Academic journal article Canadian Psychology

High Stress, Low Resilience in People at Clinical High Risk for Psychosis: Should We Consider a Strengths-Based Approach?

Academic journal article Canadian Psychology

High Stress, Low Resilience in People at Clinical High Risk for Psychosis: Should We Consider a Strengths-Based Approach?

Article excerpt

Schizophrenia continues to be one of the world's and Canada's top 10 causes of long-term disability, resulting in exorbitant economic, social, and debilitating health implications (GBD 2013 Mortality and Causes of Death Collaborators, 2015; Goeree et al., 2005; Vos et al., 2012). According to a 2006 World Health Organization (WHO) report, schizophrenia was listed 10th for males and ninth for females of years living with disability world-Lauren wide (Mathers, Lopez, & Murray, 2006). This is significant considering that all diseases, physical and mental, were accounted for in this calculation. In a more recent report, the average years lived with disability has been reported to be 209 per 100,000 globally, indicating a 13.5% increase from 1990 -2010 (Vos et al., 2012). Prior to the onset of schizophrenia is the putative prodromal phase, the clinical high risk (CHR) or at-risk mental state for psychosis. The CHR or at-risk mental state for psychosis describes individuals presenting with potentially prodromal symptoms for psychosis (Addington & Heinssen, 2012; Cannon et al., 2008; Correll, Hauser, Auther, & Cornblatt, 2010; Fusar-Poli et al., 2012; Keshavan, DeLisi, & Seidman, 2011; McGlashan, Walsh, & Woods, 2010; Ruhrmann et al., 2010). Symptoms include reduced neurocognitive functioning, attenuated psychotic symptoms, negative symptoms (e.g., avolition, social withdraw, anhedonia, flat affect), and most notably decreased tolerance to normal everyday stress. Increasing evidence has indicated that a longer duration of untreated illness during the early phases of psychosis is associated with poorer clinical outcomes (Cannon et al., 2008; Ruhrmann et al., 2010). Conversion rates from CHR to schizophrenia are reported to be about 35% within 2.5 years since CHR diagnosis (Cannon et al., 2008), with the same rate observed after a 10-year follow-up (Nelson et al., 2013). Thus, very early identification and intervention is a key preventive measure with the potential to make substantial strides to mitigating, and even to preventing, psychotic disorders such as schizophrenia. The assessment measures commonly used to identify and evaluate CHR are the Structured Interview for Psychosis-risk Syndrome (McGlashan, Walsh, & Woods, 2001) and the Comprehensive Assessment of At-Risk Mental States (Yung et al., 2005). Both psychosis risk assessment systems also assess negative symptoms, disorganization symptoms, and general symptoms (McGlashan et al., 2001, 2010; Yung et al., 2005). There are at least three syndromes of CHR, which include the attenuated positive symptoms the genetic risk and deterioration, and the brief intermittent psychosis.

Those identified at CHR for psychosis have been reported to experience everyday life events as more stressful than healthy controls (Myin-Germeys, Delespaul, & Van Os, 2005; Walker et al., 2013) and have reported lower levels of resilience than their healthy counterparts. Resilience is the ability to adaptively respond to and cope in the face of adversity (e.g., social and financial stressors, trauma; American Psychological Association, 2015). Research has indicated that stressful life events contribute to both the emergence and exacerbation of psychotic symptoms (Tessner, Mittal, & Walker, 2011). The empirical evidence for this association supports the widely accepted stress-vulnerability model, which posits that psychiatric symptoms emerge/exacerbate when the threshold of stressors exceeds the individual's vulnerability level (Gibson et al., 2014; Goh & Agius, 2010; Pruessner, Iyer, Faridi, Joober, & Malla, 2011; Walker & Diforio, 1997). It has been established that psychosocial stress is one of several risk factors contributing to the onset and relapse of psychotic symptoms (Addington & Heinssen, 2012; Aiello, Horowitz, Hepgul, Pariante, & Mondelli, 2012; Tessner et al., 2011; van Winkel, Stefanis, & Myin-Germeys, 2008). For example, multiple studies have shown that stress in psychosis is associated with greater increases in negative affect and greater decreases in positive affect (relative to those observed in healthy controls), and the intensification of psychotic symptoms (Aiello et al. …

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