Nudelman Jacob L, Waltz James A
Maryland Psychiatric Research Center (MPRC), Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21228, USA.
J Psychiatr Brain Sci. 2022;7(6). doi: 10.20900/jpbs.20220012. Epub 2022 Dec 30.
Affective reactions to acute stressors often evoke exacerbations of psychotic symptoms and sometimes de novo psychotic symptoms and initial psychotic episodes. Across the lifespan, affective reactions to acute stressors are enhanced by successive adverse childhood experiences (ACEs), in a process called "behavioral sensitization". The net effects of behavioral sensitization of acute stress responses are to alter responsivity to positive and negative feedback and to unexpected events, regardless of valence, leading to the maladaptive assignment of salience to stimuli and events. The assignment of "aberrant" salience to stimuli and events has profound consequences for learning and decision-making, which can influence both the positive and negative symptoms of psychosis. In this review, we discuss some of the psychological and neural mechanisms by which affective reactivity to acute stress, and its sensitization through the experience of stress and trauma across the lifespan, impact both the positive and negative symptoms of psychosis. We recount how the reward and salience networks of the brain, together with inputs from the dopamine and serotonin neurotransmitter systems, are implicated in both affective reactivity to stress and the symptoms of psychosis, likely mediate the effects of stress and trauma on the symptoms of psychosis and could serve as targets for interventions.
对急性应激源的情感反应常常会引发精神病症状的加剧，有时还会引发新发精神病症状和首次精神病发作。在整个生命周期中，在一个被称为“行为敏化”的过程中，童年期连续的不良经历（ACEs）会增强对急性应激源的情感反应。急性应激反应行为敏化的净效应是改变对正性和负性反馈以及意外事件的反应性，无论其效价如何，导致对刺激和事件的显著性进行适应不良的分配。对刺激和事件赋予“异常”显著性对学习和决策有深远影响，这可能会影响精神病的阳性和阴性症状。在这篇综述中，我们讨论了一些心理和神经机制，通过这些机制，对急性应激的情感反应及其在整个生命周期中通过应激和创伤经历产生的敏化作用，会影响精神病的阳性和阴性症状。我们讲述了大脑的奖赏和显著性网络，连同来自多巴胺和5-羟色胺神经递质系统的输入，如何与应激的情感反应和精神病症状都有关联，可能介导应激和创伤对精神病症状的影响，并且可以作为干预的靶点。
