Krabbendam Lydia, Myin-Germeys Inez, Hanssen Manon, de Graaf Ron, Vollebergh Wilma, Bak Maarten, van Os Jim
Department of Psychiatry and Neuropsychology, Maastricht University, The Netherlands.
Br J Clin Psychol. 2005 Mar;44(Pt 1):113-25. doi: 10.1348/014466504X19767.
Current psychological theories state that the clinical outcome of hallucinatory experiences is dependent on the degree of associated distress, anxiety, and depression. This study examined the hypothesis that the risk for onset of psychotic disorder in individuals with self-reported hallucinatory experiences would be higher in those who subsequently developed depressed mood than in those who did not.
A prospective cohort study of a general population sample.
A sample of 4,670 individuals with no lifetime evidence of any psychotic disorder were interviewed with the Composite International Diagnostic Interview Schedule (CIDI) at baseline and 1 and 3 years later. At Year 3, individuals with CIDI evidence of psychotic symptoms were interviewed by clinicians to identify potential onset of psychotic disorder. Psychotic disorder was specified at three levels; two involving severity of positive symptoms of psychosis, and one using additional clinical judgment of need for care.
Given the presence of hallucinatory experiences at baseline, the increase in risk of having the psychosis outcome at Year 3 was higher in the group with depressed mood at Year 1 than in the group without depressed mood at Year 1 (any level of psychotic symptoms: risk difference 17.0%, 95% CI - 1.7, 35.7; severe level of psychotic symptoms: risk difference 21.7%, 95% CI 3.2, 40.2; needs-based diagnosis of psychotic disorder: risk difference 16.8%, 95% CI 0.4, 33.3).
The results are in line with current psychological models of psychosis that emphasize the role of secondary appraisals of psychotic experiences in the onset of clinical disorder.
当前心理学理论表明，幻觉体验的临床结果取决于相关痛苦、焦虑和抑郁的程度。本研究检验了这样一个假设：自我报告有幻觉体验的个体中，随后出现抑郁情绪的人患精神障碍的风险要高于未出现抑郁情绪的人。
对一般人群样本进行的前瞻性队列研究。
选取4670名无任何精神障碍终生证据的个体作为样本，在基线时、1年后和3年后用复合国际诊断访谈表（CIDI）进行访谈。在第3年，对有CIDI证据显示存在精神症状的个体，由临床医生进行访谈以确定精神障碍的潜在发病情况。精神障碍分为三个级别；两个级别涉及精神病阳性症状的严重程度，另一个级别使用对护理需求的额外临床判断。
鉴于在基线时存在幻觉体验，第1年有抑郁情绪的组在第3年出现精神病结果的风险增加幅度高于第1年无抑郁情绪的组（任何级别的精神症状：风险差异17.0%，95%可信区间 - 1.7, 35.7；严重级别的精神症状：风险差异21.7%，95%可信区间3.2, 40.2；基于需求的精神障碍诊断：风险差异16.8%，95%可信区间0.4, 33.3）。
研究结果与当前强调对精神病体验的二次评估在临床疾病发病中作用的精神病心理学模型一致。
