1 Department of Psychiatry, McGill University, Montreal, QC, Canada.
2 Douglas Mental Health University Institute, Montreal, QC, Canada.
Aust N Z J Psychiatry. 2018 Aug;52(8):793-803. doi: 10.1177/0004867417747401. Epub 2017 Dec 17.
Most studies have investigated either the singular or relative contributions of premorbid adjustment, verbal memory and symptom remission to functional outcomes in first-episode psychosis. Fewer studies have examined the pathways of these factors in impacting functioning. Our study addresses this gap. The objective was to determine whether the relationship between premorbid adjustment and functional outcomes was mediated by verbal memory and symptom remission.
A total of 334 first-episode psychosis participants (aged 14-35 years) were assessed on premorbid adjustment, verbal memory upon entry, and positive and negative symptom remission and functioning at multiple time points over a 2-year follow-up.
Mediation analyses showed that over the first year, the relationship between premorbid adjustment and functioning was mediated by verbal memory and positive symptom remission (β = -0.18; 95% confidence interval = [-0.51, -0.04]), as well as by verbal memory and negative symptom remission (β = -0.41; 95% confidence interval = [-1.11, -1.03]). Over 2 years, the relationship between premorbid adjustment and functioning was mediated by verbal memory and only negative symptom remission (β = -0.38; 95% confidence interval = [-1.46, -0.02]).
Comparatively less malleable factors (premorbid adjustment and verbal memory) may contribute to functional outcomes through more malleable factors (symptoms). Promoting remission may be an important parsimonious means to achieving better functional outcomes.
大多数研究都探讨了首发精神病患者的病前适应、言语记忆和症状缓解对功能结果的单一或相对贡献。较少的研究研究了这些因素在影响功能方面的途径。我们的研究解决了这一差距。目的是确定病前适应与功能结果之间的关系是否通过言语记忆和症状缓解来介导。
共评估了 334 名首发精神病患者（年龄 14-35 岁）的病前适应、入组时的言语记忆，以及在 2 年随访期间的多个时间点的阳性和阴性症状缓解和功能。
中介分析显示，在第一年，病前适应与功能之间的关系通过言语记忆和阳性症状缓解（β=-0.18；95%置信区间=-0.51，-0.04），以及言语记忆和阴性症状缓解（β=-0.41；95%置信区间=-1.11，-1.03）来介导。在 2 年期间，病前适应与功能之间的关系通过言语记忆和仅阴性症状缓解（β=-0.38；95%置信区间=-1.46，-0.02）来介导。
相对较不可改变的因素（病前适应和言语记忆）可能通过更具可塑性的因素（症状）对功能结果产生影响。促进缓解可能是实现更好功能结果的一种重要的简约手段。
