Академический Документы
Профессиональный Документы
Культура Документы
References This article cites 0 articles, 0 of which you can access for free at:
http://bjp.rcpsych.org/content/180/6/523#BIBL
Reprints/ To obtain reprints or permission to reproduce material from this paper, please
permissions write to permissions@rcpsych.ac.uk
?@A
9 M 3 N OP
O P Q 9;P 8 9 + R
-"(#',(. () +'$- () -&'.'&2' (+' 1$#,*,'.. )5 'R"3#,"(#),F B%-'&2#.#), C". -&)2#*'* 1/ 0)2"&#",0' ",* 0+#Q.e%"&'* ('.(.= C#(+ &#.9
(+' &"(#,4.F " 2"&#'(/ )5 3'(+)*. *%&#,4 (+' .(%*/= &"(#). 0"$0%$"('* 5)& 0"('4)�"$ 2"&#"1$'.F
B(",*"&*#.'* 3'".%&'. C'&' %.'* () #,0$%*#,4 #,*#2#*%"$= 4&)%- ",* ('$'-+),'F M'.(. )5 .9'C,'.. ",* ,)&3"$#(/ "0&)..
"..'.. (+' -"&/ )%(0)3'. )5 (+' .(%*/ G"(#',(. #, (+' L8M 4&)%- ."C (+' ,%&.' 0$#,#0"$ 2"&#"1$'. C'&' C#(+#, "00'-("1$'
"( 1".'$#,' ",* "( (+' ',* )5 (+'&"-/ 73'", 5)& " ()("$ )5 %- () .#R +)%&Q$),4 .'..#),. $#3#(.F G"&/ ",* .'0),*"&/ )%(0)3'
IJ C''9.EF M+' -"&/ )%(0)3' 3'".%&'. )2'& " -'&#)* )5 (C) )& (+&'' 3),(+.F Z5 3'".%&'. C'&' "..'..'* #, &'$"(#), ()
C'&' )5 )2'&"$$ ./3-()3"()$)4/ 7L)3-&'Q (+' -"(#',(b. 0"&'& "4&''* () ("9' -"&( #, C+'(+'& (+'&' C". " .#4,#5#0",( *#55'&',0'
+',.#2' G./0+)-"(+)$)4#0"$ _"(#,4 B0"$'= (+' -&)4&"33'= +' )& .+' &'0'#2'* " ()("$ 7%!fIIE
%.#,4 #,(',(#),Q()Q(&'"( 7% fIIE ","$/.#.
^c .1'&4 !" #$=
^.1'&4 #$= >?D@E= #,.#4+( 7Z,.#4+( _"(#,4 )5 (+&'' .'..#),. )2'& (+' ."3' (#3' -'&#)*F )5 0)2"&#",0'F M+' 0)2"&#"('. %.'* C'&'
B0"$'A ["2#*= >??JE ",* 0"&'& 1%&*', G"(#',(. C+) "((',*'* $'.. (+", (+&'' L8M (&'"(3',( 4&)%- ",* 1".'$#,' 3'".%&'Q
78%&*', )5 L"&' d%'.(#),,"#&'A H%'.'& !" .'..#),. C'&' 0$"..#5#'* ". *&)-Q)%(.F 3',(. 5)& (+' 0)&&'.-),*#,4 *'-',*',(
#$=
#$= >??PEF B'0),*"&/ )%(0)3' 3'".%&'. ^$$ (+' -+".'. )5 L8M C'&' #,0$%*'* #, 2"&#"1$'.F G).( (+'&"-/= 3#..#,4 *"(" C'&'
#,0$%*'* 0+",4' #, .0+#6)-+&',#0 ./3-()3. (+' 1&#'5 "--&)"0+= #,0$%*#,4 "..'..3',( '.(#3"('* 1/ 0"$0%$"(#,4 (+' &'.-'0(#2'
7B0+#6)-+&',#" L+",4' B0"$'A H),(4)3'&/ ",* ',4"4#,4= *'2'$)-#,4 'R-$","(#),.= -).(Q(+'&"-/ 4&)%- 3'",. )5 (+).' -"(#',(.
!" #$=
#$= >?D@E ",* *'-&'..#), 7H),(4)3'&/K 0".' 5)&3%$"(#),= ./3-()3 3","4'3',(= C+) &'(%&,'* 5)& 5)$$)CQ%-F M+'.' 3'",.
^c .1'&4 _"(#,4 B0"$'A H),(4)3'&/ ;
^.1'&4 "*+'&',0'= C)&9#,4 C#(+ 0)&' 1'$#'5. ",* C'&' ',('&'* 5)& (+).' -"(#',(. C+)
^c .1'&4= >?D?EF H'".%&'. )5 -"(#',( ",*
^.1'&4= &'$"-.' -&'2',(#),F Z, 0),g%,0(#), C#(+ *&)--'* )%(F M+' $'2'$ )5 #3-&)2'3',( #,
0"&'& ."(#.5"0(#), C'&' *'2#.'* 5)& (+' (+' -+".'* "--&)"0+= ",* #,('4&"$ () '"0+ (+' 3"#, )%(0)3' 3'".%&'. #,*#0"(#,4 "
-%&-).'. )5 (+#. .(%*/F !)& (+' -"(#',(= .'..#),= C'&' " .'&#'. )5 (', .-'0#"$$/ *'2'$Q 4))* 0$#,#0"$ #3-&)2'3',( C". ("9', ".
(+' e%'.(#),. 0)2'&'* #..%'. .%0+ ". e%"$#(/ )-'* '*%0"(#),"$ 1))9$'(. K 5#2' 5)& IUaF M+#. C". *'0#*'* ), ", # &'()'( 1".#.
)5 (+'&"-/ &'$"(#),.+#-= %,*'&.(",*#,4= -"(#',(. ",* 5#2' 5)& 0"&'&.F M+' 1))9$'(. #, &'$"(#), () )(+'& -%1$#.+'* C)&9F
0)-#,4= 3))* ",* )2'&"$$ ."(#.5"0(#),F M+' 0)2'&'* (&'"(3',(= .'$5Q0"&' ",* $#5'.(/$'= ^,"$/.#. )5 0$#,#0"$$/ .#4,#5#0",( &'.%$(.
0"&'& ."(#.5"0(#), e%'.(#),,"#&' 0),("#,'* $'#.%&' (#3' ",* &'$"(#),.+#-.= *&%4 ",* C". (+', 0"&&#'* )%( %.#,4 0+#Q.e%"&'*
.#3#$"& e%'.(#),. () 1' ",.C'&'* #, &'$"(#), "$0)+)$ "*2#0'= ./3-()3 3","4'3',( ",* ('.(.F
() (+'#& &)$' ". 0"&'&F M+' e%'.(#),. C'&' .)%&0'. )5 +'$-= ",* C'&' C)&9'* (+&)%4+
",.C'&'* ), " .'2',Q-)#,( 2#.%"$ ","$)4%' #, " 5$'R#1$' 3",,'& "00)&*#,4 () (+'
.0"$'F _'.%$(. C'&' .',( 5&)3 '"0+ )5 (+' -"(#',(b. ",* 0"&'&b. #,*#2#*%"$ ,''*.F 38<MR9<
.#R .#('. () ", #,*'-',*',( 0',(&"$ *"("1".' ^--&)-&#"(' +)3'C)&9 C". 4','&"('*F ^$$
5)& *"(" ',(&/ ",* #,*'-',*',( .("(#.(#0"$ )5 (+' -"(#',(. C'&' (&'"('* #, (+' M+' 0+"&"0('&#.(#0. )5 (+' -"(#',( ."3-$'
","$/.#.F ['("#$. )5 3'*#0"(#),= 0),2'&('* 0)33%,#(/ )&= #5 "--&)-&#"('= 5)$$)C#,4 "&' *'.0'* #, M"1$' >F M+'&' C'&' ,)
() 0+$)&-&)3"6#,' 'e%#2"$',(. %.#,4 (+' "((',*",0' "( *'-)( 0$#,#0= 0)33%,#(/ .("(#.(#0"$$/ .#4,#5#0",( 1".'$#,' *#55'&',0'.
\)&$* X'"$(+ ]&4",#6"(#),b. ^,"()3#0"$ 3',("$ +'"$(+ ('"3 )& )%(Q-"(#',( "--)#,(Q 1'(C'', (+' 4&)%-.F B'2'&#(/= ". '.(#3"('*
M+'&"-'%(#0 L+'3#0"$ L$"..#5#0"(#), 3',(.F L"&'&. C'&' .'', 3).( )5(', #, (+' 1/ ,%31'& )5 -&'2#)%. &'$"-.'. ",* 1/
B/.('3 7\)&$* X'"$(+ ]&4",#6"(#),= 5"3#$/ +)3'F ,%31'& )5 -&'2#)%. *"/. #, +).-#("$ 5)&
>??NE #, (+' 0".' )5 (/-#0"$ ,'%&)$'-(#0.= M+' -"(#',(. ",* 0"&'&. &",*)3#.'* () .0+#6)-+&',#"= C". ,)( .("(#.(#0"$$/ .#4,#5#Q
"$),4 C#(+ (+' ,%31'& )5 "(/-#0"$ ,'%&)Q &'0'#2' (&'"(3',( ". %.%"$ C'&' $'5( () (+' 0",($/ *#55'&',( 1'(C'', (+' 4&)%-.F M+'
$'-(#0. ",* -&'Q.(%*/ +).-#("$#."(#),= C'&' 0"&' )5 (+'#& )C, 0)33%,#(/ 3',("$ +'"$(+ L8M #,('&2',(#), 4&)%- +"* " 3'", )5
("9', 5&)3 (+' 3'*#0"$ 0".' ,)('.F M+'.' ('"3. 1%( C'&' "C"&' (+"( L8M C)%$* 1' fFD> -&'2#)%. "*3#..#),. 5)& .0+#6)-+&',#"
C'&' (+', &'0+'09'* "( (+' ',* )5 (+' .(%*/ )55'&'* "( (+' ',* )5 (+' .(%*/ -'&#)*F ^$$ 7?Ua LZ fFJ?KUFNNE C#(+ " 3'", ,%31'&
-'&#)* () 0+'09 5)& ",/ .#4,#5#0",( "..'..3',(. 0"&&#'* )%( #, (+' #,('&2',(#), )5 -&'2#)%. *"/. #, +).-#("$ 5)& .0+#6)Q
*#55'&',0'. 1'(C'', (+' 4&)%-.F !%&(+'& 4&)%- C'&' "$.) 0)3-$'('* #, (+#. 4&)%-F -+&',#" )5 f@FUN 7?Ua LZ NDF@fKU?FI>EF
"..'..3',(. )5 -"&/ )%(0)3' .0"$'. Z, 0)3-"&#.),= (+' M^V 4&)%- +"* " 3'",
",* )5 &'+).-#("$#."(#), C#$$ 1' 0"&&#'* )%( 9&0"1-0)1 7,*04,1= )5 UF>@ "*3#..#),. 7?Ua LZ fFNNKPFJNE
), "$$ 4&)%-. ? 3),(+. "5('& (+' ',* )5 ",* UIFJ> *"/. #, +).-#("$ 7?Ua LZ
^$$ .'..#),. C'&' "%*#)("-'* C+', -"(#',(.
(+'&"-/ () ".0'&("#, C+'(+'& (+' '55'0(. )5 NDF?fKPPFJDEF H'*#0"(#), *).' ". 4#2',
"4&''* () (+#.F Z,*'-',*',( '2"$%"(#), )5 "
(&'"(3',( "&' *%&"1$'F 1/ 0+$)&-&)3"6#,' 'e%#2"$',0' ",* %.' )5
.(&"(#5#'* ."3-$' )5 ("-'. C". 0"&&#'* )%(
"(/-#0"$ ,'%&)$'-(#0. C". ,)( .("(#.(#0"$$/
%.#,4 (+' 0)4,#(#2' (+'&"-/ .0"$' 3)*#5#'*
.#4,#5#0",($/ *#55'&',( 1'(C'', (+' (C)
9&0"1-0)1 %&'(>. 5)& -./0+).#. 7X"**)09 !" #$= #$= IJJ>EF ^
4&)%-.F M+' L8M #,('&2',(#), 4&)%- +"*
0%(Q)55 .0)&' )5 NJ C". ("9', ". #,*#0"(#,4
!)& *'$#2'&/ )5 (+' "0(#2' #,('&2',(#),= " 3'", 5#4%&' 5)& 0+$)&-&)3"6#,' 'e%#Q
"00'-("1$' e%"$#(/ )5 (+'&"-/ ","$/.#.F M+#.
LGY. &'0'#2'* >J *"/. )5 #,(',.#2' (&"#,#,4 2"$',0' )5 DfPF@@ 34 7?Ua LZ PJIFD?K
&'2'"$'* (+"( (+' 2".( 3"g)&#(/ )5 .'..#),.
#, (+' %.' )5 L8MF M+' 3",%"$ C". @?JF?PE ",* (+' M^V 4&)%- )5 @@PFU@ 34
C'&' "1)2' (+#. $'2'$ 73'",!N@F@f=
73'", N@F@f= ?Ua
*'2'$)-'* 5&)3 ", )#,"$ *'.0&#-(#), )5 7?Ua LZ PPJFDIK>>>IFffEF ]5 (+).' ),
LZ NUFD@Kf>F?EF
(+'.' .(&"('4#'. 7O#,4*), ; M%&9#,4(),= "(/-#0"$ ,'%&)$'-(#0.= UU C'&' #, (+' L8M
>??fE ",* "11&'2#"('* #,() " -+".'* #,('&2',(#), 4&)%- ",* IU #, (+' M^V
"--&)"0+ *'.#4,'* () 1' .%--$'3',('* 1/ <1"1,.1,#"4 ")"4=.,. 4&)%-F
.-'0#5#0 C&#((', 3"('&#"$F M+' LGY. C'&' _'.%$(. C'&' ","$/.'* %.#,4 BGBB 2'&.#), B("(#.(#0"$$/ .#4,#5#0",( #3-&)2'3',(.
(&"#,'* 1/ 'R-'&(. #, L8M 7[FMF ",* [FOFE >J ",* B("(" 2'&.#), P ), ", #,(',(#),Q()Q C'&' .'', #, (+' L8M #,('&2',(#), 4&)%-
",* C'&' ('.('* ), (+'#& .9#$$. (+&)%4+ (&'"( 1".#.F [#55'&',0'. 1'(C'', (+' (C) 0)3-"&'* C#(+ (+' M^V 4&)%- 7M"1$'
*'3),.(&"(#),= &)$' -$"/ ",* C&#((', 4&)%-. C'&' "..'..'* %.#,4 ","$/.#. )5 IE #, )2'&"$$ ./3-()3.= #,.#4+( ",*
?@S
! 3 O 8 T 5 ! 9 OOP
P 9 8 3 U 8 P 9 O ;P OP
O P < 5 : O V; W : 3 8 PO + 9 3 8 +9 / 8 P 9
9"K40 @ Z/98B:08 9<4589 OA8/0 /01 NHD @+Q /01 <7/0;8 9<4589 OA8/0 /01 NHD @+Q /3685 658/6A806
Z/98B:08 9<458 @7/0;8 9<458 Z/98B:08 9<458 @7/0;8 9<458 E8/0 1:338580<8
"U85/BB 9PA>64A/64B4;P GFJGI OGLJXRTGRJNQ FJXH OGJRGTRJSSQ GRJFK OGGJLLTGXJRNQ LJXN O"
O"KJKR 64 FJFRQ O!!KJKLHQ
"GJGN O! KJKLHQ
+09:;76L
SJIG OSJFFTNJLKQ "LJLX O"
O"LJHI 64 KJIHQ SJXS OSJLSTNJLSQ KJLG O"
O"KJFN 64 KJXFQ O!!KJKKLQ
LJFK O!
!8>5899:40 HJRR ORJNFTHJNRQ KJSF OKJFSTLJGIQ XJKS OHJFSTXJINQ KJGN O"
O"KJGN 64 KJSXQ O!!KJKKFQ
"KJSI O! KJKKFQ
'PA>64A9 43 9<7:=4>7580:/ HJGX ORJIGTHJSLQ KJHS OKJLRTLJKGQ HJHK ORJINTXJGKQ KJFF O"
O"KJGR 64 KJSNQ O!!KJGHSQ
"KJFH O! KJGHSQ
Z?5180 43 </58 IXJRS OILJRXTSLJHLQ "GJLI O"
O"KJXN 64 HJKGQ SLJSR OIFJFFTNKJFHQ "LJKL O"
O"XJIX 64 RJIHQ O!!KJLGXQ
"RJGH O! KJLGXQ
LJ & 08;/6:U8 <7/0;8 9<458 40 67:9 >/5/A8685 :01:</689 :A>54U8A806 /01 / >49:6:U8 A8/0 1:338580<8 9<458 40 /0/BP9:9 43 <4U/5:/0<8 O&,@".&Q :01:</689 / >49:6:U8 589?B6 345 <4;0:]
6:U8 TC87/U:4?5/B 6785/>P 4U85 658/6A806 /9 ?9?/BJ
?@ ?
9 M 3 N OP
O P Q 9;P 8 9 + R
?@ Y
! 3 O 8 T 5 ! 9 OOP
P 9 8 3 U 8 P 9 O ;P OP
O P < 5 : O V; W : 3 8 PO + 9 3 8 +9 / 8 P 9
38T838P58<
@( -++%++1%(# ,; )$"(")-$$3 2+%;2$ 1%-+20%+ ,; #/% +)/"8,4/0%("-9 >6$)+&!2 E&%&@&'2 67 ,('%23&%*$ F2.*2:' ),(#0,$$%' #0"-$ ,; "(#%(+"&% ),6("#"&% 5%/-&",20 #/%0-43
),(+%e2%()%+ ,; #0%-#1%(#9 82: D!?1&!- 56/+!&1 67 <P++2% G?9 X*;,0'\ Y4'-#% U,;#.-0%9 4<5M AFIM
;,0 4-#"%(#+ ."#/ )/0,(") +)/"8,4/0%("-9 4<5M AFIM
<2-*$*!2M AFGM
<2-*$*!2M AFGM GEBb7GELL9 LFL7LFE9
<#2_"&1LE 3Z 5Z BF\\ID _,%+ "(+"6/# -;;%)# $,(6 #%01
/')1%'-0&=E <Z +Z ] [.K0&%E /Z BF\I\D @ (%.
"(4-#"%(# #0%-#1%(# ,2#),1% "( )/0,(") +)/"8,4/0%("-f
'%40%++",( +)-$% '%+"6(%' #, 5% +%(+"#"&% #, )/-(6%9 9(&$,)%1')E 6Z ] N,)%*')E 6Z B@CCCD =,6("#"&% 7
"'($)*&%+(M AGM
>630+2)2!'*.2 "'($)*&%+(M AGM BbL7Bbb9
"'($)*&%+(M FASM
4+*%*') 56/+!&1 67 "'($)*&%+(M FASM LbB7LbN9 5%/-&",20-$ #%)/("e2%+ ;,0 6%(%0-$ 4+3)/"-#0"+#+ "( #/%
` E9"=4'&E WZ ] /')1%'-0&=E 6Z BF\IGD _%&%$,41%(#
9"=4'&E <0).$=E9ZE9(&$,)%1')E 6ZE N,)%*')E 6ZE !" #$ B@CCCD @ 1-(-6%1%(# ,; 4-#"%(#+ ."#/ 4+3)/,+%+9 4+*%*') 56/+!&1 67
,; - +)/"8,4/0%("- +)-$% +%(+"#"&% #, )/-(6%9 0-(',1"8%' ),(#0,$$%' #0"-$ ,; ),6("#"&% 7 5%/-&",0-$ "'($)*&%+(M FIIM
"'($)*&%+(M FIIM GFG7GFO9
82/+60)&+3&$616?(M FIM
82/+60)&+3&$616?(M FIM GFOG7GFOL9 #/%0-43 ;,0 4%0+"+#%(# +314#,1+ "( +)/"8,4/0%("-
"'($)*&%+(M ?IM
0%+"+#-(# #, 1%'")-#",(9 #+$)*.2' 67 G2!2+&1 "'($)*&%+(M ?IM X'&4* :0"412 ;&%"),L"1,') BF\\@D B2!%) F2.*'*6! 67
/(0.0&E NZ 9ZE
9ZEX0KKE
X0KKE 5ZE W70,770&E /ZE !" #$ BF\\YD
GOD7GEB9 H!%2+!&%*6!&1 >1&''*7*$&%*6! 67 E*'2&'2' &!- F21&%2- =2&1%)
S-1"$3 520'%( ,; +)/"8,4/0%("- -(' 5"4,$-0 '"+,0'%0\
4%0)%4#",(+ ,; 0%$-#"&%+ -(' 40,;%++",(-$+9 "'($)*&%+*$ "+6@123' <P=_ 7GF?9[%(%&-\
7GF?9 [%(%&-\ `VX9
9"&&,0&E PZE !0#$011E 3ZE :"&_''*E <ZE !" #$ BF\\AD @
9"&&,0&E
,2+.*$2'M SIM
,2+.*$2'M SIM DFE7DGG9
#0"-$ ,; #., ),6("#"&% 7 5%/-&",20-$ 1%#/,'+ ,; #0%-#"(6
P:< 50)1&0 7'& 30J,0_. ")* 6,..0-,)"1,') B@CCCD '026c0%+"+#-(# 0%+"'2-$ 4+3)/,#") +314#,1+ "( ` BF\\AD @(-#,1")-$ :/%0-4%2#") =/%1")-$ <@:=?
C+3)/,+,)"-$ "(#%0&%(#",(+ ;,0 +)/"8,4/0%("-9 D772$%*.2 +)/"8,4/0%(") 4-#"%(#+9 P9 X2#),1%9 4+*%*') 56/+!&1 67 =$-++";")-#",(9 P( G/*-21*!2' 76+ #B> >1&''*7*$&%*6! <A#/
>&+2M Y <L?M G7b9
=2&1%) >&+2M "'($)*&%+(M FY@M
"'($)*&%+(M FY@M DBA7DLB9 %'(?M 449 BL7GbD9 [%(%&-\ `VX9
?@I