Lewandowski Kathryn E, Cohen Talia R, Ongur Dost
Schizophrenia and Bipolar Disorder Program, McLean Hospital, Belmont, Massachusetts, USA.
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.
Psych J. 2020 Apr;9(2):163-173. doi: 10.1002/pchj.356. Epub 2020 Mar 24.
Schizophrenia, bipolar disorder, and related psychotic illnesses are common, serious mental disorders that are often associated with functional impairments and poor quality of life, even after clinical recovery. Cognitive dysfunction is a strong predictor of functional impairment; however, findings regarding relative impairments in functioning and cognition across diagnoses have been mixed, as have reports of the contribution of clinical symptoms and other illness features to functioning across diagnostic boundaries. We assessed 211 patients with psychotic disorders and 87 healthy controls using the MATRICS Consensus Cognitive Battery, clinical measures of state mood and psychotic symptoms, and an interview measure of community functioning. Diagnostic groups were compared on MATRICS composite and domain scores, and clinical and functional measures. We then examined cognitive, clinical, and demographic predictors of community functioning using stepwise hierarchical linear regression. All three patient groups exhibited deficits in most cognitive domains relative to controls, and significantly poorer community functioning. While scores on most cognitive domains did not differ by diagnosis, when groups did differ patients with schizophrenia performed worse than patients with bipolar disorder. Cognition was correlated with functioning across the sample. The final regression model included negative symptoms, mania, social cognition, and processing speed, and explained 47% of the variance in community functioning scores across patient groups. Residual negative symptoms, residual mania, and social cognition significantly and independently predicted community functioning. These findings indicate that, while all cognitive domains are associated with community outcomes, when considered together and with clinical symptoms, negative symptoms, mania, and social cognition are the strongest predictors across diagnoses. Development of interventions targeting negative symptoms and social cognition may be effective in improving community functioning for patients across diagnoses.
精神分裂症、双相情感障碍及相关精神病性疾病是常见的严重精神障碍，即使在临床康复后，也常伴有功能损害和生活质量低下的问题。认知功能障碍是功能损害的有力预测指标；然而，关于不同诊断之间功能和认知相对损害的研究结果并不一致，临床症状和其他疾病特征对跨诊断功能的影响的报告也是如此。我们使用MATRICS共识认知量表、状态情绪和精神病性症状的临床测量方法以及社区功能访谈测量方法，对211例精神病性障碍患者和87名健康对照者进行了评估。比较了各诊断组在MATRICS综合得分和领域得分以及临床和功能测量方面的差异。然后，我们使用逐步分层线性回归分析了社区功能的认知、临床和人口统计学预测因素。与对照组相比，所有三组患者在大多数认知领域均表现出缺陷，且社区功能明显较差。虽然大多数认知领域的得分在不同诊断之间没有差异，但当组间存在差异时，精神分裂症患者的表现比双相情感障碍患者更差。在整个样本中，认知与功能相关。最终回归模型包括阴性症状、躁狂、社会认知和处理速度，解释了患者组间社区功能得分方差的47%。残留阴性症状、残留躁狂和社会认知显著且独立地预测了社区功能。这些发现表明，虽然所有认知领域都与社区结局相关，但综合考虑并结合临床症状时，阴性症状、躁狂和社会认知是跨诊断的最强预测因素。针对阴性症状和社会认知的干预措施的开发可能对改善各诊断患者的社区功能有效。
