Predictors of distress associated with psychotic-like anomalous experiences in clinical and non-clinical populations
Predictors of distress associated with psychotic-like anomalous experiences in clinical and non-clinical populations
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DOI：
10.1111/bjc.12036
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发表时间：
2014-06-01
影响因子：
3.1
通讯作者：
Peters, Emmanuelle
中科院分区：
文献类型：
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作者：
Brett, Caroline;Heriot-Maitland, Charles;Peters, Emmanuelle
目的精神类异常经历本身并不令人痛苦，也不一定会导致临床症状。然而，痛苦是精神病发病和复发的重要预测因素，也是心理健康问题的主要指标。这项研究的目的是在三组有异常经历的人群中确定预测痛苦的因素。设计和方法本研究采用横断面设计。确诊组(n=35)、高危组(n=20)和未确诊组(n=36)的参与者完成了异常体验访谈的评估(AANEX；Brett等，2007，BR。J·精神病学，191，s23)，它利用了经历的异常、评估和其他心理和背景变量。结果高痛苦的预测因子是异常状态，表现为意识和认知功能的改变(而不是更典型的积极症状)，对他人造成的体验的评价，以及对体验的更大尝试控制。较低痛苦的预测因子是精神评价、更大的社会支持/理解、更大的感知可控性、以及对中性反应的反应。结论虽然精神病患者的经历本身不一定是痛苦的，但对异常的评价和反应确实可以预测痛苦，与社会背景有关的因素也是如此。这增加了对积极精神病症状的认知-行为模型和连续统模型的支持。实践者指出，研究结果表明，通过发展可以接受、理解和分享精神病经验的正常化和验证化的环境，可以减少痛苦。建议提供促进重新评估和/或接受精神疾病经验的治疗方法，而不是试图控制它们。这些发现强化了精神病的连续统一体模型，以帮助培养更少的污名化和更正常化的精神体验观点。一个限制是，招募的样本不能被认为代表所有经历精神病样异常的人。另一个限制是，少数AANEX项目没有达成令人满意的评价者之间的协议。
ObjectivesPsychotic-like anomalous experiences are not inherently distressing, nor do they inevitably lead to clinical conditions. However, distress is an important predictor of onset and relapse in psychosis, and a primary indicator of problematic mental health. This study aimed to identify factors that predict distress across three groups with anomalous experiences.Design and methodsThis study used a cross-sectional design. Participants in Diagnosed' (n=35), At Risk' (n=20), and Undiagnosed' (n=36) groups completed the Appraisals of Anomalous Experiences Interview (AANEX; Brett etal., 2007, Br. J. Psychiatry, 191, s23), which taps anomalies experienced, appraisals, and other psychological and contextual variables. A series of ordinal logistic regression analyses was conducted to investigate which variables predicted anomaly-related distress.ResultsPredictors of higher distress were anomalous states characterized by changes in awareness and cognitive functioning (rather than more typical positive symptoms), appraisals of experiences as caused by other people', and greater attempted control over experiences. Predictors of lower distress were spiritual' appraisals, greater perceived social support/understanding, greater perceived controllability, and reacting with a neutral response'.ConclusionsWhile psychotic-like experiences themselves are not necessarily distressing, appraisals and responses to anomalies do predict distress, as do factors relating to the social context. This adds support to the cognitive-behavioural models, and continuum models, of positive psychotic symptoms.Practitioner points The findings suggest that distress is reduced by developing normalizing and validating contexts in which psychotic experiences can be accepted, understood, and shared. Recommendation for delivering therapies that promote reappraising and/or accepting psychotic experiences, rather than attempting to control them. The findings reinforce the continuum model' of psychosis to help cultivate less stigmatizing, and more normalizing, views of psychotic experiences. A limitation is that the samples recruited cannot be assumed to be representative of all people experiencing psychotic-like anomalies. A further limitation is that a small number of AANEX items did not achieve satisfactory inter-rater agreement.