Polygenic risk, familial liability and stress reactivity in psychosis: an experience sampling study

Background There is evidence for a polygenic contribution to psychosis. One targetable mechanism through which polygenic variation may impact on individuals and interact with the social environment is stress sensitization, characterized by elevated reactivity to minor stressors in daily life. The current study aimed to investigate whether stress reactivity is modified by polygenic risk score for schizophrenia (PRS) in cases with enduring non-affective psychotic disorder, first-degree relatives of cases, and controls. Methods We used the experience sampling method to assess minor stressors, negative affect, positive affect and psychotic experiences in 96 cases, 79 first-degree relatives, i.e. siblings, and 73 controls at wave 3 of the Dutch Genetic Risk and Outcome of Psychosis (GROUP) study. Genome-wide data were collected at baseline to calculate PRS. Results We found that associations of momentary stress with psychotic experiences, but not with negative and positive affect, were modified by PRS and group (all pFWE<0.001). In contrast to our hypotheses, siblings with high PRS reported less intense psychotic experiences in response to momentary stress compared to siblings with low PRS. No differences in magnitude of these associations were observed in cases with high v. low level of PRS. By contrast, controls with high PRS showed more intense psychotic experiences in response to stress compared to those with low PRS. Conclusions This tentatively suggests that polygenic risk may operate in different ways than previously assumed and amplify reactivity to stress in unaffected individuals but operate as a resilience factor in relatives by attenuating their stress reactivity.

Mindfulness-Based Interventions in Psychosis

Individuals suffering with psychotic disorders face lifelong emotional dysregulation and may have impairments in their thought processes and perceptual experiences despite the availability to pharmacological treatment and good compliance. They feel extreme distress with their psychotic experiences that may result in avoidance of these experiences which may further warrant for residual symptoms and frequent hospitalizations. For a few decades literature has focused on exploring the possibilities of acceptance-based interventions in psychosis. Mindfulness interventions employ the strategies of direct use of meditation practice or combined use of meditation with acceptance-based or compassion-based practices. This chapter tends to summarize the various mindfulness interventions used for psychosis and review their feasibility in terms of evidence base and therapeutic specificity. Furthermore, it recommends the guidelines for protocol to be used with psychotic individuals and advocates the need for more methodologically rigorous evidence.