Marten W. deVries

Emotional reactivity to daily life stress in psychosis and affective disorder: an experience sampling study.

Objective:  To investigate the emotional reactivity to small disturbances in daily life in patients with non‐affective psychosis (NAP), bipolar disorder (BD) and major depression [major depressive disorder (MDD)].

Auditory hallucinations : A comparison between patients and nonpatients

The form and the content of chronic auditory hallucinations were compared in three cohorts, namely patients with schizophrenia, patients with a dissociative disorder, and nonpatient voice-hearers. The form of the hallucinatory experiences was not significantly different between the three groups. The subjects in the nonpatient group, unlike those in the patient groups, perceived their voices as predominantly positive: they were not alarmed or upset by their voices and felt in control of the experience. In most patients, the onset of auditory hallucinations was preceded by either a traumatic event or an event that activated the memory of earlier trauma. The significance of this study is that it presents evidence that the form of the hallucinations experienced by both patient and nonpatient groups is similar, irrespective of diagnosis. Differences between groups were predominantly related to the content, emotional quality, and locus of control of the voices. In this study the disability incurred by hearing voices is associated with (the reactivation of) previous trauma and abuse.

Determinants of occurrence and recovery from hallucinations in daily life

Background Data related to the dynamics of hallucinatory experiences of patients suffering from schizophrenia are scarce. Detecting antecedent conditions and coping strategies may aid development of targeted psychological interventions. Method We studied hallucinating and non-hallucinating patients suffering from schizophrenia spectrum disorder (n = 57), and non-schizophrenic severe mentally ill patients with depression (n = 37). Data were collected using the Experience Sampling Method (ESM) over a period of 1 week. Contingent on a randomly signalling beep, subjects filled in reports of ongoing hallucinations as well as thought, mood, current activity, social circumstances and places frequented. Results More subjects suffering from schizophrenia reported hallucinations, but for all hallucinating subjects the qualities of hallucination episodes were quite similar. More subjects reported visual hallucinations at least once. In contrast, the intensity of auditory hallucinations was higher. Anxiety was the most prominent emotion during hallucinations and reports of anxiety intensity exceeded baseline levels before the first report of auditory hallucinations. Context modified hallucination intensity over the course of an episode. Social withdrawal resulted in a decrease of hallucinatory intensity (AH > VH), while social engagement slightly raised intensity levels (VH > AH). Doing nothing (VH > AH) and work activities (AH > VH) led to decreases in intensity levels over time, while passive leisure activities (watching TV) resulted in increases in intensity levels of hallucinations (AH > VH). Conclusion The results suggest that hallucinating experiences are subject to a host of contextual influences. Understanding variation offers useful insights for therapy.

The daily life of ambulatory chronic mental patients.

The purpose of this research is to describe in greater detail than is typically done the daily life experienes of 11 ambulatory chronic mental patients and 11 nonpsychiatric controls. The subjects, although diagnostically heterogeneous, were representative of Dutch chronic mental patients. The Experience-Sampling Method was used to signal subjects randomly 10 times a day for 6 consecutive days to fill out self-rating forms assessing mental state and contextual information at the moment of the signal. Compliance was good. In time-allocation comparisons with nonpsychiatric subjects the patients were found to live relatively “normal” lives. As expected, their psychopathology was influenced by social environments such as being alone, at home, or in soclety at large. Contrary to other studies that stress the social isolation of such individuals, the chronic subjects reported feeling better away from home and among people than normal subjects. When alone, chronic patients reported daydreaming more and noted a fendency to drift away from thouhts about current activities. Mental state fluctuations and daily interactions, characteristic of this group, are examined in relation to theories of vulnerability and coping style of chronic mental patients, with an eye to individualized treatment applications.

Mood Reactivity to Daily Negative Events in Early Adolescence: Relationship to Risk for Psychopathology

Emotional responses to negative daily experiences in young adolescents may provide important clues to the development of psychopathology, but research is lacking. This study assessed momentary mood reactivity to daily events as a function of risk profile in a school sample, ages 11-14. High-risk (HR, n=25) and low-risk (LR, n=106) subgroups completed frequent self-reports of mood and events for 5 days. HR adolescents reported more negative events involving family and peers. Multilevel modeling results showed that negative events, especially if stressful, were associated with increased negative and decreased positive affects, with heightened responses in HR adolescents. HR adolescents with greater stress over the last 3 months showed additional increases in depressed mood following negative events. Altered reactivity to and dysfunctional appraisals of daily events may link adolescent risk profiles to later mental health problems.

Stress, work and mental health: a global perspective.

Background: The United Nations, WHO and the World Bank have called the current prevalence rate of neuro-psychiatric disorder approaches of 1 in 4 individuals worldwide and ‘unheralded public health crisis’. Rates are driven by an early onset, high impairment and high chronicity of these disorders. Most importantly, detection and treatment rates are low, estimated at les than 10% worldwide resulting in 500 million people underserved. The related economic costs soared in 1999 to 120 billion dollars in Europe and North America, with over 60 billion dollars assigned to stress related disorders. Contributing factors are bio-psycho-social and include rapid social change as well as the time compression of modern life resulting in the experience of increased work-life stress that parallels a decade long intensification of activities in the workplace. Coping with the requirements of the new economy of mental performance has lagged behind at many individual and social levels as we cling to adjustments made during the industrial economy of the last century. A climate of transition, and more recently, terror and fear have stressed the landscape of mental health and work already ravaged by the destructive forces of stigma. Aim: This presentation will examine the other side of prosperity from the point of view of stress in the workplace as two global problems converge at this time in history, the escalation of neuro-psychiatric disorders and the increasing dependence on the mental faculties of the worlds citizens. In this paper we also discuss how the international community can work together to help reduce the burden of mental disorders worldwide and sketch the implications for research and policy. Conclusions: Ultimately the media will need to be enlisted to educate the public on the value of investments in mental health.

Patterns of salivary cortisol secretion and responses to daily events in patients with remitted bipolar disorder

Previous studies on bipolar disorder revealed abnormalities in the function of the HPA axis, including disturbed patterns of cortisol secretion, during depressive and manic episodes. It is less clear whether these abnormalities persist after symptomatic recovery. In the present study we used the experience sampling method with intensive salivary cortisol sampling to study patterns of cortisol secretion in relation to negative and positive daily events during the normal daily life of a group of 36 patients with remitted bipolar disorder and 38 healthy controls. Results of multilevel regression analysis indicated that daytime cortisol levels and reactivity to daily events were similar in remitted bipolar patients and healthy controls, but bipolar patients showed flatter diurnal slopes and larger cortisol fluctuations over successive measures. Patients with many previous episodes had higher overall cortisol levels, reduced cortisol reactivity to negative daily events, and flatter diurnal slopes than patients with fewer episodes. These results provide additional evidence of subtle HPA axis dysregulation in remitted bipolar patients, especially in those with many recurrent episodes.

Investigating mental disorders in their natural settings.

This issue of The Journal of Nervous and Mental Disease reports fundamental research into the nature of mental disorders, using both new and traditional time-sampling approaches. The studies present convincing findings gathered in a variety of patient popula tions and demonstrate the utility of using quantitative and replicable methods in psychiatric research and clinical care. Research that adequately describes the person in context as well as the influence of situations on mental state has proved difficult. Methods such as the diary and Experience-Sampling Method that explore experiences in daily life overcome some of the shortcomings of previous psychiatric research strategies, such as reliance on retrospective recall and the failure to take the variability of mental state more fully into account. The studies in this issue introduce techniques for creating a data base for psychiatric research and clinical practice that is anchored in patient experience and behavior.

Daily hassles, uplifts, and time use in individuals with bipolar disorder in remission.

Although life stress has been shown to trigger relapse in bipolar disorder, little is known about how bipolar patients perceive daily hassles or their positive counterparts, uplifts. We used the experience sampling method to investigate the daily experience of hassles and uplifts in 38 patients with remitted bipolar disorder and 38 healthy controls. Largely because of current unemployment, patients were more often alone and at home and spent less time working and more time in passive leisure activities. Contrary to expectations, the groups did not differ in total frequencies or appraisals of events. Within the patient group, however, those patients with current depressive symptoms and more previous depressive episodes experienced negative events as more stressful. These findings are consistent with hypothesized processes linking depressive symptoms to the generation of stressful conditions or to the reactivation of negative cognitive schemas.

Mood reactivity to daily events in patients with remitted bipolar disorder

Information about mood reactions to naturally occurring stress in remitted bipolar patients may help elucidate the mechanism by which stressors influence the propensity to manic or depressive relapse in these patients. Using the experience sampling method (ESM), we therefore investigated negative and positive mood states and their reactivity to daily hassles and uplifts in 38 outpatients with remitted bipolar disorder and 38 healthy volunteers. Multilevel regression analyses confirmed that mean levels of negative affect (NA) were higher and positive affect (PA) lower in bipolar patients. Reactivity of NA and PA to hassles and uplifts in bipolar patients was similar to controls and was unrelated to the number of previous episodes. Bipolar patients with subsyndromal depressive symptoms, however, showed particularly large NA responses to daily hassles, which they also rated as more stressful. Subsyndromal depressive symptoms in patients with remitted bipolar disorder thus appear to increase sensitivity to everyday stressors.