Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK.
Schizophr Bull. 2018 Jun 6;44(4):824-833. doi: 10.1093/schbul/sbx113.
22q11.2 Deletion Syndrome (22q11.2DS) is associated with increased risk for schizophrenia in adulthood while Attention Deficit Hyperactivity Disorder (ADHD) is the most prevalent diagnosis in childhood. Inattention symptoms are pronounced in 22q11.2DS and given that attentional impairment is a core feature of schizophrenia, inattention symptoms may reflect underlying ADHD, psychosis, or both. We investigate whether inattention is associated with psychosis in 22q11.2DS and in other groups at risk for psychosis but without the deletion (ND) (idiopathic clinical risk and first degree family members of individuals with schizophrenia).
One hundred thirty-seven individuals with 22q11.2DS (mean age: 14.0), 84 ND individuals with subthreshold psychosis (mean age: 16.9) and 31 ND individuals with family history of psychosis (mean age: 17.0) were included in the study. Psychopathology was assessed using research diagnostic assessments.
ADHD total symptoms were associated with overall levels of subthreshold psychosis symptoms in 22q11.2DS (β = .8, P = .04). Inattention symptoms were specifically associated with positive (β = .5, P = .004), negative (β = .5, P = .03), and disorganized (β = .5, P < .001) symptoms, while hyperactivity-impulsivity symptoms were associated with disorganized symptoms (β = .5, P = .01). The prevalence of ADHD inattention symptoms was higher in 22q11.2DS with subthreshold psychosis compared to ND individuals with subthreshold psychosis (P < .001), even when adjusting for cognitive impairment and overall psychopathology. The pattern was similar when comparing individuals with 22q11.2DS and ND individuals with family history of psychosis.
This is the first study to examine the associations between ADHD symptoms and psychosis in 22q11.2DS. Our findings support a potentially important role of ADHD inattention symptoms in psychosis in 22q11.2DS.
22q11.2 缺失综合征（22q11.2DS）与成年人精神分裂症风险增加相关，而注意缺陷多动障碍（ADHD）是儿童期最常见的诊断。22q11.2DS 患者注意力不集中症状明显，由于注意力损伤是精神分裂症的核心特征，因此注意力不集中症状可能反映潜在的 ADHD、精神病或两者兼有。我们研究了 22q11.2DS 患者中注意力不集中是否与精神病有关，以及其他有精神病风险但无缺失（ND）的患者（特发性临床风险和精神分裂症患者的一级亲属）。
研究纳入了 137 名 22q11.2DS 患者（平均年龄：14.0 岁）、84 名有亚临床精神病的 ND 患者（平均年龄：16.9 岁）和 31 名有精神病家族史的 ND 患者（平均年龄：17.0 岁）。使用研究诊断评估来评估精神病理学。
ADHD 总症状与 22q11.2DS 患者的亚临床精神病症状的总体水平相关（β=0.8，P=0.04）。注意力不集中症状与阳性症状（β=0.5，P=0.004）、阴性症状（β=0.5，P=0.03）和紊乱症状（β=0.5，P<0.001）特别相关，而多动冲动症状与紊乱症状相关（β=0.5，P=0.01）。与 ND 有亚临床精神病的患者相比，22q11.2DS 有亚临床精神病的患者中 ADHD 注意力不集中症状的患病率更高（P<0.001），即使在调整认知障碍和总体精神病理学后也是如此。当比较 22q11.2DS 患者和 ND 有精神病家族史的患者时，也出现了类似的模式。
这是第一项研究 22q11.2DS 中 ADHD 症状与精神病之间关系的研究。我们的发现支持 ADHD 注意力不集中症状在 22q11.2DS 精神病中可能具有重要作用。
