Alameda Luis, Conus Philippe, Ramain Julie, Solida Alessandra, Golay Philippe
Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program, Lausanne University Hospital CHUV, CH-1008, Lausanne, Switzerland; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Centro Investigacion Biomedica en Red de Salud Mental CIBERSAM, Instituto de Biomedicina de Sevilla IBIS, Hospital Universitario Virgen del Rocio, Departamento de Psiquiatria, Universidad de Sevilla, Sevilla, Spain.
Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program, Lausanne University Hospital CHUV, CH-1008, Lausanne, Switzerland.
J Psychiatr Res. 2022 Jun;150:353-359. doi: 10.1016/j.jpsychires.2021.11.027. Epub 2021 Nov 22.
Considerable evidence on general population suggests that an "Affective pathway to psychosis", involving depression and anxiety dimensions, mediates the abuse-psychosis association. However, this has never been tested in Early Psychosis (EP) patients. We aim at testing whether severity of depressive and anxiety mediates the abuse-positive symptoms dyad in an EP prospective sample.
330 EP subjects aged 18-35 were assessed for psychopathology after 2, 6, 12, 18, 24, 30, and 36 months of treatment. Abuse was considered as facing at least one experience of physical, sexual, or emotional abuse before age 16. Positive psychotic symptoms and anxiety were measured with the Positive and Negative Syndrome Scale and depressive symptoms with the Montgomery-Asberg Depression Rating Scale. Mediation analyses were performed to study whether the abuse-positive symptom's link was mediated by depressive, anxiety, and a combination of anxiety/mood symptoms.
Among the 330 EP patient included, 104 (31.5% of the total) were exposed to abuse. Analyses across the 36 months of follow-up showed that depression and anxiety partially mediated 26.7% of the total effect of the abuse-positive symptoms association (indirect effects (IE) = 0.392 and 0.421 respectively), while the combined anxiety/mood model mediated 28.9% (IE = 0.475). Subanalyses at two and 36 months revealed a consistent role of depression, while that of anxiety was only present at baseline.
Our work confirms a mediating role of mood and anxiety in the association between abuse and positive symptoms during the first three years of treatment.
大量针对普通人群的证据表明，一条涉及抑郁和焦虑维度的“精神病情感通路”介导了虐待与精神病之间的关联。然而，这从未在早期精神病（EP）患者中得到验证。我们旨在检验抑郁和焦虑的严重程度是否介导了EP前瞻性样本中虐待与阳性症状的二元关系。
330名年龄在18至35岁之间的EP受试者在治疗2、6、12、18、24、30和36个月后接受了精神病理学评估。虐待被定义为在16岁之前至少经历过一次身体、性或情感虐待。使用阳性和阴性症状量表测量阳性精神病性症状和焦虑，使用蒙哥马利-阿斯伯格抑郁评定量表测量抑郁症状。进行中介分析以研究虐待与阳性症状之间的联系是否由抑郁、焦虑以及焦虑/情绪症状的组合介导。
在纳入的330名EP患者中，104名（占总数的31.5%）曾遭受虐待。对36个月随访的分析表明，抑郁和焦虑部分介导了虐待与阳性症状关联总效应的26.7%（间接效应分别为0.392和0.421），而焦虑/情绪综合模型介导了28.9%（间接效应为0.475）。在2个月和36个月时的亚分析显示抑郁的作用一致，而焦虑的作用仅在基线时存在。
我们的研究证实了情绪和焦虑在治疗的前三年中虐待与阳性症状关联中的中介作用。
