Trajectories of positive, negative and general psychopathology symptoms in first episode psychosis and their relationship with functioning over a 2-year follow-up period
Trajectories of positive, negative and general psychopathology symptoms in first episode psychosis and their relationship with functioning over a 2-year follow-up period
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DOI：
10.1371/journal.pone.0187141
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发表时间：
2017-11-02
期刊：
影响因子：
3.7
通讯作者：
Subramaniam, Mythily
中科院分区：
文献类型：
--
作者：
Abdin, Edimansyah;Chong, Siow Ann;Subramaniam, Mythily
背景很少有研究考察首发精神病(FEP)症状严重程度的轨迹及其对功能的影响。本研究旨在确定阳性、阴性和一般精神病理症状和功能的离散轨迹，确定已识别的症状轨迹的预测因子，并随后调查两年随访期间症状和功能轨迹之间的关系。方法数据来源于新加坡早期精神病干预计划临床数据库。结果在本研究样本中，阳性症状有两种不同的轨迹(早期反应和稳定轨迹、早期反应和复发轨迹、早期反应和复发轨迹、较慢反应和无反应轨迹和延迟反应轨迹)和三种不同的功能轨迹(高功能轨迹、中等稳定的功能轨迹和功能恶化轨迹)。与处于早期反应轨迹和稳定轨迹中的个体相比，处于延迟反应轨迹中的阳性和阴性症状、阴性和一般精神病理症状的早期反应和复发以及一般精神病理症状的反应较慢和无反应轨迹的个体，随着时间的推移，功能恶化的几率较高。年龄较小、男性、失业和经济不活跃、受教育程度较低、未接受治疗的精神病持续时间较长以及精神分裂症谱系和妄想性障碍的诊断也对不良症状轨迹有显著预测作用。结论本研究结果证实，FEP患者的症状轨迹具有异质性，提示一小部分患者在2年的随访中症状严重程度和功能恶化的风险较高。
BackgroundFew studies have examined the trajectories of symptom severity in first episode psychosis (FEP) and their impact on functioning. This study aimed to identify discrete trajectories of positive, negative and general psychopathological symptoms and functioning, determine predictors of the identified symptom trajectories and subsequently investigate the relationship between symptom and functioning trajectories over the 2-year follow-up period. MethodsData were extracted from the Singapore Early Psychosis Intervention Programme clinical database. Trajectories of the Positive and Negative Syndrome Scale and Global Assessment of Functioning (GAF) scale over the two-year follow up were modelled using latent class growth curve modelling.ResultsTwo distinct trajectories (early response and stable trajectory and delayed response trajectory) for positive symptoms, four distinct trajectories (early response and stable trajectory, early response and relapse trajectory, slower response and no response trajectory and delayed response trajectory) for negative and general psychopathology symptoms and three distinct trajectories for functioning (high functioning trajectory, moderately stable functioning trajectory and deterioration in functioning trajectory) were identified in our sample. Compared to individuals in the early response and stable trajectory, those in the delayed response trajectory tor positive and negative symptoms, early response and relapse for negative and general psychopathology symptoms and slower response and no response trajectories for general psychopathology symptoms were significantly associated with higher odds of having deterioration in functioning over time. Poor symptom trajectories were also significantly predicted by younger age, male gender, unemployed and economically inactive status, lower education, longer duration of untreated psychosis and diagnosis of schizophrenia spectrum and delusional disorders.ConclusionsThe results confirm that the symptoms trajectories among patients with FEP are heterogeneous and suggest that a small group of patients may be at higher risk of deterioration in symptom severity and functioning over the 2-year follow-up.