ALTERED TRANSFER OF MOMENTARY MENTAL STATES (ATOMS) AS THE BASIC UNIT OF PSYCHOSIS LIABILITY IN INTERACTION WITH ENVIRONMENT AND EMOTIONS

Jim Van Os

doi:10.1016/s0920-9964(14)70221-x

Abstract

Psychotic disorders are thought to represent altered neural function. However, research has failed to map diagnostic categories to alterations in neural networks. It is proposed that the basic unit of psychotic psychopathology is the momentto-moment expression of subtle anomalous experiences of subclinical psychosis, and particularly its tendency to persist from moment-to-moment in daily life, under the influence of familial, environmental, emotional and cognitive factors. In a general population twin sample (n = 579) and in a study of patients with psychotic disorder (n = 57), their non-psychotic siblings (n = 59) and unrelated controls (n = 75), the experience sampling paradigm (ESM; repetitive, random sampling of momentary mental states and context) was applied. We analysed, in a within-person prospective design, (i) transfer of momentary anomalous experience at time point (t–1) to time point (t) in daily life, and (ii) moderating effects of negative affect, positive affect, daily stressors, IQ and childhood trauma. Additionally, (iii) familial associations between persistence of momentary anomalous experience and psychotic symptomatology were investigated. Higher level of schizotypy in the twins (but not higher level of psychotic symptoms in patients) predicted more persistence of momentary anomalous experience in daily life, both within subjects and across relatives. Persistence of momentary anomalous experience was highest in patients, intermediate in their siblings and lowest in controls. In both studies, persistence of momentary anomalous experience was moderated by higher levels of negative affect, daily stressors and childhood trauma (only in twins), and by lower levels of positive affect. The study of alterations in the moment-to-moment transfer of subtle anomalous experience of psychosis, resulting in their persistence, helps to explain why psychotic and emotional dysregulation tend to cluster in a single phenotype such as schizophrenia, and how familial and environmental risks increase the risk of expression of psychosis from, first, subtle momentary anomalous experience to, second, observable clinical symptoms. Citation: Wigman JTW, Collip D, Wichers M, Delespaul P, Derom C, et al. (2013) Altered Transfer of Momentary Mental States (ATOMS) as the Basic Unit of Psychosis Liability in Interaction with Environment and Emotions. PLoS ONE 8(2): e54653. doi:10.1371/journal.pone.0054653 Editor: James G. Scott, The University of Queensland, Australia Received May 21, 2012; Accepted December 17, 2012; Published February 15, 2013 Copyright: 2013 Wigman et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: The TWIN study has been partly supported by grants from the Fund of Scientific Research, Flanders and Twins, a non-profit association for Scientific Research in Multiple Births (Belgium). The infrastructure for the GROUP study is funded by grant 10-000-1002 from the Geestkracht program of the Netherlands Organization for Health Research and Development (ZonMw) and matching funds from participating universities and mental health care organizations (Site Amsterdam: Academic Psychiatric Centre AMC, Ingeest, Arkin, Dijk en Duin, Rivierduinen, Erasmus MC, GGZ Noord Holland Noord; Site Utrecht: University Medical Centre Utrecht, Altrecht, Symfora, Meerkanten, Riagg Amersfoort, Delta; Site Groningen: University Medical Center Groningen, Lentis, GGZ Friesland, GGZ Drenthe, Dimence, Mediant, GGZ De Grote Rivieren, and Parnassia Psychomedical Centre; Site Maastricht: Maastricht University Medical Center, GGZ Eindhoven, GGZ Midden-Brabant, GGZ Oost-Brabant, GGZ Noord-Midden Limburg, Mondriaan Zorggroep, Prins Clauscentrum Sittard, RIAGG Roermond, Universitair Centrum SintJozef Kortenberg, CAPRI University of Antwerp, PC Ziekeren Sint-Truiden, PZ Sancta Maria Sint-Truiden, GGZ Overpelt, OPZ Rekem). Supported by the European Community’s Seventh Framework Program under grant agreement No. HEALTH-F2-2009-241909 (Project EU-GEI). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have the following interest. Prof van Os conducts other studies, not related to the study that is the subject of the authors’ submission and approved by the standing ethics committee, that are in part supported by unrestricted grants from Janssen-Cilag, Eli Lilly and Co, AstraZeneca, and Lundbeck. This does not alter the authors’ adherence to all the PLOS ONE policies on sharing data and materials. * E-mail: j.vanos@maastrichtuniversity.nl . These authors contributed equally to this work. PLOS ONE | www.plosone.org 1 February 2013 | Volume 8 | Issue 2 | e54653

Highlights

The basic unit of psychopathology: from diagnostic categories to reactive mental states it is widely believed that mental disorders have their origin in altered cerebral function, the widely criticized [1,2] disease categories as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) do not map on what the brain does: mediating the continuous flow of meaningful perceptions of the social environment that guide adaptive behaviour
Altered transfer of momentary anomalous experience was not familial in the healthy twins, but in both healthy twins and patients with psychotic disorder, altered transfer of momentary anomalous experience from time point (t–1) to time point (t) in the daily life Experience Sampling Method (ESM) paradigm was predicted by higher levels of negative affect, lower levels of positive affect and higher levels of minor stressors at (t–1)
Extensive research has demonstrated a link between cognitive, environmental and familial factors on the one hand, and expression of psychosis on the other, this paper is the first, to our knowledge, to show the importance of such factors in the persistence of anomalous experiences of subclinical psychosis from moment to moment in daily life in individuals with vulnerability for psychosis and to suggest that altered transfer of momentary mental states (ATOMS) may be the basic unit underlying liability for psychosis, in interaction with an individual’s internal and external context

Summary

Introduction

The basic unit of psychopathology: from diagnostic categories to reactive mental states it is widely believed that mental disorders have their origin in altered cerebral function, the widely criticized [1,2] disease categories as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) do not map on what the brain does: mediating the continuous flow of meaningful perceptions of the social environment that guide adaptive behaviour. A reformulation of the basic psychopathological unit towards dynamic reactivity, modelled on the role of neural networks in mediating adaptive functioning to social context, may be more productive. Phenotypes combining dimensional variation and daily life reactivity are commonly assessed in medicine; examples are the longitudinal monitoring of blood pressure, muscle tone and brain waves in the flow of daily life. As these phenotypes are informative with regard to diagnosis, treatment needs and prognosis, introduction of similar dimensional reactive phenotypes in psychiatry may be fruitful. Assessing constantly changing mental representations that are not directly observable in the flow of daily life requires novel, longitudinal, within-person tracking technologies that have been introduced only relatively recently

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Conclusion