Abstract
Subclinical psychotic experiences at the level of the general population are common, forming an extended psychosis phenotype with clinical psychosis. Persistence of subclinical experiences is associated with transition to later mental disorder. Increased daily life stress reactivity is considered an endophenotype for psychotic disorders. We examined, in a longitudinal framework, whether baseline momentary assessment markers of stress reactivity would predict persistence of subclinical psychotic experiences over time. In a general population sample of female twins (N = 566), the Experience Sampling Method (ESM; repetitive random sampling of momentary emotions, psychotic experiences and context) was used to assess (emotional and psychotic) daily life stress reactivity. Persistence of subclinical psychotic experiences was based on the Community Assessment of Psychic Experiences (CAPE), assessed three times over 14 months post-baseline. It was investigated whether baseline daily life emotional and psychotic stress reactivity predicted persistence of psychotic experiences over time. Higher levels of emotional stress reactivity (a decrease in positive and an increase in negative affect in response to stress), and increased psychotic reactivity to daily stress was found in individuals with persistent psychotic experiences over time compared to individuals with transient psychotic experiences. The results suggest that markers of daily life stress reactivity may predict “macro-level” persistence of normally transient expression of psychotic liability over time. Linking daily life markers of altered reactivity in terms of emotions and psychotic experiences to longitudinal persistence of psychotic experiences, associated with increased risk of transition to overt mental disorder, may contribute to earlier and more accurate diagnosis of risk.
Highlights
Psychiatric research is complementing its previous focus on categorical, heterogeneous disease entities with dimensional approaches towards psychopathology
Given that genetic effects on psychopathology are likely sex-specific to a degree, only women were included in the original study, meaning that the current analyses pertain to women only
Higher levels of emotional sensitivity, and psychotic reactivity to daily stress were found in individuals with persistent subclinical psychotic experiences compared to individuals with persistently low levels of psychotic experiences
Summary
Psychiatric research is complementing its previous focus on categorical, heterogeneous disease entities with dimensional approaches towards psychopathology. There is evidence that subclinical psychotic experiences at the level of the general population are common, and represent an extended psychosis phenotype outside the boundaries of clinical disorder [1]. Psychotic experiences may be considered truly dimensional, extending across most mental disorders including common mental disorder [2], in which they impact negatively on course and outcome, as well as occasioning a more ‘‘schizophrenia-like’’ risk factor profile [3]. Sensitization refers to the phenomenon that the response to an environmental risk factor increases in intensity with repeated exposure to this risk factor. This may lead to a lasting change in response amplitude [11,12]. It is hypothesized that indicators of early behavioral sensitization precedes persistence of psychotic symptoms
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