RESUMEN
Subjective quality of life (SQOL) is an established patient-reported outcome in psychosis. However, current self-report measures of SQOL may be affected by recall bias and may not fully capture dynamic changes in SQOL over time. This study aimed to examine the ecological validity of self-reported and momentary assessment measures of SQOL, and their association with emotional experience, social interaction and activity in real life, in both patients with psychotic disorder (n = 56) and controls (n = 71). Self-reported QOL was assessed with the WHO-QOL, momentary QOL and real life experiences were assessed with the Experience Sampling Method (ESM). Results show that both measures were significantly associated in patients and controls, and associations with emotional experience were most relevant, momentary QOL being a stronger predictor than self-reported QOL. The association between momentary QOL and negative affect was stronger in patients than in controls. Overall, momentary QOL was more consistently associated with affect, social interaction and activity, while self-reported QOL displayed a more narrow association with mostly affect. Concluding, concurrent assessment of self-reported QOL and momentary QOL showed that momentary QOL may enhance the ecological validity of SQOL measurement. Experience sampling research may broaden our perspective on SQOL and its associations with real life functioning.
Asunto(s)
Trastornos Psicóticos/psicología , Calidad de Vida/psicología , Autoinforme , Actividades Cotidianas , Adulto , Afecto , Estudios de Casos y Controles , Evaluación Ecológica Momentánea , Emociones , Femenino , Humanos , Relaciones Interpersonales , Masculino , Análisis Multivariante , Participación Social/psicología , Adulto JovenRESUMEN
BACKGROUND: Deficits in emotion processing are thought to underlie the key negative symptoms flat affect and anhedonia observed in psychotic disorders. This study investigated emotional experience and social behavior in the realm of daily life in a sample of patients with schizophrenia and schizoaffective disorder, stratified by level of negative symptoms. METHODS: Emotional experience and behavior of 149 patients with schizophrenia and schizoaffective disorder and 143 controls were explored using the Experience Sampling Method. RESULTS: Patients reported lower levels of positive and higher levels of negative affect compared with controls. High negative symptom patients reported similar emotional stability and capacity to generate positive affect as controls, whereas low negative symptom patients reported increased instability. All participants displayed roughly comparable emotional responses to the company of other people. However, in comparison with controls, patients showed more social withdrawal and preference to be alone while in company, particularly the high negative symptom group. CONCLUSIONS: This study revealed no evidence for a generalized hedonic deficit in patients with psychotic spectrum disorders. Lower rather than higher levels of negative symptoms were associated with a pattern of emotional processing which was different from healthy controls.
Asunto(s)
Anhedonia/fisiología , Emociones/fisiología , Relaciones Interpersonales , Trastornos Psicóticos/fisiopatología , Esquizofrenia/fisiopatología , Adulto , Femenino , Humanos , Masculino , Escalas de Valoración Psiquiátrica , Trastornos Psicóticos/psicología , Psicología del Esquizofrénico , Encuestas y CuestionariosRESUMEN
OBJECTIVE: The associations of two types of childhood trauma (abuse and neglect) with psychosis symptom domains were investigated in subjects with psychotic illness, high psychosis vulnerability, and average psychosis vulnerability. METHOD: Childhood trauma was assessed with the Childhood Trauma Questionnaire. Symptoms were assessed with the Positive and Negative Syndrome Scale in the patients (N=272) and with the Structured Interview for Schizotypy-Revised in the patients' siblings (N=258), and healthy comparison subjects (N=227). RESULTS: Childhood trauma was associated with psychotic disorder in a dose-response fashion in the comparison of patients and healthy subjects (adjusted odds ratio=4.53, 95% CI=2.79-7.35). The comparison of siblings and healthy subjects suggested that siblings shared a degree of trauma with the patients (adjusted odds ratio=1.61, 95% CI=0.95-2.61), but the patient-sibling comparison indicated much greater exposure in patients than in siblings (adjusted odds ratio=2.60, 95% CI=1.78-3.78). Childhood abuse but not neglect was associated with positive but not negative symptoms in a dose-response fashion in all three groups. There was no evidence for moderation by sex. CONCLUSIONS: Discordance in psychotic illness across related individuals can be traced to differential exposure to trauma. The association between trauma and psychosis is apparent across different levels of illness and vulnerability to psychotic disorder, suggesting true association rather than reporting bias, reverse causality, or passive gene-environment correlation. Positive psychotic symptoms in vulnerable individuals may arise as a consequence of the level and frequency of exposure to abuse rather than neglect, suggesting symptom-specific and exposure-specific underlying mechanisms.
Asunto(s)
Maltrato a los Niños/psicología , Trastornos Psicóticos/etiología , Adolescente , Adulto , Estudios de Casos y Controles , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Psicóticos/diagnóstico , Hermanos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Blockade of dopamine D(2) receptors is thought to mediate the therapeutic effects of antipsychotic medication but may also induce social indifference. As antipsychotic drugs differ in D(2) receptor binding, "tight" and "loose" binding drugs may be hypothesized to differentially affect emotional experience. The present study investigates the differential effects of relatively tight versus looser binding drugs on the experience of emotions in the realm of daily life. METHOD: We assessed positive and negative affect in the daily life of 109 patients with a DSM-IV diagnosis of psychotic disorder who were currently taking antipsychotic medication by using the experience sampling method (a structured diary technique). Antipsychotic medication was classified as loose (olanzapine; n = 35) or tight (haloperidol, risperidone; n = 74) binding, based on the drug's dissociation constants at the D(2) receptor. The study was conducted from 2007 to 2008. RESULTS: Multilevel analyses showed a significant interaction between binding group (loose vs tight) and D(2) receptor occupancy estimates with regard to the experience of positive (P = .008) and negative (P = .019) affect. For tight-binding-agent users, a significant association was found between D(2) receptor binding estimates and both positive affect (P = .040) and negative affect (P = .0001) in the flow of daily life, with increasing levels of estimated D(2) receptor occupancy being associated with decreased feelings of positive affect and increased feelings of negative affect. For loose-binding-agent users, no such association was apparent. These associations were only partly mediated by clinical symptoms. CONCLUSIONS: These findings add ecological validity to previous laboratory findings showing an association between D(2) receptor occupancy and emotional experience.
Asunto(s)
Afecto/efectos de los fármacos , Antipsicóticos/uso terapéutico , Benzodiazepinas/uso terapéutico , Haloperidol/uso terapéutico , Trastornos Psicóticos/tratamiento farmacológico , Receptores de Dopamina D2/metabolismo , Risperidona/uso terapéutico , Adolescente , Adulto , Antipsicóticos/farmacología , Benzodiazepinas/farmacología , Escalas de Valoración Psiquiátrica Breve , Femenino , Haloperidol/farmacología , Humanos , Masculino , Persona de Mediana Edad , Olanzapina , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/metabolismo , Risperidona/farmacología , Esquizofrenia/diagnóstico , Esquizofrenia/tratamiento farmacológico , Esquizofrenia/metabolismo , Autoinforme , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
BACKGROUND: The interplay between the catechol-O-methyltransferase (COMT) Val158Met polymorphism and environmental stress may have etiological relevance for psychosis, but differential effects have been reported in healthy control and patient groups, suggesting that COMT Val158Met interactions with stress may be conditional on background genetic risk for psychotic disorder. METHODS: Patients with a nonaffective psychotic disorder (n = 86) and control participants (n = 109) were studied with the experience sampling method (a structured diary technique) in order to assess stress, negative affect and momentary psychotic symptoms in the flow of daily life. RESULTS: Multilevel analyses revealed significant three-way interactions between group status (patient or control), COMT genotype and stress in the model of negative affect (χ(2)(2) = 13.26, P < 0.01) as well as in the model of momentary psychotic symptoms (χ(2)(2) = 6.92, P < 0.05). Exploration of the three-way interaction revealed that in patients, COMT genotype moderated the association between stress and negative affect (χ(2)(4) = 11.50, P < 0.005), as well as the association between stress and momentary psychosis (χ(2)(4) = 12.79, P < 0.005). Met/Met genotype patients showed significantly increased psychotic and affective reactivity to stress in comparison to the Val/Met and Val/Val genotypes. In contrast, healthy controls did not display large or significant COMT Val158Met X stress interactions. CONCLUSIONS: Important differences exist in the effect of COMT Val158Met on stress reactivity, which may depend on background risk for psychotic disorder. Differential sensitivity to environmental stress occasioned by COMT Val158Met may be contingent on higher order interactions with genetic variation underlying psychotic disorder.