Psychiatry and Behavioral Health, The Ohio State University, USA.
Psychiatry and Behavioral Health, The Ohio State University, USA.
J Psychiatr Res. 2023 Jun;162:220-227. doi: 10.1016/j.jpsychires.2023.05.035. Epub 2023 May 4.
Personal agency-a key element of recovery from psychotic disorders-is formed and maintained in large part through interactions with others. Interactions with caregivers are particularly important in first-episode psychosis (FEP), as these interactions form the foundations for lifelong caregiving relationships. The present study examined shared understandings of agency (operationalized as efficacy to manage symptoms and social behaviors) within families affected by FEP. Individuals with FEP (n = 46) completed the Self-Efficacy Scale for Schizophrenia (SESS) and measures of symptom severity, social functioning, social quality of life, stigma, and discrimination. Caregivers (n = 42) completed a caregiver version of the SESS assessing perceptions of their affected relative's self-efficacy. Self-rated efficacy was higher than caregiver-rated efficacy in all domains (positive symptoms, negative symptoms, and social behavior). Self- and caregiver-rated efficacy correlated only in the social behavior domain. Self-rated efficacy was most associated with lower depression and stigmatization, whereas caregiver-rated efficacy was most associated with better social functioning. Psychotic symptoms did not relate to self- or caregiver-rated efficacy. Individuals with FEP and caregivers have discrepant perceptions of personal agency, perhaps because they base perceptions of agency on different sources of information. These findings highlight specific targets for psychoeducation, social skills training, and assertiveness training to develop shared understandings of agency and facilitate functional recovery.
个人能动性——从精神病障碍中恢复的关键因素——在很大程度上是通过与他人的互动形成和维持的。与照顾者的互动在首发精神病（FEP）中尤为重要，因为这些互动为终生的照顾关系奠定了基础。本研究探讨了受 FEP 影响的家庭中对能动性的共同理解（表现为管理症状和社会行为的效力）。46 名 FEP 患者完成了精神分裂症自我效能感量表（SESS）以及症状严重程度、社会功能、社会生活质量、耻辱感和歧视的测量。42 名照顾者完成了 SESS 的照顾者版本，评估他们受影响的亲属的自我效能感。在所有领域（阳性症状、阴性症状和社会行为）中，自我评估的效能都高于照顾者评估的效能。自我评估和照顾者评估的效能仅在社会行为领域相关。自我评估的效能与较低的抑郁和耻辱感最相关，而照顾者评估的效能与更好的社会功能最相关。精神病症状与自我或照顾者评估的效能无关。FEP 患者和照顾者对个人能动性有不同的看法，这可能是因为他们对能动性的看法基于不同的信息来源。这些发现强调了特定的心理教育、社交技能训练和自信训练目标，以发展对能动性的共同理解，并促进功能恢复。
