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Since the seminal work of Brown and Birley, the potential link between life events and psychosis has been the focus of research and speculation. However, to date, there have been few studies of life events prior to the onset of psychosis; making it impossible to disentangle whether a higher prevalence is a cause or consequence of the disorder. Furthermore, studies have neglected important characteristics, such as severity and type, and rarely considered potential psychological mechanisms. The primary aims of this study were to extend the current literature by investigating the impact of life events and difficulties on the onset of psychosis, and investigate potential synergistic effects and mediating factors. Data on 253 first-presentation cases and 301 population-based controls were drawn from the Childhood Adversity and Psychosis study. Life events and difficulties experienced one year prior to onset (cases) or interview (controls) were assessed with the Life Events and Difficulties Schedule. Potential causal partners included negative schematic beliefs (assessed using the Brief Core Schema Scales) and potential mediators included symptoms of anxiety and depression (assessed using the Hamilton Anxiety and Depression Questionnaires). There was strong evidence that severe and intrusive experiences were particularly associated with psychosis, showing a three- to twelve-fold increase in odds. The impact of severe experiences was found to be cumulative. There was also tentative evidence that low social class and negative self-schemas combined synergistically with these experiences to increase the odds of psychosis. However, there was no evidence of mediation via affective symptoms. The one year period before the initial onset of psychosis is likely to be a time of serious psychosocial stress, potentially characterised by threatening and intrusive experiences. Research must continue to examine potentially modifiable mechanisms that may link such stressors and psychosis in order to improve our understanding and treatment of these disorders.

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Made available in DSpace on 2018-08-01T22:57:56Z (GMT). No. of bitstreams: 1 tese_6914_Laisa Barroso Ribeiro PPGBF Dissertacao de mestrado 21 08 2015 Orientadora Profa Dra Ana Paula Bittencourt.pdf: 1615838 bytes, checksum: 4ec46cda64c8ecf496eb91b48761a25c (MD5) Previous issue date: 2015-08-21 / A relação maternal perinatal tem fundamental importância no desenvolvimento de circuitos neurais saudáveis que permanecerão como herança mental ao longo da vida. Logo, eventos adversos nesse período tem potencial para desencadear psicopatologias na idade adulta, aumentando a vulnerabilidade a transtornos psiquiátricos e abuso de substâncias. Neste trabalho foi realizada a Separação Maternal (SM) em ratos Wistar machos, no intuito de mimetizar um evento estressor sustentado na infância de humanos. Em seguida, os animais foram submetidos ao protocolo de Enriquecimento Ambiental, uma estratégia não farmacológica empregada num período de plasticidade cerebral, como estratégia potencial para reverter os efeitos prejudiciais da SM. Na idade adulta, procederam-se os testes comportamentais, para aferição de depressão, ansiedade e abuso de álcool, e bioquímicos, como a dosagem de corticosterona plasmática, indicativo da reatividade do eixo hipotálamo-hipófise-adrenal (HHA) ao estresse agudo, e dosagem de dopamina e seus metabólitos em estruturas envolvidas em processo de gratificação cerebral via mesocorticolímbica (núcleo accumbens e córtex pré-frontal). A análise estatística foi realizada por meio do teste t de Student, análise de variância de uma via, duas vias, três vias ou medidas repetidas. Observamos que um protocolo de SM mais extenso tem maior impacto no desenvolvimento de comportamento depressivo na idade adulta. Não observamos hiperresponsividade do eixo HHA em animais separados em resposta a estresse agudo. O EA aumentou a preferência pelo consumo de sacarose e SM e EA concomitantemente aumentaram os comportamentos ativos no Teste do Nado Forçado, sugerindo potencial antidepressivo do EA. O EA parece ter potencial ansiolítico, ao reduzir a ansiedade aprendida aversiva no Teste de Odor de Predador, sem efeito significativo da SM nesses comportamentos. A SM aumenta a preferência pelo consumo de etanol e o EA foi capaz de prevenir esse efeito. No córtex pré-frontal a SM aumentou a quantidade de dopamina e o EA aumentou o turnover dopaminérgico, sugerindo recuperação até certo ponto da atividade dopaminérgica cortical. No núcleo accumbens, SM e EA concomitantemente reduziram os níveis de DOPAC, sem alteração no turnover dopaminérgico. SM e EA parecem não interferir nas memórias de curta e longa duração. Dessa forma, observamos por meio de alterações comportamentais e bioquímicas que eventos adversos perinatais aumentam a vulnerabilidade ao desenvolvimento de abuso de álcool e outros transtornos psiquiátricos na idade adulta; e o EA, empregado na fase de plasticidade neural, tem potencial para exercer efeito compensatório sobre os déficits gerados.

Class of 2017 Abstract / Objectives: (1) To assess the access to and quality of primary care for patients living with a psychiatric condition(s). (2) To identify demographic factors that may influence the access and quality of primary care services. Methods: Subjects were recruited at HOPE Inc., a behavioral health resource center, in Tucson, Arizona, during pharmacy student-run health fairs. Participants were surveyed using the Primary Care Assessment Tool (PCAT) a questionnaire developed by Johns Hopkins, which assess four domains of primary care. Participants were also surveyed about demographics, mental health diagnosis and their SMI designation. For objective (1): Descriptive statistics for each domain of the PCAT were performed to assess the level of access and quality of care, including comparison to a hypothesized score. For objective (2): Due to the small sample size only descriptive analysis of the demographic data was performed. Results: A total of 11 subjects were surveyed using the PCAT with an average score of 67.64±12.18. This was higher than the hypothesized score of 46. On average, in all four PCAT domains participants scored higher than the hypothesized, value. The lowest scoring domains were, “Care at first contact - Access” and “Coordination of care” (10.45±3.62, Hypothesized score: 8) and (12.36±5.82, Hypothesized score: 10) respectively. The highest scoring domain was “Care at first contact - utilization” (11.09±1.92, Hypothesized score: 12). Conclusions: This study helped to provide a framework for future studies of primary care services using the PCAT survey.