Strauss Gregory P
Department of Psychology, University of Georgia, Athens, GA, United States.
Front Psychiatry. 2021 Mar 25;12:655471. doi: 10.3389/fpsyt.2021.655471. eCollection 2021.
Negative symptoms are a core feature of schizophrenia that has been linked to numerous poor clinical outcomes. Although person-level mechanisms have been identified for negative symptoms, psychosocial and pharmacological treatments targeting these mechanisms have been ineffective. The current theoretical paper proposes that limited treatment progress may result in part from a failure to identify and target environmental processes that cause and maintain negative symptoms. A novel theoretical model is outlined, called the bioecosystem theory of negative symptoms, that offers a conceptual framework for studying interactions among environmental systems and person-related biological and psychosocial factors. Relying on Bronfenbrenner's developmental theory as an organizing framework, four interactive environmental systems are proposed to be critical for the genesis and maintenance of negative symptoms: (1) Microsystem: the immediate environment; (2) Mesosystem: the interactions among microsystems; (3) Exosystem: indirect environments that influence the individual through the microsystems; (4) Macrosystem: socio-cultural factors. The environmental factors within these systems are proposed to function as a network and have dynamic within-system interactions, as well as cross-system interactions that change over time and across phases of illness. Environmental contributions to negative symptoms have received minimal empirical attention, despite their potential to explain variance in negative symptom severity. The bioecosystem model of negative symptoms introduced here offers a novel conceptual framework for exploring environmental contributions to negative symptoms and their interaction with person-level biological and psychological factors. This theory may facilitate new avenues for identifying environmental treatment targets and novel systems-level interventions.
阴性症状是精神分裂症的核心特征,与众多不良临床结局相关。尽管已确定了针对阴性症状的个体层面机制,但针对这些机制的心理社会和药物治疗均无效。当前这篇理论文章提出,治疗进展有限可能部分是由于未能识别和针对导致并维持阴性症状的环境过程。本文概述了一种新的理论模型,即阴性症状生物生态系统理论,该理论为研究环境系统与个体相关的生物和心理社会因素之间的相互作用提供了一个概念框架。以布朗芬布伦纳的发展理论为组织框架,提出了四个相互作用的环境系统对阴性症状的发生和维持至关重要:(1)微系统:直接环境;(2)中系统:微系统之间的相互作用;(3)外系统:通过微系统影响个体的间接环境;(4)宏系统:社会文化因素。这些系统中的环境因素被认为是一个网络,具有系统内的动态相互作用,以及随时间和疾病阶段变化的跨系统相互作用。尽管环境因素对阴性症状的影响可能解释阴性症状严重程度的差异,但目前受到的实证关注极少。这里介绍的阴性症状生物生态系统模型为探索环境因素对阴性症状的影响及其与个体层面生物和心理因素的相互作用提供了一个新的概念框架。这一理论可能有助于开辟新途径,以确定环境治疗靶点和新的系统层面干预措施。