Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; VISN 2 Mental Illness Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA.
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Brigham and Women's Hospital, Boston, MA, USA.
Psychiatry Res. 2019 Feb;272:655-662. doi: 10.1016/j.psychres.2018.12.169. Epub 2018 Dec 31.
Despite the overlap between schizophrenia and bipolar disorder, neurodevelopmental abnormalities are thought to be associated primarily with schizophrenia. Transdiagnostic and empirical identification of subgroups based on premorbid adjustment (PMA) may enhance understanding of illness trajectories. 160 patients with bipolar I or II disorder (BD; n = 104) or schizophrenia or schizoaffective disorder (SZ; n = 56) were assessed on PMA course from childhood to late adolescence and current symptoms and functioning. A hierarchical cluster analysis was performed using social and academic PMA scores, resulting in three optimal clusters. Cluster 1 (n = 28 SZ, 65 BD) had normal social and academic PMA, the most education, and mildest current symptoms. Cluster 2 (n = 15 SZ, 24 BD) had normal social PMA but an impaired-declining academic course and had a greater proportion of males than Cluster 1. Cluster 3 (n = 13 SZ, 15 BD) had an impaired-stable social PMA and an impaired-declining academic course and the most severe current negative symptoms and childhood trauma. The proportions of SZ and BD diagnoses, current neurocognition, and functioning did not differ between clusters. These findings suggest shared neurodevelopmental abnormalities between SZ and BD, with subgroups exhibiting distinct PMA trajectories that cut across disorders.
尽管精神分裂症和双相情感障碍有重叠，但神经发育异常被认为主要与精神分裂症有关。基于发病前调整（PMA）进行跨诊断和实证亚组识别，可能会增强对疾病轨迹的理解。对 160 名患有 I 型或 II 型双相情感障碍（BD；n=104）或精神分裂症或分裂情感障碍（SZ；n=56）的患者进行了评估，评估内容包括从儿童期到青春期后期的 PMA 病程以及当前的症状和功能。使用社会和学术 PMA 评分进行了层次聚类分析，结果得出了三个最佳聚类。聚类 1（n=28SZ，65BD）的社会和学术 PMA 正常，受教育程度最高，当前症状最轻微。聚类 2（n=15SZ，24BD）的社会 PMA 正常，但学术成绩呈下降趋势，且男性比例高于聚类 1。聚类 3（n=13SZ，15BD）的社会 PMA 呈受损-稳定趋势，学术成绩呈下降趋势，当前的负面症状和儿童创伤最严重。聚类之间的 SZ 和 BD 诊断比例、当前神经认知和功能没有差异。这些发现表明 SZ 和 BD 之间存在共同的神经发育异常，具有不同 PMA 轨迹的亚组跨越疾病存在。
