Stressful life events and first-episode psychosis
Nowadays, advances in affective and social neuroscience have shown how the exposure to environmental factors has an impact on the structure and functioning of the brain being thus, active agents in the formation of an individual’s level of vulnerability. There is an increasing interest in the influe...
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| Formato: | tesis doctoral |
| Estado: | Versión publicada |
| Fecha de publicación: | 2017 |
| País: | España |
| Recursos: | CBUC, CESCA |
| Repositorio: | TDR. Tesis Doctorales en Red |
| OAI Identifier: | oai:www.tdx.cat:10803/461706 |
| Acesso em linha: | http://hdl.handle.net/10803/461706 |
| Access Level: | acceso abierto |
| Palavra-chave: | Neurociències Neurociencias Neurosciences Estrès (Psicologia) Estrés (Psicología) Stress (Psychology) Psicosi Psicosis Psychoses Ciències de la Salut 159.9 |
| Resumo: | Nowadays, advances in affective and social neuroscience have shown how the exposure to environmental factors has an impact on the structure and functioning of the brain being thus, active agents in the formation of an individual’s level of vulnerability. There is an increasing interest in the influence of stress on many diseases including a first-episode psychosis (FEP). From the stress-vulnerability model (Zubin & Spring, 1977) to the current models of neural diathesis-stress (Pruessner et al., 2017), schizophrenia is conceptualised as an episodic disorder in which there is vulnerability and stress due to biological and/or environmental factors. This suggests that patients are likely predisposed to manifesting psychotic episodes induced by the impact of precipitating factors, such as stressful life events (SLEs). In FEP, the role of stressors, specifically SLEs, as predisposing factors or adjuvants to the onset of the disease is relevant. These events are circumstances that occur in the lives of people with an identifiable beginning and end which have the potential to alter their current mental or physical status. However, there are very few studies on SLEs in patients with schizophrenia - and even fewer in patients with FEP-, thereby emphasising the need for such studies. SLEs can be treated as prodromal events, which together with other events, contribute to the appearance of later psychotic symptomatology. Indeed, it is likely that the diversity of environmental factors associated with schizophrenia may be linked to an equal number of different underlying mechanisms. Several studies have evaluated the role of SLEs, but most of the studies include these events as trauma, what makes their research and evaluation more difficult and complicated. This thesis was aimed at achieving adequate and effective early intervention in psychotic disorders since: i) in general, few studies have specifically evaluated SLEs; ii) no studies have analysed the age of onset of FEP in relation to SLEs; iii) no studies have been found about gender differences, family history and psychotic symptomatology in relation to SLEs; and iv) no instruments are available to assess SLEs along the life cycle. The main objective of this thesis was to evaluate the relationship between SLEs and the development of FEP. This objective was developed under three specific objectives: 1) to systematically review the literature available on SLEs and FEP, 2) to evaluate the impact of SLEs and the influence of sociodemographic and clinical variables on the appearance of FEP, and 3) to validate an instrument to measure SLEs in FEP and in a healthy population. The data obtained in this thesis provide more in depth knowledge regarding SLEs and their evaluation and detection as well as the relationship of these events with clinical variables and symptoms in a sample of patients with FEP and healthy controls. The objective of identifying SLEs across the stress-vulnerability model psychosis phenotype continuum may provide insights into the aetiology of this disorder and may lead to the development of strategies for its prevention and treatment. We provide further corroboration that rather than being a correlate of frank psychosis, the variability of SLEs may play an important role in FEP populations and this is of great relevance to the practice of professionals dedicated to detecting, caring for, and treating people with this disease. The work presented in this thesis is framed within the stress-vulnerability model and the clinical staging model, which considers the phenotypic continuum reflecting a shared interactive set of diathesis, psychosocial and sociocultural factors. Currently, few studies have evaluated SLEs in these sample types and there is a need to obtain more in depth information on the influence of SLEs in these populations in which genetics and stress play a relevant role. |
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