Altered Transfer of Momentary Mental States (ATOMS) as the Basic Unit of Psychosis Liability in Interaction with Environment and Emotions

Johanna T W Wigman,Jim Van Os,Dina Collip,Wilma A M Vollebergh,Tineke Lataster,Nele Jacobs,Philippe Delespaul,Inez Myin-Germeys,Marieke Wichers,Catherine Derom,Evert Thiery

doi:10.1371/journal.pone.0054653

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 moment-to-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.

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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