Department of Psychiatry, University of Hong Kong, Hong Kong.
Department of Psychiatry, University of Hong Kong, Hong Kong.
Schizophr Res. 2019 Apr;206:251-256. doi: 10.1016/j.schres.2018.11.009. Epub 2018 Nov 16.
Achieving functional recovery in patients with psychosis is a challenge in clinical practice. Investigating the complex interplay between cognition, symptoms, insight and functional outcome in first episode psychosis will be crucial to understanding the factors leading to better functioning.
In this 12-month prospective follow-up study, we investigated how cognition, clinical symptoms, and insight into illness affected overall functioning in 160 patients with first episode psychosis recruited from the Early Assessment Service for Young People with Psychosis (EASY) in Hong Kong from July 1, 2014 to June 30, 2016. Cognition was assessed at baseline while symptoms, insight, and functioning were assessed at 12-month follow-up. Structural equation modelling was used to examine the direct and indirect relationships between functioning and other latent constructs.
Symptoms (negative symptoms and general psychopathology) and insight were shown to be significant mediators between cognition and functioning. The significant direct relationship between cognition and functioning (β = 0.387; p < 0.001) became insignificant (β = 0.079; p = 0.578) after including symptoms and insight in the model. Symptoms and insight were significantly associated with cognition (symptoms, β = -0.469; p < 0.001; insight, β = -0.372; p < 0.001) and predicted functioning (symptoms, β = -0.558; p < 0.001; insight, β = -0.264; p < 0.01).
Symptoms and insight mediated the effects of cognition on functioning. Interventions for improving functioning in patients with first episode psychosis should target not only cognition but also symptoms and insight.
在临床实践中，实现精神病患者的功能康复是一项挑战。研究首发精神病患者认知、症状、自知力和功能结局之间的复杂相互作用对于理解导致更好功能的因素至关重要。
在这项为期 12 个月的前瞻性随访研究中，我们调查了认知、临床症状和对疾病的自知力如何影响 2014 年 7 月 1 日至 2016 年 6 月 30 日期间从香港青年精神病早期评估服务（EASY）招募的 160 例首发精神病患者的整体功能。在基线时评估认知，在 12 个月随访时评估症状、自知力和功能。结构方程模型用于检验功能与其他潜在结构之间的直接和间接关系。
研究结果表明，症状（阴性症状和一般精神病学）和自知力是认知与功能之间的重要中介。认知与功能之间的显著直接关系（β=0.387;p<0.001）在纳入症状和自知力后变得不显著（β=0.079;p=0.578）。症状和自知力与认知显著相关（症状，β=-0.469;p<0.001；自知力，β=-0.372;p<0.001），并预测功能（症状，β=-0.558;p<0.001；自知力，β=-0.264;p<0.01）。
症状和自知力中介了认知对功能的影响。改善首发精神病患者功能的干预措施不仅应针对认知，还应针对症状和自知力。
