Gabínio Thalita, Ricci Thaysse, Kahn Jeffrey P, Malaspina Dolores, Moreira Helena, Veras André B
Grupo de Pesquisa Translacional em Saúde Mental, Universidade Católica Dom Bosco, Campo Grande, MS, Brazil.
Department of Psychiatry, Weill-Cornell Medical College, New York, NY, USA.
Trends Psychiatry Psychother. 2018 Jul-Sep;40(3):179-184. doi: 10.1590/2237-6089-2017-0005. Epub 2018 Apr 5.
To evaluate attachment patterns in subjects with schizophrenia and their relationships to early traumatic events, psychotic symptoms and comorbidities.
Twenty patients diagnosed with schizophrenia according to criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) underwent retrospective symptom assessment and careful assessment of the number and manner of childhood caregiver changes. The Diagnostic Interview for Psychosis and Affective Disorders (DI-PAD) was used to assess symptoms related to schizophrenia (positive and negative symptoms), depression and mania. Anxiety disorder comorbidities were assessed by the Liebowitz Social Anxiety Scale (LSAS), Yale-Brown Obsessions and Compulsions Scale (Y-BOCS) and Panic and Schizophrenia Interview (PaSI). Experience in Close Relationships - Relationship Structures (ECR-RS) and Early Trauma Inventory Self Report-Short Form (ETISR-SF) were used to assess attachment patterns and traumatic history, respectively.
Moderate and significant correlations between attachment patterns and early trauma showed that greater severity of anxious attachment was predicted by a higher frequency of total early traumas (Spearman ρ = 0.446, p = 0.04), mainly general traumas (ρ = 0.526, p = 0.017; including parental illness and separation, as well as natural disaster and serious accidents). Among the correlations between early trauma and comorbid symptoms, panic attacks occurring before the onset of schizophrenia showed significant and positive correlations with ETISR-SF total scores and the sexual trauma subscale.
Children with an unstable early emotional life are more vulnerable to the development of psychopathology, such as panic anxiety symptoms. Traumatic events may also predict later schizophrenia.
评估精神分裂症患者的依恋模式及其与早期创伤事件、精神病性症状和共病的关系。
根据《精神障碍诊断与统计手册》第5版（DSM-5）标准诊断为精神分裂症的20名患者接受了回顾性症状评估，并仔细评估了童年时期照顾者变化的数量和方式。使用精神病和情感障碍诊断访谈（DI-PAD）评估与精神分裂症相关的症状（阳性和阴性症状）、抑郁和躁狂。通过利博维茨社交焦虑量表（LSAS）、耶鲁-布朗强迫量表（Y-BOCS）和惊恐与精神分裂症访谈（PaSI）评估焦虑症共病情况。亲密关系经验-关系结构（ECR-RS）和早期创伤量表自评简表（ETISR-SF）分别用于评估依恋模式和创伤史。
依恋模式与早期创伤之间存在中度且显著的相关性，表明早期创伤总频率越高，焦虑依恋的严重程度越高（斯皮尔曼ρ = 0.446，p = 0.04），主要是一般创伤（ρ = 0.526，p = 0.017；包括父母疾病和分离，以及自然灾害和严重事故）。在早期创伤与共病症状的相关性中，精神分裂症发病前出现的惊恐发作与ETISR-SF总分和性创伤子量表呈显著正相关。
早期情感生活不稳定的儿童更容易出现精神病理学问题，如惊恐焦虑症状。创伤事件也可能预示着 later schizophrenia。（注：原文中“later schizophrenia”表述有误，可能是“later onset of schizophrenia”，但按照要求未作修改）
