Trauma and psychosis from macro to microenvironment Inez
- Slides: 70
Trauma and psychosis: from macro to micro-environment Inez Myin-Germeys Prof. of Ecological Psychiatry
Faculty name
Changing paradigms Faculty name
Psychosis as a continuum Level of psychosis What are these factors? Psychotic disorder Subclinical, “schizotypal” none birth adolescence adulthood old age Faculty name Collip et al, schiz bull 2008; Wigman et al schiz bull 2011; Cougnard et al, Psych Med 2007; Dominguez et al 2009
“An abnormal environment can disrupt normal development as effectively as can a mutant gene, if not more so, with major consequences for behavior” Faculty name
CHILDHOOD TRAUMA Faculty name
MHENS School for Mental Health and Neuroscience Is trauma a risk factor for psychosis? Faculty of Health, Medicine, and Life Sciences Faculty name
OR=2, 78 (95% CI 2. 34 – 3. 31) Faculty name
MHENS School for Mental Health and Neuroscience Case – control study Faculty of Health, Medicine, and Life Sciences Faculty name Arch Gen Psychiatry, 2010
MHENS School for Mental Health and Neuroscience Trauma in patients with psychosis 271 Patients 227 Controls OR= 4. 57 *** Faculty of Health, Medicine, and Life Sciences Faculty name Heins et al, Am J Psych, 2011
MHENS School for Mental Health and Neuroscience Trauma in siblings OR= 2. 60 271 Patients *** 259 Siblings 227 Controls OR= 4. 57 Faculty of Health, Medicine, and Life Sciences Faculty name Heins et al, Am J Psych, 2011
MHENS School for Mental Health and Neuroscience Trauma and psychosis OR= 2. 60 271 Patients *** OR= 1. 60 259 Siblings * 227 Controls OR= 4. 57 Faculty of Health, Medicine, and Life Sciences Faculty name Heins et al, Am J Psych, 2011
MHENS School for Mental Health and Neuroscience Within person associations 271 Patients 259 Siblings 227 Controls Symptoms Faculty of Health, Medicine, and Life Sciences Faculty name Heins et al, Am J Psych, 2011
MHENS School for Mental Health and Neuroscience Within person associations Faculty of Health, Medicine, and Life Sciences Faculty name Heins et al, Am J Psych, 2011
MHENS School for Mental Health and Neuroscience Dose - response Faculty of Health, Medicine, and Life Sciences Faculty name Heins et al, Am J Psych, 2011
MHENS School for Mental Health and Neuroscience General population study 13 722 Hallucinations Delusions Hall + Del 2 * * * * Neglect Psych Ab * * * * 1 0 Total Phys Ab Sex Ab Faculty of Health, Medicine, and Life Sciences Faculty name Van Nierop et al, Schiz Bull, 2014
MHENS School for Mental Health and Neuroscience General population study 13 722 3 2 Psychotic experiencs 1 0 Intention to harm No intention to harm Faculty of Health, Medicine, and Life Sciences Faculty name Van Nierop et al, Schiz Bull, 2014
MHENS School for Mental Health and Neuroscience Is trauma a risk factor for psychosis? Faculty of Health, Medicine, and Life Sciences Faculty name Arsenault, Am. J. Psychiatry, 2011
MHENS School for Mental Health and Neuroscience Is it specific for psychosis? 0, 5 0, 4 0, 3 Positive Negative 0, 2 Depressive 0, 1 0 Patients Relatives Controls Faculty of Health, Medicine, and Life Sciences Faculty name Van Dam et al, Psych Med, 2015
• General population (N=6646) • Anxiety disorder (N=1120) • Depression (N=1577) • Psychotic disorder (N=825) Faculty name DEPRESSION ANXIETY MANIA PSYCHOSIS
No Symptoms Depression only Mania only Anxiety only Psychosis only 2 Clusters 3 Clusters 4 Clusters Faculty name
General population 1, 4 OR 1, 3 Depression Mania Anxiety 1, 2 Psychosis 2 symptom clusters 3 symptom cluster 1, 1 4 symptom clusters 1 Faculty name Van Nierop et al, Acta Scan Psych, 2015
General population *** 1, 4 1, 3 *** Depression Mania Anxiety OR 1, 2 Psychosis 2 symptom clusters 3 symptom clusters 1, 1 4 symptom clusters 1 Faculty name Van Nierop et al, Acta Scan Psych, 2015
1, 35 Depression 1, 3 8 Anxiety 7 1, 25 6 1, 2 5 1, 15 OR 1, 15 4 1, 1 3 1, 05 2 1 0, 95 Depression 3 clusters Psychosis 2 clusters 4 clusters 0, 95 Anxiety 3 clusters 1 2 clusters 4 clusters 0 Psychosis 3 clusters 2 clusters 4 clusters Faculty name Van Nierop et al, Acta Scan Psych, 2015
Depression Faculty name Anxiety Psychotic
Patients with affective disorder Work / income % 40 30 20 10 0 No work Not fit for work Low income Relations % 60 3, 1 50 3, 05 40 3 30 2, 95 20 2, 9 10 2, 85 0 2, 8 Married Clinical aspects % Living together Education Social functioning (mean) 40 100 30 90 80 20 70 10 0 Education (mean) 60 Service use Medication Substance Alcohol use problems CT-/ CLFaculty name CT-/ CL+ 50 Physical Social functioning CT+/ CL- Mental health Vitality CT+/ CL+ Physical pain General health
Patients with anxiety disorder Work / income % 40 30 20 10 0 No work Not fit for work Low income Relations % 60 3, 1 50 3, 05 40 3 30 2, 95 20 2, 9 10 2, 85 0 2, 8 Married Clinical aspects % Living together Education Social functioning (mean) 40 100 30 90 80 20 70 10 0 Education (mean) 60 Service use Medication Substance Alcohol use problems CT-/ CLFaculty name CT-/ CL+ 50 Physical Social functioning CT+/ CL- Mental health Vitality CT+/ CL+ Physical pain General health
Patients with Psychotic disorder Work / income % Relations % 100 30 80 25 20 60 15 40 10 20 5 0 0 65 No work Not fit for Low income work GAF (mean) Married Living together PANSS (mean) 3 2, 5 60 1, 5 50 Protected living 4 2, 8 2, 7 2, 6 2, 5 2, 4 2, 3 2, 2 2, 1 Education WHO Quality of Life (mean) 3, 5 2 55 3 1 45 40 Education (mean) 2, 5 0, 5 Functioning CT-/ CLFaculty name Disability 0 Positive Negative Symptoms CT-/ CL+ General CT+/ CL- 2 Physical CT+/ CL+ Psychological Social Environmental
Faculty name
DEPRESSION ANXIETY PSYCHOSIS ENVIRONMENTAL STRATIFICATION Patiets exposed to trauma Faculty name
MHENS School for Mental Health and Neuroscience What is the mechanism? + – Faculty of Health, Medicine, and Life Sciences Faculty name
MHENS School for Mental Health and Neuroscience Environment – environment interaction? Environment Psychosis Faculty of Health, Medicine, and Life Sciences Faculty name
MHENS School for Mental Health and Neuroscience Sensitization? Sensitization Faculty of Health, Medicine, and Life Sciences Faculty name Collip et al, 2008, Schiz Bull
MHENS School for Mental Health and Neuroscience Sensitization? Sensitization Faculty of Health, Medicine, and Life Sciences Faculty name Collip et al, 2008, Schiz Bull
MHENS School for Mental Health and Neuroscience Trauma x cannabis? Greek Birthcohort; N= 3500 Age 7: Age 19: Cannabis No childhood trauma Childhood trauma Psychotic symptoms (CAPE) Faculty of Health, Medicine, and Life Sciences Faculty name Konings et al, Psych Med 2012
MHENS School for Mental Health and Neuroscience Trauma x cannabis No Cannabis CAPE score Cannabis 1, 5 1 0, 5 0 -0, 5 Never Occassionally Often Maltreatment Age 7 Faculty of Health, Medicine, and Life Sciences Faculty name Konings et al, Psych Med 2012
MHENS School for Mental Health and Neuroscience Trauma <- > life events Nemesis study, 4848 general population T 0 Childhood trauma No Cannabis T 1/T 2 Cannabis Psychosis Faculty of Health, Medicine, and Life Sciences Faculty name Konings et al, Psych Med 2012
MHENS School for Mental Health and Neuroscience Trauma x cannabis No Cannabis Mild Moderate 70 % T 1/T 2 Psychosis 60 50 40 30 20 10 0 Never Severe Childhood trauma Faculty of Health, Medicine, and Life Sciences Faculty name Konings et al, Psych Med 2012
MHENS School for Mental Health and Neuroscience Trauma <- > life events GROUP study, 1119 patients / 589 controls Urbanicity No Trauma T 0 Trauma Case / control Faculty of Health, Medicine, and Life Sciences Faculty name Frissen et al, SPPE, 2015
MHENS School for Mental Health and Neuroscience Trauma x urbanicity Association between high trauma score and patient status OR 7 6 5 4 3 2 1 0 1 2 3 4 Level of urbanicity Faculty of Health, Medicine, and Life Sciences Faculty name Frissen et al, SPPE, 2015
MHENS School for Mental Health and Neuroscience Trauma <- > life events EDSP study, 2437 adolescents ranging from 17 to 24 years T 0 T 2 No psychosis Life events No childhood trauma T 3 Childhood trauma Psychosis Faculty of Health, Medicine, and Life Sciences Faculty name Lataster J et al, Acta Psych Scan, 2012
Trauma <- > life events No later life adverse events n=192 c 2=4. 59; p=. 032 n=336 No early life adversity n=341 n=248 n=76 Early life adversity n=158 n=186 n=185 Percentage with psychotic symptoms / impairment Faculty of Health, Medicine, and Life Sciences Faculty name Lataster J et al, Acta Psych Scan, 2012
Trauma <- > life events No later life adverse events n=192 c 2=4. 59; p=. 032 n=336 No early life adversity n=341 n=248 n=76 Early life adversity n=158 n=186 n=185 Percentage with psychotic symptoms / impairment Faculty of Health, Medicine, and Life Sciences Faculty name Lataster J et al, Acta Psych Scan, 2012
Psychological mechanisms • Social defeat: loss of self-confidence, being hopeless, feeling less than other people • Affective dysregulation Faculty name Van Nierop et al, Acta Pscych Scan, 2014
The Experience Sampling Beep 1 Method Beep 2 DAY 1 DAY 2 Beep 3 Beep 4 DAY 3 Beep 5 DAY 4 (day 4 in detail) Beep 6 DAY 5 Beep 7 DAY 6 ü 10 times a day ü 6 consecutive days ü at random moments Faculty name Beep 8 Beep 9 Beep 10 Myin-Germeys et al, 2009; Wichers et al. , 2009; Delespaul, 1995
Emotional Reactivity to stress Daily stress Faculty of Health, Medicine, and Life Sciences Faculty name Mood
MHENS School for Mental Health and Neuroscience Emotional reactivity to daily life stress — 42 Patients, =0. 22 Negative affect — 47 Relatives, =0. 09 — 49 Controls, =0. 05 STRESS Faculty of Health, Medicine, and Life Sciences Faculty name Myin-Germeys et al. , Arch Gen Psych 2001
MHENS School for Mental Health and Neuroscience Activity-related stress and psychosis Psychotic Symptoms Psychosis intensity Daily stress 20 18 16 Patients, =0. 45 Relatives, =0. 16 14 Controls, =0. 02 12 10 8 1 2 3 4 5 6 7 Increase in activity-related stress Faculty of Health, Medicine, and Life Sciences Faculty name Myin-Germeys et al. , Psych Med 2005
Childhood trauma & stress-reactivity In a general population sample of 90 frequent attenders of the general practitioner Mood Daily stress 32% Trauma v sexual trauma v physical trauma Faculty of Health, Medicine, and Life Sciences Faculty name Glaser et al. , j. Psychosomatic Med 2006
Childhood trauma & stress-reactivity Increase NA 1, 8 No abuse Abuse 1, 4 1 1 2 3 4 5 6 7 Activity-related stress Faculty of Health, Medicine, and Life Sciences Faculty name Glaser et al. , j. Psychosomatic Med 2006
Childhood trauma & stress-reactivity Increase NA 2, 8 2, 6 2, 4 No abuse 2, 2 2 Abuse after age 10 1, 8 1, 6 Abuse before age 10 1, 4 1, 2 1 1 2 3 4 5 6 7 Activity-related stress Faculty of Health, Medicine, and Life Sciences Faculty name Glaser et al. , j. Psychosomatic Med 2006
Childhood trauma & stress-reactivity In 58 patients with psychosis Daily stress Trauma Mood v Sexual abuse v Physical abuse v Psychological abuse v Emotional neglect Faculty of Health, Medicine, and Life Sciences Faculty name
MHENS School for Mental Health and Neuroscience Childhood trauma & emotional stressreactivity NA 3 2, 5 No Trauma 2 Trauma 1, 5 1 1 2 3 4 5 6 7 STRESS Faculty of Health, Medicine, and Life Sciences Faculty name Lardinois et al, Acta Psych Scand, 2010
MHENS School for Mental Health and Neuroscience Childhood trauma & psychotic stress-reactivity Psychose 5 4, 5 4 3, 5 No abuse 3 Abuse 2, 5 2 1, 5 1 1 2 3 4 5 6 7 STRESS Faculty of Health, Medicine, and Life Sciences Faculty name Lardinois et al, Acta Psych Scand, 2010
LE & stress-reactivity Daily stress Life events Faculty of Health, Medicine, and Life Sciences Faculty name Mood
LE & stress-reactivity No LE NA LE STRESS Faculty of Health, Medicine, and Life Sciences Faculty name Myin-Germeys et al, Psych Med 2003
Need for care Prognosis Faculty name Trauma treatment?
Faculty name
Faculty name
Symptom severity Self report Trauma cognitions Faculty name
MHENS School for Mental Health and Neuroscience Alternative treatments ESM feedback TAU + ESM + feedback Baseline ESM HDRS IDS Pseudo-interventie TAU + ESM Controle TAU Faculty of Health, Medicine, and Life Sciences Faculty name Kramer et al, World Psychiatry 2014 Post ESM HDRS IDS Depressive symptoms FU 1, 2, 3 & 6 months
MHENS School for Mental Health and Neuroscience Behavioural activation in real life In depression Faculty of Health, Medicine, and Life Sciences Faculty name Kramer et al, World Psychiatry 2014
MHENS School for Mental Health and Neuroscience Behavioural activation -> results Self-report depression (IDS-SR) IDS-SR Sumscore 40 Controle 35 Pseudo-interventie Interventie 30 * 25 20 * ** 15 Kramer et al, World Psychiatry 2014 24 W ee k ee W Faculty of Health, Medicine, and Life Sciences Faculty name k 12 8 W ee k 4 k ee W in et m st Po Pr em et in g g 10
MHENS School for Mental Health and Neuroscience Behavioural activation -> results Rated depression (HAMILTON) HDRS Sumscore 18 Controle 16 Pseudo-interventie 14 Interventie 12 * * 10 * 8 ** * Kramer et al, World Psychiatry 2014 24 ee W k ee W Faculty of Health, Medicine, and Life Sciences Faculty name k 12 8 W ee k 4 k ee W et st m Po Pr em et in in g g 6
ACT in daily life Week 4: 3 -day training Evaluation Week 3: 3 -day training Evaluation Week 2: 3 -day training Evaluation Faculty name Evaluation Week 1: 3 -day training 4 -week additional ACT in Daily Life Training Debriefing Briefing Regular ACT-training
ACT in daily life -> training day Short-questionnairre (3 minutes) T 1 Morningexercise: Values T 2 T 3 T 4 T 5 ACT-Metaphor / Awareness exercise T 6 T 7 T 8 T 9 T 10 ESM-I: 10 times a day. Morning ACTexercise Faculty name Afternoon ACT-exercise Standard-exercise Evening ACTexercise ACTion-exercise Eveningexercise: Commitment
ACT in daily life -> Psy. Mate Menu Morning (values) Accept 1. Struggle 2. Invite pain 3. Obstakles 4. Dark-side ACTstandard Defusion Mindfulness 1. Observe 2. Clouds 3. Zoom out 4. Mind-control 1. Senses 2. Breathing 3. Bodyscan 4. Grounding Faculty name ACTMetaphor ACTionexercise Accept Defusion 1. Compassion 2. Explore 3. Fight or Flight 1. Repeat 2. Step-back 3. Appreciate Evening (commitment)
MHENS School for Mental Health and Neuroscience To conclude Faculty of Health, Medicine, and Life Sciences Faculty name
MHENS School for Mental Health and Neuroscience To conclude • Paradigm shift • History of interactions / learning by consequences • New treatment / prevention strategies Faculty of Health, Medicine, and Life Sciences Faculty name
Thanks to: Funding: • European Research Council (ERC consolidator grant) • Dutch Research Council • NARSAD • Health Foundation Limburg Starting October 1 st Faculty name
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