Yang Lawrence H, Ruiz Bernalyn, Mandavia Amar D, Grivel Margaux M, Wong Liang Y, Phillips Michael R, Keshavan Matcheri S, Li Huijun, Lieberman Jeffrey A, Susser Ezra, Seidman Larry J, Stone William S
New York University, School of Global Public Health, 715 Broadway, New York, NY 10003, United States; Columbia University, Department of Epidemiology, Mailman School of Public Health, 622 West 168th Street, New York, NY 10032, United States.
University of Massachusetts Boston, Department of Counseling and School Psychology, 100 Morrisey Blvd, Boston, MA 02125, United States.
Schizophr Res. 2020 Jun;220:1-15. doi: 10.1016/j.schres.2020.01.026. Epub 2020 Apr 5.
Comparing the course of antipsychotic-naïve psychosis in low- and middle-income countries (LMIC) may help to illuminate core pathophysiologies associated with this condition. Previous reviews-primarily from high-income countries (HIC)-identified cognitive deficits in antipsychotic-naïve, first-episode psychosis, but did not examine whether individuals with psychosis with longer duration of untreated psychosis (DUP > 5 years) were included, nor whether LMIC were broadly represented.
A comprehensive search of PUBMED from January 2002-August 2018 identified 36 studies that compared cognitive functioning in antipsychotic-naïve individuals with psychosis (IWP) and healthy controls, 20 from HIC and 16 from LMIC.
A key gap was identified in that LMIC study samples were primarily shorter DUP (<5 years) and were primarily conducted in urban China. Most studies matched cases and controls for age and gender but only 9 (24%) had sufficient statistical power for cognitive comparisons. Compared with healthy controls, performance of antipsychotic-naïve IWP was significantly worse in 81.3% (230/283) of different tests of cognitive domains assessed (90.1% in LMIC [118/131] and 73.7% [112/152] in HIC).
Most LMIC studies of cognition in antipsychotic-naïve IWP adopted standardized procedures and, like HIC studies, found broad-based impairments in cognitive functioning. However, these LMIC studies were often underpowered and primarily included samples typical of HIC: primarily male, young-adult, high-school educated IWP, in their first episode of illness with relatively short DUP (<5 years). To enhance understanding of the long-term natural course of cognitive impairments in untreated psychosis, future studies from LMIC should recruit community-dwelling IWP from rural areas where DUP may be longer.
比较低收入和中等收入国家（LMIC）中未使用过抗精神病药物的精神病患者的病程，可能有助于阐明与此病症相关的核心病理生理学。以往的综述——主要来自高收入国家（HIC）——在未使用过抗精神病药物的首发精神病患者中发现了认知缺陷，但未考察是否纳入了未治疗精神病持续时间更长（DUP>5年）的精神病患者，也未考察是否广泛涵盖了低收入和中等收入国家。
对2002年1月至2018年8月期间的PUBMED进行全面检索，共识别出36项比较未使用过抗精神病药物的精神病患者（IWP）与健康对照者认知功能的研究，其中20项来自高收入国家，16项来自低收入和中等收入国家。
发现一个关键差距，即低收入和中等收入国家的研究样本主要是未治疗精神病持续时间较短（<5年）的患者，且主要在中国城市开展。大多数研究在年龄和性别上对病例和对照进行了匹配，但只有9项研究（24%）在认知比较方面具有足够的统计效力。与健康对照者相比，在评估的不同认知领域测试中，81.3%（230/283）的未使用过抗精神病药物的IWP表现明显更差（低收入和中等收入国家为90.1%[118/131]，高收入国家为73.7%[112/152]）。
大多数关于未使用过抗精神病药物的IWP认知功能的低收入和中等收入国家研究采用了标准化程序，并且与高收入国家的研究一样，发现了广泛的认知功能损害。然而，这些低收入和中等收入国家的研究往往统计效力不足，且主要纳入了高收入国家典型的样本：主要是男性、年轻成年人、受过高中教育、处于首次发病且未治疗精神病持续时间相对较短（<5年）的IWP。为了增进对未治疗精神病患者认知障碍长期自然病程的理解，未来低收入和中等收入国家的研究应从农村地区招募社区居住的IWP，这些地区的未治疗精神病持续时间可能更长。
