Neurocognitive Predictors of Work Outcome in Recent-Onset Schizophrenia
Neurocognitive Predictors of Work Outcome in Recent-Onset Schizophrenia
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DOI：
10.1093/schbul/sbr084
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发表时间：
2011-09-01
影响因子：
6.6
通讯作者：
Mintz, Jim
中科院分区：
文献类型：
--
作者：
Nuechterlein, Keith H.;Subotnik, Kenneth L.;Mintz, Jim
虽然神经认知障碍在预测慢性精神分裂症患者功能结局方面的作用现在已被广泛接受，但在精神病早期阶段检验这种关系的结果令人惊讶地相当复杂。疾病早期认知障碍的预测作用特别令人感兴趣，因为在这一初始阶段的干预可能有助于预防慢性残疾的发展。在加州大学洛杉矶分校(UCLA)的一项纵向研究中，我们在最初临床稳定的门诊点使用神经认知电池评估了最近首次出现精神病的精神分裂症患者，然后在接下来的9个月里对他们进行了持续治疗。通过主成分分析得出三个正交认知因素：工作记忆、注意力和早期知觉加工、言语记忆和加工速度。所有患者都在加州大学洛杉矶分校的研究诊所接受了维持性抗精神病药物治疗、病例管理、团体技能培训和家庭教育的组合。使用社会调整量表的修订版来评估工作成果。多元回归分析表明，在门诊临床稳定后9个月，这3个神经认知因素的组合可以预测52%的回归工作或上学的变异。这些数据有力地支持了神经认知因素在精神分裂症发作后工作功能恢复中的关键作用。针对这些早期认知缺陷的认知补救和其他干预措施对预防慢性残疾具有重要意义。
While the role of neurocognitive impairment in predicting functional outcome in chronic schizophrenia is now widely accepted, the results that have examined this relationship in the early phase of psychosis are surprisingly rather mixed. The predictive role of cognitive impairment early in the illness is of particular interest because interventions during this initial period may help to prevent the development of chronic disability. In a University of California, Los Angeles (UCLA) longitudinal study, we assessed schizophrenia patients with a recent first episode of psychosis using a neurocognitive battery at an initial clinically stabilized outpatient point and then followed them during continuous treatment over the next 9 months. Three orthogonal cognitive factors were derived through principal components analysis: working memory, attention and early perceptual processing, and verbal memory and processing speed. All patients were provided a combination of maintenance antipsychotic medication, case management, group skills training, and family education in a UCLA research clinic. A modified version of the Social Adjustment Scale was used to assess work outcome. Multiple regression analyses indicate that the combination of the 3 neurocognitive factors predicts 52% of the variance in return to work or school by 9 months after outpatient clinical stabilization. These data strongly support the critical role of neurocognitive factors in recovery of work functioning after an onset of schizophrenia. Cognitive remediation and other interventions targeting these early cognitive deficits are of major importance to attempts to prevent chronic disability.