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The role of vulnerability factors in individuals with an at-risk mental state of psychosis

Die Bedeutung von Vulnerabilitätsfaktoren bei Personen mit einem Risikostatus für eine Psychose

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Summary

Background

Several indicators of heightened vulnerability to psychosis and relevant stressors have been identified. However, it has rarely been studied prospectively to what extent these vulnerability factors are in fact more frequently present in individuals with an at-risk mental state for psychosis. Moreover, it remains unknown whether any of these contribute to the prediction of psychosis onset in at-risk mental state individuals.

Methods

There were 28 healthy controls, 86 first-episode psychosis patients and 127 at-risk mental state individuals recruited within the Basel “Früherkennung von Psychosen” project. Relative frequencies of selected vulnerability factors for psychosis were compared between healthy controls, psychosis patients, those at-risk mental state individuals with subsequent psychosis onset (n = 31) and those without subsequent psychosis onset (n = 55). Survival analyses were applied to determine associations between time to transition to psychosis and vulnerability factors in all 127 at-risk mental state individuals.

Results

The vulnerability factors/indicators such as “difficulties during school education or vocational training”, “difficulties during employment”, “being single”, “difficulties with intimate relationships” and “being burdened with specific stressful situations” were more commonly found in the at-risk mental state and first-episode psychosis group than in healthy controls.

Conclusions

At-risk mental state and first-episode psychosis individuals more frequently present with vulnerability factors. Individual vulnerability factors appear, however, not to be predictive for an onset of psychosis.

Zusammenfassung

Hintergrund

Verschiedene Indikatoren für eine erhöhte Vulnerabilität für Psychosen und relevante Stressoren sind identifiziert worden. Bislang wurde jedoch nicht ausreichend untersucht, ob diese Vulnerabilitätsfaktoren auch häufiger bei Personen mit einem Risikostatus für eine Psychose und ersterkrankten Psychose-Patienten vorliegen. Zudem ist unklar, ob sie zur Prädiktion einer psychotischen Dekompensation bei Personen mit einem Psychoserisiko-Status beitragen.

Methoden

Achtundzwanzig gesunde Kontrollen, 86 ersterkrankte Psychose-Patienten und 127 Personen mit einem Psychoserisiko-Status wurden innerhalb des Basler Projektes ‚Früherkennung von Psychosen‘ rekrutiert. Die relativen Häufigkeiten ausgewählter Vulnerabilitätsfaktoren für Psychose wurden zwischen gesunden Kontrollen, Psychose-Patienten, jenen Risikopatienten mit späterer Psychose-Entwicklung (n = 31) und jenen ohne Psychose-Entwicklung (n = 55) verglichen. Survival-Analysen wurden verwendet, um Assoziationen zwischen der Zeit bis zu einer psychotischen Dekompensation und Vulnerabilitätsfaktoren in allen 127 Probanden mit Psychoserisiko-Status zu bestimmen.

Ergebnisse

Die Vulnerabilitätsfaktoren/-indikatoren „Schwierigkeiten während der Schul- oder Berufsausbildung“, „Schwierigkeiten während der Arbeit“, „alleinstehend sein“, „Schwierigkeiten bei intimen Beziehungen“ und „sich belastet fühlen durch stressige Situationen“, waren häufiger bei den Psychoserisiko-Patienten und den ersterkrankten Psychose-Patienten vorhanden als bei gesunden Kontrollen.

Schlussfolgerungen

Psychoserisiko-Patienten und ersterkrankte Psychose-Patienten weisen häufiger Vulnerabilitätsfaktoren/-indikatoren auf. Einzeln scheinen diese jedoch nicht prädiktiv für eine psychotische Dekompensation zu sein.

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Acknowledgements

We thank all patients and volunteers who participated in the study as well as the referring specialists. This work was supported by the Swiss National Science Foundation (grant numbers 3200-057216.99, 3200-0572216.99, PBBSB-106936 and 3232BO-119382), the Nora van Meeuwen-Haefliger Stiftung, Basel (CH) and by unconditional grants from the Novartis Foundation, Bristol-Myers Squibb, GmbH (CH), Eli Lilly SA (CH), AstraZeneca AG (CH), Janssen-Cilag AG (CH) and Sanofi-Synthelabo AG (CH).

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Authors and Affiliations

  1. Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Kornhausgasse 7, 4051, Basel, Switzerland

    Martina Papmeyer, Irène Würsch, Erich Studerus, Rolf-Dieter Stieglitz &  Anita Riecher-Rössler

  2. Translational Research Center, University Hospital of Psychiatry, University of Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland

    Martina Papmeyer

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  1. Martina Papmeyer
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Correspondence to Anita Riecher-Rössler.

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Papmeyer, M., Würsch, I., Studerus, E. et al. The role of vulnerability factors in individuals with an at-risk mental state of psychosis. Neuropsychiatr 30, 18–26 (2016). https://doi.org/10.1007/s40211-016-0179-9

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