Life Events and High-Trait Reactivity Together Predict Psychotic Symptom Increases in Schizophrenia

Abstract

Psychotic symptoms are exacerbated by stressful life events in schizophrenia patients as a group. Some individuals appear to be more vulnerable than others in this regard. This study tested whether schizophrenia patients are highly emotionally reactive compared with controls and whether the level of trait emotional reactivity in patients influences the degree to which they respond to life stressors with exacerbations of psychosis. Schizophrenic outpatients and nonpsychiatric controls were assessed for levels of trait emotional reactivity, arousability, and trait anxiety. Severity of symptoms was also rated in the patients. Patients were then followed up 9 months later, assessed for independent stressful life events occurring during the month before the follow-up session, and reassessed for symptom levels. The patients scored higher than the control subjects on all 3 measures of reactivity at the initial assessment. At follow-up, the occurrence of potentially stressful life events predicted increases in psychotic symptoms in patients, and there was a significant interaction between level of initial trait reactivity and the occurrence of life events in the prediction of these increases. High-trait-reactive patients showed increases in psychotic symptoms in response to life stressors, whereas low-trait-reactive patients did not. These findings support the idea that patients as a group have higher than normal levels of trait reactivity and also that patients with very high levels of trait reactivity are at elevated risk of psychotic relapse under stress. Such patients might benefit particularly from interventions designed to assist them in coping with potentially stressful life events and circumstances.

Increased stress reactivity: a mechanism specifically associated with the positive symptoms of psychotic disorder

“…The finding that high levels of positive symptoms moderate the stress-NA association is in accordance with previous studies showing an association between trait arousability and positive symptom scores (Dinzeo et al 2004 ;Docherty et al 2009). It also extends the finding of a momentary stress-induced increase in the intensity of positive psychotic experiences to a global pattern of increased stress reactivity in participants showing higher levels of positive symptoms.…”

Impact of stress on paranoia: an experimental investigation of moderators and mediators

“…Furthermore, higher levels of affective reactivity in patients have been shown to be associated with the severity of positive and affective symptoms (Dinzeo et al 2004 ;Docherty et al 2008).…”

Interpersonal distances, coping strategies and psychopathology in patients with depression and schizophrenia

“…Conversely, Henry et al [24] found neither such differences nor an association between the use of suppression and reappraisal strategies and blunted affect ratings. There are also studies that show specific differences in stressreactivity among different psychopathologies, e.g., relative to normal controls, patients with schizophrenia show significantly more frequent and higher levels of trait emotional reactivity [25] , whereas depressive patients significantly more often report an impaired tolerance to certain stresses [26] .…”