The Relationship Between Dissociation and Symptoms of Psychosis: A Meta-analysis
The Relationship Between Dissociation and Symptoms of Psychosis: A Meta-analysis
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DOI：
10.1093/schbul/sbaa037
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发表时间：
2020-09-01
影响因子：
6.6
通讯作者：
Varese, Filippo
中科院分区：
文献类型：
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作者：
Longden, Eleanor;Branitsky, Alison;Varese, Filippo
有证据表明，分离与精神病经历有关，特别是幻觉，但也与其他症状有关。然而，到目前为止，特异性的解离关系还没有得到全面的综合。这是第一项前瞻性注册（CRD 42017058214）荟萃分析，旨在量化分离经历与精神病所有症状之间的关联程度。使用表示分离和精神病症状的详尽术语检索MEDLINE、PsycINFO、PubMed和Scopus数据库。我们纳入了非临床（58项研究; 16557名参与者）和临床（46项研究; 3879名患者参与者）样本，并评估了研究质量。保留了涉及20436名受试者的93篇合格文章进行分析。分离症状与临床和非临床阳性精神病性症状之间存在强相关性（r = 0.437; 95%CI：0.386 - 0.486），在非临床研究中观察到的效应更大。在临床和非临床研究中，症状特异性相关性也很明显，包括幻觉（r = .461; 95%CI：.386 - .531）、妄想（r = .418; 95%CI：.370 - .464）、偏执（r = .447; 95%CI：.393 - .499）和混乱（r = .346; 95%CI：.249 - .436）的显著汇总效应。与阴性症状的关联很小，在某些情况下，不显着。总的来说，这些发现证实了解离现象不仅与幻觉密切相关，而且与多种阳性症状密切相关，与阴性症状的相关性较低。我们的研究结果是一致的建议，建议某些精神病症状可能会更好地概念化为解离的性质，并支持制定和治疗精神病的经验，针对解离的干预措施的发展。
Evidence suggests that dissociation is associated with psychotic experiences, particularly hallucinations, but also other symptoms. However, until now, symptom-specific relationships with dissociation have not been comprehensively synthesized. This is the first prospectively registered (CRD42017058214) meta-analysis to quantify the magnitude of association between dissociative experiences and all symptoms of psychosis. MEDLINE, PsycINFO, PubMed, and Scopus databases were searched using exhaustive terms denoting dissociation and psychotic symptoms. We included both nonclinical (58 studies; 16 557 participants) and clinical (46 studies; 3879 patient participants) samples and evaluated study quality. Ninety-three eligible articles considering 20 436 participants were retained for analysis. There was a robust association between dissociation and clinical and nonclinical positive psychotic symptoms (r = .437; 95%CI:.386 - .486), with the observed effect larger in nonclinical studies. Symptom-specific associations were also evident across clinical and nonclinical studies, and included significant summary effects for hallucinations (r = .461; 95%CI:.386 - .531), delusions (r = .418; 95%CI:.370 - .464), paranoia (r = .447; 95%CI:.393 - .499), and disorganization (r = .346; 95%CI:.249 - .436). Associations with negative symptoms were small and, in some cases, not significant. Overall, these findings confirm that dissociative phenomena are not only robustly related to hallucinations but also to multiple positive symptoms, and less robustly related to negative symptoms. Our findings are consistent with proposals that suggest certain psychotic symptoms might be better conceptualized as dissociative in nature and support the development of interventions targeting dissociation in formulating and treating psychotic experiences.