Neuropsychology of the prodrome to psychosis in the NAPLS consortium: relationship to family history and conversion to psychosis.
Neuropsychology of the prodrome to psychosis in the NAPLS consortium: relationship to family history and conversion to psychosis.
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DOI：
10.1001/archgenpsychiatry.2010.66
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发表时间：
2010-06
影响因子：
--
通讯作者：
Cornblatt, Barbara A.
中科院分区：
文献类型：
--
作者：
Seidman, Larry J.;Giuliano, Anthony J.;Meyer, Eric C.;Addington, Jean;Cadenhead, Kristin S.;Cannon, Tyrone D.;McGlashan, Thomas H.;Perkins, Diana O.;Tsuang, Ming T.;Walker, Elaine F.;Woods, Scott W.;Bearden, Carrie E.;Christensen, Bruce K.;Hawkins, Keith;Heaton, Robert;Keefe, Richard S. E.;Heinssen, Robert;Cornblatt, Barbara A.
对可能患精神分裂症或其他精神障碍的临床高危（CHR）个体进行早期检测和前瞻性评估对于预测精神病发作和测试预防性干预措施至关重要。阐明 CHR 综合征的神经心理学，确定神经心理功能与精神病转化和精神病家族史 (FH) 的关联，并检查基线神经心理功能是否可以预测随后的精神病。对 304 名符合前驱综合征结构化访谈 (SIPS) 标准的前瞻性确定的 CHR 个体、52 名一级或二级亲属患有 FH 精神病的非 CHR 患者（“家庭 HR”/FHR）和 193 名既没有精神病 FH 也没有 CHR 综合征的正常对照进行 2 1/2 年随访的纵向研究，所有这些人都进行了基线神经心理学评估，在 8 个研究对象中招募中心作为北美前驱症状纵向研究 (NAPLS) 的一部分。神经认知综合评分、八项单独的神经心理学测量、智商估计和心率状态。与对照组相比，CHR 和 FHR 组的整体（“复合”）神经心理功能受损，但各组之间的情况存在显着差异。 CHR 组中，进展为精神病的人的神经心理功能显着低于未进展为精神病的人，并且在患有精神病的 FH 亚组中最差。处理速度以及言语学习和记忆的测试对于区分 CHR 与对照组最为敏感，尽管下降幅度没有确诊的精神分裂症那么严重。神经心理学功能并不是对超出临床标准的精神病预测做出独特贡献，但较差的言语记忆预示着更快的转变。这些发现证明，CHR 个体存在显着的神经心理学困难，尤其是那些后来出现精神病的人。这种功能障碍通常为中等严重程度，但低于首发精神分裂症，表明基线 CHR 评估后可能会出现进一步下降。
Early detection and prospective evaluation of clinical high-risk (CHR) individuals who may develop schizophrenia or other psychotic disorders is critical for predicting psychosis onset and for testing preventive interventions. To elucidate the neuropsychology of the CHR syndrome, to determine the association of neuropsychological function with conversion to psychosis and family history (FH) of psychosis, and to examine whether baseline neuropsychological functioning predicts subsequent psychosis. Longitudinal study with 2 1/2 years follow-up of 304 prospectively identified CHR individuals meeting Structured Interview for Prodromal Syndromes (SIPS) criteria, 52 non-CHR persons with a FH of psychosis in first- or second-degree relatives (“family HR”/FHR), and 193 normal controls with neither a FH of psychosis nor a CHR syndrome, all of whom had baseline neuropsychological evaluations, recruited across eight centers as part of the North American Prodrome Longitudinal Study (NAPLS). A neurocognitive composite score, eight individual neuropsychological measures, an IQ estimate, and HR status. Global (“composite”) neuropsychological functioning was comparably impaired in CHR and FHR groups compared to controls, but profiles differed significantly between groups. Neuropsychological functioning in the CHR group was significantly lower in persons who progressed to psychosis than in those who did not, and worst in the subgroup with a FH of psychosis. Tests of processing speed and verbal learning and memory were most sensitive in discriminating CHR from controls, although reductions were less severe than in established schizophrenia. Neuropsychological functioning did not contribute uniquely to the prediction of psychosis beyond clinical criteria, but worse verbal memory predicted more rapid conversion. These findings document that CHR individuals have significant neuropsychological difficulties, particularly those who later develop psychosis. This dysfunction is generally of moderate severity but less than in first episode schizophrenia, suggesting that a further decline may occur after baseline CHR assessment.
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