In this prospective longitudinal study, life events and daily stressors were Critical reviews of the association of stressful life events with schizophrenia and other may even have a stronger influence on symptoms than major life events. – Therefore, understanding the prospective relationships between. investigating the relationship between life events. (considered as Key words: schizophrenia, stressful events. INTRODUCTION relation „schizophrenia - stress/ distress” and its action as “Life without home“, “Every day but not very significant troubles“ . associated with the schizophrenic symptoms (4, 7, and 10) . 1. worthy for present purposes were that: (i) daily hassles or minor stressors rather than major life events were used to predict pared longitudinal stress to symptom relations in 12 patients with schizophrenia for whom a positive family history of.
Ponizovsky and colleagues reported that patients with schizophrenia had a higher level of emotional distress and utilization of emotion-oriented coping strategies, and a lesser availability of social support compared with healthy volunteers using the Talbieh Brief Distress Inventory Ritsner et al. The General Temperament Survey Clark and Watson, has also differentiated between patients with schizophrenia and controls on trait negative affectivity, which refers to an increased likelihood to experience aversive emotional stress and distress Watson and Clark, ; Horan and Blanchard, Norman and Malla demonstrated that amount of perceived stress correlated positively with symptom severity in patients with schizophrenia using a shortened version of the Daily Hassles Scale developed by Lazarus and colleagues Kanner et al.
Taken together, these findings suggest that patients with schizophrenia differ from healthy volunteers in stress dimensions related to emotion and social support, and increased stress may be related to symptom severity in schizophrenia.
Although it is widely acknowledged that stress may play a key role in the pathophysiology of schizophrenia, little research has investigated the interactive roles of stress-inducing events, personality mediators, and emotional reactivity in patients.
Such studies may clarify the mechanisms through which exposure to stress results in symptom exacerbation or relapse. In recent studies Horan et al. In this study, we administered the Derogatis Stress Profile DSP; Derogatis, to target the multidimensional role of stress and examine its three purported domains, including environmental events, personality mediators, and emotional responses.
The DSP is a widely used and reliable self-report questionnaire that has been used to measure stress levels in students e. There is evidence that this population is as competent as nonpatients in their ability to subjectively appraise stress severity Grant et al. We tested the hypothesis that patients would demonstrate the greatest magnitude of stress in areas related to the emotional sequelae of having schizophrenia as well as areas related to social support.
We further predicted that among patients increased stress would be associated with greater symptom severity. Methods and Materials 2. Participants The 29 patients included in this study were recruited at the Zucker Hillside Hospital in Glen Oaks, NY and were participating in an NIMH-funded randomized clinical trial comparing the efficacy of risperidone versus olanzapine.
Further details regarding the overall sample are provided elsewhere Robinson et al.
Mean SD age at first psychiatric symptoms was Mean age at first psychotic symptoms was Thirty-six healthy volunteers served as a comparison group. All healthy volunteers were recruited from newspaper advertisements or through word of mouth.
They had no Axis I psychiatric disorder as determined by clinical interview and the Structured Clinical Interview for Diagnoses-Nonpatient Version SCID-NP; Spitzer and Williams,no first-degree relative with a psychiatric disorder and were not taking any psychotropic medications.
Clinical Assessments Stress was assessed using the DSP Derogatis,a item Likert scale paper-and-pencil self-report questionnaire that takes approximately 15 minutes to complete. Participants are asked to indicate the extent to which the statement is typically true of the way they behave or feel. The DSP targets 11 dimensions and 3 stress domains of stress.
The 3 domains of stress include: Each stress domain or dimension is scored as the sum of its corresponding items following reflection of individual items as required.
Interscale correlations are relatively high between primary stress dimensions and their corresponding domains as compared to non-corresponding domains, which suggests an ideal multidimensional measurement Derogatis, Internal consistency across the stress dimensions used in this analysis as determined using coefficient alpha was. We excluded vocational environment items from analyses given the potential confound that patients would not be working because they were ill.
The negative symptom cluster score was computed as the average of the global ratings of affective flattening, alogia, avolition-apathy, and asociality from the SANS. The HDRS is a widely-used and well-validated instrument for the clinical assessment of depressive symptoms. These individuals are characterized by nonspecific mood symptoms, anxiety, irritability, emotional lability, mild positive symptoms ie magical thinking, suspiciousness, and odd beliefssocial withdrawal, and cognitive and social impairment.
Patterns of stress in schizophrenia
Longitudinal research of adolescents with SPD may provide a prospective view of the etiology of psychotic disorders. Additionally, environmental factors ie, stressful life events and daily hassles that have the potential to trigger psychiatric symptoms have received little attention during adolescence, a developmental period of elevated risk for the emergence of psychiatric illness.
Research suggests that the typical timeframe for the initial episode of psychosis is during late adolescence or early adulthood. Adolescents have a heightened risk for both exposure to stressful events and increased negative appraisal of stressful experiences.
Furthermore, research on adults with personality disorders suggests that psychosocial events can influence symptom progression. For example, Jovev and Jackson 32 found that a greater occurrence of life events was associated with a decrease in psychosocial functioning in patients with a personality disorder diagnosis other than borderline personality disorder.
In contrast, positive events within the domain of romantic relationships improve functioning in individuals with SPD. For example, Daley and colleagues 34 found that late adolescent women with symptoms of cluster A and B personality disorders generate excessive amounts of interpersonal and episodic stress over a 2-year period.
Therefore, understanding the prospective relationships between self-reported stress and psychiatric symptoms in high-risk adolescents may have implications for minimizing adult psychopathology. The current study examines the relation of stressful life events and the developmental course of symptom progression in normal adolescents, adolescents who meet diagnostic criteria for SPD, and a comparison group with other Axis II disorders.
The longitudinal assessment of life events and daily hassles in these groups will allow us to determine whether these factors are associated with different patterns of symptom exacerbation in healthy and at-risk adolescents. We hypothesize that stressful life events and daily stressors precipitate increase in psychiatric symptoms in adolescents, particularly those with SPD.
Methods Participants Participants were recruited as part of a larger longitudinal study of the biological and behavioral aspects of personality disorder in adolescents. Recruitment of adolescents with personality disorders was conducted through Atlanta area newspaper announcements directed at parents of youth.
Announcements described key diagnostic signs of SPD, and a telephone screening interview was administered to all interested respondents, typically a parent or legal guardian.
Participants for the nonpsychiatric comparison group were recruited through the Emory University Research Participant Registry that maintains a database of contact information for parents and children within the community. These families have been recruited through announcements in school newsletters, hospital postings, and public forums for participation in ongoing research studies.
A telephone screening interview was administered to all respondents. The screening interview obtained information on demographics, psychiatric history, and physical health. Those who were deemed appropriate based on the screening interview were scheduled for the initial assessment. Individuals with significant substance abuse, chronic or serious medical conditions diagnosed neurological disorder, hypertension, thyroid disorder, etc. Participants with learning disorders, attention-deficit, and other disruptive behavior disorders were not excluded, given that these disorders show a high rate of comorbidity with psychosis.
Written consent or assent was obtained from all participants and a parent, in accordance with the guidelines of the Emory University Human Subjects Review Committee.
Procedures Diagnoses were determined through the administration of structured clinical interviews.
Patterns of stress in schizophrenia
Lastly, the SIPS was used to assess prodromal symptomatology. Past studies utilizing the SIPS involved samples that were on average 2 years older than the present sample. Therefore, only symptom severity on the SIPS was used as inclusion criteria. This instrument has been shown to yield reliable ratings of prodromal symptoms and predicts risk for conversion to Axis I psychotic disorders.
The DSI, a item measure of relatively common daily hassles, was used to measure stressful experiences in the previous and current day. The distress measure was generated by dividing the sum of the distress ratings by the number of events endorsed as having occurred. The PERI includes events that involve significant life changes. These 15 items and an additional 53 items that were relevant to adolescents and involve significant life changes associated with social, academic, and living environment were administered to the participants.
Also, 15 items were classified as desirable and 42 items were classified as undesirable according to ratings by Dohrenwend and colleagues.