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Stressful and intrusive life events preceding first episode psychosis

Published online by Cambridge University Press:  11 April 2011

David Raune ,
Elizabeth Kuipers  and
Paul Bebbington
David Raune
Affiliation:
Harrow Psychological Services, Northwick Park Hospital, Watford Road, Harrow (United Kingdom)
Elizabeth Kuipers
Affiliation:
Department of Psychology, Institute of Psychiatry, King’s College, London (United Kingdom)
Paul Bebbington*
Affiliation:
UCL, Department of Mental Health Sciences, London (United Kingdom)
*
Address for correspondence: Professor P. Bebbington, UCL Department of Mental Health Sciences, Charles Bell House, London W1W 7EJ (United Kingdom). E-mail: [email protected]
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Summary

Aim – To test the hypothesis that stressful life events, in particular intrusive events, would cluster before the first onset of psychosis. Method – Forty-one patients with first episode psychosis were interviewed with the Life Events and Difficulties Schedule to assess events in the year before the onset of illness. Events were rated contextually on timing, independence, threat, and intrusiveness. Within-patient group clustering was evaluated, and the patient group was compared with two general population surveys from London. Results – Events were very frequent in the year before the onset of psychosis. Stressful and intrusive events were more common in the three months before onset compared with the previous nine months, although few analyses reached conventional statistical significance. Threatening and intrusive events were much more frequent in patients than in the comparison groups. First episode psychosis patients were strikingly more likely to report an intrusive event in the three months before onset (OR=17.1, 34% v 3%), and also showed an excess between three months and one year before onset (OR=8.1, 11% v 3%). Conclusions – Events may trigger many cases of first episode psychosis. The effect emerges several months before onset, particularly if the events are intrusive. This has both theoretical and clinical implications.

Declaration of Interest: DR was supported by a UK Medical Research Council studentship. The authors have no conflicts of interest in writing this paper.

Keywords

psychosisschizophreniafirst episodelife eventsintrusive life events
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 18 , Issue 3 , September 2009 , pp. 221 - 228
Copyright
Copyright © Cambridge University Press 2009

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References

REFERENCES

Bebbington, P.E., Tennant, C. & Hurry, J. (1981a). Life events and the nature of psychiatric disorder in the community. Journal of Affective Disorders 3, 345 66.CrossRefGoogle ScholarPubMed
Bebbington, P.E., Hurry, J. & Tennant, C., Sturt, E. & Wing, J.K. (1981b). Eepidemiology of mental disorders in Camberwell. Psychological Medicine 11, 561–580.CrossRefGoogle Scholar
Bebbington, P.E., Wilkins, S., Jones, P., Foerster, A., Murray, R., Toone, B. & Lewis, S. (1993). Life events and psychosis: Initial results from the Camberwell Collaborative Psychosis Study. British Journal of Psychiatry 162, 72–79.CrossRefGoogle ScholarPubMed
Bebbington, P.E., Bowen, J., Hirsch, S.R. & Kuipers, E.A. (1995). Schizophrenia and psychosocial stress. In Schizophrenia (ed. Hirsch, S.R. and Weinberger, D.R.), pp. 587–604. Blackwell: Oxford.Google Scholar
Bebbington, P. E., Bhugra, D., Brugha, T., Singleton, N., Farrell, M., Jenkins, R., Lewis, G. & Meltzer, H. (2004). Psychosis, victimisation and childhood disadvantage. British Journal of Psychiatry 185, 220–226.CrossRefGoogle ScholarPubMed
Brilman, E. I. & Ormel, J. (2001). Life events, difficulties and onset of depressive episodes in later life. Psychological Medicine 31, 859–869.CrossRefGoogle ScholarPubMed
Brown, G.W. & Birley, J. (1968). Crises and life changes and the onset of schizophrenia. Journal of Health and Social Behaviour 9, 203–214.CrossRefGoogle ScholarPubMed
Brown, G.W. & Harris, T.O. (1989a). The Life Events and Difficulties Schedule 2 (LEDS2). Royal Holloway and Bedford New College, University of London: London.Google Scholar
Brown, G.W. & Harris, T. (1989b). Life Events and Illness. Unwin Hyman: London.Google Scholar
Cullberg, J. (2003). Stressful life events preceding the first onset of psychosis. An explorative study. Nordic Journal of Psychiatry 57, 209–214.CrossRefGoogle ScholarPubMed
Das, S.K., Malhotra, S., Basu, D. & Malhotra, R. (2001). Testing the stress-vulnerability hypothesis in ICD-10-diagnosed acute and transient psychotic disorders. Acta Psychiatrica Scandinavica 104, 56–58.CrossRefGoogle ScholarPubMed
Day, R., Nielsen, A., Korten, A., Ernberg, G., Dube, K. C. & Gebhart, J., Jablensky, A., Leon, C., Marsella, A., Olatawura, M. et al. (1987). Stressful life events preceding the acute onset of schizophrenia: A cross-national study from the World Health Organisation. Culture, Medicine, Psychiatry 11, 123–206.CrossRefGoogle Scholar
Fowler, D. (2000). Psychological formulation of early episodes of psychosis: A cognitive model. In Early Intervention in Psychosis (ed. Birchwood, M., Fowler, D. and Jackson, C.), pp. 101–127. Wiley: Chichester.Google Scholar
French, P. & Morrison, P. (2004). Early Detection and Cognitive Therapy for Participants at High Risk of Developing Psychosis. Wiley: Chichester.CrossRefGoogle Scholar
Frith, C. (2004). Schizophrenia and theory of mind. Psychological Medicine 34, 85–389.CrossRefGoogle ScholarPubMed
Garety, P.A., Kuipers, E., Fowler, D., Freeman, D. & Bebbington, P.E. (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine 31, 189–195.CrossRefGoogle ScholarPubMed
Garety, P.A., Bebbington, P., Fowler, D., Freeman, D. & Kuipers, E. (2007). Implications for neurobiological research of cognitive models of psychosis: a theoretical paper. Psychological Medicine 37, 1377–1391.CrossRefGoogle ScholarPubMed
Gleeson, J.F.M. & McGorry, P.D. (2003). Psychological Interventions in Early Psychosis. Wiley: Chichester.Google ScholarPubMed
Hardy, A., Fowler, D., Freeman, D., Smith, B., Steel, C., Evans, J., Garety, P., Kuipers, K., Bebbington, P.E. & Dunn, G. (2005). Trauma and hallucinatory experience in psychosis. Journal of Nervous and Mental Disease 193, 501–507.CrossRefGoogle ScholarPubMed
Harris, T. (1987). Recent developments in the study of life events in relation to psychiatric and physical disorders. In Psychiatric Epidemiology (ed. Cooper, B.), pp. 81–103. Croom-Helm: London.Google Scholar
Jacobs, S. & Myers, J. (1976). Recent life events and acute schizophrenic psychosis: A controlled study. Journal of Nervous and Mental Disease 162, 75–87.CrossRefGoogle ScholarPubMed
Krstev, H., Jackson, H. & Maude, D. (1999). An investigation of attributional style on first-episode psychosis. British Journal of Clinical Psychology 38, 181–194.CrossRefGoogle ScholarPubMed
Neuchterlein, K.H., Dawson, M.E., Ventura, J., Gitlin, M., Subotnik, K.L. & Snyder, K.S. (1994). The vulnerability/stress model of schizophrenic relapse: a longitudinal study. Acta Psychiatrica Scandinavica 89, Suppl. 382, 58–64.CrossRefGoogle Scholar
Pariante, C.M. (2008). Pituitary volume in psychosis: the first review of the evidence. Journal of Psychopharmacology 22, Suppl. 2, 76–81.CrossRefGoogle ScholarPubMed
Pariante, C.M., Dazzan, P., Danese, A., Morgan, K.D., Brudaglio, F., Morgan, C., Fearon, P., Orr, K., Hutchinson, G., Pantelis, C., Velakoulis, D., Jones, P.B., Leff, J. & Murray, R.M. (2005). Increased pituitary volume in antipsychotic-free and antipsychotic-treated patients of the AESOP first-onset psychosis study. Neuropsychopharmacology 30, 1923–1931.CrossRefGoogle ScholarPubMed
Paykel, E. (1978). Contribution of life events to causation of psychiatric illness. Psychological Medicine 8, 245–253.CrossRefGoogle ScholarPubMed
Phillips, L.J., McGorry, P.D., Garner, B., Thompson, K.N., Pantelis, C., Wood, S.J. & Berger, G. (2006). Stress, the hippocampus and the hypothalamic-pituitary-adrenal axis: implications for the development of psychotic disorders. Australian and New Zealand Journal of Psychiatry 40, 725–741.CrossRefGoogle ScholarPubMed
Ramana, R. & Bebbington, P.E. (1995). Social influences on bipolar affective disorder. Social Psychiatry and Psychiatric Epidemiology 30, 152 160.CrossRefGoogle Scholar
Raune, D., Bebbington, P. E., Dunn, G. & Kuipers, E. (2006). Event attributes and the content of psychotic experiences in first episode psychosis. Psychological Medicine 36, 221–230.CrossRefGoogle ScholarPubMed
Ricciardi, A., McAllister, V. & Dazzan, P. (2008). Is early intervention in psychosis effective? Epidemiologia e Psichiatria Sociale 17, 227–235.CrossRefGoogle ScholarPubMed
Rooke, O. & Birchwood, M. (1998). Loss, humiliation and entrapment as appraisals of schizophrenic illness: A prospective study of depressed and non-depressed patients. British Journal of Clinical Psychology 37, 259–268.CrossRefGoogle Scholar
Stolar, N. (2004). Cognitive conceptualization of the negative symptoms of schizophrenia. Journal of Cognitive Psychotherapy 18, 237–253.CrossRefGoogle Scholar
Tennant, C., Smith, A., Bebbington, P.E. & Hurry, J. (1979). The contextual rating of life events: the concept and its reliability. Psychological Medicine 9, 525–528.CrossRefGoogle ScholarPubMed
World Health Organisation (1992). The ICD-10 International Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. WHO: Geneva.Google Scholar