Do cognitive schema mediate the association between childhood trauma and being at ultra-high risk for psychosis?
Do cognitive schema mediate the association between childhood trauma and being at ultra-high risk for psychosis?
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DOI：
10.1016/j.jpsychires.2017.01.003
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发表时间：
2017-05-01
影响因子：
4.8
通讯作者：
Bhattacharyya, S.
中科院分区：
文献类型：
--
作者：
Appiah-Kusi, E.;Fisher, H. L.;Bhattacharyya, S.
童年创伤与精神病症状、精神错乱(UHR)的超高风险以及精神分裂症等精神障碍有关。消极的自我信念已经被证明在童年创伤和偏执之间的关系中起到部分中介作用，并且已经被证明是精神病患者的特征。然而，儿童创伤与发展成精神病(如UHR)和偏执狂症状的高风险之间的联系是否由认知图式改变所中介尚不清楚，因此需要进行调查，以便为预防干预提供信息。来自伦敦南部外展和支持中心的30名UHR患者的数据是从童年创伤、认知图式、偏执狂和大麻使用中收集的。与健康对照组(n=38)相比，UHR患者报告的童年创伤(情感和性虐待，以及情感和身体忽视)的可能性明显更大，对自己和他人的负面图式更多，正面图式更少，每月吸食大麻以上的可能性更大。即使在控制了以前使用大麻的影响后，情绪忽视也被发现与UHR状况显著相关(b=0.262，95%CI：0.115-0.408)，这种联系部分地由负面自我图式(b=0.045，95%CI：0.004-0.159)中介。同样，情绪忽视与偏执显著相关(b=1.354，95%CI：0.246-2.462)，并且这种关联部分由负面自我图式中介(b=0.988，95%CI：0.323-1.895)。这些发现为认知机制提供了初步证据，这些认知机制可能是童年创伤和后来患精神病风险之间的联系的基础。(C)2017爱思唯尔有限公司。保留所有权利。
Exposure to childhood trauma has been associated with psychotic symptoms, being at ultra-high risk for psychosis (UHR), and psychotic disorders such as schizophrenia. Negative self-beliefs have been shown to partially mediate the relationship between childhood trauma and paranoia and have been shown to be characteristic of patients with psychosis. However, whether the association between childhood trauma and being at high risk of developing psychosis (e.g., UHR) and paranoia symptoms is mediated by altered cognitive schema is unknown and warrants investigation to inform preventive interventions. Data was collected on 30 UHR patients from Outreach and Support in South London about exposure to childhood trauma, cognitive schema, paranoia and cannabis use. Relative to healthy controls (n = 38), UHR patients were significantly more likely to report exposure to various types of childhood trauma (emotional and sexual abuse, and emotional and physical neglect), had more negative schema and less positive schema about themselves and others, and were more likely to use cannabis more than once a month. Emotional neglect was found to be significantly associated with UHR status even after controlling for the effects of previous exposure to cannabis use (b = 0.262, 95% CI: 0.115-0.408), and this association was partially mediated by negative self-schema (b = 0.045, 95% CI: 0.004-0.159). Similarly, emotional neglect was significantly associated with paranoia (b = 1.354, 95% CI: 0.246-2.462), and this association was partially mediated by negative self-schema (b = 0.988, 95% CI: 0.323-1.895). These findings provide preliminary evidence about the cognitive mechanisms that may underlie the association between childhood trauma and later risk for psychosis. (C) 2017 Elsevier Ltd. All rights reserved.