Meta-analysis of Cognitive Deficits in Ultra-high Risk to Psychosis and First-Episode Psychosis: Do the Cognitive Deficits Progress Over, or After, the Onset of Psychosis?
Meta-analysis of Cognitive Deficits in Ultra-high Risk to Psychosis and First-Episode Psychosis: Do the Cognitive Deficits Progress Over, or After, the Onset of Psychosis?
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DOI：
10.1093/schbul/sbt085
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发表时间：
2014-07-01
影响因子：
6.6
通讯作者：
Murray, Robin M.
中科院分区：
文献类型：
--
作者：
Bora, Emre;Murray, Robin M.
认知功能障碍是精神分裂症的一个明确特征，有证据表明认知缺陷是继发于神经发育异常，导致获得此类能力出现问题。然而，尚不清楚精神病发作期间或之后认知能力是否也会下降。我们的目的是定量检查首发精神病（FEP）、精神病超高风险（UHR）患者和对照患者认知功能的纵向变化。在电子数据库中检索了 1987 年 1 月至 2013 年 2 月期间发表的研究。检索了报告 FEP 和 UHR 受试者纵向认知数据的所有研究。我们对 25 项研究进行了荟萃分析，其中包括 905 名 FEP 患者、560 名 UHR 患者和 405 名健康对照者。随着时间的推移，FEP、UHR 和健康对照组的认知表现均显着改善。不存在发表偏倚，效应大小的分布非常均匀。在 FEP 中，言语工作记忆和执行功能的改善程度与阴性症状的减少显着相关。没有证据表明 UHR 和 FEP 患者认知能力下降。相比之下，两组的认知表现在随访中都有所改善。这些发现表明，认知缺陷在精神病的前驱阶段之前就已经存在。这些数据支持神经发育模型，而不是精神分裂症的神经退行性和相关分期模型。
Cognitive dysfunction is a well-established feature of schizophrenia, and there is evidence suggesting that cognitive deficits are secondary to abnormal neurodevelopment leading to problems in acquiring such abilities. However, it is not clear whether there is also a decline in cognitive performance over, or after, the onset of psychosis. Our objective was to quantitatively examine the longitudinal changes in cognitive function in patients who presented with first-episode psychosis (FEP), ultra-high risk (UHR) for psychosis, and controls. Electronic databases were searched for the studies published between January 1987 and February 2013. All studies reporting longitudinal cognitive data in FEP and UHR subjects were retrieved. We conducted meta-analyses of 25 studies including 905 patients with FEP, 560 patients at UHR, and 405 healthy controls. The cognitive performances of FEP, UHR, and healthy controls all significantly improved over time. There was no publication bias, and distributions of effect sizes were very homogenous. In FEP, the degree of improvement in verbal working memory and executive functions was significantly associated with reduction in negative symptoms. There was no evidence of cognitive decline in patients with UHR and FEP. In contrast, the cognitive performances of both groups improved at follow-up. These findings suggest that cognitive deficits are already established before the prodromal phases of psychosis. These data support the neurodevelopmental model rather than neurodegenerative and related staging models of schizophrenia.