认知障碍是精神疾病的强力预测因子


  【24drs.com】一篇具有指标意义的研究认为,神经认知障碍—特别是涉及注意力与记忆时—是精神病临床高风险(clinical high risk,CHR)者的强力预测因子,尤其是那些后来转而发生精神病的人。
  
  第一作者、麻塞诸塞州波士顿哈佛医学院贝斯以色列女执事医疗中心Larry J. Seidman博士等研究者写道,我们的研究结果支持理论模型假设:注意力和工作记忆能力障碍,甚至,更强烈地,受损的陈述性记忆能力是临床高风险的核心。
  
  这篇研究在线发表于11月2日JAMA Psychiatry期刊。
  
  这篇分析的资料来自「North American Prodrome Longitudinal Study (NAPLS-2)」第二阶段,包括689名因为精神病临床高风险而寻求照护者,以及264名健康对照组,临床高风险者有89人(12.9%)在2年内发生临床精神病。
  
  整体比较时,相较于对照组,临床高风险者在注意力与操作记忆(P < .001)以及陈述性记忆(P < .001)等方面显著受损,在19项神经心理测试中,有14项显著较差。但是,这19项神经心理测试的平均影响程度小(effect size,ES)(Cohen d = 0.30)。
  
  不过,转变成精神疾病的89名临床高风险者中,注意力与操作记忆以及陈述性记忆都比对照组有更大幅度的缺损(Cohen d,约 0.80),且这些测量也比没有转变成精神病的临床高风险者显著更糟(Cohen d分别是0.28与0.48)。
  
  研究者表示,这些结果没有考虑一般认知能力、当前的忧郁症状态、或使用药物、酒精或大麻。
  
  Seidman博士在声明中表示,就我们所知,这是有关发生精神病/精神分裂症前的高风险期认知的最大型与最明确的研究。这是变换方式的一部份,我们专注于疾病的早期、前驱阶段,致力于找出最可能发展为精神病的人。
  
  各个领域间的表现显著不同, 特别是那些后来发生转变的临床高风险者,他们指出,这代表,在早期精神病阶段,特定型式的神经认知受到影响,并且预示著随后发生的精神病。
  
  研究者结论表示,神经认知测试与其它临床和心理生理测量一起使用,可以增强精神病或功能结果的预测。
  
  在编辑评论中,英国伦敦国王学院的Josephine Mollon、纽约市西奈山伊坎医学院精神科Abraham Reichenberg博士指出,这篇研究是一篇全面性和重要的报告,然而,不可避免地,作者只有有限的空间来呈现和讨论文章本身的发现。
  
  透过阐明与前驱症状相关的神经认知缺陷样貌,以及它们作为转化成临床精神病之风险标志的潜力,这些结果为临床医生和研究人员提供了一个新的参考点。
  
  如果本篇邀请评论可向读者提出一个建议,那就是:必须如同阅读主文一般详读补充资料。补充资料几乎与主文本身相关,这是相当罕见的。
  
  资料来源:http://www.24drs.com/
  
  Native link:Cognitive Trouble a 'Robust' Predictor of Psychosis

Cognitive Trouble a 'Robust' Predictor of Psychosis

By Megan Brooks
Medscape Medical News

Neurocognitive impairment, particularly involving attention and memory, is a "robust" characteristic of individuals at clinical high risk (CHR) for psychosis, especially those who transition to psychosis later on, a landmark study suggests.

"Our findings support theoretical models hypothesizing attention and working memory abilities impairments and, even more strongly, impaired declarative memory abilities as central to the CHR stage," the investigators, with first author Larry J. Seidman, PhD, of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, Massachusetts, write.

The study was published online November 2 in JAMA Psychiatry.

Landmark Study

The analysis included data from the second phase of the North American Prodrome Longitudinal Study (NAPLS-2) and included 689 care-seeking individuals at CHR for psychosis and 264 healthy control persons. Eighty-nine (12.9%) of the CHR individuals developed clinical psychosis within 2 years.

As a group, CHR individuals were significantly impaired compared with control persons with respect to attention and working memory (P < .001) and declarative memory (P < .001) and performed significantly worse on 14 of 19 neuropsychological tests. But the mean effect size (ES) across the 19 neuropsychological tests was small (Cohen d = 0.30).

However, the 89 CHR individuals who experienced conversion to psychosis had large deficits in attention and working memory and declarative memory (Cohen d, approximately 0.80) compared with control persons and performed significantly worse on these measures than CHR individuals who did not experience conversion to psychosis (Cohen d, 0.28 and 0.48, respectively).

These results were not accounted for by general cognitive ability, current depression, or use of medication, alcohol, or cannabis, the researchers say.

"To our knowledge, this is the largest and most definitive study of cognition in the high-risk period before onset of psychosis/schizophrenia," Dr Seidman said in a statement. "This is part of a paradigm shift in the way we are focusing on the earlier, prodromal phase of the disorder in an effort to identify those most likely to develop psychosis."

The distinct profile of performance across domains, especially in those at CHR who subsequently experienced conversion, suggests that "at the incipient psychotic phase, specific forms of neurocognition are affected and are predictive of later psychosis," they add.

"Neurocognitive tests used in concert with other clinical and psychobiological measures may enhance prediction of psychosis or functional outcome," the researchers conclude.

New Reference Point

In an accompanying commentary, Abraham Reichenberg, PhD, Department of Psychiatry, Icahn School of Medicine at Mount Sinai in New York City, and Josephine Mollon, King's College London, United Kingdom, note the study is "a comprehensive and significant report. Yet, unavoidably, the authors only have limited space to present and discuss findings in the article itself.

"The results provide a new reference point for clinicians and researchers by elucidating the profile of neurocognitive deficits associated with the prodrome as well as their potential as risk markers for conversion to clinical psychosis," they write.

"If this Invited Commentary may make one recommendation to readers, it is that the supplementary material should be read with the same level of interest as the main article. This may be one of those rare occasions when the supplementary material is almost as relevant as the article itself," they write.

The study was supported by the National Institute of Mental Health. The study authors and the authors of the commentary have disclosed no relevant financial relationships.

JAMA Psychiatry. Published online November 2, 2016.

    
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