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A systematic review on mediators between adversity and psychosis: potential targets for treatment

Published online by Cambridge University Press:  03 August 2020

Luis Alameda Open the ORCID record for Luis Alameda [Opens in a new window] ,
Victoria Rodriguez ,
Ewan Carr ,
Monica Aas ,
Giulia Trotta ,
Paolo Marino ,
Natasha Vorontsova ,
Andrés Herane-Vives ,
Romayne Gadelrab  and
Edoardo Spinazzola
...Show all authors
Luis Alameda*
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program, Lausanne University Hospital (CHUV), CH-1008Lausanne, Switzerland Department of Psychiatry, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Spain Instituto de Investigacion Sanitaria de Sevilla, IBiS, Spain
Victoria Rodriguez
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Ewan Carr
Affiliation:
Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Monica Aas
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
Giulia Trotta
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Paolo Marino
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Natasha Vorontsova
Affiliation:
Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Andrés Herane-Vives
Affiliation:
Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK Departamento de Clínicas, Facultad de Medicina, Universidad Católica del Norte, Coquimbo, Chile
Romayne Gadelrab
Affiliation:
Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Edoardo Spinazzola
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK Psychiatry Residency Training Program, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
Marta Di Forti
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Craig Morgan
Affiliation:
ESRC Centre for Society and Mental Health, King's College London, UK
Robin M Murray
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
*
Author for correspondence: Luis Alameda, E-mail: [email protected]
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Abstract

Various psychological and biological pathways have been proposed as mediators between childhood adversity (CA) and psychosis. A systematic review of the evidence in this domain is needed. Our aim is to systematically review the evidence on psychological and biological mediators between CA and psychosis across the psychosis spectrum. This review followed PRISMA guidelines. Articles published between 1979 and July 2019 were identified through a literature search in OVID (PsychINFO, Medline and Embase) and Cochrane Libraries. The evidence by each analysis and each study is presented by group of mediator categories found. The percentage of total effect mediated was calculated. Forty-eight studies were included, 21 in clinical samples and 27 in the general population (GP) with a total of 82 352 subjects from GP and 3189 from clinical studies. The quality of studies was judged as ‘fair’. Our results showed (i) solid evidence of mediation between CA and psychosis by negative cognitive schemas about the self, the world and others (NS); by dissociation and other post-traumatic stress disorder symptoms; and through an affective pathway in GP but not in subjects with disorder; (iii) lack of studies exploring biological mediators. We found evidence suggesting that various overlapping and not competing pathways involving post-traumatic and mood symptoms, as well as negative cognitions contribute partially to the link between CA and psychosis. Experiences of CA, along with relevant mediators should be routinely assessed in patients with psychosis. Evidence testing efficacy of interventions targeting such mediators through cognitive behavioural approaches and/or pharmacological means is needed in future.

Keywords

Adversitymechanismsmediationpsychosis
Type
Review Article
Information
Psychological Medicine , Volume 50 , Issue 12 , September 2020 , pp. 1966 - 1976
Copyright
Copyright © The Author(s) 2020. Published by Cambridge University Press

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