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2.
Br J Clin Psychol ; 59(4): 524-551, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32944971

RESUMO

OBJECTIVE: Psychological interventions reduce the impact of psychosis, but widescale implementation is problematic. We tested the feasibility of group acceptance and commitment therapy for Psychosis (G-ACTp), delivered by frontline staff, and co-facilitated by service-user experts-by-experience (SU-EbyE), for service-users and informal caregivers (ISRCTN: 68540929). We estimated recruitment/retention rates and outcome variability for future evaluation. METHODS: Staff and SU-EbyE facilitators completed 1-day workshops, then delivered closely supervised G-ACTp, comprising four sessions (weeks 1-4) and two boosters (10 and 12 weeks). Participants recruited from adult community psychosis services were randomized to receive G-ACTp immediately or after 12 weeks, completing outcome assessments at 0, 4, and 12 weeks. Service-use/month was calculated for 1-year pre-randomization, weeks 0-12, and 5-year uncontrolled follow-up. RESULTS: Of 41 facilitators trained (29 staff, 12 SU-EbyE), 29 (71%; 17 staff, 12 SU-EbyE) delivered 18 G-ACTp courses. Participant refusal rates were low (9% of service-users [10/112]; 5% of caregivers [4/79]); 60% of those invited to participate attended ≥1 G-ACTp session (64% of service-users [39/61]; 56% of caregivers [35/63]). Randomization of facilitators and participants proved problematic and participant follow-up was incomplete (78% [66/85]; 82% of service-users [36/44]; 73% of caregivers [30/41]). Effect sizes ranged from very small to large mostly favouring treatment. Service-use reductions require cautious interpretation, as very few participants incurred costs. CONCLUSIONS: Implementation appears feasible for service-users; for caregivers, retention needs improving. Outcome variability indicated n = 100-300/arm followed up (α = 0.05, 90% power). Methodological limitations' mean replication is needed: identified sources of potential bias may be reduced in a cluster randomized design with sessional outcome completion. PRACTITIONER POINTS: Group acceptance and commitment therapy can be successfully adapted for people with psychosis and their caregivers. Implementation (training and delivery) is possible in routine community mental health care settings. Clinical and economic outcomes are promising, but replication is needed. Recommendations are made for future studies.


Assuntos
Terapia de Aceitação e Compromisso , Cuidadores/psicologia , Transtornos Psicóticos/terapia , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicoterapia de Grupo , Transtornos Psicóticos/psicologia , Resultado do Tratamento
4.
PLoS One ; 15(9): e0238774, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915832

RESUMO

Brain reward processing mechanisms that underlie complex decision-making are compromised in psychosis. The goal of this research was to advance our understanding of the underlying (1) neural mechanisms and (2) discrete neuro-economic/motivational processes that may be altered in complex decision-making in euthymic patients on the psychosis spectrum (PPS). Utilizing a functional magnetic resonance neuroimaging (fmri) paradigm of a well-validated laboratory measure of complex decision-making (Iowa Gambling Task-IGT), the brain activation patterns of a target group of PPS were compared to a demographically matched healthy comparison group (HMC). These two groups were also evaluated on real-life decision outcomes on day of scan. PPS primarily activate the Dorsal Attentional Network (DAN) in real-life decision outcomes and in achieving similar levels of performance on the IGT as the HMC, in-spite of dysregulated dopamine-based brain-reward circuit and salience network fmri activation patterns. However, PPS report more significant negative outcomes of their decision-making in real-life, compared to HMC. The differential engagement of brain networks by PPS on the IGT appear to be moderated by antipsychotic, dopamine antagonist, medication lifetime/daily dose levels. These findings may also be mediated by extent of dysregulation in brain reward circuitry and salience network associated with psychosis severity in the target PPS group. This is also evident in case studies of unmedicated PPS. We conclude by suggesting that the brain may adapt to this dysregulation by co-opting the DAN network, which is implicated in the related function of problem-solving, towards complex decision-making. The extent of utilization of the DAN network in complex decision-making may be moderated by psychosis severity.


Assuntos
Encéfalo/fisiopatologia , Tomada de Decisões/fisiologia , Rede Nervosa/fisiopatologia , Transtornos Psicóticos/psicologia , Adulto , Encéfalo/efeitos dos fármacos , Tomada de Decisões/efeitos dos fármacos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/fisiopatologia , Recompensa
5.
Br J Clin Psychol ; 59(4): 503-523, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32862467

RESUMO

BACKGROUND: No studies have examined the association between self-esteem and paranoia developmentally across the critical stages of psychosis emergence. The present study fills this gap and extends previous research by examining how different dimensions, measures, and types of self-esteem relate to daily-life paranoia across at-risk mental states for psychosis (ARMS) and first episode of psychosis (FEP) stages. Furthermore, the moderation effects of momentary anxiety and momentary perceived social support on the association between momentary self-esteem and paranoia were examined. DESIGN: This study used a multilevel, cross-sectional design. METHODS: One-hundred and thirteen participants (74 ARMS and 39 FEP) were assessed repeatedly over seven consecutive days on levels of momentary paranoia, self-esteem, anxiety and perceived social support using experience sampling methodology. Measures of trait and implicit self-esteem were also collected. RESULTS: Global momentary and trait self-esteem, and their positive and negative dimensions, were related to daily-life paranoia in both ARMS and FEP groups. Conversely, implicit self-esteem was not associated with daily-life paranoia in either group. Anxiety negatively moderated the association between positive self-esteem and lower paranoia, whereas both feeling close to others and feeling cared for by others strengthened this association. However, only feeling cared for by others moderated the association between negative self-esteem and higher paranoia. CONCLUSIONS: Different types, measures and dimensions of self-esteem are differentially related to paranoia in early psychosis and are influenced by contextual factors in daily-life. This yields a more complex picture of these associations and offers insights that might aid psychological interventions. PRACTITIONER POINTS: Different measures (trait and momentary) and dimensions (positive and negative) of explicit self-esteem are distinctly related to paranoia across risk and first-episode stages of psychosis. Explicit, but not implicit, self-esteem is associated with real-life paranoia in incipient psychosis. Anxiety boosted the association of poor self-esteem and paranoia ideation in daily-life. Social closeness, but feeling cared for by others in particular, interacts with self-esteem tempering the expression of paranoia in real life.


Assuntos
Ansiedade/psicologia , Transtornos Paranoides/psicologia , Transtornos Psicóticos/psicologia , Autoimagem , Adulto , Transtornos de Ansiedade , Estudos Transversais , Avaliação Momentânea Ecológica , Emoções , Feminino , Humanos , Masculino
6.
BMJ Case Rep ; 13(8)2020 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-32784244

RESUMO

A 36-year-old previously healthy woman with no personal or family history of mental illness presented with new-onset psychosis after a diagnosis of symptomatic COVID-19. Her psychotic symptoms initially improved with antipsychotics and benzodiazepines and further improved with resolution of COVID-19 symptoms. This is the first case of COVID-19-associated psychosis in a patient with no personal or family history of a severe mood or psychotic disorder presenting with symptomatic COVID-19, highlighting the need for vigilant monitoring of neuropsychiatric symptoms in these individuals.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/psicologia , Pneumonia Viral/complicações , Pneumonia Viral/psicologia , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/psicologia , Adulto , Antipsicóticos/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Pandemias , Transtornos Psicóticos/tratamento farmacológico
7.
Clín. salud ; 31(2): 99-103, jul. 2020.
Artigo em Inglês | IBECS | ID: ibc-190320

RESUMO

In response to the coronavirus (COVID-19) pandemic several adaptations have allowed us to continue to provide one form of recovery-oriented psychotherapy to persons with psychosis: Metacognitive Insight and Reflection Therapy (MERIT). These successful adaptations have included the incorporation of patients' experience of the pandemic and the exploration of challenges from temporary changes in therapy platforms to deepen reflections about patients' self-experience, their experience of intersubjectivity and their own agentic responses to psychosocial challenges


En respuesta a la pandemia del coronavirus (COVID-19) varias adaptaciones han permitido que sigamos facilitando una de las formas de psicoterapia orientada a la recuperación de las personas que padecen psicosis: la terapia de percepción metacognitiva y reflexión (MERIT). Estas adaptaciones satisfactorias incluyen la incorporación de la experiencia de los pacientes de la pandemia y el uso de los desafíos que plantean los cambios temporales en las plataformas terapéuticas con objeto de profundizar en la reflexión sobre la autoexperiencia de los pacientes, su experiencia en intersubjetividad y sus propias respuestas a los desafíos psicosociales


Assuntos
Humanos , Infecções por Coronavirus/psicologia , Pneumonia Viral/psicologia , Pandemias , Transtornos Psicóticos/psicologia , Psicoterapia/métodos , Psicoterapia/tendências , Transtornos Psicóticos/terapia , Metacognição , Estados Unidos
8.
Soins Psychiatr ; 41(327): 35-38, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32718461

RESUMO

Patients with psychosis are known to dislike change or being hurried. Their relationship with time must therefore be taken into account, all the more so given that today's society leads us to believe that immediate satisfaction takes priority. Constant switching and addiction upset the stability which supports these patients with difficulty. The case of a patient visited at home shows that the team's decision to adapt to that one time will favour her subjectivation and the consolidation of her equilibrium.


Assuntos
Visita Domiciliar , Relações Profissional-Paciente , Transtornos Psicóticos/terapia , Feminino , Humanos , Transtornos Psicóticos/psicologia , Fatores de Tempo
9.
Soins Psychiatr ; 41(326): 37-41, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32718526

RESUMO

The nursepatient relationship is particularly challenging when the patient experiences psychosis and when he or she is placed in a context of coercion. Psychosis causes relational problems in the patient, which are further complicated in a context of coercion as this practice implies differences of understanding, status and power between the nurse and the patient. The Tidal Model, a care model focused on recovery, comprises ten principles of commitment for caregivers, which help to build a bridge between them and the person experiencing psychosis.


Assuntos
Coerção , Relações Enfermeiro-Paciente , Transtornos Psicóticos/enfermagem , Transtornos Psicóticos/psicologia , Feminino , Humanos , Masculino , Modelos de Enfermagem
10.
Psychopathology ; 53(2): 95-102, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32623434

RESUMO

INTRODUCTION: Within the psychosis continuum that includes schizophrenia (SZ) at the severe end and the general population at the mild end, anxiety may negatively impact social functioning more than psychosis or psychotic-like experiences (PLE). This claim is supported by previous reports that show anxiety mediates the relationship between psychosis and social functioning in SZ, suggesting anxiety is critical to social functioning in SZ. Yet no studies have examined a similar relationship in the general population, and this is important because people with PLE are at a significantly higher risk for developing full-blown psychosis. METHODS: Similar to those with SZ, we predicted heightened anxiety would mediate the relationship between PLE, as measured by The -Oxford-Liverpool Inventory of Feelings and Experiences, and social functioning, as measured by Social Adjustment Scale - Self-Report, in the general population. RESULTS: Indeed, the current study showed that the relationship between PLE and social functioning was mediated by anxiety (z = 7.81, p < 0.001) within an unselected crowdsourcing sample representative of the general population (Amazon M-Turk; n = 197, mean age 32.38 years). CONCLUSION: Taken together with previous reports, the current findings suggest that anxiety is a functionally relevant dimension across the psychosis continuum and improving anxiety may improve social functioning across this continuum.


Assuntos
Ansiedade/psicologia , Transtornos Psicóticos/epidemiologia , Ajustamento Social , Adulto , Feminino , Humanos , Masculino , Transtornos Psicóticos/psicologia
11.
Psychiatry Res ; 291: 113254, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32603930

RESUMO

Psychotic symptoms have been related to other coronavirus infections. We conducted a single-centre retrospective and observational study to describe new-onset psychotic episodes in COVID-19 patients. Ten patients infected by the novel coronavirus with psychotic symptoms and no previous history of psychosis were identified by the emergency and liaison psychiatry departments. Nine of the cases presented with psychotic symptoms at least two weeks after the first somatic manifestations attributed to COVID-19 and receiving pharmacological treatment. Structured delusions mixed with confusional features were the most frequent clinical presentations. Hence, COVID-19 patients can develop psychotic symptoms as a consequence of multiple concurrent factors.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Transtornos Psicóticos/complicações , Adulto , Infecções por Coronavirus/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/psicologia , Transtornos Psicóticos/psicologia , Estudos Retrospectivos
13.
Rev. psiquiatr. salud ment. (Barc., Ed. impr.) ; 13(2): 95-104, abr.-jun. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-193407

RESUMO

La conceptualización de la esquizofrenia ha cambiado desde su concepción inicial en el siglo XIX hasta la reciente publicación de la CIE-11. Los cambios incorporados en esta última versión se han realizado con base en la evaluación de la CIE vigente, la evidencia científica disponible y los consensos logrados por sus desarrolladores. En el presente trabajo se describen los cambios en la conceptualización (criterios diagnósticos y especificadores) de la esquizofrenia de la CIE-11 respecto a aquella de la CIE-10 y del DSM-5. Los cambios encontrados son discutidos con base en la bibliografía científica publicada en Medline, Scopus y Scielo hasta julio del 2019 y la información de las páginas web de la Organización Mundial de la Salud y la American Psychiatric Association. Dado que el diagnóstico de la esquizofrenia se basa en los criterios diagnósticos de los sistemas de clasificación diagnóstica, resulta importante conocer los cambios hechos en su conceptualización y la evidencia que sustenta tales modificaciones


The conceptualization of schizophrenia has changed from its initial conception in the 19th century to the recent publication of the ICD-11. The changes incorporated in this latest version were made based on the evaluation of the current ICD, the available scientific evidence, and the consensus reached by its developers. In this paper we describe the conceptualization changes (diagnostic criteria and specifiers) of ICD-11 schizophrenia with respect to those of ICD-10 and DSM-5. The changes found are discussed based on the scientific literature published in Medline, Scopus and Scielo until July 2019 and the information on the Wordl Health Organization and American Psychiatric Association websites. Given that the diagnosis of schizophrenia is based on the diagnostic criteria of the diagnostic classification systems, it is important to know the changes made in its conceptualization and the evidence supporting such modifications


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Infecções por Coronavirus/psicologia , Pneumonia Viral/psicologia , Pandemias , Transtornos Psicóticos/psicologia , Quarentena/psicologia
14.
PLoS One ; 15(6): e0234325, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32542020

RESUMO

Mechanisms underlying the manifestation of relatives' expressed emotion (EE) in the early stages of psychosis are still not properly understood. The present study aimed to examine whether relatives' psychological distress and subjective appraisals of the illness predicted EE dimensions over-and-above patients' poor clinical and functional status. Baseline patient-related variables and relatives attributes comprising criticism, emotional over-involvement (EOI), psychological distress, and illness attributions were assessed in 91 early psychosis patients and their respective relatives. Relatives were reassessed regarding EE dimensions at a 6-month follow-up. Relatives' psychological distress and illness attributions predicted criticism and EOI over-and-above patients' illness characteristics at both time points. Relatives' increased levels of anxiety, attributions of blame toward the patients, an emotional negative representation about the disorder, and decreased levels of self-blame attributions predicted EE-criticism at baseline. Relatives' anxiety and negative emotional representation of the disorder were the only significant predictors of EE-criticism at follow-up, whereas anxiety, attributions of control by the relative and an emotional negative representation about the disorder predicted EE-EOI both at baseline and follow-up assessments. Understanding the components that comprise and maintain EE attitudes should guide early psychosis caregivers in family interventions, enhancing proper management of psychological distress and reduction of negative appraisals about the illness. The prevention of high-EE attitudes over time in a sensitive period such as early psychosis might be critical in shaping the health of caregivers and the outcome of the affected relatives.


Assuntos
Cuidadores/psicologia , Emoções Manifestas/fisiologia , Família/psicologia , Adaptação Psicológica/fisiologia , Adulto , Ansiedade/psicologia , Atitude , Emoções/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/psicologia , Percepção Social
15.
Lancet Psychiatry ; 7(7): 602-610, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32563307

RESUMO

BACKGROUND: Delayed treatment for first episodes of psychosis predicts worse outcomes. We hypothesised that delaying treatment makes all symptoms more refractory, with harm worsening first quickly, then more slowly. We also hypothesised that although delay impairs treatment response, worse symptoms hasten treatment, which at presentation mitigates the detrimental effect of treatment delay on symptoms. METHODS: In this longitudinal analysis and modelling study, we included two longitudinal cohorts of patients with first-episode psychosis presenting to English early intervention services from defined catchments: NEDEN (recruiting 1003 patients aged 14-35 years from 14 services between Aug 1, 2005, and April 1, 2009) and Outlook (recruiting 399 patients aged 16-35 years from 11 services between April 1, 2006, and Feb 28, 2009). Patients were assessed at baseline, 6 months, and 12 months with the Positive and Negative Symptom Scale (PANSS), Calgary Depression Scale for Schizophrenia, Mania Rating Scale, Insight Scale, and Social and Occupational Functioning Assessment Scale. Regression was used to compare different models of the relationship between duration of untreated psychosis (DUP) and total symptoms at 6 months. Growth curve models of symptom subscales tested predictions arising from our hypotheses. FINDINGS: We included 948 patients from the NEDEN study and 332 patients from the Outlook study who completed baseline assessments and were prescribed dopamine antagonist antipsychotics. For both cohorts, the best-fitting models were logarithmic, describing a curvilinear relationship of DUP to symptom severity: longer DUP predicted reduced treatment response, but response worsened more slowly as DUP lengthened. Increasing DUP by ten times predicted reduced improvement in total symptoms (ie, PANSS total) by 7·339 (95% CI 5·762 to 8·916; p<0·0001) in NEDEN data and 3·846 (1·689 to 6·003; p=0·0005) in Outlook data. This was true of treatment response for all symptom types. Nevertheless, longer DUP was not associated with worse presentation for any symptoms except depression in NEDEN (coefficients 0·099 [95% CI 0·033 to 0·164]; p=0·0028 in NEDEN and 0·007 [-0·081 to 0·095]; p=0·88 in Outlook). INTERPRETATION: Long DUP was associated with reduced treatment response across subscales, consistent with a harmful process upstream of individual symptoms' mechanisms; response appeared to worsen quickly at first, then more slowly. These associations underscore the importance of rapid access to a comprehensive range of treatments, especially in the first weeks after psychosis onset. FUNDING: UK Department of Health, National Institute of Health Research, and Medical Research Council.


Assuntos
Antipsicóticos/uso terapêutico , Antagonistas de Dopamina/uso terapêutico , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/psicologia , Tempo para o Tratamento , Adolescente , Adulto , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Modelos Psicológicos , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/diagnóstico , Fatores de Tempo , Adulto Jovem
17.
BMC Psychiatry ; 20(1): 288, 2020 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-32513133

RESUMO

BACKGROUND: Employment holds many benefits for people living with psychosis. However, significant barriers to employment for this cohort appear to exist, notably stigma and discrimination against people living with serious mental health conditions. We asked: Would a qualitative sample including multiple stakeholder groups reveal similar results and if so, what would be the main impacts of such stigma and discrimination? METHOD: This analysis used data from a qualitative study that had employed focus groups and interviews to investigate the employment barriers and support needs of people living with psychosis, including views of the multiple stakeholders (those living with mental health conditions, health professionals, care-givers, employments consultants and community members and employers). RESULTS: The impacts of workplace stigma and discrimination on people living with psychosis included work avoidance, reluctance to disclose mental health conditions to employers, work-related stress, and reduced longevity of employment. CONCLUSIONS: Significant impacts from such stigma and discrimination were found in this study. The findings indicate a need to provide support mechanisms and to change the culture of workplaces to improve employment opportunities and outcomes for people living with psychosis.


Assuntos
Discriminação Psicológica , Transtornos Psicóticos/psicologia , Estigma Social , Local de Trabalho/psicologia , Emprego , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Pesquisa Qualitativa
18.
BMC Psychiatry ; 20(1): 289, 2020 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-32513209

RESUMO

BACKGROUND: This study aimed to identify predictors and perceived facilitators of positive change and posttraumatic growth in persons with a first episode of psychosis using a mixed methods convergent design. METHODS: In the quantitative component, 94 participants completed measures of posttraumatic growth and predictors of posttraumatic growth. The qualitative component involved in-depth interviews with 12 participants. RESULTS: Quantitative results revealed that being hospitalized for psychosis, spiritual coping, positive reframing and subjective recovery were significant predictors of posttraumatic growth. Qualitative findings revealed that positive change was perceived to be facilitated by the psychosis itself; receiving mental health services; drawing on personal and social resources and strategies; healing and recovering; a meaning-making and knowledge gaining process; and normative developmental processes. CONCLUSIONS: Posttraumatic growth following a first episode of psychosis may therefore be facilitated by complex person-environment interactions.


Assuntos
Adaptação Psicológica , Serviços de Saúde Mental/organização & administração , Crescimento Psicológico Pós-Traumático , Transtornos Psicóticos/diagnóstico , Adulto , Feminino , Humanos , Entrevistas como Assunto , Masculino , Transtornos Psicóticos/psicologia , Pesquisa Qualitativa
19.
Rev Psiquiatr Salud Ment ; 13(2): 90-94, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: covidwho-125044

RESUMO

INTRODUCTION: The world is currently undergoing an extremely stressful scenario due to the COVID-19 pandemic. This unexpected and dramatic situation could increase the incidence of mental health problems, among them, psychotic disorders. The aim of this paper was to describe a case series of brief reactive psychosis due to the psychological distress from the current coronavirus pandemic. MATERIALS AND METHODS: We report on a case series including all the patients with reactive psychoses in the context of the COVID-19 crisis who were admitted to the Virgen del Rocío and Virgen Macarena University Hospitals (Seville, Spain) during the first two weeks of compulsory nationwide quarantine. RESULTS: In that short period, four patients met the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for a brief reactive psychotic disorder. All of the episodes were directly triggered by stress derived from the COVID-19 pandemic and half of the patients presented severe suicidal behavior at admission. CONCLUSIONS: We may now be witnessing an increasing number of brief reactive psychotic disorders as a result of the COVID-19 pandemic. This type of psychosis has a high risk of suicidal behavior and, although short-lived, has a high rate of psychotic recurrence and low diagnostic stability over time. Therefore, we advocate close monitoring in both the acute phase and long-term follow-up of these patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/psicologia , Pneumonia Viral/psicologia , Angústia Psicológica , Transtornos Psicóticos/etiologia , Quarentena/psicologia , Estresse Psicológico/complicações , Adulto , Infecções por Coronavirus/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Fatores de Risco , Espanha , Suicídio/psicologia
20.
Lancet Psychiatry ; 7(5): 431-440, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32353278

RESUMO

BACKGROUND: Evidence exists that maternal depression in the perinatal period has an adverse effect on a range of early childhood outcomes and increases the risk of offspring depression during adolescence. However, the association between maternal depression during the perinatal period and offspring psychotic experiences has not been investigated. We aimed to investigate whether there is an association between maternal antenatal or postnatal depression and offspring psychotic experiences at 18 years of age. METHODS: This longitudinal study used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a prospective birth cohort, which recruited 14 541 pregnant women with an estimated delivery date between April 1, 1991, and Dec 31, 1992. Perinatal depression was measured using the Edinburgh Postnatal Depression Scale (EPDS); offspring psychotic experiences at 18 years of age were measured using the Psychosis-Like Symptom Interview. Offspring of mothers with complete data on maternal perinatal depression measures, and complete data on outcome (psychotic experiences) and confounding variables were included in the main analysis. For the main analysis, we used logistic regression to examine the associations between maternal depression (antenatal and postnatal) and offspring psychotic experiences at the age of 18 years. We used biprobit regression to model the association between maternal antenatal depression and the two offspring outcomes (psychotic experiences and depression) at 18 years of age jointly. FINDINGS: 3067 offspring for whom data were available on maternal perinatal depression and offspring psychotic experiences aged 18 years were included in analyses. Maternal antenatal depressive symptoms were associated with offspring psychotic experiences at 18 years of age, with an unadjusted odds ratio (OR) of 1·38 (95% CI 1·18-1·61, p=0·0001) and after adjustment for confounders, an OR of 1·26 (1·06-1·49, p=0·0074). Maternal antenatal depressive symptoms were associated with both offspring psychotic experiences at the age of 18 years (n=2830, OR for a 5-point increase in EPDS score: 1·32 [95% CI 1·16-1·51], p<0·0001) and offspring depression at 18 years (OR for a 5-point increase in EPDS score: 1·18 [1·03-1·34], p=0·016). From joint modelling, there was no evidence that the association between maternal antenatal depression and offspring psychotic experiences differed in strength compared with offspring depression (p=0·19). INTERPRETATION: The offspring of mothers who experience depression in the perinatal period are more likely to report psychotic experiences at 18 years of age. If the association is found to be causal, it would strengthen the case for identifying and treating maternal depression during and after pregnancy. FUNDING: UK Medical Research Council and the Wellcome Trust.


Assuntos
Filho de Pais Incapacitados/estatística & dados numéricos , Depressão Pós-Parto , Depressão/epidemiologia , Complicações na Gravidez/epidemiologia , Transtornos Psicóticos/epidemiologia , Adolescente , Adulto , Filho de Pais Incapacitados/psicologia , Inglaterra/epidemiologia , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Gravidez , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/psicologia , Transtornos Psicóticos/psicologia , Adulto Jovem
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