Baseline demographics, clinical features and predictors of conversion among 200 individuals in a longitudinal prospective psychosis-risk cohort
Baseline demographics, clinical features and predictors of conversion among 200 individuals in a longitudinal prospective psychosis-risk cohort
复制标题
DOI：
10.1017/s0033291717000319
复制
发表时间：
2017-08-01
影响因子：
6.9
通讯作者：
Girgis, R. R.
中科院分区：
文献类型：
--
作者：
Brucato, G.;Masucci, M. D.;Girgis, R. R.
背景资料。DSM-5根据精神病-危险综合征(SIPS)结构化访谈中的弱化阳性症状综合征(APSS)，提出了弱化精神病综合征(APS)的概念以供进一步研究。在2015年NAPLS-2联盟的一份报告中，SIPS异常思维内容、无组织沟通和完全无组织得分预测了精神病的进展。我们试图在一个大型的单部位高危队列中独立复制这一结果，并确定超出当前APS/APSS标准的基线人口学和临床预测因素。我们前瞻性地研究了200名符合SIPAPSS和DSM-5 APS标准的参与者。在基线上评估SIPS评分、人口统计学、精神病家族史、DSM Axis-I诊断、分裂类型以及社会和角色功能，并每3个月随访一次，为期2年。中转率为30%(n=60)，或37.7%(不包括随访2年以下的参与者)。这一比率在一段时间内是稳定的。60%的精神分裂症患者平均转归时间为7.97个月，其他精神病患者平均转归时间为15.68个月。男性的平均转换年龄为20.3岁，女性为23.5岁。在Logistic回归中，减弱的奇怪想法和思维障碍似乎是最能预测精神病的积极症状。阴性症状总分、亚洲/太平洋岛民和黑人/非裔美国人也具有预测性。由于没有Axis-I诊断或分裂型预测转换，APS被支持为一种独特的综合征。此外，大麻使用障碍不会增加转化为精神病的风险。在控制临床和人口学因素的同时，NAPLS SIPS的发现被复制，有力地支持了SIPSAPSS和DSM-5 APS诊断的有效性。
Background. DSM-5 proposes an Attenuated Psychosis Syndrome (APS) for further investigation, based upon the Attenuated Positive Symptom Syndrome (APSS) in the Structured Interview for Psychosis-Risk Syndromes (SIPS). SIPS Unusual Thought Content, Disorganized Communication and Total Disorganization scores predicted progression to psychosis in a 2015 NAPLS-2 Consortium report. We sought to independently replicate this in a large single-site high-risk cohort, and identify baseline demographic and clinical predictors beyond current APS/APSS criteria.Method. We prospectively studied 200 participants meeting criteria for both the SIPS APSS and DSM-5 APS. SIPS scores, demographics, family history of psychosis, DSM Axis-I diagnoses, schizotypy, and social and role functioning were assessed at baseline, with follow-up every 3 months for 2 years.Results. The conversion rate was 30% (n = 60), or 37.7% excluding participants who were followed under 2 years. This rate was stable across time. Conversion time averaged 7.97 months for 60% who developed schizophrenia and 15.68 for other psychoses. Mean conversion age was 20.3 for males and 23.5 for females. Attenuated odd ideas and thought disorder appear to be the positive symptoms which best predict psychosis in a logistic regression. Total negative symptom score, Asian/Pacific Islander and Black/African-American race were also predictive. As no Axis-I diagnosis or schizotypy predicted conversion, the APS is supported as a distinct syndrome. In addition, cannabis use disorder did not increase risk of conversion to psychosis.Conclusions. NAPLS SIPS findings were replicated while controlling for clinical and demographic factors, strongly supporting the validity of the SIPS APSS and DSM-5 APS diagnosis.