Cognitive and clinical predictors of community functioning across the psychoses.
Cognitive and clinical predictors of community functioning across the psychoses.
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精神病社区功能的认知和临床预测因素。
DOI：
10.1002/pchj.356
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发表时间：
2020
期刊：
影响因子：
1.6
通讯作者：
Ongur,Dost
中科院分区：
文献类型：
--
作者：
Lewandowski,KathrynE;Cohen,TaliaR;Ongur,Dost
精神分裂症、双相情感障碍和相关精神疾病是常见的严重精神障碍，通常伴有功能障碍和生活质量差，即使在临床康复后也是如此。认知功能障碍是功能障碍的有力预测因子；然而，关于跨诊断的功能和认知的相对损伤的发现是混合的，正如临床症状和其他疾病特征对跨诊断界限的功能的贡献的报告一样。我们评估了211名精神障碍患者和87名健康对照者，使用了matrix共识认知电池、状态情绪和精神症状的临床测量以及社区功能的访谈测量。对诊断组进行matrix综合评分和领域评分，以及临床和功能指标的比较。然后，我们使用逐步层次线性回归检查了社区功能的认知、临床和人口统计学预测因子。与对照组相比，所有三组患者在大多数认知领域都表现出缺陷，而且社区功能明显较差。虽然大多数认知领域的得分并没有因诊断而不同，但当两组存在差异时，精神分裂症患者的表现比双相情感障碍患者差。在整个样本中，认知与功能是相关的。最终的回归模型包括阴性症状、躁狂症、社会认知和处理速度，并解释了患者群体中47%的社区功能评分差异。残留的阴性症状、残留的躁狂症和社会认知显著且独立地预测社区功能。这些发现表明，虽然所有认知领域都与社区结果相关，但当与临床症状一起考虑时，阴性症状、躁狂和社会认知是所有诊断中最强的预测因子。针对阴性症状和社会认知的干预措施的发展可能有效地改善跨诊断患者的社区功能。
Schizophrenia, bipolar disorder, and related psychotic illnesses are common, serious mental disorders that are often associated with functional impairments and poor quality of life, even after clinical recovery. Cognitive dysfunction is a strong predictor of functional impairment; however, findings regarding relative impairments in functioning and cognition across diagnoses have been mixed, as have reports of the contribution of clinical symptoms and other illness features to functioning across diagnostic boundaries. We assessed 211 patients with psychotic disorders and 87 healthy controls using the MATRICS Consensus Cognitive Battery, clinical measures of state mood and psychotic symptoms, and an interview measure of community functioning. Diagnostic groups were compared on MATRICS composite and domain scores, and clinical and functional measures. We then examined cognitive, clinical, and demographic predictors of community functioning using stepwise hierarchical linear regression. All three patient groups exhibited deficits in most cognitive domains relative to controls, and significantly poorer community functioning. While scores on most cognitive domains did not differ by diagnosis, when groups did differ patients with schizophrenia performed worse than patients with bipolar disorder. Cognition was correlated with functioning across the sample. The final regression model included negative symptoms, mania, social cognition, and processing speed, and explained 47% of the variance in community functioning scores across patient groups. Residual negative symptoms, residual mania, and social cognition significantly and independently predicted community functioning. These findings indicate that, while all cognitive domains are associated with community outcomes, when considered together and with clinical symptoms, negative symptoms, mania, and social cognition are the strongest predictors across diagnoses. Development of interventions targeting negative symptoms and social cognition may be effective in improving community functioning for patients across diagnoses.