Estudio de la fenomenología y dinámica de mecanismos psicológicos implicados en la psicosis incipiente
- Autores: Manel Monsonet Bardají
- Directores de la Tesis: Neus Barrantes-Vidal (dir. tes.)
- Lectura: En la Universitat Autònoma de Barcelona ( España ) en 2019
- Idioma: español
- Tribunal Calificador de la Tesis: Anabel Martínez Arán (presid.), Juan Francisco Rodríguez Testal (secret.), Miriam Fornells-Ambrojo (voc.)
- Programa de doctorado: Programa de Doctorado en Psicología Clínica y de la Salud por la Universidad Autónoma de Barcelona
- Materias:
- Enlaces
- Tesis en acceso abierto en: TESEO
- Resumen
The main objective of this thesis was to study the phenomenology and dynamics of potential psychological mechanisms related to psychosis onset. For this purpose, a sample of individuals with psychometric risk of developing a psychosis, as well as a clinical sample composed of individuals with at-risk mental state for psychosis (ARMS) and a first-episode of psychosis (FEP) was employed. Experience sampling methodology (ESM) was employed in four of the six empirical investigations presented, which through repeated assessments of mental experiences in real-time in the real world offers complementary and more ecologically valid data than that yielded by traditional clinical and psychometric evaluations.
This thesis shows that in a non-clinical sample the interaction between paranoid and depressive traits entail a more negative self-representation and a high discrepancy between implicit and explicit self-esteem, which could lead to an increased risk towards psychopathology. In the clinical samples, it was found that trait and state explicit self- esteem were associated with paranoid ideation in daily life, while no association was found between implicit self-esteem and paranoia, neither in the ARMS group nor in the FEP group. Anxiety and social support moderated the relationships between self-esteem and paranoia, being feeling cared for by others a key protective factor regarding the possible negative impact that low self-esteem could exert on paranoid ideation in daily life. Another study indicated that sadness, anxiety, and low self-esteem partly mediated the association between stress and positive symptoms, while sadness and low self-esteem, but not anxiety, mediated the relationship between stress and paranoia. In the same way, the association between self-esteem and psychotic symptoms (and paranoia) was mediated by anxiety and sadness, although sadness had a greater relative contribution. Furthermore, the causal relationships between different psychological factors and positive symptoms were analyzed, finding that stress, sadness, and perceived social support predicted subsequent levels of paranoia and positive symptoms in daily life with time-lagged analyses. Anxiety was associated with a subsequent increase in positive symptoms, but not paranoia, while being in an unwanted social environment increased paranoia, but not positive symptoms. A study examining the impact of the family environment of individuals with ARMS and FEP on the expression of positive symptoms showed that the association between relatives’ expressed emotion and patients’ positive symptoms was serially mediated first by the expressed emotion perceived by patients, and then by patients’ negative self-esteem. In addition, patients’ emotional distress moderated this association. Finally, a psychometric study of the main instrument used to assess depression in schizophrenia was performed in a sample composed of people with psychometric risk of developing psychosis, ARMS patients, and FEP patients. Results showed that it is a valid and reliable to assess depressive symptoms across the psychosis continuum.
Overall, the results of this thesis underline the relevance of affective processes and self-esteem in the development and onset of positive psychotic symptoms, both directly and in interaction with other factors such as stress or the family environment. In addition, findings highlight the need to refine and broaden the understanding of the complex psychosocial interactions that underlie the genesis of psychosis.
