Department of Psychology, Institute of Psychiatry, King's College London.
Department of Psychiatry, University of Oxford.
J Abnorm Psychol. 2013 Nov;122(4):1121-31. doi: 10.1037/a0034952.
Depression is common in people with schizophrenia, but how it might directly contribute to the persistence of psychotic symptoms has rarely been tested. The key aim of the present study was to test whether depression and associated cognitive processes predict the maintenance of persecutory delusions. Three groups of participants were tested at baseline: 60 patients with persecutory delusions in the context of a schizophrenia spectrum diagnosis, 30 patients with depression, and 30 nonclinical controls. They completed interviewer and self-report assessments of depression and paranoia, and measures of six cognitive factors (schematic beliefs, experiential avoidance, autobiographical memory, problem solving, rumination, worry style). The patients with persecutory delusions were then assessed again, six months later. It was found that 50% of the patients with persecutory delusions met diagnostic criteria for major depression. Cognitive processes found to be associated with depression across the groups were negative schematic beliefs about the self, experiential avoidance and rumination, but not autobiographical memory or problem solving. The severity of initial depression in patients with persecutory delusions predicted the persistence of paranoia over six months. A number of cognitive factors also predicted the persistence of persecutory delusions, including negative schematic beliefs about the self, worry, and problem-solving difficulties. In conclusion, depression is common in patients with current persecutory delusions, and it shows similar cognitive features to major depressive disorder. The results of this study indicate that depression and related processes may contribute to the maintenance of paranoia. Trials are warranted of depression-related therapeutic techniques for people with persecutory delusions.
抑郁症在精神分裂症患者中很常见，但它如何直接导致精神病症状持续存在，这一点很少被检验。本研究的主要目的是检验抑郁和相关认知过程是否能预测持续性妄想。在基线时，三组参与者接受了测试：60 名有被害妄想的精神分裂症谱系患者，30 名抑郁症患者和 30 名非临床对照者。他们完成了访谈者和自我报告的抑郁和妄想评估，以及六项认知因素（图式信念、体验回避、自传体记忆、问题解决、反刍、担忧风格）的测量。然后，有被害妄想的患者在六个月后再次接受评估。结果发现，有 50%的有被害妄想的患者符合重度抑郁症的诊断标准。在所有组中与抑郁相关的认知过程是对自己的消极图式信念、体验回避和反刍，但不是自传体记忆或问题解决。有被害妄想的患者最初抑郁的严重程度预测了六个月后妄想的持续存在。一些认知因素也预测了被害妄想的持续存在，包括对自己的消极图式信念、担忧和解决问题的困难。总之，目前有被害妄想的患者中抑郁症很常见，且其表现出与重度抑郁症相似的认知特征。这项研究的结果表明，抑郁和相关过程可能导致妄想的持续存在。有必要对有被害妄想的人进行与抑郁相关的治疗技术的试验。
