Dynamic interplay between life events and course of psychotic disorders: 10-year longitudinal study following first admission

Background Life events (LEs) are a risk factor for first onset and relapse of psychotic disorders. However, the impact of LEs on specific symptoms - namely reality distortion, disorganization, negative symptoms, depression, and mania - remains unclear. Moreover, the differential effects of negative v. positive LEs are poorly understood. Methods The present study utilizes an epidemiologic cohort of patients (N = 428) ascertained at first-admission for psychosis and followed for a decade thereafter. Symptoms were assessed at 6-, 24-, 48-, and 120-month follow-ups. Results We examined symptom change within-person and found that negative events in the previous 6 months predicted an increase in reality distortion (beta = 0.07), disorganized (beta = 0.07), manic (beta = 0.08), and depressive symptoms (beta = 0.06), and a decrease in negative symptoms (beta = -0.08). Conversely, positive LEs predicted fewer reality distortion (beta = -0.04), disorganized (beta = -0.04), and negative (beta = -0.13) symptoms, and were unrelated to mood symptoms. A between-person approach to the same hypotheses confirmed that negative LEs predicted change in all symptoms, while positive LEs predicted change only in negative symptoms. In contrast, symptoms rarely predicted future LEs. Conclusions These findings confirm that LEs have an effect on symptoms, and thus contribute to the burden of psychotic disorders. That LEs increase positive symptoms and decrease negative symptoms suggest at least two different mechanisms underlying the relationship between LEs and symptoms. Our findings underscore the need for increased symptom monitoring following negative LEs, as symptoms may worsen during that time.