Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA 19122, USA.
Clin Psychol Rev. 2011 Apr;31(3):383-98. doi: 10.1016/j.cpr.2011.01.004. Epub 2011 Jan 16.
Most life stress literature in bipolar disorder (BD) fails to account for the possibility of a changing relationship between psychosocial context and episode initiation across the course of the disorder. According to Post's (1992) influential kindling hypothesis, major life stress is required to trigger initial onsets and recurrences of affective episodes, but successive episodes become progressively less tied to stressors and may eventually occur autonomously. Subsequent research on kindling has largely focused on unipolar depression (UD), and the model has been tested in imprecise and inconsistent ways. The aim of the present paper is to evaluate evidence for the kindling model as it applies to BD. We first outline the origins of the hypothesis, the evidence for the model in UD, and the issues needing further clarification. Next, we review the extant literature on the changing relationship between life stress and bipolar illness over time, and find that evidence from the methodologically strongest studies is inconsistent with the kindling hypothesis. We then integrate this existing body of research with two emerging biopsychosocial models of BD: the Behavioral Approach System dysregulation model, and the circadian and social rhythm theory. Finally, we present therapeutic implications and suggestions for future research.
大多数双相情感障碍（BD）的生活压力文献都没有考虑到在疾病过程中，心理社会环境与发作起始之间的关系可能发生变化。根据 Post（1992）的有影响力的点燃假说，重大的生活压力是触发情感发作初始发作和复发的必要条件，但连续发作与应激源的联系越来越不紧密，最终可能会自主发生。随后对点燃的研究主要集中在单相抑郁（UD）上，并且该模型已经以不精确和不一致的方式进行了测试。本文的目的是评估点燃模型在 BD 中的应用证据。我们首先概述了该假说的起源、UD 中该模型的证据以及需要进一步澄清的问题。接下来，我们回顾了关于随着时间的推移生活压力与双相情感障碍之间关系变化的现有文献，发现来自方法学最强的研究的证据与点燃假说不一致。然后，我们将这一现有研究与双相情感障碍的两个新兴的生物心理社会模型整合在一起：行为趋近系统失调模型和昼夜节律和社会节奏理论。最后，我们提出了治疗意义和对未来研究的建议。
