Orygen,The National Centre of Excellence in Youth Mental Health,Parkville,Australia.
Department of Child and Adolescent Psychiatry,Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM,School of Medicine,Universidad Complutense de Madrid,Madrid,Spain.
Psychol Med. 2018 Jul;48(10):1592-1607. doi: 10.1017/S0033291717003002. Epub 2017 Nov 27.
Previous reviews suggest there is minimal evidence for an association between duration of untreated psychosis (DUP) and neurocognition. This is based on tallied findings of studies with small samples and neurocognition viewed as a single construct. We aimed to conduct a systematic review and meta-analysis examining the association between DUP and individual neurocognitive domains and tests in first-episode psychosis (FEP).
MOOSE and PRISMA guidelines were followed. Forty-three studies involving 4647 FEP patients were included. For studies providing correlations between DUP and neurocognition, 12 separate meta-analyses were performed based on neurocognitive domains/indices. The influence of demographic/clinical variables was tested using weighted linear meta-regression analyses.
The relationship between DUP and most neurocognitive domains/indices was not significant. Longer DUP was associated with a larger cognitive deterioration index, i.e. current minus premorbid intellectual functioning (N = 4; mean ES -0.213, 95% confidence interval (CI) (-0.344 to -0.074), p = 0.003). Findings were homogeneous, with no evidence of publication bias or significant influence from moderators. For studies providing mean and standard deviations for neurocognitive measures and DUP, 20 meta-regressions were performed on individual neurocognitive tests. One significant finding emerged showing that longer DUP was associated with fewer Wisconsin Card Sorting Test-perseverative errors (mean ES -0.031, 95% CI (-0.048 to -0.013), p < 0.001). Exploratory meta-regressions in studies with mean DUP <360 days showed longer DUP was significantly associated with poorer performance on Trail Making Test A and B and higher Full-Scale IQ.
There may not be a generalised association between DUP and neurocognition, however, specific cognitive functions may be associated with longer DUP or delayed help-seeking.
先前的综述表明，未治疗的精神病持续时间（DUP）与神经认知之间的关联证据很少。这是基于对小样本研究的汇总结果，以及将神经认知视为单一结构得出的。我们旨在进行系统评价和荟萃分析，以检查首次发作精神病（FEP）中 DUP 与个体神经认知领域和测试之间的关联。
遵循 MOOSE 和 PRISMA 指南。纳入了 43 项涉及 4647 名 FEP 患者的研究。对于提供 DUP 与神经认知之间相关性的研究，根据神经认知领域/指数进行了 12 项单独的荟萃分析。使用加权线性荟萃回归分析测试了人口统计学/临床变量的影响。
DUP 与大多数神经认知领域/指数之间的关系不显著。较长的 DUP 与更大的认知恶化指数相关，即当前减去发病前智力功能（N = 4；平均 ES -0.213，95%置信区间（CI）（-0.344 至-0.074），p = 0.003）。结果是同质的，没有发表偏倚的证据，也没有来自调节因素的显著影响。对于提供神经认知测量和 DUP 的平均值和标准差的研究，对 20 项个体神经认知测试进行了荟萃回归。出现了一个显著的发现，即较长的 DUP 与威斯康星卡片分类测试中的坚持错误较少有关（平均 ES -0.031，95%CI（-0.048 至-0.013），p <0.001）。在平均 DUP<360 天的研究中进行的探索性荟萃回归表明，较长的 DUP 与 Trail Making Test A 和 B 的表现较差以及全量表智商较高显著相关。
DUP 与神经认知之间可能没有普遍的关联，但是特定的认知功能可能与较长的 DUP 或延迟寻求帮助有关。
