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Evidence that the presence of psychosis in non-psychotic disorder is environment-dependent and mediated by severity of non-psychotic psychopathology

Published online by Cambridge University Press:  25 March 2015

S. Guloksuz ,
M. van Nierop ,
R. Lieb ,
R. van Winkel ,
H.-U. Wittchen  and
J. van Os
S. Guloksuz
Affiliation:
Department of Psychiatry and Psychology, Maastricht University Medical Centre, EURON, Maastricht, The Netherlands Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
M. van Nierop
Affiliation:
Department of Psychiatry and Psychology, Maastricht University Medical Centre, EURON, Maastricht, The Netherlands
R. Lieb
Affiliation:
Epidemiology and Health Psychology, Institute of Psychology, University of Basel, Basel, Switzerland
R. van Winkel
Affiliation:
Department of Psychiatry and Psychology, Maastricht University Medical Centre, EURON, Maastricht, The Netherlands Department of Psychiatry, University Psychiatric Center KU Leuven, KU Leuven, Belgium
H.-U. Wittchen
Affiliation:
Institute of Clinical Psychology and Psychotherapy, Technical University Dresden, Dresden, Germany Max Planck Institute of Psychiatry, Munich, Germany
J. van Os*
Affiliation:
Department of Psychiatry and Psychology, Maastricht University Medical Centre, EURON, Maastricht, The Netherlands Department of Psychosis Studies, King's College London, King's Health Partners, Institute of Psychiatry, London, UK
*
* Address for correspondence: J. van Os, Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre, EURON, PO Box 616, 6200 MD Maastricht, The Netherlands. (Email: vanosj@gmail.com)
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Abstract

Background

Evidence suggests that in affective, non-psychotic disorders: (i) environmental exposures increase risk of subthreshold psychotic experiences (PEs) and strengthen connectivity between domains of affective and subthreshold psychotic psychopathology; and (ii) PEs are a marker of illness severity.

Method

In 3021 adolescents from the Early Developmental Stages of Psychopathology cohort, we tested whether the association between PEs and presence of DSM-IV mood disorder (MD)/obsessive–compulsive disorder (OCD) would be moderated by risk factors for psychosis (cannabis use, childhood trauma and urbanicity), using the interaction contrast ratio (ICR) method. Furthermore, we analysed whether the interaction between environment and PEs was mediated by non-psychotic psychopathology.

Results

The association between PEs and MD/OCD was moderated by urbanicity (ICR = 2.46, p = 0.005), cannabis use (ICR = 3.76, p = 0.010) and, suggestively, trauma (ICR = 1.91, p = 0.063). Exposure to more than one environmental risk factor increased the likelihood of co-expression of PEs in a dose–response fashion. Moderating effects of environmental exposures were largely mediated by the severity of general non-psychotic psychopathology (percentage explained 56–68%, all p < 0.001). Within individuals with MD/OCD, the association between PEs and help-seeking behaviour, as an index of severity, was moderated by trauma (ICR = 1.87, p = 0.009) and urbanicity (ICR = 1.48, p = 0.005), but not by cannabis use.

Conclusions

In non-psychotic disorder, environmental factors increase the likelihood of psychosis admixture and help-seeking behaviour through an increase in general psychopathology. The findings are compatible with a relational model of psychopathology in which more severe clinical states are the result of environment-induced disturbances spreading through a psychopathology network.

Keywords

Affective disorderscannabischildhood traumapsychosisrisk factorsurbanicity
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 11 , August 2015 , pp. 2389 - 2401
Copyright
Copyright © Cambridge University Press 2015 

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