From the psychosis prodrome to the first-episode of psychosis: No evidence of a cognitive decline
From the psychosis prodrome to the first-episode of psychosis: No evidence of a cognitive decline
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DOI：
10.1016/j.jpsychires.2017.10.014
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发表时间：
2018-01-01
影响因子：
4.8
通讯作者：
Cornblatt, Barbara A.
中科院分区：
文献类型：
--
作者：
Carrion, Ricardo E.;Walder, Deborah J.;Cornblatt, Barbara A.
认知缺陷在精神分裂症和其他精神障碍的神经发育中具有重要作用。然而，关于精神病前驱症状中的认知障碍是否是最终精神病的稳定预测因子，或者由于精神病的发作而发生下降，仍然存在持续的争论。在本研究中，为了确定认知如何随着疾病的出现而变化，我们检查了大量寻求帮助的青少年的基线神经认知表现，这些青少年的临床状态从精神病的低风险到疾病的临床高风险（EEP）到早期首次发作患者（EFEP）。在基线时，对322名个体（205名CHR，28名EFEP和89名寻求帮助的对照，HSC）进行了MATRICS认知共识测试，这些个体是更大的早期发现，干预和预防精神病计划研究的一部分。在随访期间，163例患者被进一步分为有精神病转化的患者（CHR-T; n = 12，6.8%）和无精神病转化的患者（CHR-NT，n = 163）（平均值= 99.20周，SD = 21.54）。ANCOVA显示，相对于健康对照组（CNTL），在处理速度、言语学习和整体神经认知方面存在显著的整体组差异（ESTA、EFEP、HSC）。此外，CHR-NT的表现与HSC组相似，相对于CTRL组有轻度至中度的认知缺陷。CHR-Ts反映了EFEP组，在处理速度、工作记忆、注意力/警惕性和语言学习方面存在较大缺陷（低于CNTL> 1 SD）。有趣的是，当调整年龄、教育、症状、抗精神病药物和其他领域的神经认知表现时，只有语言学习障碍可以预测向精神病的转变。我们的研究结果表明，大的神经认知缺陷存在于疾病发作之前，并代表精神病的脆弱性标志。本研究的结果进一步加强了语言学习应该是专门针对精神病的预防性干预。
Cognitive deficits have an important role in the neurodevelopment of schizophrenia and other psychotic disorders. However, there is a continuing debate as to whether cognitive impairments in the psychosis prodrome are stable predictors of eventual psychosis or undergo a decline due to the onset of psychosis. In the present study, to determine how cognition changes as illness emerges, we examined baseline neurocognitive performance in a large sample of helping-seeking youth ranging in clinical state from low-risk for psychosis through individuals at clinical high-risk (CHR) for illness to early first-episode patients (EFEP). At baseline, the MATRICS Cognitive Consensus battery was administered to 322 individuals (205 CHRs, 28 EFEPs, and 89 help-seeking controls, HSC) that were part of the larger Early Detection, Intervention and Prevention of Psychosis Program study. CHR individuals were further divided into those who did (CHR-T; n = 12, 6.8%) and did not (CHR-NT, n = 163) convert to psychosis over follow-up (Mean = 99.20 weeks, SD = 21.54). ANCOVAs revealed that there were significant overall group differences (CHR, EFEP, HSC) in processing speed, verbal learning, and overall neurocognition, relative to healthy controls (CNTL). In addition, the CHR-NTs performed similarly to the HSC group, with mild to moderate cognitive deficits relative to the CTRL group. The CHR-Ts mirrored the EFEP group, with large deficits in processing speed, working memory, attention/vigilance, and verbal learning (> 1 SD below CNTLs). Interestingly, only verbal learning impairments predicted transition to psychosis, when adjusting for age, education, symptoms, antipsychotic medication, and neurocognitive performance in the other domains. Our findings suggest that large neurocognitive deficits are present prior to illness onset and represent vulnerability markers for psychosis. The results of this study further reinforce that verbal learning should be specifically targeted for preventive intervention for psychosis.