University of Birmingham, School of Clinical and Experimental Medicine, Birmingham, UK; Birmingham and Solihull Mental Health Foundation Trust, Early Intervention Service, Birmingham, UK.
Wolverhampton Early Intervention Service, Wolverhampton, UK.
Psychiatry Res. 2014 Jul 30;217(3):177-84. doi: 10.1016/j.psychres.2014.03.023. Epub 2014 Mar 29.
Depression in early psychosis is linked to poor outcome, relapse and risk of suicide, yet remains poorly understood. This article aims to examine the development of depression in acute and post psychotic phases of first episode psychosis (FEP), and its relationship to persecutors, voices, insight, and recovery. Data were gathered on 92 patients with acute FEP on depression course, severity and experience of positive symptoms, insight and appraisals of illness using validated semi-structured interviews and questionnaires. Measures were repeated at 12 months. Malevolent voices, use of safety behaviours and subordination to persecutors were associated with depression and suicidal behaviour in acute FEP. Loss, Shame, low level continuing positive symptoms and longer duration of untreated psychosis were associated with post psychotic depression. Negative appraisals remained stable despite recovery in other symptom domains. Thus, depression and risk in early psychosis may be propagated by the personal significance and content of positive symptoms experienced. When in recovery, low level symptoms, longer period of illness and negative appraisals are significant factors.
早期精神病中的抑郁症与不良预后、复发和自杀风险相关，但目前仍了解不足。本文旨在探讨首发精神病（FEP）急性和精神病后阶段的抑郁症发展情况，及其与迫害者、幻听、洞察力和康复之间的关系。对 92 名急性 FEP 患者进行了关于抑郁过程、严重程度和阳性症状体验、洞察力以及对疾病的评估的研究，使用了经过验证的半结构化访谈和问卷。这些措施在 12 个月时进行了重复。在急性 FEP 中，恶意幻听、使用安全行为和屈从于迫害者与抑郁和自杀行为有关。丧失感、羞耻感、持续存在的低水平阳性症状和更长的未治疗精神病持续时间与精神病后抑郁有关。尽管其他症状领域有所恢复，但负面评估仍保持稳定。因此，早期精神病中的抑郁和风险可能是由阳性症状的个人意义和内容所推动的。在康复时，低水平症状、更长的疾病持续时间和负面评估是重要因素。
