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Childhood Trauma in Individuals at Ultra-High Risk for Psychosis
2019, October 9th
Popuralized by Camille Vézina
Before receiving a diagnosis of schizophrenia or experiencing psychosis, some individuals in the population may be at greater risk than others of developing psychosis. Individuals at ultra-high risk (UHR) for psychosis present with less severe psychotic symptoms than people with a psychotic disorder, such as magical thinking or ideas of reference, in addition to exhibiting certain major risk factors such as a family history of psychosis. One risk factor frequently observed among UHR individuals is childhood trauma. Indeed, it is estimated that approximately 86% of UHR individuals have experienced childhood trauma, compared to 42.7% to 60% of the general population. Furthermore, UHR individuals who have experienced childhood trauma exhibit more severe and more specific psychotic symptoms. Studies have also shown that childhood trauma is associated with the progression from a UHR state to a psychotic state.
Certain types of childhood trauma have been associated with specific psychotic symptoms. Sexual abuse has been linked to hallucinations, psychotic experiences with sexual content, as well as aggressive behaviors during a psychotic episode. Physical trauma, on the other hand, has been associated with cognitive deficits such as neuronal loss and neuroendocrine dysregulation.
Several explanations have been proposed to better understand the link between childhood trauma and UHR individuals. Childhood trauma may contribute to the development of negative schemas that make individuals more vulnerable and, consequently, increase the likelihood of psychotic symptoms emerging. Childhood trauma may also make individuals more sensitive to stressors, while their reactions to these stressors may become more negative. These stress reactions may create distortions in reality and intensify psychotic symptoms. Because individuals who experienced childhood trauma are more sensitive to stress, their HPA axis (hypothalamic-pituitary-adrenal axis) is often overactivated due to prolonged exposure to stress. This leads to elevated dopamine concentrations and may be associated with the development of psychotic symptoms.
To date, no specific intervention for UHR individuals who have experienced one or more forms of childhood trauma has been scientifically validated. However, family involvement in intervention, stress management training, and psychoeducation appear to be essential components of interventions with this population. The objective of such interventions would be to promote resilience and reduce vulnerability among these individuals. Future research should therefore focus on the effectiveness of interventions for individuals at ultra-high risk for psychosis who have experienced childhood trauma.
To access the article: https://www.sciencedirect.com/science/article/pii/S0755498218304810
Fekih-Romdhane, F., Fadhel, S. B., Hakiri, A., & Cheour, M. (2019). Les traumatismes de l’enfance chez les sujets à ultra haut risque de psychose. La Presse Médicale, 48(3), 243-249.
Correlates and moderators of stigma resistance among people with severe
mental illness
Popuralized by Briana Cloutier
People diagnosed with a serious mental illness (SMI) may experience societal stigma (i.e., stigma imposed by others in the form of rejection, discrimination, or aggression), self-stigma (i.e., stigma imposed by oneself through the acceptance of negative attitudes and beliefs about one’s condition), or both. However, many individuals with SMI also exhibit stigma resistance, a refusal to adhere to stigmatizing views and the development of an identity that is distinct from mental illness.
The present study sought to clarify the relationship between self-stigma and stigma resistance in 353 adults with schizophrenia and schizoaffective disorder. Findings indicate that self-stigma and stigma resistance are separate but related processes, with stigma resistance contributing to recovery from SMI. More specifically, participants with higher levels of stigma resistance showed greater social functioning and self-esteem. They also used more problem-centered coping strategies, while participants with higher levels of self-stigma used more avoidant coping strategies, which tend to increase individuals’ negative self-perceptions. Although higher levels of self-stigma were linked to more feelings of hopelessness in all age groups, this relationship was stronger for younger participants, highlighting a need for early intervention in persons prone to self-stigma. Ethnicity was also found to influence the relationship between stigma resistance and self-stigma, such that the ‘‘double-stigma’’ experienced by visible minorities with SMI may reduce the positive effects of stigma resistance on self-stigma.
This highlights a need for more research on the role of ethnicity in mental health-related stigma. To better understand the impact of self-stigma and stigma resistance across the lifespan, future studies will need to follow people with SMI over time and evaluate how these two variables might influence each other, as well as interact with other important factors (e.g., symptoms, quality of life). Interventions designed to increase stigma resistance and decrease self-stigma should also be developed in order promote recovery in persons with SMI.
To access the article: https://www.sciencedirect.com/science/article/pii/S0165178118305043
O'Connor, L. K., Yanos, P. T., & Firmin, R. L. (2018). Correlates and moderators of stigma resistance among people with severe mental illness. Psychiatry research, 270, 198-204.
CBT and recovery in schizophrenia - a winning combination
Summary and popularization by Camille Vézina
Schizophrenia has long been viewed as a lifelong diagnosis that left little hope for those affected. However, the past few decades have shown that most people with this diagnosis can recover and live satisfying lives. More and more researchers and clinicians are focusing on the concept of recovery, that is, helping the person to regain hope, autonomy and aspire to personal goals and to accomplish them despite obstacles. related to mental disorder. This article offers a great example of cognitive behavioral therapy and how it fits into the concept of recovery using a clinical case.
Many people with schizophrenia hold defeatist beliefs and negative attitudes about their ability to achieve their goals. " I'll never be good enough to complete a study degree " Where " I'm not worth anything Are phrases that can be heard frequently. These beliefs and attitudes prevent individuals from fulfilling themselves and encourage non-action and negative symptoms, such as lack of energy, lack of motivation, and loss of pleasure. The medication has little effect on these symptoms and they greatly affect the lives of those affected. That is why it is very difficult for them to develop life goals and achieve them.
Cognitive behavioral therapy based on the concept of recovery has three steps to get the person to achieve personal goals despite negative symptoms. The first step is to build the therapeutic relationship, that is to say a relationship of trust between the therapist and the person being followed, and thus develop commitment to therapy. The therapist focuses on the individual himself and his interests, not on his mental disorder. The second step in therapy is to determine personal goals. Then, with the help of the therapist, the person works out the different steps to reach their goals. These must be concrete and measurable. The third step of therapy is to remove obstacles that the person will encounter in achieving their goals. Barriers are almost always related to dysfunctional beliefs that keep symptoms negative. So it's about working on those dysfunctional beliefs and finding methods to remove future obstacles.
Cognitive therapy based on the concept of recovery has been shown to be effective in reducing negative symptoms, dysfunctional beliefs and in promoting recovery in individuals with schizophrenia. This offers a source of hope and techniques to realize their full potential, despite their diagnosis of schizophrenia.
To see the full article : https://www.sciencedirect.com/science/article/pii/S1155170418300910#!
Vidal S, Huguelet P. (2018). Concept-based cognitive therapy for schizophrenia: a clinical case. Journal of Cognitive Behavioral Therapy https://doi.org/10.1016/j.jtcc.2018.11.001