D-BSSE, ETH Zurich,Basel,Switzerland.
Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel and University of Basel,Basel,Switzerland.
Psychol Med. 2019 Feb;49(3):388-395. doi: 10.1017/S0033291718000879. Epub 2018 May 29.
Non-psychotic affective symptoms are important components of psychotic syndromes. They are frequent and are now thought to influence the emergence of paranoia and hallucinations. Evidence supporting this model of psychosis comes from recent cross-fertilising epidemiological and intervention studies. Epidemiological studies identify plausible targets for intervention but must be interpreted cautiously. Nevertheless, causal inference can be strengthened substantially using modern statistical methods.
Directed Acyclic Graphs were used in a dynamic Bayesian network approach to learn the overall dependence structure of chosen variables. DAG-based inference identifies the most likely directional links between multiple variables, thereby locating them in a putative causal cascade. We used initial and 18-month follow-up data from the 2000 British National Psychiatric Morbidity survey (N = 8580 and N = 2406).
We analysed persecutory ideation, hallucinations, a range of affective symptoms and the effects of cannabis and problematic alcohol use. Worry was central to the links between symptoms, with plausible direct effects on insomnia, depressed mood and generalised anxiety, and recent cannabis use. Worry linked the other affective phenomena with paranoia. Hallucinations were connected only to worry and persecutory ideation. General anxiety, worry, sleep problems, and persecutory ideation were strongly self-predicting. Worry and persecutory ideation were connected over the 18-month interval in an apparent feedback loop.
These results have implications for understanding dynamic processes in psychosis and for targeting psychological interventions. The reciprocal influence of worry and paranoia implies that treating either symptom is likely to ameliorate the other.
非精神病性情感症状是精神病综合征的重要组成部分。它们很常见，现在被认为会影响妄想和幻觉的出现。支持这种精神病模型的证据来自最近的交叉促进的流行病学和干预研究。流行病学研究确定了干预的合理目标，但必须谨慎解释。尽管如此，使用现代统计方法可以大大加强因果推断。
有向无环图（DAG）在动态贝叶斯网络方法中用于学习所选变量的整体依赖结构。基于 DAG 的推理确定了多个变量之间最可能的定向链接，从而将它们定位在一个假定的因果级联中。我们使用了 2000 年英国国家精神疾病发病率调查（N = 8580 和 N = 2406）的初始和 18 个月随访数据。
我们分析了被害妄想、幻觉、一系列情感症状以及大麻和问题性酒精使用的影响。担忧是症状之间联系的核心，对失眠、情绪低落和广泛性焦虑以及最近的大麻使用有合理的直接影响。担忧将其他情感现象与妄想联系起来。幻觉仅与担忧和被害妄想有关。一般焦虑、担忧、睡眠问题和被害妄想具有强烈的自我预测性。在 18 个月的间隔内，担忧和被害妄想在一个明显的反馈循环中相互连接。
这些结果对理解精神病中的动态过程和针对心理干预具有重要意义。担忧和妄想的相互影响意味着治疗任何一种症状都可能改善另一种症状。
