Department of Psychology and Counselling, La Trobe University, Bundoora, Australia.
Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; The Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia; Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria.
Schizophr Res. 2019 Apr;206:67-74. doi: 10.1016/j.schres.2018.12.013. Epub 2018 Dec 14.
Neurocognitive impairments experienced by individuals at ultra-high risk (UHR) for psychosis are potential predictors of outcome within this population, however there is inconsistency regarding the specific neurocognitive domains implicated. This study aimed to examine whether baseline neurocognition predicted transition to psychosis, or functional outcomes, at medium-term (mean = 3.4 years) follow-up, while controlling for other clinical/treatment variables associated with transition to psychosis.
Analysis of data collected as part of a multi-centre RCT of omega-3 fatty acids and cognitive-behavioural case management (NEURAPRO) for UHR individuals was conducted on the 294 participants (134 males, 160 females) who completed neurocognitive assessment (Brief Assessment of Cognition for Schizophrenia) at baseline. Transition to psychosis was determined using the Comprehensive Assessment of At-Risk Mental States (CAARMS), and functioning was measured with the Global Functioning: Social and Role Scales.
Mean baseline z-scores indicated that UHR participants performed a quarter to half a standard deviation below normative means in all domains (range mean z = -0.24 to -0.47), except for executive functioning (mean z = 0.16). After adjusting for covariates, poorer Executive (p = .010) and Motor (p = .030) functions were predictive of transition to psychosis. Processing Speed and Verbal Fluency were significant predictors of role functioning at 12 months (p = .004), and social functioning at medium-term follow-up (p = .015), respectively.
Neurocognitive abilities are independent predictors of both transition to psychosis and functional outcomes within the UHR population. Further research is needed to determine the best combination of risk variables in UHR individuals for prediction of psychosis transition, functioning and other psychopathology outcomes.
精神病超高风险（UHR）个体经历的神经认知损伤是该人群结局的潜在预测指标，但涉及的具体神经认知领域存在不一致性。本研究旨在检验基线神经认知是否能预测 UHR 个体在中期（平均=3.4 年）随访时向精神病的转变或功能结局，同时控制与向精神病转变相关的其他临床/治疗变量。
对参加多中心 RCT（NEURAPRO）的 294 名参与者（134 名男性，160 名女性）的数据进行了分析，这些参与者完成了基线时的神经认知评估（Brief Assessment of Cognition for Schizophrenia）。精神病的转变通过使用全面的风险精神状态评估（CAARMS）来确定，功能通过全球功能：社会和角色量表来衡量。
平均基线 z 分数表明，UHR 参与者在所有领域的表现都比正常平均值低四分之一到一半标准差（范围平均 z=-0.24 到-0.47），除了执行功能（平均 z=0.16）。在调整了协变量后，较差的执行（p=0.010）和运动（p=0.030）功能与向精神病的转变相关。加工速度和言语流畅性是 12 个月时角色功能（p=0.004）和中期随访时社会功能（p=0.015）的显著预测因素。
神经认知能力是 UHR 人群向精神病转变和功能结局的独立预测因素。需要进一步研究，以确定 UHR 个体中最佳的风险变量组合，用于预测精神病转变、功能和其他精神病理学结局。
