IQ trajectory, cognitive reserve, and clinical outcome following a first episode of psychosis: a 3-year longitudinal study.
IQ trajectory, cognitive reserve, and clinical outcome following a first episode of psychosis: a 3-year longitudinal study.
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DOI：
10.1093/schbul/sbp143
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发表时间：
2011-07
影响因子：
6.6
通讯作者：
Joyce EM
中科院分区：
文献类型：
--
作者：
Leeson VC;Sharma P;Harrison M;Ron MA;Barnes TR;Joyce EM
精神分裂症患者目前和估计的病前智商的比较表明，存在智商低、智商下降(DIQ)或智商保持的亚组，这是由精神病发作建立的。没有对照研究来检验这些智商亚群的纵向轨迹或它们与临床和社会结果的关系。在129名首发精神分裂症或分裂情感障碍患者中，25%的人表现出稳定的低智商，31%的人智商稳定在中/高范围，44%的人智力下降10分或更多。低智商/高智商组和低智商/高智商组患者在记忆和执行功能测试中的受损程度与对照组和对照组相比相同，并且表现出更多的阴性症状和组织紊乱症状。60名患者和27名对照组在1年和3年后再次进行评估。没有证据表明那些智商在基线水平下降的人继续处于认知下降的轨道上，或者那些保持平均/高智商的人经历了随后的智商下降。低智商组的智商无明显变化，而智力低下组和智商保存组的智商均有提高。然而，这两个亚组的改善率并不高于健康对照组，这表明这反映了练习的效果。低度组和恶化组在3年时都有更长的指数入院时间，更多的核心阴性症状，以及更差的职业结果。这些数据表明，在精神病发作后，智商是稳定的，而且是精神病发作时的智商，而不是发病前的智商预测更严重的疾病。
Comparison of current and estimated premorbid IQ in schizophrenia suggests that there are subgroups with low IQ, deteriorated IQ (DIQ), or preserved IQ and that this is established by psychosis onset. There are no controlled studies examining the trajectory of these IQ subgroups longitudinally or their relationship with clinical and social outcomes. Of 129 individuals with first-episode schizophrenia or schizoaffective disorder, 25% showed stable low IQ, 31% showed stable IQ in the average/high range, and 44% demonstrated intellectual deterioration by 10 points or more. Patients in the low and deteriorated groups were equally impaired on tests of memory and executive function compared with the preserved average/high-IQ group and controls and showed more negative and disorganization symptoms than the preserved average/high-IQ group. Sixty patients and 27 controls were assessed again 1 and 3 years later. There was no evidence that those with IQ deterioration at baseline continued on a declining cognitive trajectory or that those with preserved average/high IQ experienced subsequent IQ decline. The low IQ group showed no change in IQ, whereas both the DIQ and the preserved IQ groups improved. However, the rate of improvement of these 2 subgroups was no greater than that of the healthy controls, suggesting that this reflected practice effects. Both the low and the deteriorated groups had longer index admissions, more core negative symptoms, and worse occupational outcomes at 3 years. These data suggest that following psychosis onset, IQ is stable and that it is IQ at psychosis onset rather than premorbid IQ predicts a more severe illness.