The Role of Emotion in Psychosis Onset and Symptom Persistence: A Systematic Review

IF 2.2 4区医学 Q3 PSYCHIATRY

Early Intervention in Psychiatry Pub Date : 2025-10-04 DOI:10.1111/eip.70096

R. Gurnani, A. Georgiades

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Abstract

Aim

Emotions have repeatedly been implicated in the development and maintenance of psychosis. However, there is no universally acknowledged theory to account for how emotions influence psychosis. This review, therefore, aims to explore how emotions and emotional coping strategies contribute to the onset and persistence of psychosis symptoms.

Method

A systematic review was conducted to summarise the existing evidence base regarding the role of emotions and emotional coping strategies across the psychosis continuum, including individuals at Clinical High Risk (CHR), those experiencing a First Episode of Psychosis (FEP), and those with a diagnosis of Schizophrenia (SZ).

Results

Seventy-eight studies were eligible for inclusion. Compared to Healthy Controls (HCs), SZ and CHR individuals demonstrated significant impairments in emotional awareness, emotional understanding of self and others, and emotional regulation, along with heightened emotional reactivity. In SZ, lower emotional awareness, negative emotional reactivity, and emotional dysregulation were significantly associated with increased positive symptoms. Individuals with SZ reported high levels of Negative Affect (NA) and low levels of Positive Affect (PA), with NA being a strong predictor of paranoia and rumination strengthening the affective pathway to paranoia. In terms of coping, CHR and SZ demonstrated significantly greater use of Maladaptive Coping Strategies (MCS) than Adaptive Coping Strategies (ACS) compared to HCs. MCS such as suppression were significantly associated with increased positive and negative symptoms, social withdrawal, and depression severity in SZ, while ACS such as cognitive reappraisal significantly decreased negative symptoms, depression, and social withdrawal and improved social functioning. Individuals with SZ predominantly employed Emotion-Focused Coping (EFC) rather than Problem-Focused Coping (PFC), which were associated with negative and positive outcomes, respectively.

Conclusion

These findings highlight the important role of emotion in psychosis onset and symptom persistence. Given the prominence of emotions in the manifestation and maintenance of psychosis, the development of emotion-focused interventions for psychosis is necessary to not only prevent transition and relapse but also to maintain recovery. To support clinical application, this review also provides Socratic questions and recommends practical therapeutic tools to assist clinicians in the assessment, formulation, and intervention of emotional dysregulation in psychosis.

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情绪在精神病发病和症状持续中的作用：一项系统综述

目的情绪与精神病的发展和维持有反复的关系。然而，目前还没有一个公认的理论来解释情绪是如何影响精神病的。因此，本综述旨在探讨情绪和情绪应对策略如何促进精神病症状的发生和持续。方法系统回顾了现有的关于情绪和情绪应对策略在精神病连续体中的作用的证据基础，包括临床高危人群（CHR）、首发精神病患者（FEP）和精神分裂症患者（SZ）。结果78项研究符合纳入条件。与健康对照组（hc）相比，SZ和CHR个体在情绪意识、对自我和他人的情绪理解和情绪调节方面表现出显著的障碍，同时情绪反应性增强。在SZ中，较低的情绪意识、消极的情绪反应和情绪失调与阳性症状的增加显著相关。SZ个体报告高水平的负性情感（NA）和低水平的正性情感（PA），负性情感是偏执狂的强预测因子，反刍强化了偏执狂的情感途径。在应对方面，高智商学生和高智商学生使用非适应应对策略的比例显著高于适应应对策略的比例。抑制等MCS与SZ患者阳性和阴性症状、社交退缩和抑郁严重程度的增加显著相关，而认知重评等ACS显著降低了SZ患者的阴性症状、抑郁和社交退缩，改善了社会功能。SZ型个体主要采用情绪聚焦型应对（EFC）而非问题聚焦型应对（PFC），二者分别与消极结果和积极结果相关。结论情绪在精神病发病和症状持续中的重要作用。鉴于情绪在精神病的表现和维持中的突出地位，发展以情绪为中心的精神病干预措施不仅可以防止过渡和复发，而且可以维持康复。为了支持临床应用，本综述还提供了苏格拉底式的问题，并推荐了实用的治疗工具，以帮助临床医生评估、制定和干预精神病患者的情绪失调。

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来源期刊

Early Intervention in Psychiatry 医学-精神病学

CiteScore

4.80

自引率

5.00%

发文量

112

审稿时长

6-12 weeks

期刊介绍： Early Intervention in Psychiatry publishes original research articles and reviews dealing with the early recognition, diagnosis and treatment across the full range of mental and substance use disorders, as well as the underlying epidemiological, biological, psychological and social mechanisms that influence the onset and early course of these disorders. The journal provides comprehensive coverage of early intervention for the full range of psychiatric disorders and mental health problems, including schizophrenia and other psychoses, mood and anxiety disorders, substance use disorders, eating disorders and personality disorders. Papers in any of the following fields are considered: diagnostic issues, psychopathology, clinical epidemiology, biological mechanisms, treatments and other forms of intervention, clinical trials, health services and economic research and mental health policy. Special features are also published, including hypotheses, controversies and snapshots of innovative service models.