Divergent Trajectories of Physical, Cognitive, and Psychosocial Aging in Schizophrenia
Divergent Trajectories of Physical, Cognitive, and Psychosocial Aging in Schizophrenia
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DOI：
10.1093/schbul/sbr026
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发表时间：
2011-05-01
影响因子：
6.6
通讯作者：
Palmer, Barton W.
中科院分区：
文献类型：
--
作者：
Jeste, Dilip V.;Wolkowitz, Owen M.;Palmer, Barton W.
衰老不是一个统一的过程。在一般人群中，存在着衰老的悖论：与年龄相关的身体和某些认知功能的下降与主观生活质量和心理社会功能的提高形成鲜明对比。这种悖论在精神分裂症患者身上更为引人注目。与总体人群相比，精神分裂症患者的身体衰老速度加快（合并症和死亡率增加和过早发生），但认知衰老速度正常，尽管从病前时期开始存在轻度认知障碍并持续终生。值得注意的是，心理社会功能随着年龄的增长而改善，精神病症状减少，需要住院治疗的精神疾病复发减少，自我管理也更好。许多患有精神分裂症的老年人通过更多地使用积极的应对技巧、增强的自尊和增加的社会支持，成功地适应了这种疾病。尽管完全缓解并不常见，但大多数精神分裂症患者的健康质量都有显着改善。群体效应和幸存者偏差可能为这一现象提供部分解释。然而，这种改善也可能反映出一些大脑变化，这些变化有利于精神分裂症的病程以及衰老的神经可塑性。所提出的假设有几个含义。由于精神分裂症的显着医学发病率需要数年时间才能形成，因此对疾病过程中衰老的敏感生物标志物变化的研究可能会指出旨在使精神分裂症的生物衰老率正常化的新疗法。与此同时，有效的心理治疗干预措施可以影响大脑结构和功能，并对老年精神分裂症患者产生持久的积极行为变化。
Aging is not a uniform process. In the general population, there is a paradox of aging: age-associated decline in physical and some cognitive functions stands in contrast to an enhancement of subjective quality of life and psychosocial functioning. This paradox is even more striking in people with schizophrenia. Compared with the overall population, individuals with schizophrenia have accelerated physical aging (with increased and premature medical comorbidity and mortality) but a normal rate of cognitive aging, although with mild cognitive impairment starting from premorbid period and persisting throughout life. Remarkably, psychosocial function improves with age, with diminished psychotic symptoms, reduced psychiatric relapses requiring hospitalization and better self-management. Many older adults with schizophrenia successfully adapt to the illness, with increased use of positive coping techniques, enhanced self-esteem and increased social support. Although complete remission is uncommon, most individuals with schizophrenia experience significant improvement in their quality of well-being. Cohort effect and survivor bias may provide a partial explanation for this phenomenon. However, the improvement also may reflect some brain changes that are beneficial for the course of schizophrenia along with neuroplasticity of aging. The proposed hypothesis has several implications. As significant medical morbidity in schizophrenia takes years to develop, studies of changes in sensitive biomarkers of aging during the course of illness may point to new treatments aimed at normalizing the rate of biological aging in schizophrenia. At the same time, effective psychotherapeutic interventions can affect brain structure and function and produce lasting positive behavioral changes in aging adults with schizophrenia.