Psychosis spectrum features, neurocognition and functioning in a longitudinal study of youth with 22q11.2 deletion syndrome.
Psychosis spectrum features, neurocognition and functioning in a longitudinal study of youth with 22q11.2 deletion syndrome.
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DOI：
10.1017/s0033291723000259
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发表时间：
2023-03-29
影响因子：
6.9
通讯作者：
Gur, Ruben C.
中科院分区：
文献类型：
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作者：
Gur, Raquel E.;McDonald-McGinn, Donna M.;Moore, Tyler M.;Gallagher, R. Sean;McClellan, Emily;White, Lauren;Ruparel, Kosha;Hillman, Noah;Crowley, T. Blaine;McGinn, Daniel E.;Zackai, Elaine;Emanuel, Beverly S.;Calkins, Monica E.;Roalf, David R.;Gur, Ruben C.
关键词：
22q11.2缺失综合征（22q11DS）中常见神经精神疾病，约25%的受影响个体在成年早期发展为精神分裂症谱系障碍。精神病谱系特征和神经认知的纵向评估可以建立发展轨迹和对功能结局的影响。对157名22q11DS青少年进行纵向精神病理学评估，重点是精神病谱系症状、神经认知表现和整体功能。我们对比了阳性和阴性精神病症状和神经认知表现的模式，以区分有更突出的精神病症状（PS+）和没有明显精神病症状（PS−）的人。我们确定了两组之间精神病症状和神经认知表现轨迹的差异。PS+组表现出与年龄相关的症状严重程度增加，尤其是阴性症状和一般非特异性症状。相应的，他们的功能水平比PS−组更差，恶化更快。PS+组和PS−组的神经认知表现大致相当，并表现出类似的年龄相关轨迹。然而，执行功能的恶化将PS+组与PS−组区分开来。值得注意的是，在三项执行功能测试中，只有工作记忆的变化率在两组之间有显著差异。最后，结构方程模型表明，神经认知能力下降驱动了临床变化。22q11DS和更突出的精神病特征的青年表现为由神经认知衰退引起的症状恶化和功能下降，主要与执行功能，特别是工作记忆有关。研究结果强调了工作记忆在精神病发展过程中的重要性。
Neuropsychiatric disorders are common in 22q11.2 Deletion Syndrome (22q11DS) with about 25% of affected individuals developing schizophrenia spectrum disorders by young adulthood. Longitudinal evaluation of psychosis spectrum features and neurocognition can establish developmental trajectories and impact on functional outcome. 157 youth with 22q11DS were assessed longitudinally for psychopathology focusing on psychosis spectrum symptoms, neurocognitive performance and global functioning. We contrasted the pattern of positive and negative psychosis spectrum symptoms and neurocognitive performance differentiating those with more prominent Psychosis Spectrum symptoms (PS+) to those without prominent psychosis symptoms (PS−). We identified differences in the trajectories of psychosis symptoms and neurocognitive performance between the groups. The PS+ group showed age associated increase in symptom severity, especially negative symptoms and general nonspecific symptoms. Correspondingly, their level of functioning was worse and deteriorated more steeply than the PS− group. Neurocognitive performance was generally comparable in PS+ and PS− groups and demonstrated a similar age-related trajectory. However, worsening executive functioning distinguished the PS+ group from PS− counterparts. Notably, of the three executive function measures examined, only working memory showed a significant difference between the groups in rate of change. Finally, structural equation modeling showed that neurocognitive decline drove the clinical change. Youth with 22q11DS and more prominent psychosis features show worsening of symptoms and functional decline driven by neurocognitive decline, most related to executive functions and specifically working memory. The results underscore the importance of working memory in the developmental progression of psychosis.