Goldstein M J
Schizophr Bull. 1987;13(1):157-71. doi: 10.1093/schbul/13.1.157.
This article uses a version of the vulnerability-stress model to examine psychosocial factors related to the onset, course, and treatment of schizophrenia. High-risk studies, most of which study offspring of a schizophrenic parent, suggest that signs of vulnerability to the disorder may emerge in early to middle childhood in neuromotor integration, attentional and information-processing abilities, and deviant social behavior. It is still not clear that these markers are specific to the subsequent development of schizophrenia. The evidence for stressful family relationships as potentiators of the disorder in vulnerable off-spring is also reviewed. Although few studies are available that bear directly on this issue, the preliminary evidence suggests that further investigation is warranted. Stressors, particularly those arising from within the family, are also examined as they relate to the course of schizophrenia. The data on expressed emotion (EE) have been replicated more often than not, although the origins of high EE attitudes are not precisely understood. These attitudes do not arise as reactions to the form or severity of a relative's disorder, but they may relate to the length of time between initial onset of the disorder and first hospitalization. Family-based intervention programs, overlaid on regular antipsychotic drug treatment, appear to reduce the risk for relapse in the short-term. At least one of the mechanisms of action of these programs is to reduce the negative affective climate in the family.
本文运用一种版本的易感性-应激模型来研究与精神分裂症的发病、病程及治疗相关的心理社会因素。高危研究大多针对精神分裂症患者的后代，这些研究表明，在神经运动整合、注意力和信息处理能力以及异常社会行为方面，该疾病的易感性迹象可能在儿童早期至中期出现。目前尚不清楚这些标志物是否特定于精神分裂症的后续发展。本文还综述了应激性家庭关系作为易患后代中该疾病增强因素的证据。尽管直接针对这一问题的研究很少，但初步证据表明有必要进行进一步调查。应激源，尤其是家庭内部产生的应激源，也因其与精神分裂症病程的关系而得到研究。关于情感表达（EE）的数据虽大多得到重复验证，但对高情感表达态度的根源尚不完全清楚。这些态度并非因亲属疾病的形式或严重程度而产生，但可能与疾病首次发作至首次住院之间的时间长短有关。基于家庭的干预项目与常规抗精神病药物治疗相结合，似乎能在短期内降低复发风险。这些项目的至少一种作用机制是减少家庭中的负面情感氛围。
