Ziermans Tim, de Wit Sanne, Schothorst Patricia, Sprong Mirjam, van Engeland Herman, Kahn René, Durston Sarah
Department of Clinical Child and Adolescent Studies, Leiden University, Leiden, the Netherlands.
Department of Psychiatry, University Medical Center Utrecht, Rudolf Magnus Institute of Neuroscience, Utrecht, the Netherlands.
PLoS One. 2014 Apr 4;9(4):e93994. doi: 10.1371/journal.pone.0093994. eCollection 2014.
Most studies aiming to predict transition to psychosis for individuals at ultra-high risk (UHR) have focused on either neurocognitive or clinical variables and have made little effort to combine the two. Furthermore, most have focused on a dichotomous measure of transition to psychosis rather than a continuous measure of functional outcome. We aimed to investigate the relative value of neurocognitive and clinical variables for predicting both transition to psychosis and functional outcome.
Forty-three UHR individuals and 47 controls completed an extensive clinical and neurocognitive assessment at baseline and participated in long-term follow-up approximately six years later. UHR adolescents who had converted to psychosis (UHR-P; n = 10) were compared to individuals who had not (UHR-NP; n = 33) and controls on clinical and neurocognitive variables. Regression analyses were performed to determine which baseline measures best predicted transition to psychosis and long-term functional outcome for UHR individuals.
Low IQ was the single neurocognitive parameter that discriminated UHR-P individuals from UHR-NP individuals and controls. The severity of attenuated positive symptoms was the only significant predictor of a transition to psychosis and disorganized symptoms were highly predictive of functional outcome.
Clinical measures are currently the most important vulnerability markers for long-term outcome in adolescents at imminent risk of psychosis.
大多数旨在预测超高风险（UHR）个体向精神病转变的研究都集中在神经认知或临床变量上，很少有人努力将两者结合起来。此外，大多数研究都集中在向精神病转变的二分法测量上，而不是对功能结局的连续测量。我们旨在研究神经认知和临床变量对预测向精神病转变和功能结局的相对价值。
43名UHR个体和47名对照在基线时完成了广泛的临床和神经认知评估，并在大约六年后参与了长期随访。将已转变为精神病的UHR青少年（UHR-P；n = 10）与未转变的个体（UHR-NP；n = 33）以及对照在临床和神经认知变量上进行比较。进行回归分析以确定哪些基线测量最能预测UHR个体向精神病的转变和长期功能结局。
低智商是区分UHR-P个体与UHR-NP个体和对照的单一神经认知参数。阳性症状衰减的严重程度是向精神病转变的唯一重要预测因素，而紊乱症状对功能结局具有高度预测性。
目前，临床测量是即将患精神病的青少年长期结局最重要的脆弱性标志物。
