Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-22T14:32:28.842Z Has data issue: false hasContentIssue false
  • English
  • Français

Steinberg and Durell (1968) revisited: increased rates of First Episode Psychosis following military induction in Greek Army Recruits

Published online by Cambridge University Press:  22 August 2017

S. Dimitrakopoulos ,
S. Vitoratou ,
T. Mougiakos ,
N. Bogeas ,
O. Giotakos ,
J. van Os  and
N. C. Stefanis
S. Dimitrakopoulos*
Affiliation:
Psychiatric Clinic, 414 Military Hospital of Athens, P. Penteli, Greece 1st Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
S. Vitoratou
Affiliation:
Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
T. Mougiakos
Affiliation:
Psychiatric Clinic, 414 Military Hospital of Athens, P. Penteli, Greece
N. Bogeas
Affiliation:
Psychiatric Clinic, 414 Military Hospital of Athens, P. Penteli, Greece
O. Giotakos
Affiliation:
Psychiatric Clinic, 414 Military Hospital of Athens, P. Penteli, Greece
J. van Os
Affiliation:
Department Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands Department of Psychosis Studies, King's College London, King's Health Partners, Institute of Psychiatry, London, UK
N. C. Stefanis
Affiliation:
1st Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, Athens, Greece
*
*Address for correspondence: S. Dimitrakopoulos, M.D., 414 Military Hospital of Athens, Tax. Velliou 6, P. Penteli, 15236, Attiki, Greece. (Email: stefandimi13@gmail.com)
Get access Rights & Permissions [Opens in a new window]

Abstract

Since the seminal study of Steinbeck and Durell (1968), few epidemiological studies have attempted to replicate whether psychosocial stress precipitates the onset of a first psychotic episode. Our aim was to support or refute the finding of elevated psychosis incidence in the first month of army induction and to examine factors impacting the timing of onset. Data were collected from medical files of 186 army conscripts, hospitalized with a diagnosis of First Episode Psychosis (FEP) between 2005 and 2014 in the Psychiatric Military Hospital in Athens, Greece. FEP rates were at least 4.5 times higher in the first month of military service, compared with any other month. Earlier FEP onset was associated with rural environment at the time of birth, multiple drug use and service away from home. Psychosocial stress precipitates FEP, particularly in those exposed to other risk factors.

Keywords

PsychosisFirst episode psychosispsychosocial stressduration of untreated psychosis
Type
Review Article
Information
Psychological Medicine , Volume 48 , Issue 5 , April 2018 , pp. 728 - 736
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Agerbo, E, Sullivan, PF, Vilhjalmsson, BJ, Pedersen, CB, Mors, O, Borglum, AD, Hougaard, DM, Hollegaard, MV, Meier, S, Mattheisen, M, Ripke, S, Wray, NR, Mortensen, PB (2015). Polygenic risk score, parental socioeconomic status, family history of psychiatric disorders, and the risk for schizophrenia: a Danish population-based study and meta-analysis. JAMA Psychiatry 72, 635–641.CrossRefGoogle ScholarPubMed
Compton, MT, Carter, T, Bergner, E, Franz, L, Stewart, T, Trotman, H, McGlashan, TH, McGorry, PD (2007). Defining, operationalizing and measuring the duration of untreated psychosis: advances, limitations and future directions. Early Intervention in Psychiatry 1, 236–250.Google Scholar
DeVylder, JE, Ben-David, S, Schobel, SA, Kimhy, D, Malaspina, D, Corcoran, CM (2013). Temporal association of stress sensitivity and symptoms in individuals at clinical high risk for psychosis. Psychological Medicine 43, 259–268.Google Scholar
Hageman, I, Pinborg, A, Andersen, HS (2008). Complaints of stress in young soldiers strongly predispose to psychiatric morbidity and mortality: Danish national cohort study with 10-year follow-up. Acta Psychiatrica Scandinavica 117, 148–155.Google Scholar
Hatzitaskos, P, Soldatos, C, Giouzelis, G, Karvelis, D, Spilioti, M (1997). Psychotic symptomatology first appeared in the military environment. Psychiatriki 8, 41–48.Google Scholar
Herrell, R, Henter, ID, Mojtabai, R, Bartko, JJ, Venable, D, Susser, E, Merikangas, KR, Wyatt, RJ (2006). First psychiatric hospitalizations in the US military: the national collaborative study of early psychosis and suicide (NCSEPS). Psychological Medicine 36, 1405–1415.CrossRefGoogle ScholarPubMed
Jones, SR, Fernyhough, C (2007). A new look at the neural diathesis–stress model of schizophrenia: the primacy of social-evaluative and uncontrollable situations. Schizophrenia Bulletin 33, 1171–1177.Google Scholar
Large, M, Sharma, S, Compton, MT, Slade, T, Nielssen, O (2011). Cannabis use and earlier onset of psychosis: a systematic meta-analysis. Archives of General Psychiatry 68, 555–561.CrossRefGoogle ScholarPubMed
Lewis, G, David, AS, Malmberg, A, Allebeck, P (2000). Non-psychotic psychiatric disorder and subsequent risk of schizophrenia. Cohort study. British Journal of Psychiatry 177, 416–420.Google Scholar
Martin, PD, Williamson, DA, Alfonso, AJ, Ryan, DH (2006). Psychological adjustment during Army basic training. Military Medicine 171, 157–160.Google Scholar
McGorry, PD, Nelson, B, Goldstone, S, Yung, AR (2010). Clinical staging: a heuristic and practical strategy for new research and better health and social outcomes for psychotic and related mood disorders. Canadian Journal of Psychiatry 55, 486–497.Google Scholar
Myin-Germeys, I, Krabbendam, L, Delespaul, PA, Van Os, J (2003). Do life events have their effect on psychosis by influencing the emotional reactivity to daily life stress? Psychological Medicine 33, 327–333.Google Scholar
Myin-Germeys, I, van Os, J, Schwartz, JE, Stone, AA, Delespaul, PA (2001). Emotional reactivity to daily life stress in psychosis. Archives of General Psychiatry 58, 1137–1144.Google Scholar
Reijnen, A, Rademaker, AR, Vermetten, E, Geuze, E (2015). Prevalence of mental health symptoms in Dutch military personnel returning from deployment to Afghanistan: a 2-year longitudinal analysis. European Psychiatry 30, 341–346.CrossRefGoogle ScholarPubMed
Reininghaus, U, Kempton, MJ, Valmaggia, L, Craig, TKJ, Garety, P, Onyejiaka, A, Gayer-Anderson, C, So, SH, Hubbard, K, Beards, S, Dazzan, P, Pariante, C, Mondelli, V, Fisher, HL, Mills, JG, Viechtbauer, W, McGuire, P, van Os, J, Murray, RM, Wykes, T, Myin-Germeys, I, Morgan, C (2016). Stress sensitivity, aberrant salience, and threat anticipation in early psychosis: an experience sampling study. Schizophrenia Bulletin 42, 712–722.Google Scholar
Schultze-Lutter, F, Michel, C, Schmidt, SJ, Schimmelmann, BG, Maric, NP, Salokangas, RK, Riecher-Rossler, A, van der Gaag, M, Nordentoft, M, Raballo, A, Meneghelli, A, Marshall, M, Morrison, A, Ruhrmann, S, Klosterkotter, J (2015). EPA guidance on the early detection of clinical high risk states of psychoses. European Psychiatry 30, 405–416.CrossRefGoogle ScholarPubMed
Selten, JP, van der Ven, E, Rutten, BPF, Cantor-Graae, E (2013). The social defeat hypothesis of schizophrenia: an update. Schizophrenia Bulletin 39, 1180–1186.Google Scholar
Shakoor, S, Zavos, HMS, Haworth, CMA, McGuire, P, Cardno, AG, Freeman, D, Ronald, A (2016). Association between stressful life events and psychotic experiences in adolescence: evidence for gene–environment correlations. British Journal of Psychiatry 208, 532–538.CrossRefGoogle ScholarPubMed
Stefanis, NC, Henquet, C, Avramopoulos, D, Smyrnis, N, Evdokimidis, I, Myin-Germeys, I, Stefanis, CN, Van Os, J (2007). COMT val158met moderation of stress-induced psychosis. Psychological Medicine 37, 1651–1656.Google Scholar
Steinberg, HR, Durell, J (1968). A stressful social situation as a precipitant of schizophrenic symptoms: an epidemiological study. British Journal of Psychiatry 114, 1097–1105.CrossRefGoogle ScholarPubMed
Tessner, KD, Mittal, V, Walker, EF (2011). Longitudinal study of stressful life events and daily stressors among adolescents at high risk for psychotic disorders. Schizophrenia Bulletin 37, 432–441.Google Scholar
van Os, J, Kenis, G, Rutten, BPF (2010). The environment and schizophrenia. Nature 468, 203–212.Google Scholar
van Os, J, Rutten, BPF, Poulton, R (2008). Gene–Environment interactions in schizophrenia: review of epidemiological findings and future directions. Schizophrenia Bulletin 34, 1066–1082.Google Scholar
van Winkel, R, Stefanis, NC, Myin-Germeys, I (2008). Psychosocial stress and psychosis. A review of the neurobiological mechanisms and the evidence for gene-stress interaction. Schizophrenia Bulletin 34, 1095–1105.CrossRefGoogle ScholarPubMed
Vassos, E, Pedersen, CB, Murray, R, Collier, D, Lewis, C (2012). A meta-analysis of the association of urbanicity with schizophrenia. Schizophrenia Bulletin 38, 1118–1123.Google Scholar
Walker, EF, Diforio, D (1997). Schizophrenia: a neural diathesis-stress model. Psychological Review 104, 667–685.Google Scholar
Wiles, NJ, Zammit, S, Bebbington, P, Singleton, N, Meltzer, H, Lewis, G (2006). Self-reported psychotic symptoms in the general population: results from the longitudinal study of the British National Psychiatric Morbidity Survey. British Journal of Psychiatry 188, 519–526.Google Scholar