Criticism and Depression among the Caregivers of At-Risk Mental State and First-Episode Psychosis Patients.
Criticism and Depression among the Caregivers of At-Risk Mental State and First-Episode Psychosis Patients.
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DOI：
10.1371/journal.pone.0149875
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Matsumoto K
中科院分区：
文献类型：
--
作者：
Hamaie Y;Ohmuro N;Katsura M;Obara C;Kikuchi T;Ito F;Miyakoshi T;Matsuoka H;Matsumoto K
情感表达（EE），尤其是批评，是多种心理健康问题患者预后的一个重要预测因素。为了解早期精神病阶段情感表达与各种相关变量之间的复杂联系，本研究考察了照顾者的批评、痛苦程度，其他患者及照顾者的变量，以及处于精神病风险精神状态（ARMS）和首发精神病（FEP）患者中批评与这些变量之间的联系。参与者包括56名处于ARMS的患者（平均年龄18.8±4.2岁）及其照顾者（49.4±5.8岁），以及43名患有FEP的患者（21.7±5.2岁）及其照顾者（49.3±7.4岁）。我们使用日版家庭态度量表调查照顾者的批评情况，并通过自评贝克抑郁量表评估照顾者的抑郁症状。我们还评估了患者的精神症状和功能。大约三分之一的ARMS或FEP患者的照顾者有抑郁症状，主要是轻至中度症状水平，而只有一小部分表现出高度批评。ARMS和FEP照顾者的批评和抑郁水平相当。在FEP照顾者中观察到批评、照顾者抑郁和患者症状之间的联系，但在ARMS照顾者中未观察到。这些发现表明，批评与照顾者及患者精神状态之间的相互作用可能在确诊精神病发作期间或之后形成，并且对照顾者的干预措施应根据患者疾病的特定阶段进行调整。对FEP照顾者的干预应针对他们的情绪困扰，并包括有关患者一般症状的教育。
Expressed emotion (EE), especially criticism, is an important predictor of outcomes for the patient for a wide range of mental health problems. To understand complex links between EE and various relevant variables in early phase psychosis, this study examined criticism, distress of caregivers, other patients’, and caregivers’ variables, and links between criticism and these variables in those with at-risk mental state (ARMS) for psychosis and first-episode psychosis (FEP). The participants were 56 patients (mean age 18.8 ± 4.2 years) with ARMS and their caregivers (49.4 ± 5.8 years) and 43 patients (21.7 ± 5.2 years) with FEP and their caregivers (49.3 ± 7.4 years). We investigated criticisms made by caregivers using the Japanese version of the Family Attitude Scale and caregiver depressive symptoms via the self-report Beck Depression Inventory. We also assessed psychiatric symptoms and functioning of the patients. Approximately one-third of caregivers of patients with ARMS or FEP had depressive symptoms, predominately with mild-to-moderate symptom levels, whereas only a small portion exhibited high criticism. The level of criticism and depression were comparable between ARMS and FEP caregivers. The link between criticism, caregivers’ depression, and patients’ symptoms were observed in FEP but not in ARMS caregivers. These findings imply that the interaction between criticism and caregivers’ and patients’ mental states may develop during or after the onset of established psychosis and interventions for the caregivers should be tailored to the patient’s specific stage of illness. Interventions for FEP caregivers should target their emotional distress and include education about patient’s general symptoms.