Developmental influences on symptom expression in antipsychotic-naïve first-episode psychosis.
Developmental influences on symptom expression in antipsychotic-naïve first-episode psychosis.
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在未使用过抗精神病药物的首发精神病患者中症状表现的发展性影响
DOI：
10.1017/s0033291720003463
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发表时间：
2022-07
影响因子：
6.9
通讯作者：
Jalbrzikowski M
中科院分区：
文献类型：
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作者：
Bridgwater M;Bachman P;Tervo-Clemmens B;Haas G;Hayes R;Luna B;Salisbury DF;Jalbrzikowski M
精神病的神经发育模型在30多年前就已建立；然而，发育对精神病症状表现的影响——年龄如何影响首发精神病的临床表现——尚未得到彻底研究。
我们利用广义相加模型（该模型允许年龄相关变化呈线性和非线性函数形式），利用了1990年至2017年在匹兹堡大学收集的大量未使用过抗精神病药物的首发精神病患者（N = 340，年龄12 - 40岁，就诊1 - 12次）的症状数据。我们研究了年龄与感知性和非感知性阳性症状以及阴性症状的严重程度之间的关系。我们测试了基线评估后年龄对阳性或阴性症状严重程度变化的相关影响，并探讨了青少年发育过程中感知性和非感知性阳性症状之间的时变关系。
感知性阳性症状的严重程度随着年龄的增长显著降低（F = 7.0，p = 0.0007；q = 0.003），而非感知性阳性症状的严重程度随着年龄增长而增加（F = 4.1，p = 0.01，q = 0.02）。快感缺乏的严重程度随着年龄增长而增加（F = 6.7，p = 0.00035；q = 0.0003），而情感平淡的严重程度随着年龄增长而降低（F = 9.8，p = 0.002；q = 0.006）。当社会经济地位、智商和病程作为协变量纳入时，研究结果仍然显著。对阳性或阴性症状严重程度的变化没有发育影响（所有p > 0.25）。从18岁开始，随着年龄增长，非感知性和感知性症状的严重程度之间出现了关联。
这些研究结果表明，随着认知成熟的推进，感知性症状减弱而非感知性症状增强，反映了发育过程对精神病表现的影响。研究结果强调了病理性脑 - 行为关系如何随着发育而变化。
The neurodevelopmental model of psychosis was established over 30 years ago; however, the developmental influence on psychotic symptom expression – how age affects clinical presentation in first-episode psychosis – has not been thoroughly investigated. Using generalized additive modeling, which allows for linear and non-linear functional forms of age-related change, we leveraged symptom data from a large sample of antipsychotic-naïve individuals with first episode psychosis (N=340, 12–40 years, 1–12 visits), collected at the University of Pittsburgh from 1990–2017. We examined relationships between age and severity of perceptual and non-perceptual positive symptoms and negative symptoms. We tested for age-associated effects on change in positive or negative symptom severity following baseline assessment, and explored the time-varying relationship between perceptual and non-perceptual positive symptoms across adolescent development. Perceptual positive symptom severity significantly decreased with increasing age (F=7.0, p=0.0007; q=0.003) while non-perceptual positive symptom severity increased with age (F=4.1, p=0.01, q=0.02). Anhedonia severity increased with increasing age (F=6.7, p=0.00035; q=0.0003), while flat affect decreased in severity with increased age (F=9.8, p=0.002; q=0.006). Findings remained significant when SES, IQ, and illness duration were included as covariates. There were no developmental effects on change in positive or negative symptom severity (all p>0.25). An association between severity of non-perceptual and perceptual symptoms developed with increasing age starting at age 18. These findings suggest that as cognitive maturation proceeds, perceptual symptoms attenuate while non-perceptual symptoms are enhanced, reflecting influences of developmental processes on psychosis expression. Findings underscore how pathological brain-behavior relationships vary as a function of development.