Hatzipanayioti Adamantini, Walther Sebastian, Gangl Nicole, Conring Frauke, Wüthrich Florian, Stegmayer Katharina
Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University of Würzburg, Würzburg, Germany.
Mol Psychiatry. 2025 Apr 9. doi: 10.1038/s41380-025-02999-x.
Paranoia is a central feature of schizophrenia and linked with poor outcomes. Paranoid experience is sometimes hard to identify in the clinical interview. In contrast, personal space (PS) measures detected patients with paranoia with excellent sensitivity and specificity. Here we test whether we can substantiate aberrant PS regulation in paranoia and whether PS was associated with stress markers and longitudinal outcomes. We included 144 participants (92 patients with schizophrenia spectrum disorders and 52 age and sex-matched healthy controls). We measured PS and stress markers during two behavioural tasks on interpersonal distance. In addition, we assessed social outcomes at baseline and after 6 months. Data corroborated that paranoia increased PS. Moreover, we confirmed that PS detected paranoia with excellent sensitivity (92%) at 1.1 m, and severe paranoia with 87% sensitivity and 81% specificity at 1.6 m. In addition, stress (Electrodermal activity) during the PS task was associated with paranoia and PS. Furthermore, higher stress at baseline predicted less improvement of social outcome after 6 months. Finally, improvement of PS over 6 months was associated with improvement of social functioning. PS may indeed serve as a simple bedside test for paranoia. Furthermore, results have direct implications in clinical practice as they suggest that it is advisable to maintain increased PS with paranoid patients. In addition, altered stress regulation and persistently increased PS may indicate unfavourable outcomes in the short-term follow-up. Thus, patients with persistently increased PS may benefit from special therapeutic attention.
偏执是精神分裂症的核心特征，且与不良预后相关。偏执体验在临床访谈中有时难以识别。相比之下，个人空间（PS）测量能以出色的敏感性和特异性检测出偏执患者。在此，我们测试是否能证实偏执中存在异常的个人空间调节，以及个人空间是否与压力指标和纵向预后相关。我们纳入了144名参与者（92名精神分裂症谱系障碍患者和52名年龄及性别匹配的健康对照）。我们在两项关于人际距离的行为任务中测量了个人空间和压力指标。此外，我们在基线和6个月后评估了社会预后。数据证实偏执会增加个人空间。而且，我们确认个人空间在1.1米时能以92%的出色敏感性检测出偏执，在1.6米时能以87%的敏感性和81%的特异性检测出严重偏执。此外，个人空间任务期间的压力（皮肤电活动）与偏执和个人空间相关。再者，基线时较高的压力预示着6个月后社会预后改善较少。最后，6个月内个人空间的改善与社会功能的改善相关。个人空间确实可作为偏执的一种简单床边测试。此外，研究结果对临床实践有直接影响，因为它们表明对偏执患者保持增大的个人空间是可取的。此外，压力调节改变和个人空间持续增加可能表明短期随访结果不佳。因此，个人空间持续增加的患者可能会从特殊的治疗关注中受益。
