“多环境风险评分”：综合环境风险因素可预测家族性高危个体向精神病的转化。
The "polyenviromic risk score": Aggregating environmental risk factors predicts conversion to psychosis in familial high-risk subjects.
作者信息
Padmanabhan Jaya L, Shah Jai L, Tandon Neeraj, Keshavan Matcheri S
机构信息
Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Behavioral Neurology and Neuropsychiatry, McLean Hospital, Belmont, MA, USA.
PEPP-Montréal, Douglas Mental Health University Institute, Montreal, Canada; Department of Psychiatry, McGill University, Montreal, Canada.
出版信息
Schizophr Res. 2017 Mar;181:17-22. doi: 10.1016/j.schres.2016.10.014. Epub 2016 Oct 29.
BACKGROUND
Young relatives of individuals with schizophrenia (i.e. youth at familial high-risk, FHR) are at increased risk of developing psychotic disorders, and show higher rates of psychiatric symptoms, cognitive and neurobiological abnormalities than non-relatives. It is not known whether overall exposure to environmental risk factors increases risk of conversion to psychosis in FHR subjects.
METHODS
Subjects consisted of a pilot longitudinal sample of 83 young FHR subjects. As a proof of principle, we examined whether an aggregate score of exposure to environmental risk factors, which we term a 'polyenviromic risk score' (PERS), could predict conversion to psychosis. The PERS combines known environmental risk factors including cannabis use, urbanicity, season of birth, paternal age, obstetric and perinatal complications, and various types of childhood adversity, each weighted by its odds ratio for association with psychosis in the literature.
RESULTS
A higher PERS was significantly associated with conversion to psychosis in young, familial high-risk subjects (OR=1.97, p=0.009). A model combining the PERS and clinical predictors had a sensitivity of 27% and specificity of 96%.
CONCLUSION
An aggregate index of environmental risk may help predict conversion to psychosis in FHR subjects.
背景
精神分裂症患者的年轻亲属（即家族高危青年，FHR）患精神障碍的风险增加，且与非亲属相比，其精神症状、认知和神经生物学异常的发生率更高。目前尚不清楚环境危险因素的总体暴露是否会增加FHR受试者转化为精神病的风险。
方法
研究对象为83名年轻FHR受试者的纵向试点样本。作为原理验证，我们研究了环境危险因素暴露的综合评分，即“多环境风险评分”（PERS），是否能够预测转化为精神病的情况。PERS综合了已知的环境危险因素，包括大麻使用、城市化程度、出生季节、父亲年龄、产科和围产期并发症以及各种类型的童年逆境，每项因素根据其在文献中与精神病关联的比值比进行加权。
结果
在年轻的家族高危受试者中，较高的PERS与转化为精神病显著相关（OR=1.97，p=0.009）。结合PERS和临床预测指标的模型敏感性为27%，特异性为96%。
结论
环境风险综合指数可能有助于预测FHR受试者转化为精神病的情况。
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