Trotman Hanan D, Holtzman Carrie W, Walker Elaine F, Addington Jean M, Bearden Carrie E, Cadenhead Kristin S, Cannon Tyrone D, Cornblatt Barbara A, Heinssen Robert K, Mathalon Daniel H, Tsuang Ming T, Perkins Diana O, Seidman Larry J, Woods Scott W, McGlashan Thomas H
Department of Psychology, Emory University, Atlanta, GA 30322, USA.
Department of Psychology, Emory University, Atlanta, GA 30322, USA.
Schizophr Res. 2014 Dec;160(1-3):104-9. doi: 10.1016/j.schres.2014.09.017. Epub 2014 Nov 7.
There is inconsistent evidence for increased stress exposure among individuals at clinical high risk (CHR) for psychosis. Yet similar to patients with a diagnosed psychotic illness, the preponderance of evidence suggests that CHR individuals tend to experience stressful life events (LE) and daily hassles (DH) as more subjectively stressful than healthy individuals. The present study utilizes data from the North American Prodrome Longitudinal Study Phase 2 (NAPLS-2) to test the hypotheses that (1) CHR individuals manifest higher self-reported stress in response to both LE and DH when compared to healthy controls (HC), (2) group differences in self-reported stress increase with age, (3) baseline self-reported stress is associated with follow-up clinical status, and (4) there is a sensitization effect of LE on the response to DH. In contrast to some previous research, the present findings indicate that the CHR group (N=314) reported exposure to more LE when compared to the HC group (N=162). As predicted, CHR participants rated events as more stressful, and those who progressed to psychosis reported a greater frequency of LE and greater stress from events compared to those whose prodromal symptoms remitted. There was also some evidence of stress-sensitization; those who experienced more stress from LE rated current DH as more stressful. The results indicate that the "prodromal" phase is a period of heightened stress and stress sensitivity, and elevated cumulative lifetime exposure to stressful events may increase reactions to current stressors.
对于临床高危（CHR）精神病个体而言，压力暴露增加的证据并不一致。然而，与已确诊精神病性疾病的患者类似，大量证据表明，与健康个体相比，CHR个体往往在主观上会将生活应激事件（LE）和日常困扰（DH）视为更大的压力。本研究利用北美前驱期纵向研究第二阶段（NAPLS - 2）的数据来检验以下假设：（1）与健康对照（HC）相比，CHR个体在面对LE和DH时自我报告的压力更高；（2）自我报告压力的组间差异随年龄增加；（3）基线自我报告压力与随访临床状态相关；（4）LE对DH反应存在致敏效应。与之前的一些研究不同，本研究结果表明，与HC组（N = 162）相比，CHR组（N = 314）报告经历了更多的LE。正如预测的那样，CHR参与者将事件评定为压力更大，与前驱症状缓解的参与者相比，那些进展为精神病的参与者报告的LE频率更高，且事件带来的压力更大。也有一些压力致敏的证据；那些从LE中经历更多压力的人将当前的DH评定为压力更大。结果表明，“前驱期”是一个压力和压力敏感性增强的时期，一生中累积暴露于应激事件的增加可能会增强对当前应激源的反应。
