Kosteletos I, Kollias K, Stefanis N
1st Psychiatric Department, University of Athens, Eginition Hospital, Athens, Greece.
Psychiatriki. 2020 Jan-Mar;31(1):23-35. doi: 10.22365/jpsych.2020.311.23.
Εpidemiological research during last decades has demonstrated the association of certain environmental variables with psychosis. Ιn parallel with understanding environmental contributors to schizophrenia, identification of those at high risk of psychosis has become a priority. These risk factors include adverse traumatic experiences, such as discrimination, social environment adversities, bullying, emigration and childhood trauma. For many years the possibility of a relationship of adverse traumatic experiences with schizophrenia was minimized in favor of a biological paradigm. However, there is evidence supporting that childhood adversities is one of the most significant environmental risk factors for psychosis, if not the most significant. Studies have demonstrated the validity and the reliability of retrospective reports of adverse traumatic experiences in psychotic patients. The question on the causal relationship between adverse traumatic experiences and psychosis has been raised for many years, but it has not yet been answered. Researchers have focused on the study of dysfunctional cognitive schemes being formed due to childhood adversities and interpreting the world as unfriendly and threatening. According to social defeat hypothesis, the patients do not experience more stressful life events but they experience them as less controllable. Furthermore, researchers study the mediator psychopathology associated directly with adverse traumatic experiences, such as anxiety, mood, dissociative and adaptation disorders, which possibly predispose to psychosis. Cannabis use and childhood adversities may interact to increase the risk of psychotic symptoms in adolescence, according to research findings. Several publications have positively linked the number of traumatic adverse experiences with the severity of mental health and possibly with high risk of psychosis in a dose-response relationship model. Taking note that it is important to have a plausible hypothesis of the biological mechanisms involved with the relationship between adverse traumatic experiences and psychosis, the putative systems being explored are: (1) the hypothalamus-pituitary-adrenal (HPA) axis because it mediates the principal adaptive response to perceived psychological or physiological stress and (2) the dopamine system, which is considered to be important in the development of psychosis. The biological and environmental risk factors are both important in the etiology of psychosis but the effects of some forms of childhood adversity act largely independently of pre-existing genetic liability to increase the risk of psychosis. A supposed differentiation of psychosis associated with adverse traumatic experiences from the classic neurodegenerative model possibly should be considered seriously by the clinician in order to design the best therapeutic plan.
过去几十年的流行病学研究表明，某些环境变量与精神病之间存在关联。在了解精神分裂症的环境因素的同时，识别精神病高风险人群已成为当务之急。这些风险因素包括不良创伤经历，如歧视、社会环境逆境、欺凌、移民和童年创伤。多年来，不良创伤经历与精神分裂症之间存在关联的可能性因倾向于生物学范式而被最小化。然而，有证据支持童年逆境是精神病最重要的环境风险因素之一，如果不是最重要的话。研究已经证明了精神病患者不良创伤经历回顾性报告的有效性和可靠性。不良创伤经历与精神病之间的因果关系问题已经提出多年，但尚未得到解答。研究人员专注于研究因童年逆境而形成的功能失调认知模式，并将世界解读为不友好和具有威胁性。根据社会挫败假说，患者经历的压力性生活事件并不更多，但他们觉得这些事件更难以控制。此外，研究人员研究与不良创伤经历直接相关的中介性精神病理学，如焦虑、情绪、解离和适应障碍，这些可能易导致精神病。研究结果表明，使用大麻和童年逆境可能相互作用，增加青少年出现精神病症状的风险。一些出版物在剂量反应关系模型中，将创伤性不良经历的数量与心理健康的严重程度以及可能与精神病的高风险呈正相关。需要注意的是，对于不良创伤经历与精神病之间关系所涉及的生物学机制有一个合理假说是很重要的，正在探索的假定系统是：(1)下丘脑 - 垂体 - 肾上腺（HPA）轴，因为它介导对感知到的心理或生理压力的主要适应性反应；(2)多巴胺系统，其在精神病的发展中被认为很重要。生物学和环境风险因素在精神病的病因学中都很重要，但某些形式的童年逆境的影响在很大程度上独立于预先存在的遗传易感性，以增加患精神病的风险。临床医生可能应该认真考虑将与不良创伤经历相关的精神病与经典神经退行性模型进行假定区分，以便设计出最佳治疗方案。
