Predicting the longitudinal effects of the family environment on prodromal symptoms and functioning in patients at-risk for psychosis

University of California at Los Angeles, 300 Medical Plaza, Box 666824, Los Angeles, CA 90095, United States.
Schizophrenia Research (Impact Factor: 3.92). 02/2010; 118(1-3):69-75. DOI: 10.1016/j.schres.2010.01.017
Source: PubMed


The current study examined the relationship between the family environment and symptoms and functioning over time in a group of adolescents and young adults at clinical high risk for psychosis (N=63). The current study compared the ability of interview-based versus self-report ratings of the family environment to predict the severity of prodromal symptoms and functioning over time. The family environmental factors were measured by interviewer ratings of the Camberwell Family Interview (CFI), self-report questionnaires surveying the patient's perceptions of criticism and warmth, and parent reported perceptions of their own level of criticism and warmth. Patients living in a critical family environment, as measured by the CFI at baseline, exhibited significantly worse positive symptoms at a 6-month follow-up, relative to patients living in a low-key family environment. In terms of protective effects, warmth and an optimal level of family involvement interacted such that the two jointly predicted improved functioning at the 6-month follow-up. Overall, both interview-based and self-report ratings of the family environment were predictive of symptoms and functioning at follow-up; however patient's self-report ratings of criticism had stronger predictive power. These results suggest that the family environment should be a specific target of treatment for individuals at risk for psychosis.

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Available from: Danielle A Schlosser
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    • "Particularly, attitudes related to positive affect predicted improvement in negative symptoms and functioning (O'Brien et al., 2006, 2008), whereas negative affect in the form of criticism predicted worsening of attenuated psychotic symptoms (Schlosser et al., 2010). "
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    ABSTRACT: The mechanisms underlying the association between expressed emotion (EE) and the prognosis in early psychosis are still not well understood. Based on the attributional model, this study investigated the association of criticism and emotional over-involvement (EOI) with symptoms and functioning in At-Risk Mental State (ARMS) and First-Episode Psychosis (FEP) patients, and whether these associations were mediated by relatives’ attributions of control and blame. Forty-four patients (20 ARMS and 24 FEP) and their relatives were included. Findings indicated that relatives’ criticism was associated with positive, negative, and general symptoms. EOI was related with negative and general symptoms. Both indices were related with impaired functioning. Most of the relations between EE indices and illness severity were mediated by relatives’ attributions of blame toward the patient. Relatives’ self-blaming attributions and attributions of control over the disorder by either relatives or patients were not associated with patients’ variables or EE. Findings highlight the importance of family emotional environment in the early stages of psychosis, as well as the mediating role that relatives’ beliefs can exert in those relationships. Family interventions aimed to assist relatives to change attributions that blame patient should be included in clinical protocols in order to prevent the entrenchment of high-EE.
    Full-text · Article · Aug 2014 · Psychiatry Research
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    • "One limitation of the study was to use a small, predominantly university student sample where RS due to close relationships may not be comparable to that of the general population because 93% were single and it is common for students to live away from home. Future research could replicate this study's findings in a larger community-based sample in the context of participants' close relationships, since hostility as rejection from carers increases psychopathology in at-risk individuals (Schlosser et al., 2010). "
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    ABSTRACT: Social anxiety due to rejection sensitivity (RS) exacerbates psychosis-like experiences in the general population. While reduced dorsal anterior cingulate cortex (dACC) activity during social rejection in high schizotypy has suggested self-distancing from rejection, earlier stages of mental processing such as feature encoding could also contribute to psychosis-like experiences. This study aimed to determine the stage of mental processing of social rejection that relates to positive schizotypy. Forty-one healthy participants were assessed for schizotypy and RS. Event-related potential amplitudes (ERPs) were measured at frontal, temporal and parieto-occipital sites and their cortical sources (dACC, temporal pole and lingual gyrus) at early (N100) and late (P300 and late slow wave, LSW) timeframes during rejection, acceptance and neutral scenes. ERPs were compared between social interaction types. Correlations were performed between positive schizotypy (defined as the presence of perceptual aberrations, hallucinatory experiences and magical thinking), RS and ERPs during rejection. Amplitude was greater during rejection than acceptance or neutral conditions at the dACC-P300, parieto-occipital-P300, dACC-LSW and frontal-LSW. RS correlated positively with positive schizotypy. Reduced dACC N100 activity during rejection correlated with greater positive schizotypy and RS. Reduced dACC N100 activity and greater RS independently predicted positive schizotypy. An N100 deficit that indicates reduced feature encoding of rejection scenes increases with greater positive schizotypy and RS. Higher RS shows that a greater tendency to misattribute ambiguous social situations as rejecting also increases with positive schizotypy. These two processes, namely primary bottom-up sensory processing and secondary misattribution of rejection, combine to increase psychosis-like experiences.
    Full-text · Article · Jul 2014 · Neuropsychologia
    • "Expressed emotion is measured through the presence of critical comments, hostility, and emotional over-involvement found in spontaneous speech by a family member, and has been linked to poor outcomes in schizophrenia in a meta-analysis of 27 studies (Butzlaff & Hooley, 1998). Rates of expressed emotion appear to be comparable between CHR and first-episode psychosis, and one study that longitudinally demonstrated the positive effects of family support (described above) also showed an association between a critical family environment and more severe positive symptoms at 6-month followup (Schlosser et al., 2010). The family microsystem appears to play a central role as a source of both risk and protection against the development of psychosis , likely reflecting a dynamic family system in which behavior of the at-risk youth may elicit critical behavior from family members, which may in turn further exacerbate symptoms. "
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    ABSTRACT: Developments in psychosis-risk assessment over recent decades have made it possible to identify a “clinical high risk” population that has a substantially elevated likelihood of developing a psychotic disorder relative to the general population. The expanding body of research on the clinical high risk population has identified risk and protective factors from a variety of environmental sources ranging from the immediate, such as social function and daily hassles, to the more distal, such as mental health policy and societal stigma. An ecological model of the psychosis-risk state would facilitate an understanding of the complex and interactive processes that contribute to the attenuated psychotic symptoms and decline in function that characterize someone as being at clinical high risk. The present paper reviews clinical high risk research on social factors operating at various levels within the ecological systems framework, as defined by Bronfenbrenner (1977). An ecological model allows integration across levels of social influences that may directly or indirectly serve as risk or protective factors for the individual, thereby contributing to the onset or prevention of a full psychotic disorder.
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