Horton Leslie E, Tarbox Sarah I, Olino Thomas M, Haas Gretchen L
Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O׳Hara Street, Pittsburgh, PA 15213, United States; Mental Illness Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, University Drive C., Pittsburgh, PA 15240, United States.
Department of Psychiatry, Yale University School of Medicine, Connecticut Mental Health Center, 34 Park Street, New Haven, CT 06159, United States.
Psychiatry Res. 2015 Jun 30;227(2-3):339-46. doi: 10.1016/j.psychres.2015.02.013. Epub 2015 Mar 2.
Evidence of social and behavioral problems preceding the onset of schizophrenia-spectrum psychoses is consistent with a neurodevelopmental model of these disorders. Here we predict that individuals with a first episode of schizophrenia-spectrum psychoses will evidence one of three patterns of premorbid adjustment: an early deficit, a deteriorating pattern, or adequate or good social adjustment. Participants were 164 (38% female; 31% black) individuals ages 15-50 with a first episode of schizophrenia-spectrum psychoses. Premorbid adjustment was assessed using the Cannon-Spoor Premorbid Adjustment Scale. We compared the fit of a series of growth mixture models to examine premorbid adjustment trajectories, and found the following 3-class model provided the best fit with: a "stable-poor" adjustment class (54%), a "stable-good" adjustment class (39%), and a "deteriorating" adjustment class (7%). Relative to the "stable-good" class, the "stable-poor" class experienced worse negative symptoms at 1-year follow-up, particularly in the social amotivation domain. This represents the first known growth mixture modeling study to examine premorbid functioning patterns in first-episode schizophrenia-spectrum psychoses. Given that the stable-poor adjustment pattern was most prevalent, detection of social and academic maladjustment as early as childhood may help identify people at increased risk for schizophrenia-spectrum psychoses, potentially increasing feasibility of early interventions.
精神分裂症谱系精神病发作前存在社会和行为问题的证据与这些疾病的神经发育模型一致。在此，我们预测，首次发作精神分裂症谱系精神病的个体将呈现病前适应的三种模式之一：早期缺陷模式、恶化模式或充分或良好的社会适应模式。研究参与者为164名年龄在15至50岁之间、首次发作精神分裂症谱系精神病的个体（女性占38%；黑人占31%）。使用坎农 - 斯普尔病前适应量表评估病前适应情况。我们比较了一系列生长混合模型的拟合度，以检验病前适应轨迹，发现以下三类模型拟合度最佳：“稳定 - 差”适应组（54%）、“稳定 - 好”适应组（39%）和“恶化”适应组（7%）。与“稳定 - 好”组相比，“稳定 - 差”组在1年随访时出现更严重的阴性症状，尤其是在社交无动力领域。这是已知的第一项采用生长混合模型研究首次发作精神分裂症谱系精神病病前功能模式的研究。鉴于“稳定 - 差”适应模式最为普遍，早在童年时期发现社会和学业适应不良可能有助于识别精神分裂症谱系精神病风险增加的人群， potentially increasing feasibility of early interventions.（原文此处表述有误，正确应为“这可能会提高早期干预的可行性”）
