Disorganization/Cognitive and Negative Symptom Dimensions in the At-Risk Mental State Predict Subsequent Transition to Psychosis
Disorganization/Cognitive and Negative Symptom Dimensions in the At-Risk Mental State Predict Subsequent Transition to Psychosis
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DOI：
10.1093/schbul/sbq088
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发表时间：
2012-03-01
影响因子：
6.6
通讯作者：
McGuire, Philip
中科院分区：
文献类型：
--
作者：
Demjaha, Arsime;Valmaggia, Lucia;McGuire, Philip
处于危险的精神状态（ARMS）与精神病的高风险相关，但很难根据他们的症状预测哪些人以后会发展为精神病。我们调查了ARMS受试者的精神病理学维度，并研究了特定的症状维度是否预测随后向Psychosis的转变，样本包括122名受试者（年龄16-35岁），符合ARMS的个人评估和危机评估诊所标准，该标准是通过在南伦敦的外展和支持招募的，这是一项为ARMS患者提供的临床服务。采用方差最大旋转法，对从高危精神状态综合评估中获得的症状评分进行主轴因子分析。在接下来的24个月内，维度得分和精神病转变之间的关系，然后采用考克斯回归分析，因子分析产生了一个5因素的解决方案，消极，焦虑，混乱/认知，自我伤害，躁狂症状维度，占总方差的37%。在随访期间，消极和混乱/认知维度的得分与向精神病的转变相关（分别为P = 0.044和P = 0.005）。ARMS的症状具有与精神分裂症患者明显相似的维度结构，但阳性症状维度除外。混乱/认知和消极维度的评分与后期过渡之间的关联与独立证据一致，即正式思维障碍、主观认知障碍和阴性症状与随后的精神病发作有关。
The at-risk mental state (ARMS) is associated with a very high risk of psychosis, but it is difficult to predict which individuals will later develop psychosis on the basis of their presenting symptoms. We investigated psychopathological dimensions in subjects with an ARMS and examined whether particular symptom dimensions predicted subsequent transition to psychosis.The sample comprised 122 subjects (aged 16-35 years) meeting Personal Assessment and Crisis Evaluation clinic criteria for the ARMS recruited through Outreach and Support in South London, a clinical service for people with an ARMS. A principal axis factor analysis was performed on symptom scores, obtained at presentation from the Comprehensive Assessment of the At-Risk Mental State, using Varimax rotation. The relationship between dimension scores and transition to psychosis during the following 24 months was then examined employing Cox regression analysis.Factor analysis gave rise to a 5-factor solution of negative, anxiety, disorganization/cognitive, self-harm, and manic symptom dimensions, accounting for 37% of the total variance. Scores on the negative and on the disorganization/cognitive dimensions were associated with transition to psychosis during the follow-up period (P = 0.044 and P = 0.005, respectively).The symptoms of the ARMS have a dimensional structure similar to that evident in patients with schizophrenia except for the positive symptom dimension. The association between scores on the disorganization/cognitive and negative dimensions and later transition is consistent with independent evidence that formal thought disorder, subjective cognitive impairments, and negative symptoms are linked to the subsequent onset of psychosis.