Department of Psychiatry, McGill University, Montreal, QC, Canada.
Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Verdun, QC, Canada.
Schizophr Bull. 2020 Dec 1;46(6):1587-1595. doi: 10.1093/schbul/sbaa054.
Verbal memory (VM) is one of the most affected cognitive domains in first-episode psychosis (FEP) and is a robust predictor of functioning. Given that healthy females demonstrate superior VM relative to males and that female patients show less-severe illness courses than male patients, this study examined whether normative sex differences in VM extend to FEP and influence functioning. Four hundred and thirty-five patients (299 males, 136 females) with affective or nonaffective psychosis were recruited from a catchment-based specialized FEP intervention service and 138 nonclinical controls (96 males, 42 females) were recruited from the same community. One of the two neurocognitive batteries comprising six cognitive domains (VM, visual memory, working memory, attention, executive function, processing speed) were administered at baseline. In patients, positive and negative symptoms were evaluated at baseline and functioning was assessed at 1-year follow-up. Patients were more impaired than controls on all cognitive domains, but only VM showed sex differences (both patient and control males performed worse than females), and these results were consistent across batteries. In patients, better baseline VM in females was related to better functioning after 1 year, mediated through fewer baseline negative symptoms. Supplemental analyses revealed these results were not driven by affective psychosis nor by age and parental education. Thus, normative sex differences in VM are preserved in FEP and mediate functioning at 1-year follow-up via negative symptoms. This study highlights the importance of investigating sex effects for understanding VM deficits in early psychosis and suggests that sex may be a disease-modifying variable with important treatment implications.
言语记忆（VM）是首发精神病（FEP）中受影响最严重的认知领域之一，也是功能的有力预测指标。鉴于健康女性的 VM 明显优于男性，且女性患者的疾病严重程度较男性患者轻，本研究探讨了 VM 的正常性别差异是否延伸至 FEP 并影响功能。从基于人群的专门 FEP 干预服务中招募了 435 名患有情感或非情感性精神病的患者（299 名男性，136 名女性），并从同一社区招募了 138 名非临床对照者（96 名男性，42 名女性）。两个认知测试包中的一个，包含六个认知领域（VM、视觉记忆、工作记忆、注意力、执行功能、处理速度），在基线时进行了测试。在患者中，在基线时评估阳性和阴性症状，并在 1 年随访时评估功能。与对照组相比，患者在所有认知领域都表现出障碍，但只有 VM 存在性别差异（患者和对照组男性的表现均不如女性），并且这一结果在两个测试包中都一致。在患者中，女性在基线时 VM 更好与 1 年后功能更好相关，这一结果通过较少的基线阴性症状来介导。补充分析显示，这些结果不受情感性精神病或年龄和父母教育的影响。因此，VM 的正常性别差异在 FEP 中得到保留，通过阴性症状在 1 年随访时介导功能。本研究强调了研究性别效应对于理解早期精神病中 VM 缺陷的重要性，并表明性别可能是具有重要治疗意义的疾病修饰变量。
