Advertisement

Social Psychiatry and Psychiatric Epidemiology

, Volume 49, Issue 10, pp 1541–1544 | Cite as

The journey to psychosis: an exploration of specific psychological pathways

  • Stephanie BeardsEmail author
  • Helen L. Fisher
Commentary

Abstract

Recent models of psychosis have implicated specific psychological processes in the aetiology of this disorder, and these factors may form a route to later symptoms—either directly or via a mediating pathway after exposure to adversity. Researchers are beginning to bring together findings that look into specific pathways between early experiences of adversity and different symptoms of psychosis, including thought disorder, hallucinations and persecutory delusions. The adversity-specific pathways include parental communication deviance, source monitoring biases, and insecure attachment. Researchers have also begun to utilise specific psychological factors as targets for treatment, and these include a focus on a worrying thinking style, negative beliefs about the self, interpersonal sensitivity, sleep disturbance, anomalous internal experience, and reasoning biases. Research on the impact of psychological processes is beginning to mount and is likely to improve our understanding of aetiology and lead to significant advances in the treatment of psychotic symptoms and disorders.

Keywords

Psychosis Adversity Mechanisms Thought disorder Hallucinations Delusions 

Notes

Acknowledgments

SB is supported by an Economic and Social Research Council Ph.D. studentship. HF is supported by a Medical Research Council Population Health Scientist fellowship.

Conflict of interest

There is no conflict of interest.

References

  1. 1.
    Bentall RP, Corcoran R, Howard R, Blackwood N, Kinderman P (2001) Persecutory delusions: a review and theoretical integration. Clin Psychol Rev 21:1143–1192PubMedCrossRefGoogle Scholar
  2. 2.
    Freeman D, Garety PA, Kuipers E, Fowler D, Bebbington PE (2002) A cognitive model of persecutory delusions. Br J Clin Psychol 41:331–347PubMedCrossRefGoogle Scholar
  3. 3.
    Garety PA, Kuipers E, Fowler D, Freeman D, Bebbington PE (2001) A cognitive model of the positive symptoms of psychosis. Psychol Med 31:189–195PubMedCrossRefGoogle Scholar
  4. 4.
    Garety PA, Bebbington P, Fowler D, Freeman D, Kuipers E (2007) Implications for neurobiological research of cognitive models of psychosis: a theoretical paper. Psychol Med 37(10):1377–1391PubMedCrossRefGoogle Scholar
  5. 5.
    Morrison AP (2001) The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behav Cognit Psychother 29(3):257–276Google Scholar
  6. 6.
    Freeman D, Garety P (2014) Advances in understanding and treating persecutory delusions: a review. Soc Psychiatry Psychiatr Epidemiol 49(8):1179–1189Google Scholar
  7. 7.
    Bentall R, Sousa P, Varese F, Wickham S, Sitko K, Haarmans M, Read J (2014) From adversity to psychosis: pathways and mechanisms from specific adversities to specific symptoms. Soc Psychiatry Psychiatr Epidemiol 49(7):1011–1022PubMedCrossRefGoogle Scholar
  8. 8.
    Varese F, Smeets F, Drukker M et al (2012) Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective and cross-sectional cohort studies. Schizophr Bull 38(4):61–671CrossRefGoogle Scholar
  9. 9.
    Morgan C, Fisher H (2007) Environmental factors in schizophrenia: childhood trauma—a critical review. Schizophr Bull 33(1):3–10PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Varese F, Barkus E, Bentall RP (2011) Dissociation mediates the relationship between childhood trauma and hallucination-proneness. Psychol Med 42:1025–1036PubMedCrossRefGoogle Scholar
  11. 11.
    Perona-Garcelán S et al (2012) Dissociative experiences as mediators between childhood trauma and auditory hallucinations. J Trauma Stress 25(3):323–329PubMedCrossRefGoogle Scholar
  12. 12.
    Sitko K et al (2014) Associations between specific psychotic symptoms and specific childhood adversities are mediated by attachment styles: an analysis of the National Comorbidity Survey. Psychiatry Res 217:202–209PubMedCrossRefGoogle Scholar
  13. 13.
    Beards S, Gayer-Anderson C, Borges S, Dewey ME, Fisher HL, Morgan C (2013) Life events and psychosis: a review and meta-analysis. Schizophr Bull 39(4):740–747PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Morgan C, Charalambides M, Hutchinson G, Murray RM (2010) Migration, ethnicity, and psychosis: toward a sociodevelopmental model. Schizophr Bull 36(4):655–664PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Morgan C, Reininghaus U, Fearon P, Hutchinson G, Morgan K, Dazzan P, Boydell J, Kirkbride JB, Doody GA, Jones PB, Murray RM, Craig T (2014) Modelling the interplay between childhood and adult adversity in pathways to psychosis: initial evidence from the AESOP study. Psychol Med 44(2):407–419PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Fisher HL, Appiah-Kusi E, Grant C (2012) Anxiety and negative self-schemas mediate the association between childhood maltreatment and paranoia. Psychiatry Res 196:323–324PubMedCrossRefGoogle Scholar
  17. 17.
    Freeman D, Thompson C, Vorontsova N, Dunn G, Carter L-A, Garety P, Kuipers E, Slater M, Antley A, Glucksman E, Ehlers A (2013) Paranoia and post-traumatic stress disorder in the months after a physical assault. Psychol Med 43:2673–2684PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Gracie A, Freeman D, Green S, Garety PA, Kuipers E, Hardy A, Ray K, Dunn G, Bebbington P, Fowler D (2007) The association between traumatic experience, paranoia and hallucinations: a test of the predictions of psychological models. Acta Psychiatr Scand 116:280–289PubMedCrossRefGoogle Scholar
  19. 19.
    Bebbington P, Jonas S, Kuipers E, King M, Cooper C, Brugha T, Meltzer H, McManus S, Jenkins R (2011) Childhood sexual abuse and psychosis: data from a cross-sectional national psychiatric survey in England. Br J Psychiatry 199(1):29–37PubMedCrossRefGoogle Scholar
  20. 20.
    Fisher HL, Schreier A, Zammit S, Maughan B, Munafo MR, Lewis G, Wolke D (2013) Pathways between childhood victimization and psychosis-like symptoms in the ALSPAC Birth Cohort. Schizophr Bull 39(5):1045–1055PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Freeman D, Dunn G, Startup H, Pugh K, Cordwell J, Mander H, Cernis E, Wingham G, Shirvell K, Kingdon D (2014) An explanatory randomised controlled trial testing the effects of cognitive behaviour therapy for worry on persecutory delusions in psychosis: the Worry Intervention Trial (WIT) (submitted)Google Scholar
  22. 22.
    Garety P, Waller H, Emsley R, Jolley S, Kuipers E, Bebbington P, Dunn G, Fowler D, Hardy A, Freeman D (2014) Cognitive mechanisms of change in delusions: an experimental investigation targeting reasoning to effect change in paranoia. Schizophr Bull. doi: 10.1093/schbul/sbu103
  23. 23.
    Fowler D, Hodgekins J, Garety P, Freeman D, Kuipers E, Dunn G, Smith B, Bebbington P (2012) Negative cognition, depressed mood and paranoia: a longitudinal pathway analysis using structural equation modelling. Schizophr Bull 38:1063–1073PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Vorontsova N, Garety P, Freeman D (2013) Cognitive factors maintaining persecutory delusions in psychosis: the contribution of depression. J Abnorm Psychol 122:1121–1131PubMedCrossRefGoogle Scholar
  25. 25.
    Hall PL, Tarrier N (2003) The cognitive-behavioural treatment of low self-esteem in psychotic patients: a pilot study. Behav Res Ther 41:317–332PubMedCrossRefGoogle Scholar
  26. 26.
    Freeman D, Stahl D, McManus S, Meltzer H, Brugha T, Wiles N, Bebbington P (2012) Insomnia, worry, anxiety and depression as predictors of the occurrence and the persistence of persecutory ideation. Soc Psychiatry Psychiatr Epidemiol 47:1195–1203PubMedCrossRefGoogle Scholar
  27. 27.
    Freeman D et al (2008) A virtual reality study of paranoid thinking in the general population. Br J Psychiatry 192:258–263PubMedCrossRefGoogle Scholar
  28. 28.
    Myers E, Startup H, Freeman D (2011) Cognitive behavioural treatment of insomnia in patients with persecutory delusions. J Behav Ther Exp Psychiatry 42:330–336PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Bell V, Freeman D (2014) A pilot trial of cognitive behavioural therapy for interpersonal sensitivity in individuals with persecutory delusions. J Behav Ther Exp Psychiatry 45(4):441–446Google Scholar
  30. 30.
    Read J et al (2001) A traumagenic neurodevelopmental model of schizophrenia. Psychiatry Interpers Biol Process 64:319–345CrossRefGoogle Scholar
  31. 31.
    Read J et al (2014) The traumagenic neurodevelopmental model of psychosis revisited. Neuropsychiatry 4:65–79CrossRefGoogle Scholar
  32. 32.
    Walker EF, Diforio D (1997) Schizophrenia: a neural diathesis-stress model. Psychol Rev 104(4):667–685PubMedCrossRefGoogle Scholar
  33. 33.
    Borges S, Gayer-Anderson C, Mondelli V (2013) A systematic review of the activity of the hypothalamic-pituitary-adrenal axis in first episode psychosis. Psychoneuroendocrinology 38:603–611PubMedCrossRefGoogle Scholar
  34. 34.
    McGowan PO, Sasaki A, D’Alessio AC et al (2009) Epigenetic regulation of the glucocorticoid receptor in human brain associates with childhood abuse. Nat Neurosci 12:342–348PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Health Service and Population Research DepartmentCentre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College LondonLondonUK
  2. 2.MRC Social, Genetic and Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & Neuroscience, King’s College LondonLondonUK

Personalised recommendations