title: Stress Sensitivity, Aberrant Salience, and Threat Anticipation in Early Psychosis: An Experience Sampling Study.
abstract: While contemporary models of psychosis have proposed a number of putative psychological mechanisms, how these impact on individuals to increase intensity of psychotic experiences in real life, outside the research laboratory, remains unclear. We aimed to investigate whether elevated stress sensitivity, experiences of aberrant novelty and salience, and enhanced anticipation of threat contribute to the development of psychotic experiences in daily life. We used the experience sampling method (ESM) to assess stress, negative affect, aberrant salience, threat anticipation, and psychotic experiences in 51 individuals with first-episode psychosis (FEP), 46 individuals with an at-risk mental state (ARMS) for psychosis, and 53 controls with no personal or family history of psychosis. Linear mixed models were used to account for the multilevel structure of ESM data. In all 3 groups, elevated stress sensitivity, aberrant salience, and enhanced threat anticipation were associated with an increased intensity of psychotic experiences. However, elevated sensitivity to minor stressful events (χ(2)= 6.3,P= 0.044), activities (χ(2)= 6.7,P= 0.036), and areas (χ(2)= 9.4,P= 0.009) and enhanced threat anticipation (χ(2)= 9.3,P= 0.009) were associated with more intense psychotic experiences in FEP individuals than controls. Sensitivity to outsider status (χ(2)= 5.7,P= 0.058) and aberrantly salient experiences (χ(2)= 12.3,P= 0.002) were more strongly associated with psychotic experiences in ARMS individuals than controls. Our findings suggest that stress sensitivity, aberrant salience, and threat anticipation are important psychological processes in the development of psychotic experiences in daily life in the early stages of the disorder.
authors.affiliation: Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; ulrich.reininghaus@kcl.ac.uk.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Reininghaus
authors.affiliation: Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK;
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kempton
authors.affiliation: Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK;
authors.forename: Lucia
authors.initials: L
authors.lastname: Valmaggia
authors.affiliation: Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK;
authors.forename: Tom K J
authors.initials: TK
authors.lastname: Craig
authors.affiliation: Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK;
authors.forename: Philippa
authors.initials: P
authors.lastname: Garety
authors.affiliation: Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK;
authors.forename: Adanna
authors.initials: A
authors.lastname: Onyejiaka
authors.affiliation: Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK;
authors.forename: Charlotte
authors.initials: C
authors.lastname: Gayer-Anderson
authors.affiliation: Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China;
authors.forename: Suzanne H
authors.initials: SH
authors.lastname: So
authors.affiliation: Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK;
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hubbard
authors.affiliation: Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK;
authors.forename: Stephanie
authors.initials: S
authors.lastname: Beards
authors.affiliation: Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK;
authors.forename: Paola
authors.initials: P
authors.lastname: Dazzan
authors.affiliation: National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK;
authors.forename: Carmine
authors.initials: C
authors.lastname: Pariante
authors.affiliation: National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK;
authors.forename: Valeria
authors.initials: V
authors.lastname: Mondelli
authors.affiliation: MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK;
authors.forename: Helen L
authors.initials: HL
authors.lastname: Fisher
authors.affiliation: Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK;
authors.forename: John G
authors.initials: JG
authors.lastname: Mills
authors.affiliation: Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands;
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Viechtbauer
authors.affiliation: Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK;
authors.forename: Philip
authors.initials: P
authors.lastname: McGuire
authors.affiliation: Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands;
authors.forename: Jim
authors.initials: J
authors.lastname: van Os
authors.affiliation: Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK;
authors.forename: Robin M
authors.initials: RM
authors.lastname: Murray
authors.affiliation: Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK;
authors.forename: Til
authors.initials: T
authors.lastname: Wykes
authors.affiliation: Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Center for Contextual Psychiatry, Department of Neuroscience, Catholic University of Leuven, Leuven, Belgium.
authors.forename: Inez
authors.initials: I
authors.lastname: Myin-Germeys
authors.affiliation: Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK;
authors.forename: Craig
authors.initials: C
authors.lastname: Morgan
mesh_terms: D000293:Adolescent; D000328:Adult; D059031:Anticipation, Psychological / Q000502:physiology*; D000072860:Ecological Momentary Assessment; D005239:Fear / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062706:Prodromal Symptoms; D011618:Psychotic Disorders / Q000503:physiopathology*; D013315:Stress, Psychological / Q000503:physiopathology*; D055815:Young Adult
keywords: aberrant salience; ecological momentary assessment; first-episode psychosis; prodrome; stress sensitivity; threat anticipation
references.citation: Schizophr Bull. 2010 Jan;36(1):182-91
references.pmid: 18579555
references.citation: Nature. 2010 Nov 11;468(7321):203-12
references.pmid: 21068828
references.citation: Psychol Med. 2005 May;35(5):733-41
references.pmid: 15918350
references.citation: Schizophr Res. 2010 Dec;124(1-3):43-8
references.pmid: 20855184
references.citation: Schizophr Res. 2005 Nov 1;79(1):59-68
references.pmid: 16005191
references.citation: Schizophr Bull. 2016 Mar;42(2):264-9
references.pmid: 26707864
references.citation: BMJ. 2001 Dec 8;323(7325):1336-8
references.pmid: 11739218
references.citation: Drug Alcohol Depend. 2014 Jan 1;134:22-29
references.pmid: 24332365
references.citation: Annu Rev Clin Psychol. 2008;4:1-32
references.pmid: 18509902
references.citation: Schizophr Bull. 2013 Nov;39(6):1288-95
references.pmid: 23091267
references.citation: Psychol Med. 2014 Oct;44(13):2713-26
references.pmid: 25066181
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2014 Jan;49(1):1-2
references.pmid: 24306040
references.citation: Br J Psychiatry. 2007 Oct;191:355-6
references.pmid: 17906248
references.citation: Schizophr Bull. 2012 Mar;38(2):227-30
references.pmid: 22355185
references.citation: Psychol Med. 2009 Feb;39(2):199-209
references.pmid: 18588739
references.citation: J Biopharm Stat. 2001 Feb-May;11(1-2):9-21
references.pmid: 11459446
references.citation: Psychol Med. 2013 Jun;43(6):1133-49
references.pmid: 22850401
references.citation: Schizophr Bull. 2014 Jul;40(4):729-36
references.pmid: 24860087
references.citation: Arch Gen Psychiatry. 2001 Dec;58(12):1137-44
references.pmid: 11735842
references.citation: Clin Psychol Rev. 2007 May;27(4):409-24
references.pmid: 17222489
references.citation: Schizophr Res. 2011 Nov;132(2-3):135-9
references.pmid: 21907546
references.citation: Br J Psychiatry. 2008 Mar;192(3):185-90
references.pmid: 18310577
references.citation: Schizophr Bull. 2013 Jul;39(4):884-95
references.pmid: 22258881
references.citation: Can J Psychiatry. 2010 Aug;55(8):486-97
references.pmid: 20723276
references.citation: Arch Gen Psychiatry. 1991 Aug;48(8):764-70
references.pmid: 1883262
references.citation: Schizophr Bull. 2014 Jan;40(1):169-80
references.pmid: 23236081
references.citation: Trends Neurosci. 2014 Feb;37(2):85-94
references.pmid: 24388426
references.citation: World Psychiatry. 2013 Oct;12(3):187-97
references.pmid: 24096775
references.citation: Am J Psychiatry. 2003 Jan;160(1):13-23
references.pmid: 12505794
references.citation: Psychol Med. 2006 Aug;36(8):1109-18
references.pmid: 16734944
references.citation: Schizophr Bull. 2014 Jan;40(1):120-31
references.pmid: 23180756
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2008 Sep;43(9):743-51
references.pmid: 18491023
references.citation: Schizophr Bull. 2011 Nov;37(6):1179-86
references.pmid: 20360211
references.citation: Schizophr Bull. 2015 Jan;41(1):115-22
references.pmid: 24894884
references.citation: Schizophr Bull. 2013 Nov;39(6):1328-36
references.pmid: 23236077
references.citation: Psychol Med. 2014 Jan;44(1):17-24
references.pmid: 23414600
references.citation: Psychol Med. 2012 May;42(5):1003-12
references.pmid: 22067414
references.citation: Cogn Neuropsychiatry. 2007 Nov;12(6):495-510
references.pmid: 17978936
references.citation: Br J Psychiatry. 2016 Aug;209(2):107-13
references.pmid: 26989099
references.citation: Schizophr Bull. 2011 Mar;37(2):244-7
references.pmid: 21224492
references.citation: Schizophr Bull. 2015 May;41(3):664-73
references.pmid: 25262443
references.citation: Arch Gen Psychiatry. 2009 Mar;66(3):236-47
references.pmid: 19255373
references.citation: JAMA Psychiatry. 2013 Jan;70(1):107-20
references.pmid: 23165428
references.citation: Acta Psychiatr Scand. 2011 Jan;123(1):12-20
references.pmid: 20712828
references.citation: Curr Pharm Des. 2012;18(4):351-7
references.pmid: 22239566
references.citation: Nature. 2011 Jun 22;474(7352):498-501
references.pmid: 21697947
references.citation: PLoS One. 2012;7(3):e31660
references.pmid: 22457710
references.citation: Schizophr Bull. 2014 Mar;40(2):248-51
references.pmid: 24442853
references.citation: Br J Psychiatry Suppl. 2007 Dec;51:s38-42
references.pmid: 18055936
references.citation: World Psychiatry. 2011 Oct;10(3):165-74
references.pmid: 21991266
references.citation: Acta Psychiatr Scand. 2009 Jan;119(1):45-53
references.pmid: 18822092
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2014 Apr;49(4):507-17
references.pmid: 24638893
references.citation: Lancet. 2014 May 10;383(9929):1677-1687
references.pmid: 24315522
references.citation: Aust N Z J Psychiatry. 2005 Nov-Dec;39(11-12):964-71
references.pmid: 16343296
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2002 Mar;37(3):97-104
references.pmid: 11990012
references.citation: J Nerv Ment Dis. 2008 May;196(5):375-83
references.pmid: 18477879
references.citation: Schizophr Bull. 2013 Nov;39(6):1281-7
references.pmid: 23223342
references.citation: JAMA Psychiatry. 2015 Jul;72(7):697-705
references.pmid: 26018466
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2014 Jul;49(7):1011-22
references.pmid: 24919446
references.citation: Psychol Med. 2008 Dec;38(12):1701-15
references.pmid: 19000327
references.citation: Br J Psychiatry. 2008 Jun;192(6):412-23
references.pmid: 18515890
references.citation: Br J Psychiatry. 2014;204:346-53
references.pmid: 24627297
references.citation: Psychol Med. 2011 Nov;41(11):2305-15
references.pmid: 21733219
references.citation: Schizophr Res. 1999 Aug 23;39(1):79-83
references.pmid: 10480670
references.citation: Schizophr Bull. 2009 May;35(3):549-62
references.pmid: 19325164
references.citation: Soc Psychiatry Psychiatr Epidemiol. 2014 Aug;49(8):1179-89
references.pmid: 25005465
references.citation: Psychol Med. 2007 Oct;37(10):1377-91
references.pmid: 17335638
references.citation: Psychol Med. 2009 Sep;39(9):1533-47
references.pmid: 19215626
references.citation: Psychol Med. 2015 Jun;45(8):1665-74
references.pmid: 25482840
references.citation: Psychiatry Res. 2013 Nov 30;210(1):82-8
references.pmid: 23849758
references.citation: Psychol Assess. 2009 Dec;21(4):498-505
references.pmid: 19947784
references.citation: Eur Psychiatry. 2013 Jun;28(5):315-26
references.pmid: 23137782
references.citation: Schizophr Bull. 2010 Jul;36(4):655-64
references.pmid: 20513653
references.citation: Schizophr Bull. 2010 Jan;36(1):151-6
references.pmid: 18562343
references.citation: Am J Psychiatry. 2011 Dec;168(12):1311-7
references.pmid: 21768612
references.citation: World Psychiatry. 2014 Jun;13(2):143-4
references.pmid: 24890061