Environmental Risk Factors and Cognitive Outcomes in Psychosis: Pre-, Perinatal, and Early Life Adversity.
Environmental Risk Factors and Cognitive Outcomes in Psychosis: Pre-, Perinatal, and Early Life Adversity.
复制标题
DOI：
10.1007/7854_2022_378
复制
发表时间：
2023
影响因子：
--
通讯作者：
Ellman, Lauren M
中科院分区：
文献类型：
--
作者：
Lipner, Emily;O'Brien, Kathleen J;Pike, Madeline R;Ered, Arielle;Ellman, Lauren M
精神病的风险早在胎儿时期就开始通过暴露于胎儿缺氧、母亲压力和产前感染等产科并发症而积累。产后的压力因素，例如童年创伤、同伴受害和邻里逆境，进一步增加了精神病的易感性。认知困难是继发精神障碍的个体中首先出现的症状之一。我们回顾了精神病患者的产前、围产期和幼儿期逆境与认知结果之间的关系。目前的证据表明，上述环境风险因素可能与精神病患者的整体智力较低和执行功能障碍有关，这种情况从发病前开始一直持续到成年。早期生活压力可能会通过身体对压力的反应失调而导致精神病的认知困难，从而导致皮质醇水平升高和慢性免疫激活等变化，从而对神经发育产生负面影响。身份的交叉方面（例如，性/性别、种族/民族）以及基因与环境的相互作用，可能会影响整个精神障碍过程中认知困难的发展级联，下文将进行综述。对出生队列的前瞻性研究将有助于进一步阐明早期环境危险因素与精神障碍发展过程中认知结果之间的关系。为未来的研究提供了具体的方法学建议。
Risk for psychosis begins to accumulate as early as the fetal period through exposure to obstetric complications like fetal hypoxia, maternal stress, and prenatal infection. Stressors in the postnatal period, such as childhood trauma, peer victimization, and neighborhood-level adversity, further increase susceptibility for psychosis. Cognitive difficulties are among the first symptoms to emerge in individuals who go on to develop a psychotic disorder. We review the relationship between pre-, perinatal, and early childhood adversities and cognitive outcomes in individuals with psychosis. Current evidence shows that the aforementioned environmental risk factors may be linked to lower overall intelligence and executive dysfunction, beginning in the premorbid period and persisting into adulthood in individuals with psychosis. It is likely that early life stress contributes to cognitive difficulties in psychosis through dysregulation of the body’s response to stress, causing changes such as increased cortisol levels and chronic immune activation, which can negatively impact neurodevelopment. Intersectional aspects of identity (e.g., sex/gender, race/ethnicity), as well as gene–environment interactions, likely inform the developmental cascade to cognitive difficulties throughout the course of psychotic disorders and are reviewed below. Prospective studies of birth cohorts will serve to further clarify the relationship between early-life environmental risk factors and cognitive outcomes in the developmental course of psychotic disorders. Specific methodological recommendations are provided for future research.