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Psychology & Neuroscience of Psychosis > Psychological and Social Factors > Flashcards

Psychological and Social Factors Flashcards

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1
Q

What did the WHO Ten-Country study suggest?

A

1980s - 1990s: rate in which new cases of psychotic disorder emerge in populations over time

  • Narrow schizophrenia = classical symptoms : no significant differences across populations
  • > schizophrenia uniform around the world
  • Broad schizophrenia: wider variations in rates of schizophrenia
  • > not uniform across populations
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2
Q

What did meta-analyses reveal after the WHO Ten-Country study (McGrath et al., 2004)?

A
  • 100 studies reported incidence rates of schizophrenia (top and bottom 10% rates removed)
  • Variation in incidence found across geographical areas: 7.7 to 43 per 100,000
    = 5 fold variation in incidence
  • Incidence higher in males than females, urban areas, and migrant groups
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3
Q

Which findings are amongst the most replicated findings in the epidemiology of schizophrenia and psychotic disorders?

A

Incidence rate of schizophrenia is higher in:
- males than females

  • urban areas
  • migrant groups
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4
Q

How does the relative risk of schizophrenia vary according to where people lived in their childhood (Pedersen and Mortensen, 2001)?

A
  • Most urbanised area: 2 times higher risk of schizophrenia than in rural areas
  • Incidence reduced in individuals who moved out of urban environments
  • Incidence increased when people moved in urban environments
  • > increased interest in social factors in psychotic disorders
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5
Q

What is the dose response effect?

A

The higher the population density, the higher the risk

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6
Q

What do the meta-analysis on schizophrenia and migration show (Kirkbride et al., 2006)?

A
  • Incidence is higher in all migrants (compared to non-migrant populations) (weighted relative risk: 2.9)
  • Incidence is higher in developing countries (weighted relative risk: 3.3)
  • Incidence is higher in majority of black population (weighted relative risk: 4.9)
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7
Q

What do meta-analyses show on psychosis and ethnicity show (Kirkbride et al., 2006; Morgan et al., 2006; Fearon et al., 2006)?

A
  • Higher incidence of psychotic disorders amongst individuals who’ve migrated from countries with majority of black population (Caribbean, Sub-Saharan Africa)
  • Migrant effect: incidence varies from different migrant groups (higher in groups are more visible minorities)
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8
Q

What do meta-analyses show on variations in the incidence of psychotic disorders between generations (Bourque, van der Ver and Malla, 2011)?

A
  • No reduction in incidence rates
  • Similar or even higher rates for 2nd generation
  • Increased incidence is not primarily due to migration BUT rather living as minority in a majority population
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9
Q

What is the incidence of common psychotic experiences within the general population?

A

Up to 10%

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10
Q

What characterises the common psychotic experiences in the general population?

A

They share the qualities of psychotic experiences without the level of intensity, frequency or severity of psychotic disorders

  • short-lived hallucinations
  • low-level delusions and strange beliefs
  • > share the same risk factors as psychotic disorder
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11
Q

What is the problem with studies that focused on psychotic experiences?

A

They rely on assumptions that psychotic experiences might give a clue to the risk of developing a psychotic experience

  • psychotic experiences share same risk factors as psychotic disorder
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12
Q

What does the research on the social factors in psychosis relate to?

A

Psychotic experiences in the general population

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13
Q

What are the social risk factors of psychosis at the neighbourhood/area level?

A
  • Ethnic density
  • Population density
  • Social fragmentation
  • Deprivation
  • Crime
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14
Q

What are the social risk factors of psychosis at the individual-level?

A
  • Separation in childhood (e.g. abuse, bullying)

- Isolation in adulthood (e.g. life events, discrimination)

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15
Q

What did researchers in Chicago find out about the neighbourhood factors in the occurence of mental disorders (Faris and Dunham, 1939; Park and Burgess, 1925)?

A
  • Occurence of schizophrenia much more common in the middle of city (downtown, fragmented areas)
  • high levels of geographical / social mobility, crime, proportion of migrant groups, single person households or rented accommodation
  • Incidence decreased when going out of those areas (heart of city)
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16
Q

What was the key issue with studies on neighbourhood/area factors of psychosis?

A

Is psychosis due to social drift or social causation?

  • whether people have developed disorder prior to moving into these areas or is it living in these areas that increases the risk?
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17
Q

What is the role of social fragmentation in the development of psychotic disorders (Allardyce et al., 2005)?

A
  • The higher the level of fragmentation, the higher the level of admission for schizophrenia
  • Effect for social fragmentation persists even after adjusting for deprivation
  • > living in impoverished/deprived areas is not key factor
  • Key factor: living in disjointed and fragmented environments
18
Q

What does ethnic density refer to?

A

The proportion of people from minority ethnic groups living in a certain area

19
Q

What is the role of ethnic density in the risk of schizophrenia?

A
  • As level of ethnic density decreases, relative risk of schizophrenia increases
  • > risk of schizophrenia might be higher where people feel marginalised or isolated
  • > living in areas with greater levels of social support and integration might protect against developing schizophrenia
  • > Social environment and social risk factors might be important in relation to psychotic disorders
20
Q

Can social drift explain why a decreased level of ethnic density is associated with an increased relative risk of schizophrenia?

A

No
- most areas with low proportions of minority ethnic groups tend to be wealthier areas

-> developing a severe psychotic disorder is unlikely to cause social drift in wealthier areas

21
Q

What is adversity?

A

Difficult and unpleasant experiences or circumstances

22
Q

What are the identified indicators of childhood adversity (Wicks, Hjern, Gunnell, Lewis and Dalman, 2005)?

A
  • Rented apartment
  • Low social economic status
  • Single parent household
  • Unemployment
  • Receiving welfare benefits
  • > increased incidence of psychotic disorder in relation to each indicator
23
Q

What is the role of childhood adversity in the risk of psychosis (Wicks, Hjern, Gunnell, Lewis and Dalman, 2005)?

A

Linear increase with cumulative effect

  • the more of indicators of childhood adversity are present, the greater the risk of schizophrenia or other psychotic disorders
  • adversity in childhood is associated with later risk of psychotic disorder AND with other mental disorders in adulthood (e.g. depression, anxiety)
24
Q

What did the meta-analysis of Varese and colleagues (2012) on childhood adversity show?

A
  • 2 to 3 fold increased risk of psychosis in relation to any childhood adversity
  • Each type of adversity was associated with increased risk of schizophrenia or psychosis
25
Q

What are the methodological issues in most studies on childhood adversity and psychosis?

A
  • Most studies have been in relation to psychotic experiences, looking at their occurence over short time periods, rather than psychotic disorder
  • Psychotic experiences are associated not only with psychosis but other disorders such as depression and anxiety

Often:

  • small studies
  • non-first episodes
  • poorly-selected controls
  • recall of past experiences
  • multiple exposures (combined effect)
  • no consideration to age, type, severity, duration
26
Q

What is the problem of multiple exposures in studies on childhood adversity in relation to psychosis?

A

There’s a combined effect of the experiences of adversity
- many types of adversity don’t occur in isolation but occur together

  • > most people exposed to one, tend to be exposed to multiple forms of adversity
  • > lack of specificity
27
Q

Why do must studies of childhood adversity have been in relation to psychotic experiences rather than psychotic disorder?

A
  • Very difficult to study psychotic disorder, especially in relation to childhood factors
  • Onset of psychotic disorders is in mid to late 20s
  • Psychotic disorders are rare (affecting 10 to 20 per 100,000 per year)
28
Q

What is required to prospectively study psychotic disorder?

A
  • Follow large number of people

- Over long period of time

29
Q

What did the study of Arseneault and colleagues (2011) on childhood trauma and the risk of psychosis show?

A
  • Children age 8-10, with follow up at age 12, associations with psychotic experiences are with bullying and maltreatment (not accident)
  • > some specificity on the type of event and the impact on risk of psychosis
  • > events that have an intention to harm (directed experiences) seem to reflect higher incidence of psychosis
  • Combined effect bullying + maltreatment is in excess of the effect of bullying and maltreatment alone
  • > important to consider multiple factors together
30
Q

What did the study of Cutajar and colleagues (2010) on sexual abuse and the risk of psychosis and schizophrenia show?

A

Odds ratios of any psychotic disorder and schizophrenia

  • are higher for sexual abuse with penetration (2.6 ; 3.3)
  • than for sexual abuse without penetration (1.3 ; 1.4)
  • > increased risk for severe level (with penetration), not for those sexually abused without penetration
  • > Important to consider specificity of type and severity of experience in relation to psychotic disorder
31
Q

What did the meta-analysis of Beards and colleagues (2013) show on adult adversity and life event in relation to psychosis and psychotic experiences?

A
  • Life event were three times more common amongst those with psychosis compared to those without

However, methodologically weak
- high heterogeneity

Differences in:

  • the way experiences and life event have been measured
  • sample selection and size
  • time period of life events
32
Q

What did the household survey of Morgan and colleagues (2014) show on life events and psychotic experiences?

A
  • 15% reported having experienced psychotic symptoms at some point in their lives
  • in relation to a range of life events
  • Events that involve intention to harm had strongest effect on likelihood of psychotic experiences
  • > factor of type and severity of events
  • The more events people are exposed to, the greater the risk of psychotic experiences
  • very large effect for those exposed to more than 3 events
  • Evidence of linear trend
33
Q

What is the role of discrimination in the risk of psychotic disorder (Arisen and Nazroo, 2002; Veling et al., 2007)?

A
  • Evidence of linear trend
  • > the higher the level of discrimination felt, the higher the risk of psychotic disorder
  • Greatest risk of psychotic disorder for those who reported exposure to physical racial harassment (vs verbal)
34
Q

What is the concept of causal partners in psychotic disorders?

A
  • Cluster of component causes contribute to onset of disorder
  • Psychotic disorders are complex multifactorial disorders (not caused by single factor)
  • > Potential interactions between different types of risk factors
  • Impact of environmental or socio-environmental factors on risk of psychotic disorder is dependent of pre-existing genetic vulnerability
  • > epigenetic interactions
35
Q

What did the study of van Os, Pedersen and Mortensen (2004) show on urbanity and familial liability in the causation of psychosis?

A
  • Higher risk of psychosis amongst those who were both exposed to urban areas AND who had family history of psychotic disorder
36
Q

What did the study of van Os, Pedersen and Mortensen (2004) show on urbanity and familial liability in the causation of psychosis?

A
  • Higher risk of psychosis amongst those who were both exposed to urban areas AND who had family history of psychotic disorder
37
Q

What were the consequences of advances in molecular genetics for research?

A

Researchers began studying genetic risk directly

  • candidate genes
  • polygenic risk scores (total genetic risk)

-> future research would then combine polygenic risk scores and analyses of environmental factors, to study gene-environment interactions

38
Q

What did the study of Clarke and colleagues (2011) show on the combination of neurodevelopment risk markers of psychotic disorders?

A
  • Some increased risk of psychotic disorders for each of the 2 neurodevelopment risk markers
  • Higher risk when both were present
  • > Combined effect
39
Q

What is the impact of the combination of abuse in childhood and adversity in adulthood (Morgan et al., 2014)?

A

Effect of the two combined is greater than the sum of each individual effect

40
Q

What is the evidence on the role of a person’s attributional style in the risk of psychosis?

A
  • Those who attribute experience and difficulties to external phenomena are at higher risk of psychosis
    (experiences of threat and violence might increase external blame)
  • Plausible psychological mechanisms BUT circumstantial evidence (still thin)
41
Q

What is the evidence on the role of the dysregulation of the HPA axis in psychosis?

A

Some dysregulation of HPA axis in those with psychotic disorder and those with psychotic experiences

42
Q

What is the evidence on the role of the dopaminergic system in psychosis?

A

Dopaminergic system is affected in those with psychotic disorder and those exposed to difficult experiences

Psychology & Neuroscience of Psychosis (16 decks)

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