基于人群样本的精神病体验与神经心理学功能。
Psychotic Experiences and Neuropsychological Functioning in a Population-based Sample.
机构信息
Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, England.
Department of Health Services and Population Research, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, England.
出版信息
JAMA Psychiatry. 2016 Feb;73(2):129-38. doi: 10.1001/jamapsychiatry.2015.2551.
IMPORTANCE
Psychotic experiences in early life are associated with neuropsychological impairment and the risk for later psychiatric disorders. Psychotic experiences are also prevalent in adults, but neuropsychological investigations spanning adulthood are limited, and confounding factors have not been examined rigorously.
OBJECTIVE
To characterize neuropsychological functioning in adults with psychotic experiences while adjusting for important sociodemographic characteristics and familial factors and investigating the effect of age.
DESIGN, SETTING, AND PARTICIPANTS: The South East London Community Health (SELCoH) study is a population-based household survey of physical and mental health in individuals 16 years or older conducted from June 1, 2008, to December 31, 2010, in 2 London boroughs. The study included 1698 participants from 1075 households. Data were analyzed from May 6, 2014, to April 22, 2015.
EXPOSURES
Psychotic experiences measured using the Psychosis Screening Questionnaire.
MAIN OUTCOMES AND MEASURES
Neuropsychological functioning measured using tests assessing verbal knowledge (Wechsler Test of Adult Reading), working memory (Spatial Delayed Response Task), memory (Visual Object Learning Task), and processing speed (digit symbol coding task). A composite IQ score of general cognitive ability was calculated.
RESULTS
A total of 1677 participants with a mean (SD) age of 40 (17) years were included in the analysis. Compared with the group without psychotic experiences, the 171 (9.7%) adults with psychotic experiences did not show a statistically significant impairment on mean (SD) measures of IQ (95.25 [16.58] vs 100.45 [14.77]; Cohen d, -0.22; P = .06) or processing speed (40.63 [13.06] vs 42.17 [13.79]; Cohen d, -0.03; P = .73) but were impaired on measures of verbal knowledge (31.36 [15.78] vs 38.83 [12.64]; Cohen d, -0.37; P = .003), working memory (20.97 [4.12] vs 22.51 [3.26]; Cohen d, -0.34; P = .005), and memory (43.80 [8.45] vs 46.53 [7.06]; Cohen d, -0.28; P = .01). Only participants 50 years and older with psychotic experiences showed medium to large impairments in neuropsychological functioning (mean [SD]) on measures of IQ (81.22 [15.97] vs 91.28 [14.31]; Cohen d, -0.70), verbal knowledge (28.31 [13.83] vs 38.51 [11.50]; Cohen d, -0.88), working memory (19.11 [4.77] vs 21.99 [3.42]; Cohen d, -0.82), and memory (39.17 [8.23] vs 44.09 [6.51]; Cohen d, -0.45) after adjusting for socioeconomic status, cannabis use, and common mental disorders. Medium impairments (mean [SD]) on measures of working memory (21.27 [3.64] vs 22.62 [2.97]; Cohen d, -0.45) and memory (44.32 [5.84] vs 46.91 [5.74]; Cohen d, -0.45) were seen in those aged 35 to 49 years and on a measure of verbal knowledge (30.81 [14.17] vs 37.60 [10.48]; Cohen d, -0.62) in those aged 16 to 24 years. First-degree relatives of adults with psychotic experiences showed a small impairment on a measure of verbal knowledge (34.71 [12.10] vs 38.63 [10.97]; Cohen d, -0.36; P = .02), and unrelated cohabitants showed no neuropsychological impairment.
CONCLUSIONS AND RELEVANCE
The profile of cognitive impairment in adults with psychotic experiences differed from that seen in adults with psychotic disorders, suggesting important differences between subclinical and clinical psychosis.
重要性
早期生活中的精神病体验与神经认知障碍和以后发生精神障碍的风险有关。精神病体验在成年人中也很普遍，但跨越成年期的神经心理学研究有限，而且混杂因素尚未得到严格检查。
目的
在调整重要的社会人口特征和家族因素的情况下，描述有精神病体验的成年人的神经认知功能，并调查年龄的影响。
设计、地点和参与者：东南伦敦社区健康（SELCoH）研究是一项针对身体和心理健康的基于人群的家庭调查，参与者为 16 岁或以上的个体，于 2008 年 6 月 1 日至 2010 年 12 月 31 日在伦敦的两个行政区进行。该研究包括 1075 户家庭中的 1698 名参与者。数据分析于 2014 年 5 月 6 日至 2015 年 4 月 22 日进行。
暴露
使用精神病筛查问卷测量精神病体验。
主要结果和测量
使用评估言语知识（韦氏成人阅读测验）、工作记忆（空间延迟反应任务）、记忆（视觉物体学习任务）和处理速度（数字符号编码任务）的测试测量神经认知功能。计算一般认知能力的复合智商得分。
结果
共纳入 1677 名平均（SD）年龄为 40（17）岁的参与者进行分析。与没有精神病体验的组相比，171 名（9.7%）有精神病体验的成年人在智商（95.25[16.58]与 100.45[14.77]；Cohen d，-0.22；P=0.06）或处理速度（40.63[13.06]与 42.17[13.79]；Cohen d，-0.03；P=0.73）方面没有统计学意义上的损伤，但在言语知识（31.36[15.78]与 38.83[12.64]；Cohen d，-0.37；P=0.003）、工作记忆（20.97[4.12]与 22.51[3.26]；Cohen d，-0.34；P=0.005）和记忆（43.80[8.45]与 46.53[7.06]；Cohen d，-0.28；P=0.01）方面存在损伤。只有年龄在 50 岁及以上的有精神病体验的参与者在智商（81.22[15.97]与 91.28[14.31]；Cohen d，-0.70）、言语知识（28.31[13.83]与 38.51[11.50]；Cohen d，-0.88）、工作记忆（19.11[4.77]与 21.99[3.42]；Cohen d，-0.82）和记忆（39.17[8.23]与 44.09[6.51]；Cohen d，-0.45）方面表现出中等至较大的损伤，这些损伤在调整社会经济地位、大麻使用和常见精神障碍后仍存在。在工作记忆（21.27[3.64]与 22.62[2.97]；Cohen d，-0.45）和记忆（44.32[5.84]与 46.91[5.74]；Cohen d，-0.45）方面也存在中等程度的损伤（mean[SD]），在 35 岁至 49 岁之间，在言语知识（30.81[14.17]与 37.60[10.48]；Cohen d，-0.62）方面，在 16 岁至 24 岁之间。有精神病体验的成年人的一级亲属在言语知识方面存在轻微损伤（34.71[12.10]与 38.63[10.97]；Cohen d，-0.36；P=0.02），而无关的同居者没有神经认知损伤。
结论和相关性
有精神病体验的成年人的认知损伤特征与有精神病障碍的成年人不同，这表明亚临床和临床精神病之间存在重要差异。
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