Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada.
Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada.
Schizophr Res. 2019 Jun;208:441-446. doi: 10.1016/j.schres.2019.01.006. Epub 2019 Jan 14.
Some individuals identified as being at clinical high risk (CHR) for developing psychosis may suffer substantial anxiety due to a fear of transitioning to psychosis. This can be associated with catastrophic misinterpretation of normal mental experiences, such as a momentary lapse in attention, as markers for psychosis, fueled by hypervigilance for mental experiences that may be perceived as signs of impending psychosis. This anxiety may only worsen due to the self-stigma triggered by admission to a psychiatric CHR clinic, independent of whether or not the individual transitions to psychosis. Based on a clinical case study, we propose a cognitive model for this anxiety, an extension of Clark's model of panic. Our model accounts for causal factors of this distress, such as self-stigma and maladaptive core beliefs. It also includes maintaining factors such as hypervigilance for mental experiences and catastrophic misinterpretation of normal mental experiences as anomalous and portending eventual psychosis. We outline assessment and treatment guidelines and offer suggestions for how this model could be empirically validated. We suggest that treatment with this model, under the neural diathesis-stress framework, may have the potential to lower the risk of transition to psychosis and that assessment for such anxiety should be part of standard CHR care.
一些被认为处于精神病临床高风险（CHR）的个体可能会因为担心发展为精神病而承受巨大的焦虑。这种焦虑可能源于对正常心理体验的灾难性误解，例如注意力短暂不集中，被视为精神病的标志，这是由于对可能被视为即将发生精神病的心理体验的过度警觉所导致的。这种焦虑可能会因进入精神病 CHR 诊所而引发的自我污名化而进一步恶化，而无论个体是否发展为精神病。基于一项临床案例研究，我们提出了一种针对这种焦虑的认知模型，即克拉克恐慌模型的扩展。我们的模型解释了这种痛苦的因果因素，例如自我污名化和适应不良的核心信念。它还包括维持因素，如对心理体验的过度警觉和对正常心理体验的灾难性误解，将其视为异常并预示着最终的精神病。我们概述了评估和治疗指南，并提出了如何通过实证验证该模型的建议。我们认为，在神经素质-应激框架下，采用该模型进行治疗可能有助于降低向精神病转化的风险，因此，对这种焦虑的评估应该成为 CHR 标准护理的一部分。
