Stress Reactivity & Protective Factors in Schizophrenia

有压力的生活事件显著增加精神分裂症患者精神病复发和抑郁加重的风险，但并非所有人对压力的反应都相同。在反应性方面存在差异，个体的典型或“环境”反应性水平在疾病过程中可能发生变化。Nuechterlein、Dawson、Gitlin和我提出了一个多因素模型，假设神经认知和心理生理脆弱性因素和紧张的生活经历随着时间的推移相互作用和修改，从而产生精神分裂症的特征性精神病症状。本研究建议使用纵向、前瞻性的数据集，包括频繁评估的压力生活事件、对压力的认知评估、工作记忆表现和精神病症状的反复评估，以了解更多关于精神分裂症早期病程中的压力反应性和保护因素。为了解决预测因素和结果的关键问题，我们计划使用创新的生物统计学策略，如随机效应建模。我们的目的是确定对压力的反应是否存在可靠的个体差异，并确定对压力的认知评估是否是压力和精神病症状的中介和调节因素。我们提出了一个模型来解释暴露于负面压力生活事件和工作记忆缺陷之间的相互作用如何影响对压力的认知评估，以及随后精神病症状的严重程度。

Stressful life events significantly increase the risk of psychotic relapse and depressive exacerbation in people with schizophrenia, but not all individuals respond to stress in the same way. There are differences in reactivity and in individual's typical or "ambient" level of reactivity may change during the course of illness. Nuechterlein, Dawson, Gitlin, and I have proposed a multifactorial model positing that neurocognitive and psychophysiological vulnerability factors and stressful life experience interact with and modify each other over time to produce the characteristic psychotic symptoms of schizophrenia. This study proposes to use a longitudinal, prospective data set of frequently assessed stressful life events, cognitive appraisals of stress, working memory performance and repeated assessment of psychotic symptoms to learn more about stress reactivity and protective factors in the early course of schizophrenia. To address critical issues of predictors of course and outcome, we plan to use innovative biostatistical strategies such as random effects modeling. Our aims are to identify whether there are reliable individual differences in reactivity to stress and to determine if cognitive appraisal of stress is a mediator and a moderator of stress and psychotic symptoms. We propose a model that explains how an interaction among exposure to negative stressful life events, and working memory deficits may influence cognitive appraisal of stress, and the subsequent severity of psychotic symptoms.