有证据表明，精神障碍的环境和遗传风险可能通过影响感知改变和妄想观念等核心症状之间的联系起作用。
Evidence that environmental and genetic risks for psychotic disorder may operate by impacting on connections between core symptoms of perceptual alteration and delusional ideation.
作者信息
Smeets Feikje, Lataster Tineke, Viechtbauer Wolfgang, Delespaul Philippe
机构信息
Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, the Netherlands;
出版信息
Schizophr Bull. 2015 May;41(3):687-97. doi: 10.1093/schbul/sbu122. Epub 2014 Sep 12.
BACKGROUND
Relational models of psychopathology propose that symptoms are dynamically connected and hypothesize that genetic and environmental influences moderate the strength of these symptom connections. Previous findings suggest that the interplay between hallucinations and delusions may play a crucial role in the development of psychotic disorder. The current study examined whether the connection between hallucinations and delusions is impacted by proxy genetic and environmental risk factors.
METHODS
Hallucinations and delusions at baseline and at 3-year follow-up were assessed in a sample of 1054 healthy siblings and 918 parents of 1109 patients with psychosis, and in 589 healthy controls (no familial psychosis risk). Environmental factors assessed were cannabis use, childhood trauma, and urbanicity during childhood. Logistic regression analyses tested whether familial psychosis risk predicted increased risk of delusions, given presence of hallucinations. Moderating effects of environmental factors on the hallucination-delusion association were tested in a similar fashion, restricted to the control and sibling groups.
RESULTS
The risk of delusions, given hallucinations, was associated with proxy genetic risk: 53% in parents, 47% in siblings, and 36% in controls. The hallucination-delusion association was stronger in those reporting cannabis use (risk difference: 32%) and childhood trauma (risk difference: 15%) although not all associations were statistically conclusive (respectively: p = .037; p = .054). A directionally similar but nonsignificant effect was found for urb anicity during childhood (risk difference: 14%, p =.357).
CONCLUSION
The strength of the connection between delusions and hallucinations is associated with familial and environmental risks for psychotic disorder, suggesting that specific symptom connections in the early psychosis psychopathology network are informative of underlying mechanisms.
背景
精神病理学的关系模型提出，症状是动态相连的，并假设基因和环境影响会调节这些症状联系的强度。先前的研究结果表明，幻觉与妄想之间的相互作用可能在精神障碍的发展中起关键作用。本研究探讨了幻觉与妄想之间的联系是否受到替代基因和环境风险因素的影响。
方法
对1054名健康同胞和1109名精神病患者的918名父母以及589名健康对照者（无家族性精神病风险）进行了基线及3年随访时的幻觉和妄想评估。评估的环境因素包括大麻使用、童年创伤和童年时期的城市化程度。逻辑回归分析检验了在存在幻觉的情况下，家族性精神病风险是否预示着妄想风险增加。以类似方式检验了环境因素对幻觉-妄想关联的调节作用，仅限于对照组和同胞组。
结果
在存在幻觉的情况下，妄想风险与替代基因风险相关：父母组为53%，同胞组为47%，对照组为36%。在报告使用大麻者（风险差异：32%）和童年创伤者（风险差异：15%）中，幻觉-妄想关联更强，尽管并非所有关联都具有统计学结论性（分别为：p = 0.037；p = 0.054）。童年时期的城市化程度有方向相似但无统计学意义的效应（风险差异：14%，p = 0.357）。
结论
妄想与幻觉之间联系的强度与精神障碍的家族和环境风险相关，这表明早期精神病精神病理学网络中的特定症状联系有助于了解潜在机制。
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