Course of Cognitive Development From Infancy to Early Adulthood in the Psychosis Spectrum
Course of Cognitive Development From Infancy to Early Adulthood in the Psychosis Spectrum
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DOI：
10.1001/jamapsychiatry.2017.4327
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发表时间：
2018-03-01
期刊：
影响因子：
25.8
通讯作者：
Reichenberg, Abraham
中科院分区：
文献类型：
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作者：
Mollon, Josephine;David, Anthony S.;Reichenberg, Abraham
重要性大多数精神病患者都有严重的认知功能障碍，但这种功能障碍的发病和病程尚不清楚。此外，其他精神疾病的认知功能过程在很大程度上还没有被研究。目的绘制患有精神障碍、精神病经历和抑郁的个体的一般和特殊认知功能的过程。设计、背景和参与者雅芳父母和孩子纵向研究(ALSPAC)是一项前瞻性队列研究，包括1991年4月1日至1992年12月31日在英国雅芳出生的所有活产婴儿。分析日期为2015年9月至2016年7月。研究对象包括在18个月、4、8、15和20岁时接受认知测试以及在18岁时进行精神评估的参与者。将患有精神病障碍、精神病伴抑郁、精神病经历和抑郁的个体与对照组进行比较。结果在18个月、4、8、15和20岁时，结果是全面的、口头的和非语言的智商，以及在8岁和20岁时的加工速度、工作记忆、语言、视觉空间能力和注意力的测量。结果在这项纵向出生队列研究中，可用于分析的个体数量如下：18个月时511人(平均1.53[0.03]岁)，483人(229人男性[47.4%])，4.07[0.03]岁)，3930(1679名男性[42.7%])8岁(平均[SD]年龄，8.65[0.29]岁)，3783(1686名男性[44.6%])15岁(平均15.45[0.27]岁)，257(90名男性[35.0%])20岁(平均[SD]年龄，20.06[0.55]岁)。精神障碍患者从婴儿期(18个月)到成年期(20岁)在全量智商(Es Delta=-1.09，P=0.02)和非言语智商(Es Delta=-0.94，P=0.008)上表现出持续增长的不足。抑郁症组在婴儿期和成年期之间的非语言智商表现出轻微的、不断增加的缺陷(ES Delta=-0.29，P=0.04)。在8岁到20岁之间，精神障碍组在处理速度(ES Delta=-0.68，P=.001)、工作记忆(ES Delta=-0.59，P=.004)和注意力(ES Delta=-0.44，P=.001)方面表现出发展滞后(即生长缓慢)，在语言(ES=-0.87，P=.005)和视觉空间能力(ES=-0.90，P=.001)方面表现出严重的静态缺陷。在精神病伴抑郁组和精神病经历组中，仅有微弱的证据表明认知障碍。结论和相关性本研究结果表明，精神病的起源涉及动态的发展过程，在生命的前20年影响言语和非言语能力，并导致功能障碍的增加。这些发育过程在其他精神障碍中并不明显，例如伴有抑郁和抑郁的精神病。
IMPORTANCE Most patients with psychotic disorders experience severe cognitive impairment, but the onset and course of this impairment remain unclear. Moreover, the course of cognitive functions in other psychiatric conditions remains largely unexamined.OBJECTIVE To chart the course of general and specific cognitive functions in individuals with psychotic disorders, psychotic experiences, and depression.DESIGN, SETTING, AND PARTICIPANTS The Avon Longitudinal Study of Parents and Children (ALSPAC) is a prospective cohort study comprising all live births between April 1, 1991, and December 31, 1992, in Avon, England. The dates of analysis were September 2015 to July 2016. Participants who underwent cognitive testing at ages 18 months and 4, 8, 15, and 20 years and psychiatric assessment at age 18 years were included.MAIN OUTCOMES AND MEASURES Individuals with psychotic disorder, psychosis with depression, psychotic experiences, and depression were compared with controls. Outcomes were full-scale, verbal, and nonverbal IQ at ages 18 months and 4, 8, 15, and 20 years, as well as measures of processing speed, working memory, language, visuospatial ability, and attention at ages 8 and 20 years.RESULTS The following numbers of individuals were available for analyses in this longitudinal birth cohort study: 511 (238 male [46.6%]) at age 18 months (mean [SD] age, 1.53 [0.03] years), 483 (229 male [47.4%]) at age 4 years (mean [SD] age, 4.07 [0.03] years), 3930 (1679 male [42.7%]) at age 8 years (mean [SD] age, 8.65 [0.29] years), 3783 (1686 male [44.6%]) at age 15 years (mean [SD] age, 15.45 [0.27] years), and 257 (90 male [35.0%]) at age 20 years (mean [SD] age, 20.06 [0.55] years). Individuals with psychotic disorder showed continually increasing deficits between infancy (18 months) and adulthood (20 years) in full-scale IQ (effect size of change [ES Delta] = -1.09, P =.02) and nonverbal IQ (ES Delta = -0.94, P =.008). The depression group showed a small, increasing deficit in nonverbal IQ (ES Delta = -0.29, P =.04) between infancy and adulthood. Between ages 8 and 20 years, the psychotic disorder group exhibited developmental lags (ie, slower growth) in measures of processing speed (ES Delta = -0.68, P =.001), working memory (ES Delta = -0.59, P =.004), and attention (ES Delta = -0.44, P =.001) and large, static deficits in measures of language (ES = -0.87, P =.005) and visuospatial ability (ES = -0.90, P =.001). There was only weak evidence for cognitive deficits in the psychosis with depression group and the psychotic experiences group.CONCLUSIONS AND RELEVANCE The findings herein suggest that the origins of psychotic disorder involve dynamic developmental processes, affecting both verbal and nonverbal abilities throughout the first 2 decades of life and leading to increasing dysfunction. These developmental processes do not manifest in other psychiatric disorders, such as psychosis with depression and depression.