A metabolic perturbation paradigm causing plasma elevation of homovanillic acid (HVA) was used as proxy for DA-sensitization. Results: Multilevel regression analyses revealed significant increases in psychosis intensity associated with increases in subjective stress in patients and relatives. No association was found in control subjects. In addition, it was found that HVA-reactivity modified ESM psychotic experiences in response to daily life stress in relatives but not in control subjects. Conclusions: Subjects at increased risk for psychosis show continuous variation in intensity of subtle psychotic experiences in response to minor stresses in the flow of daily life, which may be functional states of an underlying abnormal DA-reactivity. The results, therefore, add credence to the suggestion that abnormal DA-reactivity may be part of the substrate that increases risk for psychotic symptoms in individuals at risk. TC15B PSYCHOSIS OUTSIDE OF THE RESEARCHER’S OFFICE: ASSOCIATION WITH “REAL TIME” STRESS AND PHYSIOLOGICAL AROUSAL D. Kimhy1 *, R. Sloan1 , P. Delespaul2 , D. Malaspina1 . 1 Columbia University, New York, NY, United States, 2 Maastricht University, Maastricht, Netherlands Presenting author contact: [email protected] Background: Stress has long been assumed to be relevant to the course of psychosis in schizophrenia. Previous studies using Experience Sampling Method (ESM) have linked momentary increases in psychotic symptoms with subjective stress. However, little is known about the pathophysiology associated with this link. Methods: We used ESM with Palm computers along with ambulatory assessment of cardiac autonomic regulation (Heart Rate Variability) to assess simultaneously momentary interactions between psychosis, subjective stress, and physiological arousal in hospitalized schizophrenia patients. Physiological arousal was assessed over 36
Abstracts hours (10am Day 1−10pm Day 2) using the LifeShirt System, a vestlike undergarment used to assess ambulatory cardiopulmonary data. During this period, subjects’ stress and psychotic experiences were sampled 10 times a day (10am-10pm) with Palm computers. The times of the Palm and LifeShirt System were synchronized allowing for the ESM data to be nested within a continuous measure of cardiac autonomic regulation. Mean parasympathetic activity was calculated for epochs 5 min. before/after each experience sample using power spectral analyses. Results: Subjects responded to 78% of the experience samples. Psychosis, stress and parasympathetic activity fluctuated markedly across time of day. High psychosis moments were characterized by significant lower parasympathetic activity, as well as reports of significantly higher ratings of confusion, irritation, and racing thoughts. Momentary ratings of preoccupation, depression/sadness, and fear of losing control displayed a trend toward higher ratings during High psychosis moments. Conclusions: Momentary ratings of psychosis are associated with increased arousal characterized by reduced parasympathetic activity. TC15C EXPERIENCES OF STRESS AND COPING OF YOUNG PEOPLE AT ULTRA HIGH RISK OF PSYCHOSIS L.J. Phillips1 *, N. McMurray1 , J. Edwards3 , S. Francey2 . of Melbourne, Melbourne, Australia, 2 PACE Clinic, Melbourne, Australia, 3 ORYGEN Youth Health, Melbourne, Australia Presenting author contact: [email protected]
1 University
Objectives: Although the experience of stress is thought to play a role in the onset of psychotic disorders, there is little evidence to support this due to a lack of prospective studies incorporating different aspects of the stress and coping process. Method: This study compared the experiences of stress and coping of young people at ‘ultra’ high risk (UHR) of psychosis and young people without mental health concerns. The experiences of major and minor stressful events, coping strategies employed and available social support were recorded over a 12-month persiod. Results: The UHR group experienced significantly fewer life events than the HC group, but the same number of minor events. Appraisal of their experiences differentiated the groups. The UHR group reported feeling significantly more distressed by events and felt they coped worse, utilised different coping skills, had fewer social contacts and felt they had lower levels of social support than the HC group. Conclusions: The results indicated that treatment focussing on stress management and coping skills might be important in the development of preventive interventions TC15D HPA AXIS AND THE STRESS RESPONSE IN PSYCHOSIS M. Lardinois1 *, N. Jacobs1 , C. Derom2 , J. Van Os1 , I. Myin-Germeys1 . 1 Maastricht University, Maastricht, Limburg, Netherlands, 2 Catholic University Leuven, Leuven, Limburg, Belgium Presenting author contact: [email protected] Introduction: Sensitivity to stress seems to be an endophenotype for psychosis. However, the biological mechanism underlying this stresssensitivity is poorly understood. It is attractive to hypothesize that hypothalamic-pituitary-adrenal (HPA) axis activity, one of the major mediating systems involved in stress responses, is involved. So far,
Symposium 18: Meeting the needs of families in early psychosis the results of research investigating HPA axis activity and cortisol in psychosis are inconclusive. The current study will investigate whether vulnerability for psychosis in a general population sample is associated with changes in HPA axis responsivity, measured in the realm of daily life. Methods: The Experience Sampling Method, a validated momentary assessment technique, was used in a female general population sample (n = 618) to assess different types of stressors, current mood and salivary cortisol 10 times daily for 5 consecutive days. Subjects were divided in a high and low psychosis-risk group based on their scores on the CAPE (a questionnaire assessing psychotic-like symptoms). Results: Multilevel analyses showed that underlying vulnerability did not alter cortisol responses in reaction to daily life stressors. However, cortisol more strongly mediated the emotional reaction to stress in the high-risk group compared to the low-risk group. Discussion: The data suggest that subjects at risk for psychosis do not report increased levels of cortisol secretion in reaction to stress. However, vulnerability to psychosis is associated with an increased susceptibility to the effects of cortisol, thus increasing emotional reactivity to stress. TC15E HPA AXIS REACTIVITY IN PRODROMAL PATIENTS AND POSITIVE SYMPTOMS C. Corcoran1 *, C. Smith2 , D. McLaughlin2 , A. Auther2 , E. Nakayama2 , B. Cornblatt2 . 1 Columbia/NYSPI, New York, NY, United States, 2 Mt. Sinai School of Medicine, New York, NY, United States Presenting author contact: [email protected] Introduction: Stress sensitivity may underlie psychosis risk, but has not yet been characterized in terms of putative biomarkers: the HPA axis is a natural candidate. We used cortisol secretion in response to a laboratory stressor as a proxy for stress sensitivity, and determined if this was related to symptoms in prodromal patients. Methods: Prodromal patients at RAP were characterized as to prodromal symptoms (SOPS), life events, cognition and cortisol reactivity to a stressor. “Stress-reactive” cortisol secretion was measured using a paradigm by Wolfgang Meier. Salivary cortisol levels were assessed at clinic arrival (11:00 am), acclimation 30 minutes later (11:30), and again 60 minutes later, after cognitive testing (12:30). Results: 16 prodromal patients were studied. Consonant with cortisol secretion normally decreasing in late morning and the mildness of the stressor, mean change in cortisol levels from acclimation to posttesting was approximately zero [−0.69(1.1)], range −4.8 (decrease) to 1.2 (increase). Cortisol reactivity was associated with suspiciousness (r = 0.51) and better memory performance on the CVLT (.56). Other correlations for cortisol reactivity were SOPS “impaired stress tolerance” (r = 0.43), SOPS disorganization (r = −0.45), and life events (r = 0.42). Discussion: Cortisol reactivity in prodromal patients was associated with stress indices, including stress intolerance, suspiciousness, and life events. Our findings add to the literature that shows that dysregulated HPA axis function may be related to mood and stress in prodromal patients (Thompson et al., 2006).
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Friday 6th October, 2006 Symposium 18: Meeting the needs of families in early psychosis Chair: G. Fadden FC1A CONSTRUAL, COPING STRATEGIES AND INTERACTIONAL CYCLES IN EARLY PSYCHOSIS: INTRODUCING KEY CONCEPTS TO MENTAL HEALTH STAFF F. Burbach *, R. Stanbridge. Somerset Partnership and NHS and Social Care Trust, Somerset, United Kingdom Presenting author contact: [email protected] Introduction: We will present our approach to introducing the concepts of interactional cycles, coping strategies, appraisal and construal, which are key to the understanding of helpseeking behaviour in families where there is early psychosis. These concepts are introduced both to staff on our one-year family interventions in psychosis course as well as in more general ‘family focused practice’ awareness raising sessions. Methods: We will discuss the key concepts, the rationale for their inclusion in staff training sessions and demonstrate how they are taught. Results: We have found that this is an effective way of introducing these ideas to mental health staff. It enables clinicians to understand the links between beliefs, behaviour and interactions and helps to equip them to use these concepts with families. Discussion: The way in which family members appraise an emerging psychosis and their responses (coping strategies) can result in the development of more-or-less helpful interactional cycles and influence the duration of untreated psychosis. We will also consider the clinical implications of these ideas as part of the integrated cognitivebehavioural and systemic approach developed in the Somerset Family Interventions Service. FC1B FAMILY CONSULTATION ACROSS THE INTERFACE OF CAMHS AND EARLY PSYCHOSIS SERVICES D. Pearson *. Leicestershire Mental Health Partnership NHS Trust, Leicestershire, United Kingdom Presenting author contact: [email protected] This presentation is about the complexities and challenges of Family Therapy and Consultation at the interface between Child and Adolescent (CAMHS) and Early Psychosis (EP) Services. Historically Adolescent and Adult Mental Health Services have been quite separate; divided not just by age, but also philosophy, approach and even client group. EP Services have bridged that traditional divide, and whilst that does introduce creative and exciting opportunities for collaborative practice, it, also, brings with it the potential for tensions and uncertainties; and especially so in relation to the provision of Family Consultation. With regard to the particular question of family support or intervention for these younger service users, different and quite specific issues are raised in situations where, either, EP and Adolescent Services offer conjoint packages of care – Parallel Therapies; or, where EP Services are asked to become involved at the point of the individual’s discharge from CAMHS – Serial Therapies.
Schizophrenia Research 86 (2006)
Symposium 17: Stress-sensitivity in psychosis: phenomenology and biology Chair: I. Myin-Germeys TC15A BEHAVIOURAL AND DOPAMINE SENSITIZATION TO STRESS IN INDIVIDUALS AT RISK FOR PSYCHOSIS I. Myin-Germeys *, M. Marcelis, P. Delespaul, J. van Os. Maastricht University, Maastricht, Netherlands Presenting author contact: [email protected] Background: Recent neurobiological models (Kapur, 2003) provide a possible mechanism of daily life stress directly affecting the intensity of psychotic experiences in vulnerable individuals. In order to validate such a mechanism, the impact of daily stress on psychosis intensity was investigated in two groups at increased risk of onset (relatives) and relapse (patients) of psychosis. In addition, it was investigated whether the association between daily stress and psychosis was mediated by dopamine-reactivity in drug-na¨ıve subjects (relatives). Methods: Patients in remission (n = 42), relatives (n = 47), and controls (n = 49) were studied with the Experience Sampling Method (a structured diary technique assessing current context and psychopathology in daily life) to assess 1) appraised subjective stress, and 2) intensity of subtle psychotic experiences. A metabolic perturbation paradigm causing plasma elevation of homovanillic acid (HVA) was used as proxy for DA-sensitization. Results: Multilevel regression analyses revealed significant increases in psychosis intensity associated with increases in subjective stress in patients and relatives. No association was found in control subjects. In addition, it was found that HVA-reactivity modified ESM psychotic experiences in response to daily life stress in relatives but not in control subjects. Conclusions: Subjects at increased risk for psychosis show continuous variation in intensity of subtle psychotic experiences in response to minor stresses in the flow of daily life, which may be functional states of an underlying abnormal DA-reactivity. The results, therefore, add credence to the suggestion that abnormal DA-reactivity may be part of the substrate that increases risk for psychotic symptoms in individuals at risk. TC15B PSYCHOSIS OUTSIDE OF THE RESEARCHER’S OFFICE: ASSOCIATION WITH “REAL TIME” STRESS AND PHYSIOLOGICAL AROUSAL D. Kimhy1 *, R. Sloan1 , P. Delespaul2 , D. Malaspina1 . 1 Columbia University, New York, NY, United States, 2 Maastricht University, Maastricht, Netherlands Presenting author contact: [email protected] Background: Stress has long been assumed to be relevant to the course of psychosis in schizophrenia. Previous studies using Experience Sampling Method (ESM) have linked momentary increases in psychotic symptoms with subjective stress. However, little is known about the pathophysiology associated with this link. Methods: We used ESM with Palm computers along with ambulatory assessment of cardiac autonomic regulation (Heart Rate Variability) to assess simultaneously momentary interactions between psychosis, subjective stress, and physiological arousal in hospitalized schizophrenia patients. Physiological arousal was assessed over 36
Abstracts hours (10am Day 1−10pm Day 2) using the LifeShirt System, a vestlike undergarment used to assess ambulatory cardiopulmonary data. During this period, subjects’ stress and psychotic experiences were sampled 10 times a day (10am-10pm) with Palm computers. The times of the Palm and LifeShirt System were synchronized allowing for the ESM data to be nested within a continuous measure of cardiac autonomic regulation. Mean parasympathetic activity was calculated for epochs 5 min. before/after each experience sample using power spectral analyses. Results: Subjects responded to 78% of the experience samples. Psychosis, stress and parasympathetic activity fluctuated markedly across time of day. High psychosis moments were characterized by significant lower parasympathetic activity, as well as reports of significantly higher ratings of confusion, irritation, and racing thoughts. Momentary ratings of preoccupation, depression/sadness, and fear of losing control displayed a trend toward higher ratings during High psychosis moments. Conclusions: Momentary ratings of psychosis are associated with increased arousal characterized by reduced parasympathetic activity. TC15C EXPERIENCES OF STRESS AND COPING OF YOUNG PEOPLE AT ULTRA HIGH RISK OF PSYCHOSIS L.J. Phillips1 *, N. McMurray1 , J. Edwards3 , S. Francey2 . of Melbourne, Melbourne, Australia, 2 PACE Clinic, Melbourne, Australia, 3 ORYGEN Youth Health, Melbourne, Australia Presenting author contact: [email protected]
1 University
Objectives: Although the experience of stress is thought to play a role in the onset of psychotic disorders, there is little evidence to support this due to a lack of prospective studies incorporating different aspects of the stress and coping process. Method: This study compared the experiences of stress and coping of young people at ‘ultra’ high risk (UHR) of psychosis and young people without mental health concerns. The experiences of major and minor stressful events, coping strategies employed and available social support were recorded over a 12-month persiod. Results: The UHR group experienced significantly fewer life events than the HC group, but the same number of minor events. Appraisal of their experiences differentiated the groups. The UHR group reported feeling significantly more distressed by events and felt they coped worse, utilised different coping skills, had fewer social contacts and felt they had lower levels of social support than the HC group. Conclusions: The results indicated that treatment focussing on stress management and coping skills might be important in the development of preventive interventions TC15D HPA AXIS AND THE STRESS RESPONSE IN PSYCHOSIS M. Lardinois1 *, N. Jacobs1 , C. Derom2 , J. Van Os1 , I. Myin-Germeys1 . 1 Maastricht University, Maastricht, Limburg, Netherlands, 2 Catholic University Leuven, Leuven, Limburg, Belgium Presenting author contact: [email protected] Introduction: Sensitivity to stress seems to be an endophenotype for psychosis. However, the biological mechanism underlying this stresssensitivity is poorly understood. It is attractive to hypothesize that hypothalamic-pituitary-adrenal (HPA) axis activity, one of the major mediating systems involved in stress responses, is involved. So far,
Symposium 18: Meeting the needs of families in early psychosis the results of research investigating HPA axis activity and cortisol in psychosis are inconclusive. The current study will investigate whether vulnerability for psychosis in a general population sample is associated with changes in HPA axis responsivity, measured in the realm of daily life. Methods: The Experience Sampling Method, a validated momentary assessment technique, was used in a female general population sample (n = 618) to assess different types of stressors, current mood and salivary cortisol 10 times daily for 5 consecutive days. Subjects were divided in a high and low psychosis-risk group based on their scores on the CAPE (a questionnaire assessing psychotic-like symptoms). Results: Multilevel analyses showed that underlying vulnerability did not alter cortisol responses in reaction to daily life stressors. However, cortisol more strongly mediated the emotional reaction to stress in the high-risk group compared to the low-risk group. Discussion: The data suggest that subjects at risk for psychosis do not report increased levels of cortisol secretion in reaction to stress. However, vulnerability to psychosis is associated with an increased susceptibility to the effects of cortisol, thus increasing emotional reactivity to stress. TC15E HPA AXIS REACTIVITY IN PRODROMAL PATIENTS AND POSITIVE SYMPTOMS C. Corcoran1 *, C. Smith2 , D. McLaughlin2 , A. Auther2 , E. Nakayama2 , B. Cornblatt2 . 1 Columbia/NYSPI, New York, NY, United States, 2 Mt. Sinai School of Medicine, New York, NY, United States Presenting author contact: [email protected] Introduction: Stress sensitivity may underlie psychosis risk, but has not yet been characterized in terms of putative biomarkers: the HPA axis is a natural candidate. We used cortisol secretion in response to a laboratory stressor as a proxy for stress sensitivity, and determined if this was related to symptoms in prodromal patients. Methods: Prodromal patients at RAP were characterized as to prodromal symptoms (SOPS), life events, cognition and cortisol reactivity to a stressor. “Stress-reactive” cortisol secretion was measured using a paradigm by Wolfgang Meier. Salivary cortisol levels were assessed at clinic arrival (11:00 am), acclimation 30 minutes later (11:30), and again 60 minutes later, after cognitive testing (12:30). Results: 16 prodromal patients were studied. Consonant with cortisol secretion normally decreasing in late morning and the mildness of the stressor, mean change in cortisol levels from acclimation to posttesting was approximately zero [−0.69(1.1)], range −4.8 (decrease) to 1.2 (increase). Cortisol reactivity was associated with suspiciousness (r = 0.51) and better memory performance on the CVLT (.56). Other correlations for cortisol reactivity were SOPS “impaired stress tolerance” (r = 0.43), SOPS disorganization (r = −0.45), and life events (r = 0.42). Discussion: Cortisol reactivity in prodromal patients was associated with stress indices, including stress intolerance, suspiciousness, and life events. Our findings add to the literature that shows that dysregulated HPA axis function may be related to mood and stress in prodromal patients (Thompson et al., 2006).
S33
Friday 6th October, 2006 Symposium 18: Meeting the needs of families in early psychosis Chair: G. Fadden FC1A CONSTRUAL, COPING STRATEGIES AND INTERACTIONAL CYCLES IN EARLY PSYCHOSIS: INTRODUCING KEY CONCEPTS TO MENTAL HEALTH STAFF F. Burbach *, R. Stanbridge. Somerset Partnership and NHS and Social Care Trust, Somerset, United Kingdom Presenting author contact: [email protected] Introduction: We will present our approach to introducing the concepts of interactional cycles, coping strategies, appraisal and construal, which are key to the understanding of helpseeking behaviour in families where there is early psychosis. These concepts are introduced both to staff on our one-year family interventions in psychosis course as well as in more general ‘family focused practice’ awareness raising sessions. Methods: We will discuss the key concepts, the rationale for their inclusion in staff training sessions and demonstrate how they are taught. Results: We have found that this is an effective way of introducing these ideas to mental health staff. It enables clinicians to understand the links between beliefs, behaviour and interactions and helps to equip them to use these concepts with families. Discussion: The way in which family members appraise an emerging psychosis and their responses (coping strategies) can result in the development of more-or-less helpful interactional cycles and influence the duration of untreated psychosis. We will also consider the clinical implications of these ideas as part of the integrated cognitivebehavioural and systemic approach developed in the Somerset Family Interventions Service. FC1B FAMILY CONSULTATION ACROSS THE INTERFACE OF CAMHS AND EARLY PSYCHOSIS SERVICES D. Pearson *. Leicestershire Mental Health Partnership NHS Trust, Leicestershire, United Kingdom Presenting author contact: [email protected] This presentation is about the complexities and challenges of Family Therapy and Consultation at the interface between Child and Adolescent (CAMHS) and Early Psychosis (EP) Services. Historically Adolescent and Adult Mental Health Services have been quite separate; divided not just by age, but also philosophy, approach and even client group. EP Services have bridged that traditional divide, and whilst that does introduce creative and exciting opportunities for collaborative practice, it, also, brings with it the potential for tensions and uncertainties; and especially so in relation to the provision of Family Consultation. With regard to the particular question of family support or intervention for these younger service users, different and quite specific issues are raised in situations where, either, EP and Adolescent Services offer conjoint packages of care – Parallel Therapies; or, where EP Services are asked to become involved at the point of the individual’s discharge from CAMHS – Serial Therapies.