Department of Psychology, Duke University, Durham, NC 27708, USA.
Am J Psychiatry. 2010 Feb;167(2):160-9. doi: 10.1176/appi.ajp.2009.09040574. Epub 2010 Jan 4.
Premorbid cognitive deficits in schizophrenia are well documented and have been interpreted as supporting a neurodevelopmental etiological model. The authors investigated the following three unresolved questions about premorbid cognitive deficits: What is their developmental course? Do all premorbid cognitive deficits follow the same course? Are premorbid cognitive deficits specific to schizophrenia or shared by other psychiatric disorders?
Participants were members of a representative cohort of 1,037 males and females born between 1972 and 1973 in Dunedin, New Zealand. Cohort members underwent follow-up evaluations at specific intervals from age 3 to 32 years, with a 96% retention rate. Cognitive development was analyzed and compared in children who later developed schizophrenia or recurrent depression as well as in healthy comparison subjects.
Children who developed adult schizophrenia exhibited developmental deficits (i.e., static cognitive impairments that emerge early and remain stable) on tests indexing verbal and visual knowledge acquisition, reasoning, and conceptualization. In addition, these children exhibited developmental lags (i.e., growth that is slower relative to healthy comparison subjects) on tests indexing processing speed, attention, visual-spatial problem solving ability, and working memory. These two premorbid cognitive patterns were not observed in children who later developed recurrent depression.
These findings suggest that the origins of schizophrenia include two interrelated developmental processes evident from childhood to early adolescence (ages 7-13 years). Children who will grow up to develop adult schizophrenia enter primary school struggling with verbal reasoning and lag further behind their peers in working memory, attention, and processing speed as they get older.
精神分裂症的发病前认知缺陷已有大量记载，并被解释为支持神经发育病因学模型。作者研究了发病前认知缺陷的以下三个未解决的问题：它们的发展过程是什么？所有发病前认知缺陷是否遵循相同的过程？发病前认知缺陷是否仅存在于精神分裂症，还是与其他精神障碍共有？
参与者是新西兰达尼丁 1972 年至 1973 年间出生的 1037 名男性和女性的代表性队列成员。队列成员在特定的时间间隔内接受了随访评估，从 3 岁到 32 岁，保留率为 96%。对后来发展为精神分裂症或复发性抑郁症的儿童以及健康对照组进行了认知发展分析和比较。
患有成年精神分裂症的儿童在言语和视觉知识获取、推理和概念化测试中表现出发育缺陷（即早期出现且稳定的静态认知障碍）。此外，这些儿童在处理速度、注意力、视觉空间问题解决能力和工作记忆测试中表现出发育迟缓（即相对于健康对照组生长较慢）。这些两种发病前认知模式在后来发展为复发性抑郁的儿童中没有观察到。
这些发现表明，精神分裂症的起源包括从儿童期到青春期早期（7-13 岁）可见的两个相互关联的发育过程。将发展为成年精神分裂症的儿童在进入小学时就已经在言语推理方面挣扎，随着年龄的增长，他们在工作记忆、注意力和处理速度方面进一步落后于同龄人。
