Tang S X, Moore T M, Calkins M E, Yi J J, McDonald-McGinn D M, Zackai E H, Emanuel B S, Gur R C, Gur R E
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Transl Psychiatry. 2017 Jul 25;7(7):e1180. doi: 10.1038/tp.2017.157.
Individuals with 22q11.2 deletion syndrome (22q11DS) are at markedly elevated risk for schizophrenia-related disorders. Stability, emergence, remission and persistence of psychosis-spectrum symptoms were investigated longitudinally. Demographic, clinical and cognitive predictors of psychosis were assessed. Prospective follow-up over 2.8 years was undertaken in 75 individuals with 22q11DS aged 8-35 years. Mood, anxiety, attention-deficit hyperactivity disorders and psychosis-spectrum symptoms were assessed with the Kiddie-Schedule for Affective Disorders and Schizophrenia and Scale of Prodromal Symptoms (SOPS). Four domains of cognition were evaluated with the Penn Computerized Neurocognitive Battery (executive functioning, memory, complex cognition and social cognition). Psychotic disorder or clinically significant SOPS-positive ratings were consistently absent in 35%, emergent in 13%, remitted in 22% and persistent in 31% of participants. Negative symptoms and functional impairment were found to be predictive of the emergence of positive psychosis-spectrum symptoms and to reflect ongoing deficits after remission of positive symptoms. Dysphoric mood and anxiety were predictive of emergent and persistent-positive psychosis-spectrum symptoms. Lower baseline global cognition and greater global cognitive decline were predictive of psychosis-spectrum outcomes but no particular cognitive domain stood out as being significantly more discriminating than others. Our findings suggest that negative symptoms, functioning and dysphoric mood are important predictors of psychosis risk in this population.
患有22q11.2缺失综合征（22q11DS）的个体患精神分裂症相关疾病的风险显著升高。对精神病性症状谱的稳定性、出现、缓解和持续性进行了纵向研究。评估了精神病的人口统计学、临床和认知预测因素。对75名年龄在8至35岁之间的22q11DS个体进行了2.8年的前瞻性随访。使用儿童情感障碍和精神分裂症量表以及前驱症状量表（SOPS）评估情绪、焦虑、注意力缺陷多动障碍和精神病性症状谱。使用宾夕法尼亚计算机化神经认知电池评估四个认知领域（执行功能、记忆、复杂认知和社会认知）。在35%的参与者中始终未出现精神障碍或临床上显著的SOPS阳性评分，13%的参与者出现了精神障碍，22%的参与者症状缓解，31%的参与者症状持续存在。发现阴性症状和功能损害可预测阳性精神病性症状谱的出现，并反映阳性症状缓解后的持续缺陷。烦躁情绪和焦虑可预测新出现的和持续存在的阳性精神病性症状谱。较低的基线整体认知水平和较大的整体认知衰退可预测精神病性症状谱的结果，但没有一个特定的认知领域比其他领域更具显著的区分性。我们的研究结果表明，阴性症状、功能状态和烦躁情绪是该人群精神病风险的重要预测因素。
