احساسات روانپریشی: لینک های بین افسردگی، عزت نفس، اعتقادات شماتیک منفی و هذیان های و توهم

Background The role of emotion in psychosis is being increasingly recognised. Cognitive conceptualisations of psychosis (e.g. [Garety, P.A., Kuipers, E.K., Fowler, D., Freeman, D., Bebbington, P.E., 2001. A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31, 189–195]) emphasise a central, normal, direct and non-defensive role for negative emotion in the development and maintenance of psychosis. This study tests specific predictions made by Garety et al. [Garety, P.A., Kuipers, E.K., Fowler, D., Freeman, D., Bebbington, P.E., 2001. A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31, 189–195] about the role of emotion and negative evaluative beliefs in psychosis. Methods 100 participants who had suffered a recent relapse in psychosis were recruited at baseline for the Prevention of Relapse in Psychosis (PRP) trial. In a cross-sectional analysis, we examined the role of depression, self-esteem and negative evaluative beliefs in relation to specific positive symptoms (persecutory delusions, auditory hallucinations and grandiose delusions) and symptom dimensions (e.g. distress, negative content, pre-occupation and conviction). Results Analysis indicated that individuals with more depression and lower self-esteem had auditory hallucinations of greater severity and more intensely negative content, and were more distressed by them. In addition, individuals with more depression, lower self-esteem and more negative evaluations about themselves and others had persecutory delusions of greater severity and were more pre-occupied and distressed by them. The severity of grandiose delusions was related inversely to depression scores and negative evaluations about self, and directly to higher self-esteem. Conclusions This study provides evidence for the role of emotion in schizophrenia spectrum-disorders. Mood, self-esteem and negative evaluative beliefs should be considered when conceptualising psychosis and designing interventions.

The role of emotion in the development and maintenance of psychosis is being increasingly recognised (e.g. Birchwood, 2003, Birchwood and Trower, 2006, Freeman and Garety, 2003, Guillem et al., 2005 and Hafner et al., 2005). There is now a body of evidence from epidemiological, questionnaire, experimental and treatment studies that low mood, low self-esteem and negative schematic beliefs can contribute to the development of symptoms of psychosis (e.g. Barrowclough et al., 2003, Bowins and Shugar, 1998, Close and Garety, 1998, Drake et al., 2004, Freeman et al., 1998, Freeman et al., 2003, Guillem et al., 2005, Hafner et al., 2005, Hall and Tarrier, 2003, Iqbal et al., 2000, Krabbendam et al., 2002, Krabbendam et al., 2005, Martin and Penn, 2001 and Trower and Chadwick, 1995). Krabbendam et al. (2005) reported a study of over 4500 individuals screened for psychiatric status and followed up for 3 years. Given the presence of hallucinatory experiences at baseline, the increase in risk of psychosis outcome at Year 3 was higher in those with depressed mood at Year 1 than in those without depressed mood at Year 1. Barrowclough et al. (2003) assessed negative self-evaluation using an in-depth interview in a group with schizophrenia (N = 59). They found that negative self-evaluation was strongly associated with the positive symptoms of psychosis (PANSS positive sub-scale). Importantly, this remained significant even when levels of depression were controlled.

3.1. Demographic and clinical data Sixty-eight percent of the sample was male and the mean age was 39 years (S.D. = 10.9 years), range = 19–65. Sixty-nine percent had been admitted to hospital as a result of their recent relapse in psychosis. Almost 70% described themselves as White-British, 10% as Black-Caribbean, 7% as Black-African and 11% as from other ethic backgrounds. Seventy eight percent had a diagnosis of schizophrenia, 20% of schizoaffective disorder and 2% of delusional disorder. The mean length of illness was 11.7 years (S.D. = 10.1 years), with a range from less than 1 year up to 44 years. The mean scores for the psychotic symptom measures are presented in Table 1. Fifty five percent of the sample reported persecutory delusions, 57% auditory hallucinations, and 17% grandiose delusions (all rated moderate-severe on the SAPS). Self-esteem, depression and negative evaluative belief scores are also presented in Table 1.