Stouten Luyken H, Veling Wim, Laan Winfried, van der Helm Mischa, van der Gaag Mark
Centre for Early Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands.
Department of Psychiatry, University Medical Centre Groningen, Groningen, The Netherlands.
Early Interv Psychiatry. 2017 Feb;11(1):23-36. doi: 10.1111/eip.12210. Epub 2015 Jan 13.
Most studies on the determinants of psychosocial functioning in first-episode psychosis used few predictors. This study examines the effects of multiple cognitive domains and multiple symptoms on psychosocial functioning.
A total of 162 patients with a first-episode psychosis were assessed within 3 months after referral to an early psychosis treatment department. Four psychopathological subdomains (positive and negative symptoms, depression and anxiety) and five subdomains of psychosocial functioning (work/study, relationships, self-care, disturbing behaviour and general psychosocial functioning) were measured. Neurocognitive and social cognitive factors were identified through principal component analyses (PCA) of a 15-measure cognitive battery. Stepwise backward regression models were computed to identify the determinants of psychosocial functioning.
The three neurocognitive and four social cognitive factors identified through PCA were largely independent of psychopathology. The strongest associations were between cognitive factors and anxiety. Higher levels of negative symptoms, poor general neurocognition and poor general social cognition showed strongest associations with impaired psychosocial functioning, followed by low verbal processing speed and low emotion processing speed. Together, these factors accounted for 39.4% of the variance in psychosocial functioning.
The results suggest that negative symptoms, impaired neurocognition and poor social cognition are related to psychosocial problems in patients with first-episode psychosis. None of the affective or positive symptoms had a marked impact on psychosocial functioning.
大多数关于首发精神病患者心理社会功能决定因素的研究使用的预测因素较少。本研究考察多个认知领域和多种症状对心理社会功能的影响。
共有162例首发精神病患者在转诊至早期精神病治疗科后的3个月内接受评估。测量了四个精神病理学子领域（阳性和阴性症状、抑郁和焦虑）以及心理社会功能的五个子领域（工作/学习、人际关系、自我照顾、干扰行为和总体心理社会功能）。通过对一个包含15项测量的认知测试组合进行主成分分析（PCA）来确定神经认知和社会认知因素。计算逐步向后回归模型以确定心理社会功能的决定因素。
通过PCA确定的三个神经认知因素和四个社会认知因素在很大程度上独立于精神病理学。最强的关联存在于认知因素和焦虑之间。更高水平的阴性症状、较差的总体神经认知和较差的总体社会认知与受损的心理社会功能表现出最强的关联，其次是低言语处理速度和低情绪处理速度。这些因素共同解释了心理社会功能变异的39.4%。
结果表明，阴性症状、神经认知受损和社会认知不良与首发精神病患者的心理社会问题有关。情感症状或阳性症状均未对心理社会功能产生显著影响。
