Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, QC, Canada.
Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neurosciences, King's College London, London, United Kingdom.
Neurosci Biobehav Rev. 2017 Feb;73:191-218. doi: 10.1016/j.neubiorev.2016.12.013. Epub 2016 Dec 16.
Over the past decade, our understanding of the role of stress in serious mental illness has become more sophisticated. In this paper, we revisit the neural diathesis-stress model of schizophrenia that was initially proposed in 1997 and updated in 2008. In light of cumulative research findings, we must now encompass evidence on the premorbid periods of psychosis, and our more nuanced understanding of hypothalamic-pituitary-adrenal (HPA) axis function and its association with neurodevelopmental, epigenetic, neurotransmitter, and inflammatory processes, as well as brain structure and function. Giving consideration to the methodological complexities that have become more apparent as research in this area has burgeoned, the various indices of HPA axis function, and the different stages of illness, we review relevant research published since the 2008 update of the model. We conclude by proposing an extended neural diathesis-stress model that addresses the broader neurobiological context of stress psychobiology in psychosis progression. Implications of this model for best practice, with regards to both future research and treatment strategies, are discussed.
在过去的十年中，我们对压力在严重精神疾病中的作用的理解变得更加复杂。在本文中，我们重新审视了 1997 年最初提出并于 2008 年更新的精神分裂症神经素质-应激模型。鉴于累积的研究结果，我们现在必须包含精神病前阶段的证据，以及我们对下丘脑-垂体-肾上腺 (HPA) 轴功能及其与神经发育、表观遗传、神经递质和炎症过程以及大脑结构和功能的更细微的理解。考虑到随着该领域研究的蓬勃发展，方法学的复杂性变得更加明显，我们回顾了自该模型 2008 年更新以来发表的相关研究。最后，我们提出了一个扩展的神经素质-应激模型，该模型解决了精神病进展中应激生物心理学的更广泛的神经生物学背景。我们讨论了该模型对最佳实践的影响，包括未来的研究和治疗策略。
