Stress Reactivity & Protective Factors in Schizophrenia

压力性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，但并非所有个体对压力的反应都是一样的。反应性存在差异，个体的典型或“环境”反应水平可能在疾病过程中发生变化。Nuechterlein、Dawson、Gitlin和我提出了一个多因素模型，认为神经认知和心理生理脆弱性因素与应激性生活经历随着时间的推移相互作用并相互修正，从而产生精神分裂症的特征性精神病症状。本研究建议使用一个纵向的，前瞻性的数据集，经常评估的压力生活事件，认知评估的压力，工作记忆的表现和精神病症状的重复评估，以了解更多关于精神分裂症的早期过程中的应激反应和保护因素。为了解决过程和结果的预测因素的关键问题，我们计划使用创新的生物统计策略，如随机效应建模。我们的目的是确定是否有可靠的个体差异的反应压力，并确定是否认知评估的压力是一个调解人和调解人的压力和精神病症状。我们提出了一个模型，解释了如何暴露于负压力的生活事件之间的相互作用，和工作记忆缺陷可能会影响认知评估的压力，以及随后的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.