Background and Hypothesis Influential models of psychosis indicate that the impact of putative causal factors on positive symptoms might be explained partly through affective disturbances. We aimed to investigate whether pathways from stress and self-esteem to positive symptoms, as well as reversal pathways from symptoms to stress and self-esteem, were mediated through specific affective disturbances across the extended psychosis phenotype. Study Design Using experience sampling methodology, 178 participants (65 high-schizotypy, 74 at-risk mental state, and 39 first-episode psychosis) were assessed on levels of momentary stress, self-esteem, anxiety, sadness, psychotic-like experiences (PLE), and paranoia. Multilevel mediation models were fit to examine indirect effects of each of these pathways. Considering evidence of mediation, each indirect pathway will be combined in a single model to explore their relative contributions. Study Results Anxiety, sadness, and self-esteem mediated the pathways from stress to PLE and paranoia in daily-life. In the pathway to paranoia, sadness, and self-esteem showed larger contributions than anxiety. Pathways from self-esteem to PLE and paranoia were mediated by anxiety and sadness, the later showing a larger contribution. Pathways from symptoms to stress, but not from symptoms to self-esteem, were differently explained by emotional states; sadness lost its mediating effect and anxiety was the most important mediator. Few differences across groups were found. Conclusions This study lends support to psychological models of psychosis that highlight the relevance of affective disturbances in the risk and expression of psychosis. Furthermore, specific influences of different negative emotional states were identified, which could enhance psychological treatments.

中文翻译：

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日常生活中偏执狂和精神病样体验的心理途径：不同情感障碍的中介作用

背景和假设 精神病的影响模型表明，假定的因果因素对阳性症状的影响可能部分通过情感障碍来解释。我们旨在调查从压力和自尊到积极症状的途径，以及从症状到压力和自尊的逆转途径，是否通过扩展精神病表型中的特定情感障碍介导。研究设计 使用经验抽样方法，对 178 名参与者（65 名高度分裂型、74 名处于危险精神状态和 39 名首发精神病）的瞬时压力、自尊、焦虑、悲伤、精神病样体验水平进行了评估（ PLE）和偏执狂。多级中介模型适合检查这些途径中的每一个的间接影响。考虑到调解的证据，每个间接途径将被组合在一个模型中，以探索它们的相对贡献。研究结果 焦虑、悲伤和自尊在日常生活中介导了从压力到 PLE 和偏执狂的途径。在通往偏执狂的道路上，悲伤和自尊比焦虑表现出更大的贡献。从自尊到 PLE 和偏执狂的途径是由焦虑和悲伤介导的，后者表现出更大的贡献。从症状到压力的途径，而不是从症状到自尊的途径，对情绪状态的解释不同；悲伤失去了中介作用，焦虑是最重要的中介。几乎没有发现各组之间的差异。结论 本研究支持精神病的心理模型，强调情感障碍与精神病风险和表达的相关性。此外，