Kates W R, Russo N, Wood W M, Antshel K M, Faraone S V, Fremont W P
Departments of Psychiatry and Behavioral Sciences,State University of New York at Upstate Medical University,Syracuse,NY,USA.
Department of Psychology,Syracuse University,Syracuse,NY,USA.
Psychol Med. 2015 Jun;45(8):1629-39. doi: 10.1017/S0033291714002724. Epub 2014 Nov 14.
Although risk for psychosis in velocardiofacial (22q11.2 deletion) syndrome (VCFS) is well established, the cognitive and familial factors that moderate that risk are poorly understood.
A total of 75 youth with VCFS were assessed at three time points, at 3-year intervals. Time 1 (T1) psychiatric risk was assessed with the Behavior Assessment System for Children (BASC). Data reduction of BASC scores yielded avoidance-anxiety and dysregulation factors. Time 2 (T2) neuropsychological and family function and time 3 (T3) prodromal/overt psychosis were assessed. Poisson regression models tested associations between T3 positive prodromal symptoms/overt psychosis and T1 psychiatric risk, T2 cognitive and familial factors, and their interactions.
T1 avoidance-anxiety ratings predicted T3 prodromal/overt psychosis. T2 verbal learning scores moderated this association, such that individuals with low avoidance-anxiety scores and stronger verbal learning skills were the least likely to demonstrate prodromal/overt psychosis at T3. Low scores on a T2 visual vigilance task also predicted T3 prodromal/overt psychosis, independently of the effect of T1 avoidance-anxiety scores. T1 dysregulation scores did not predict T3 prodromal/overt psychosis in a linear manner. Instead, the association between dysregulation and prodromal/overt psychosis was amplified by T2 levels of family organization, such that individuals with low dysregulation scores and low family organization scores were the most likely to exhibit T3 prodromal/overt psychosis.
Significant moderators of psychiatric risk in VCFS include verbal learning skills as well as levels of family organization, carrying implications for early identification and preventative treatment of youth with VCFS at highest risk for psychosis.
虽然心脏颜面综合征（22q11.2缺失综合征，VCFS）患者患精神病的风险已得到充分证实，但对缓和该风险的认知和家族因素却知之甚少。
对75名患有VCFS的青少年进行了三次评估，时间间隔为3年。时间1（T1）时，使用儿童行为评估系统（BASC）评估精神疾病风险。对BASC分数进行数据简化后得出回避 - 焦虑和失调因素。时间2（T2）时评估神经心理学和家庭功能，时间3（T3）时评估前驱期/明显精神病症状。采用泊松回归模型测试T3期前驱症状阳性/明显精神病与T1期精神疾病风险、T2期认知和家族因素及其相互作用之间的关联。
T1期回避 - 焦虑评分可预测T3期前驱期/明显精神病。T2期言语学习分数调节了这种关联，即回避 - 焦虑分数低且言语学习技能较强的个体在T3期最不可能表现出前驱期/明显精神病。T2期视觉警觉任务得分低也可预测T3期前驱期/明显精神病，且独立于T1期回避 - 焦虑分数的影响。T1期失调分数不能以线性方式预测T3期前驱期/明显精神病。相反，失调与前驱期/明显精神病之间的关联因T2期家庭组织水平而增强，即失调分数低且家庭组织分数低的个体最有可能表现出T3期前驱期/明显精神病。
VCFS患者精神疾病风险的重要调节因素包括言语学习技能和家庭组织水平，这对早期识别和预防性治疗具有精神病高风险的VCFS青少年具有重要意义。
