Unravelling psychosis: psychosocial epidemiology, mechanism, and meaning Translated title: 对精神病的社会心理流行病学、发病机制和病症意义的阐述

Summary

This paper reviews a revolution in our understanding of psychosis over the last 20 years. To a major extent, this has resulted from a process of cross-fertilization between psychosocial epidemiology and cognitive behavior therapy for psychosis (CBT-p). This encouraged complementary strategies for the acquisition and analysis of data. These include the use of a range of dependent variables related to psychosis, and the exploitation of data from cross-sectional and longitudinal epidemiological surveys, virtual reality experiments, experience sampling methodology, and treatment trials. The key element is to investigate social and psychological measures in relation to each other. This research has confirmed the role of the external social world in the development and persistence of psychotic disorder. In addition, several psychological drivers of psychotic experiences have been identified. There is now persuasive evidence that the influence of social factors in psychosis is significantly mediated by non-psychotic symptoms, particularly mood symptoms and other attributes of affect such as insomnia. Psychotic symptoms are also driven by reasoning biases such as jumping to conclusions and belief inflexibility, though little is known about social influences on such biases. It is now clear that there are many routes to psychosis and that it takes many forms. Treatment of all kinds should take account of this: the dependence of CBT-p on a detailed initial formulation in terms of psychological processes and social influences is an example of the required flexibility. Individual mediators are now being targeted in specific forms of CBT-p, with good effect. This in turn corroborates the hypothesized role of non-psychotic symptoms in mediation, and attests to the power of the approaches described.

Translated abstract

概述

本文回顾了过去20 年我们对精神病认识的革命性变化。很大程度上说，这一变化主要得益于社会心理流行病学与针对精神病的认知行为治疗（cognitive behavior therapy for psychosis，CBT-p）的发展和交互促进。而后者也促进了数据的采集和分析方法的补充策略。这些方法包括利用与精神病相关的一系列因变量，如何分析横断面和纵向流行病学调查、虚拟现实研究、经验抽样方法研究及治疗学临床试验中采集到的数据。研究的关键是探索各个社会心理因素的相互关系和作用。这些研究证明了外部社会在精神病性障碍的发生和发展中的作用。此外，一些产生精神病性体验的心理驱动因素也被发现。现已有可靠证据表明，社会因素明显受到非精神病性症状的影响，尤其情绪症状及其他对情感有影响的症状，如失眠。精神病性症状也可以受到归因偏移的影响，如武断下结论、顽固的信念等，但是社会因素对此如何起作用仍所知甚少。现在可以明确的是精神病的成因各异，表现形式多样。对各种类型的治疗都应考虑以下这点：应根据心理过程和社会因素影响在原始的CBT-p 方案上进行相应的调整。目前某些特定形式的CBT-p 将个体调节因素作为治疗目标并取得良好的效果。这反过来证实了非精神病性症状的调节作用，并证明了所描述方法的有效性。

中文全文

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