Department of Methods and Experimental Psychology, University of Deusto, Avda. Universidades 24, 48007 Bilbao, Spain.
J Psychiatr Res. 2012 Jun;46(6):774-81. doi: 10.1016/j.jpsychires.2012.03.014. Epub 2012 Apr 7.
The aim of this two-year longitudinal study was to identify the best baseline predictors of functional outcome in first-episode psychosis (FEP). We tested whether the same factors predict functional outcomes in two different subsamples of FEP patients: schizophrenia and non-schizophrenia syndrome groups.
Ninety-five patients with FEP underwent a full clinical evaluation (i.e., PANSS, Mania, Depression and Insight). Functional outcome measurements included the WHO Disability Assessment Schedule (DAS-WHO), Global Assessment of Functioning (GAF) and Clinical Global Impression (CGI). Estimation of cognition was obtained by a neuropsychological battery which included attention, processing speed, language, memory and executive functioning.
Greater severity of visuospatial functioning at baseline predicted poorer functional outcome as measured by the three functional scales (GAF, CGI and DAS-WHO) in the pooled FEP sample (explaining ut to the 12%, 9% and 10% of the variance, respectively). Negative symptoms also effectively contributed to predict GAF scores (8%). However, we obtained different predictive values after differentiating sample diagnoses. Processing speed significantly predicted most functional outcome measures in patients with schizophrenia, whereas visuospatial functioning was the only significant predictor of functional outcomes in the non-schizophrenia subgroup.
Our results suggest that processing speed, visuospatial functioning and negative symptoms significantly (but differentially) predict outcomes in patients with FEP, depending on their clinical progression. For patients without a schizophrenia diagnosis, visuospatial functioning was the best predictor of functional outcome. The performance on processing speed seemed to be a key factor in more severe syndromes. However, only a small proportion of the variance could be explained by the model, so there must be many other factors that have to be considered.
本为期两年的纵向研究旨在确定首发精神病（FEP）患者功能结局的最佳基线预测因子。我们检验了相同的因素是否可以预测两种不同的 FEP 患者亚组（精神分裂症和非精神分裂症综合征组）的功能结局。
95 名首发精神病患者接受了全面的临床评估（即 PANSS、躁狂、抑郁和洞察力）。功能结局测量包括世界卫生组织残疾评定量表（DAS-WHO）、总体功能评估（GAF）和临床总体印象（CGI）。认知评估通过神经心理学测试获得，包括注意力、加工速度、语言、记忆和执行功能。
在合并的 FEP 样本中，基线时视空间功能障碍越严重，三个功能量表（GAF、CGI 和 DAS-WHO）的功能结局越差（分别解释了 12%、9%和 10%的方差）。阴性症状也能有效地预测 GAF 评分（8%）。然而，我们在区分样本诊断后获得了不同的预测值。在精神分裂症患者中，加工速度显著预测了大多数功能结局，而在非精神分裂症亚组中，视空间功能是功能结局的唯一显著预测因子。
我们的结果表明，加工速度、视空间功能和阴性症状在首发精神病患者中显著（但不同）地预测结局，这取决于他们的临床进展。对于没有精神分裂症诊断的患者，视空间功能是功能结局的最佳预测因子。加工速度的表现似乎是更严重综合征的关键因素。然而，该模型只能解释一小部分方差，因此一定还有许多其他因素需要考虑。
