OBJECTIVE Obsessive-compulsive symptoms (OCS) frequently occur in patients with psychotic disorders and are associated with higher burden and poorer prognosis. This study prospectively investigated the effect of stressful experiences on the severity of OCS and co-occurring psychotic and affective symptoms, with a focus on within-subject processes. METHOD Monthly assessments over 6 months in patients with a psychotic disorder (n = 56) and unaffected siblings (n = 49) resulted in 309 and 277 observations, respectively. Linear mixed-effects models investigated the disaggregated effects of within-subject changes and between-subject differences in stressful events on OCS, positive, negative and depressive symptoms. Subsequently, moderating effects of coping strategies and dysfunctional metacognitive beliefs were assessed. Mediation analyses investigated direct and indirect effects of stressful events on OCS four weeks later. RESULTS Stressful experiences were associated with severity in almost all symptom domains on the between- and within-subject levels. Dysfunctional coping and metacognitive beliefs moderated these associations. Patients and siblings with a tendency for passive coping showed higher within-subject increase in depressive symptoms, whereas passive coping and dysfunctional beliefs moderated the association between stressful experiences and severity of positive symptoms and OCS on the between-subject level. Effects of stressful experiences on OCS four weeks later were partially mediated by depressive and positive symptoms in patients and siblings. CONCLUSIONS Findings suggest that severity and variability of co-occurring psychopathology can partly be explained by recent stressful events and the way individuals cope with these experiences. The implementation of coping-oriented interventions could possibly help to prevent development and/or aggravation of co-occurring symptom severity.

中文翻译：

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压力经历影响同时发生的强迫症和精神病症状的过程：关注对象内过程

目的 强迫症 (OCS) 经常发生在精神病患者中，并且与更高的负担和更差的预后相关。本研究前瞻性地调查了压力经历对 OCS 严重程度和同时发生的精神病和情感症状的影响，重点是受试者内部过程。方法 对精神病患者 (n = 56) 和未受影响的兄弟姐妹 (n = 49) 进行 6 个月的每月评估，结果分别为 309 和 277 次观察。线性混合效应模型研究了压力事件中受试者内变化和受试者间差异对 OCS、阳性、阴性和抑郁症状的分解影响。随后，评估了应对策略和功能失调的元认知信念的调节作用。中介分析调查了 4 周后压力事件对 OCS 的直接和间接影响。结果 压力经历与受试者间和受试者内几乎所有症状领域的严重程度相关。功能失调的应对和元认知信念调节了这些关联。有被动应对倾向的患者和兄弟姐妹表现出更高的受试者内抑郁症状增加，而被动应对和功能失调的信念在受试者间水平上缓和了压力经历与阳性症状的严重程度和 OCS 之间的关联。4 周后压力经历对 OCS 的影响部分由患者和兄弟姐妹的抑郁和阳性症状介导。结论 研究结果表明，同时发生的精神病理学的严重性和可变性可以部分地由最近的压力事件和个人应对这些经历的方式来解释。以应对为导向的干预措施的实施可能有助于防止同时发生的症状严重程度的发展和/或恶化。