Bentall Richard P, de Sousa Paulo, Varese Filippo, Wickham Sophie, Sitko Katarzyna, Haarmans Maria, Read John
University of Liverpool, Liverpool, UK,
Soc Psychiatry Psychiatr Epidemiol. 2014 Jul;49(7):1011-22. doi: 10.1007/s00127-014-0914-0. Epub 2014 Jun 12.
Although there is considerable evidence that adversities in childhood such as social deprivation, sexual abuse, separation from parents, neglect and exposure to deviant parental communication are associated with psychosis in later life, most studies have considered broad diagnoses as outcomes. In this review we consider evidence for pathways between specific types of adversity and specific symptoms of psychosis.
We present theoretical arguments for expecting some degree of specificity (although by no means perfect specificity) between different kinds of adversity and different symptoms of psychosis. We review studies that have investigated social-environmental risk factors for thought disorder, auditory-verbal hallucinations and paranoid delusions, and consider how these risk factors may impact on specific psychological and biological mechanisms.
Communication deviance in parents has been implicated in the development of thought disorder in offspring, childhood sexual abuse has been particularly implicated in auditory-verbal hallucinations, and attachment-disrupting events (e.g. neglect, being brought up in an institution) may have particular potency for the development of paranoid symptoms. Current research on psychological mechanisms underlying these symptoms suggests a number of symptom-specific mechanisms that may explain these associations.
Few studies have considered symptoms, underlying mechanisms and different kinds of adversity at the same time. Future research along these lines will have the potential to elucidate the mechanisms that lead to severe mental illness, and may have considerable clinical implications.
尽管有大量证据表明，童年时期的逆境，如社会剥夺、性虐待、与父母分离、忽视以及接触异常的父母沟通方式，与日后的精神病有关，但大多数研究都将宽泛的诊断结果作为研究对象。在本综述中，我们探讨特定类型的逆境与精神病特定症状之间的关联途径的证据。
我们提出理论依据，认为不同类型的逆境与精神病的不同症状之间存在一定程度的特异性（尽管绝非完美的特异性）。我们回顾了研究社会环境风险因素与思维紊乱、幻听和偏执妄想之间关系的研究，并思考这些风险因素如何影响特定的心理和生物学机制。
父母沟通异常与子女思维紊乱的发展有关，童年性虐待尤其与幻听有关，而破坏依恋关系的事件（如忽视、在机构中长大）可能对偏执症状的发展具有特殊影响。目前对这些症状背后心理机制的研究表明，有一些症状特异性机制可以解释这些关联。
很少有研究同时考虑症状、潜在机制和不同类型的逆境。沿着这些方向的未来研究有可能阐明导致严重精神疾病的机制，并可能具有重要的临床意义。
