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37. Impacts of positive and adverse life stress on psychotic symptoms: Evidence from multi-level modeling over the decade following first admission
Retrospective studies of first-episode and prodromal cohorts report increased life events (LEs) preceding first onset and relapse of psychosis. However, the impact of LEs on specific psychotic symptom progression over the full course of illness has not been characterized, or examined between and within individuals in one sample. Further, studies generally examine adverse LEs, with few addressing the effects of positive events. The present study utilizes a large cohort of individuals with schizophrenia-spectrum disorders, mood disorders with psychosis, and other psychotic disorders, over the decade following first psychiatric hospitalization. Multi-level models were employed to examine the impact of positive and adverse LEs both between and within subjects on symptoms of reality distortion, disorganization, inexpressivity, and avolition. Within-subjects, greater adverse LEs over the 6 months preceding each assessment were associated with increased reality distortion and disorganization at that timepoint; greater positive LEs were associated with reduced avolition. Between-subjects, individuals with more positive LEs had fewer symptoms on all dimensions, and individuals with greater adverse LEs had fewer inexpressivity symptoms. This study suggests positive and adverse LEs differentially predict psychotic symptoms across the course of illness. Results confirm the importance of examining these relationships within individuals over time in addition to cross-sectionally.