Conduct research to improve the quality of life of people with psychosis
Mental health research is a shared need between professionals, the people being treated and their families. Research is the key to advancing knowledge about different mental disorders and, in this way, being able to prevent their appearance and improve treatments and interventions, thus increasing people's quality of life.
Psychotic disorders affect 1.2% of the adult population and 0.8% of children. Early detection and treatment in the initial stages are essential to achieve a good recovery. Knowing more about psychosis helps us to prevent it, but also to improve the lives of people who have this mental health problem. But what is being researched about psychosis right now at Sant Joan de Déu and how can it impact people's well-being?
What is being researched about psychosis?
Psychosocial stressors: traumatic experiences in childhood
The presence of psychosocial stressors has important physiological and emotional consequences at any time during development, but it is in childhood and adolescence that their impact is most significant. One of the most prominent psychosocial stressors for the development of psychosis is traumatic experiences in childhood , especially sexual, physical or emotional abuse and physical and emotional neglect.
For example, children who have experienced childhood trauma are more likely to show delays in cognitive development, such as deficits in language development, low scores on intelligence tests, and lower school performance.
One of the most prominent psychosocial stress factors for the development of psychosis is traumatic experiences in childhood.
Between 17 and 25% of the general population has suffered some traumatic experience in childhood, and this percentage increases when we talk about people who have had a psychotic disorder, standing between 50 and 75%. In addition, having a traumatic experience in childhood is related to an increase in positive symptomatology , higher levels of anxiety and depression, higher risk of suicide , an earlier onset of psychotic disorder and lower cognitive functioning, among other aspects.
Seeing the relevance that these experiences have in the appearance and prognosis of these disorders, different types of studies are being carried out, focused mainly on these three lines:
- To understand the importance of these experiences in the emergence and evolution of psychotic disorders , with the aim of making recommendations for the creation of specific interventions focused on these experiences, which can help improve the course of the disorder and the well-being and quality of life of people who have it.
- To assess the effectiveness of specific interventions for people with a psychotic disorder who have had a traumatic experience in childhood . The ultimate goal is that they can be implemented in the mental health services of the territory.
- Create campaigns aimed at the general population, especially focused on children, teaching teams and healthcare teams. The aim is to help in the early detection of these experiences and create interventions when there has been a traumatic experience in childhood or adolescence, to reduce the likelihood of developing a mental disorder such as psychosis. Many of these interventions, in addition to focusing on the traumatic experience itself, also focus on providing skills to improve stress management, emotional regulation, coping strategies and problem solving.
Some examples of studies that are being carried out in this line are: Impact of traumatic experiences in childhood on cerebrocortical parameters and cognitive functioning in people with first-episode psychosis (FEP) ; History of stressful life events and psychopathology in young people serving time in an educational center and in mental health monitoring , and Impact of trauma (childhood, adulthood and institutional) on the mental health of women in prison .
Psychological interventions
Antipsychotics (pharmacological medication) are effective in improving symptoms and preventing relapses in psychosis, but they are associated with considerable side effects and, even so, in some cases they do not always eliminate symptoms and do not prevent relapses. In fact, 24% of people with psychosis relapse in the first year, despite following pharmacological treatment. For this reason, several psychosocial and psychological interventions have been developed that can play an important role in preventing relapses and in improving the emotional well-being and quality of life of the people treated.
It is important that the interventions carried out are effective and efficient. For this reason, part of the research in psychosis focuses on studying the role that different types of interventions play in the relevant variables of this disorder, in improving the well-being of the person and in improving their functionality and quality of life, among other aspects.
Some of the interventions in which this research is carried out are family interventions, family or person-centered psychoeducation, cognitive-behavioral therapy, third-generation therapies ( mindfulness and acceptance and commitment therapy, for example), integrated interventions and relapse prevention programs.
Several psychosocial and psychological interventions have been developed that can play an important role in preventing relapses and improving the emotional well-being of the people treated.
The Sant Joan de Déu Health Park, for example, has a line of research focused on psychological intervention in metacognitive training , which aims to make the person more aware of common cognitive errors and typical biases of the disorder , teach them to reflect on them critically and complement and change their current repertoire of problem solutions. With this intervention, in addition to improving certain symptoms and the functioning of these people, it is also intended to study which profiles can benefit most from it. In addition, during the COVID pandemic, this intervention was created and validated in digital format, and the material has been adapted for relatives of people who have a psychotic disorder, with the aim of studying its impact.
Other research projects are also being carried out on the impact of other interventions, such as the effectiveness of eye movement desensitization and reprocessing therapy, for people with psychosis who have experienced a traumatic situation.
Mutual support groups
New technologies
The use of new technologies, specifically mobile phones, computers and tablets, along with the increasing use of social networks by adolescents, has created new opportunities to promote mental health .
Psychosis usually appears between the ages of 15 and 29, and therefore young people who have recently been diagnosed with a psychotic disorder may be a favorable age group for adhering to e-health interventions.
This has led to an increase in the development, implementation and use of new technologies in healthcare over the last decade, due to the benefits they have shown to have in health management. Mobile devices are being used to achieve faster symptom detection, better adherence to treatment and more accurate monitoring of the condition of the person being treated, among other uses.
For this reason, some of the lines of research focus on the use of these technologies in people with mental health problems or within healthcare systems, and on the creation of applications to improve mental health and healthcare management.
Mobile devices are being used to achieve faster detection of symptoms, greater adherence to treatment and more accurate monitoring of the condition of the person being treated.
In this sense, the Research Unit of the Sant Joan de Déu Health Park is carrying out different projects related to technologies, with the aim of preventing the onset of psychosis, improving its course and improving the quality of life of people who have this disorder:
- Parental-Psych APP: a mobile application to detect cases of high risk of psychosis and provide parental guidelines for relationships with adolescent sons and daughters.
- ERAPERMED : a European project for the creation of a technological application to personalize psychological interventions in people with psychosis.
- App-Psychosis: the creation of an application aimed at people who have had a first psychotic episode within the Sant Joan de Déu Health Park, to offer them psychoeducation guidelines, information about psychosis, cognitive training and access to the center's clinical history, among other aspects. Its objective is to be able to detect relapses and improve the course and evolution of these people to simultaneously improve their well-being.
Biomarkers
Psychotic disorders are complex disorders in which multiple genetic and environmental factors interact to produce cumulative alterations during brain development. Neural circuits can be altered and affect the transmission of information and the interpretation of our environment and reality, and provide appropriate social behavioral and problem-solving responses. All of this is called cognitive functioning and gives rise to psychotic symptoms in people with schizophrenia. The cognitive part and non-psychotic symptoms are the most difficult to treat , and current drugs do not have a significant effect on them.
Therefore, it is necessary to study the biological basis of the disorder and explore possible molecular targets to better understand schizophrenia and develop treatments that can improve its symptoms. On the other hand, the identification of specific biomarkers could be an important step in early detection to establish therapies before symptoms become chronic. In addition, having biomarkers of treatment response will help to establish more personalized treatments for each person.
The Research Unit of the Sant Joan de Déu Health Park is carrying out several projects to identify alterations in possible molecular markers in the blood (biomarkers), both in people with recent-onset psychosis and in people with chronic schizophrenia, and their possible contribution to the symptoms present in the different stages of the disorder. The final objective is to be able to study and identify possible molecular targets involved in the development of the disorder and their association with the symptoms present during the evolution of schizophrenia, with a special interest in cognitive symptoms and other non-psychotic symptoms. The effect of COVID-19 on cognitive and neurological sequelae in people without a previous mental disorder and in people with a mental disorder prior to infection is also being investigated . The research focuses on finding out whether the cause of the sequelae could be alterations in inflammatory molecules that alter the barrier that protects our brain so that it functions correctly.
Stigma and psychosis
People with psychosis are one of the most stigmatized groups in society. The lack of awareness of these disorders and the treatment that has been given to them by the media and the audiovisual industry have created and perpetuated stereotypes and beliefs about psychosis that are far from reality . For this reason, there is a variety of research that focuses on finding the most effective way to reduce this stigma, especially among children and adolescents.
We highlight the awareness-raising program #EducaSJD , promoted by the Obra Social Sant Joan de Déu, which aims to increase young people's awareness of the most vulnerable groups. Through talks in schools, teaching materials, first-person testimonies and awareness-raising campaigns, with joint work with teams of professionals, this project aims to combat the stigma of people at risk of exclusion, including people with a mental health disorder.
Mental disorders in film and television
Risk factors for developing psychosis
Establishing the risk factors for the development of psychosis has great clinical relevance, mainly because it allows:
- Being able to predict when the disorder will develop in populations at high risk for psychosis.
- Create and implement interventions to prevent its occurrence or improve its course, as some of the factors are potentially modifiable.
- Informing the general population about the importance of these factors so that they become aware of them. This will help promote people's mental health and quality of life.
The factors most related to the risk of developing a psychotic disorder are:
- History of obstetric and perinatal complications.
- Having a first-degree relative with a psychotic disorder.
- Trauma and child abuse.
- The fact of living in a highly populated urban environment.
- Social adversity.
- The consumption of toxic substances, specifically cannabis.
In the case of this last factor, thanks to research focused on cannabis and psychosis , it has been shown that:
- Psychotic disorders occur more frequently in cannabis users than in non-users.
- Lifetime cannabis use is associated with a 1.4-fold increased risk of developing a psychotic disorder; and cannabis dependence, with a 3.4-fold increased risk
- Cannabis users have an earlier onset of psychosis than non-users.
In order to establish the risk factors for psychosis, research includes people who have just had a psychotic episode for the first time, and, through various questionnaires and tools, information related to variables and factors prior to this episode is collected. From this perspective, the Sant Joan de Déu Health Park is carrying out the PROFEP project , a longitudinal observational study that has this objective: to establish risk factors for the development of a first psychotic episode.
Factors that increase the risk of having a psychosis
Mental states at high risk for psychosis
The study of early stages and early detection are essential in mental health in order to prevent or delay the development of some disorders or, at least, to detect them and be able to establish a diagnosis and treatment as soon as possible. In this sense, in the field of psychotic disorders, what are called high-risk mental states for psychosis have been described, which identify a series of early symptoms that some people present before having a frank psychotic disorder. High-risk mental states are identified through a combination of clinical criteria (mainly the presence of mild or attenuated psychotic symptoms) and genetic vulnerability. Currently, it has been described that the psychosis risk criteria allow people at risk of having this disorder to be correctly identified, and that 22% of these people will end up having it. In other words, these criteria have been used to detect several people and treat them early. This fact is essential for the course of the disorder.
High-risk mental states for psychosis identify a series of early symptoms that some people present before they have a frank psychotic disorder.
The Hospital Sant Joan de Déu Barcelona has been running a research program for the detection of children and adolescents who present high-risk mental states for more than ten years, led by Dr. Montserrat Dolz . This project is being carried out in collaboration with the Hospital Clínic de Barcelona, and its main purpose is to define several biomarkers that may be involved in the development of psychosis. More specifically, the research is currently focused on the detection of possible markers of obstetric risk.
Why is it important to take gender into account in research?
The androcentric bias of our society, in which man is the universal reference and, therefore, women are rendered invisible, has also meant that health research has perverted the scientific vision and practices. medical interventions that affect women. Therefore, having a gender perspective means including women in the entire health research process . To do this, it is necessary to study sex differences (between women and men), include specific aspects of women's health and also always take into account the influence of gender.
Investigating and approaching health from a gender perspective implies recognizing the differences and similarities in the health status of women and men, starting from the basis that it is as wrong to seek equality in health where there are differences as to assume differences that do not exist. It is necessary to take into account biological factors, but also the inequalities in health that are socially and culturally constructed and that, therefore, are questionable and above all modifiable.
The necessary gender perspective on psychosis
