Orygen Youth Health Research Centre and Centre for Youth Mental Health, University of Melbourne, Australia.
Psychol Med. 2013 Nov;43(11):2349-60. doi: 10.1017/S0033291713000123. Epub 2013 Feb 6.
Individuals at ultra-high risk (UHR) for psychosis show reduced neurocognitive performance across domains but it is unclear which reductions are associated with transition to frank psychosis. The aim of this study was to investigate differences in baseline neurocognitive performance between UHR participants with (UHR-P) and without transition to psychosis (UHR-NP) and a healthy control (HC) group and examine neurocognitive predictors of transition over the medium to long term.
A sample of 325 UHR participants recruited consecutively from the Personal Assessment and Crisis Evaluation (PACE) Clinic in Melbourne and 66 HCs completed a neurocognitive assessment at baseline. The UHR group was followed up between 2.39 and 14.86 (median = 6.45) years later. Cox regression was used to investigate candidate neurocognitive predictors of psychosis onset.
The UHR group performed more poorly than the HC group across a range of neurocognitive domains but only performance on digit symbol coding and picture completion differed between the groups. The risk of transition was only significantly associated with poorer performance on visual reproduction [hazard ratio (HR) 0.919, 95% confidence interval (CI) 0.876-0.965, p = 0.001] and matrix reasoning (HR 0.938, 95% CI 0.883-0.996, p = 0.037). These remained significant even after controlling for psychopathology at baseline.
This study is the longest follow-up of an UHR sample to date. UHR status was associated with poorer neurocognitive performance compared to HCs on some tasks. Cognition at identification as UHR was not a strong predictor of risk for transition to psychosis. The results suggests the need to include more experimental paradigms that isolate discrete cognitive processes to better understand neurocognition at this early stage of illness.
处于精神病超高风险（UHR）的个体在多个领域表现出神经认知能力下降，但尚不清楚哪些下降与向明显精神病转变有关。本研究的目的是调查 UHR 患者（UHR-P）与未向精神病过渡的 UHR 患者（UHR-NP）以及健康对照组（HC）之间基线神经认知表现的差异，并检验中长程过渡的神经认知预测指标。
本研究从墨尔本的个人评估和危机评估（PACE）诊所连续招募了 325 名 UHR 参与者和 66 名 HC 完成了基线神经认知评估。UHR 组在 2.39 到 14.86 年（中位数=6.45 年）后进行随访。使用 Cox 回归分析探讨精神病发病的候选神经认知预测指标。
UHR 组在一系列神经认知领域的表现均差于 HC 组，但只有数字符号编码和图片完成测试的结果存在组间差异。过渡风险仅与视觉再现[危险比（HR）0.919，95%置信区间（CI）0.876-0.965，p=0.001]和矩阵推理（HR 0.938，95%CI 0.883-0.996，p=0.037）的表现较差显著相关。即使在基线时控制了精神病学因素，这些结果仍然具有统计学意义。
本研究是迄今为止对 UHR 样本进行的最长随访。与 HC 相比，UHR 状态与某些任务上的神经认知表现较差相关。在识别为 UHR 时的认知并不能很好地预测向精神病过渡的风险。结果表明，需要包括更多的实验范式来分离离散的认知过程，以更好地了解疾病早期的神经认知。
