抗精神病药初发精神分裂症症状表达的发育影响。
Developmental influences on symptom expression in antipsychotic-naïve first-episode psychosis.
机构信息
Department of Psychology, University of Maryland, Baltimore County, Maryland, USA.
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
出版信息
Psychol Med. 2022 Jul;52(9):1698-1709. doi: 10.1017/S0033291720003463. Epub 2020 Oct 6.
BACKGROUND
The neurodevelopmental model of psychosis was established over 30 years ago; however, the developmental influence on psychotic symptom expression - how age affects clinical presentation in first-episode psychosis - has not been thoroughly investigated.
METHODS
Using generalized additive modeling, which allows for linear and non-linear functional forms of age-related change, we leveraged symptom data from a large sample of antipsychotic-naïve individuals with first-episode psychosis ( = 340, 12-40 years, 1-12 visits), collected at the University of Pittsburgh from 1990 to 2017. We examined relationships between age and severity of perceptual and non-perceptual positive symptoms and negative symptoms. We tested for age-associated effects on in positive or negative symptom severity following baseline assessment and explored the time-varying relationship between perceptual and non-perceptual positive symptoms across adolescent development.
RESULTS
Perceptual positive symptom severity significantly decreased with increasing age ( = 7.0, = 0.0007; = 0.003) while non-perceptual positive symptom severity increased with age ( = 4.1, = 0.01, = 0.02). Anhedonia severity increased with increasing age ( = 6.7, = 0.00035; = 0.0003), while flat affect decreased in severity with increased age ( = 9.8, = 0.002; = 0.006). Findings remained significant when parental SES, IQ, and illness duration were included as covariates. There were no developmental effects on change in positive or negative symptom severity (all > 0.25). Beginning at age 18, there was a statistically significant association between severity of non-perceptual and perceptual symptoms. This relationship increased in strength throughout adulthood.
CONCLUSIONS
These findings suggest that as maturation proceeds, perceptual symptoms attenuate while non-perceptual symptoms are enhanced. Findings underscore how pathological brain-behavior relationships vary as a function of development.
背景
精神分裂症的神经发育模型建立于 30 多年前；然而，年龄对精神病症状表现的发展影响——即首次发作精神分裂症的临床特征随年龄的变化——尚未得到充分研究。
方法
我们利用广义加性模型（允许年龄相关变化的线性和非线性函数形式），利用来自匹兹堡大学从 1990 年到 2017 年收集的大量未经抗精神病药物治疗的首发精神分裂症患者（=340 名，年龄 12-40 岁，就诊 1-12 次）的症状数据，研究了年龄与知觉和非知觉阳性症状及阴性症状严重程度之间的关系。我们检验了基线评估后阳性或阴性症状严重程度的年龄相关效应，并探索了青少年发育过程中知觉和非知觉阳性症状之间的时变关系。
结果
知觉阳性症状严重程度随年龄增加而显著下降（=7.0，=0.0007；=0.003），而非知觉阳性症状严重程度随年龄增加而增加（=4.1，=0.01，=0.02）。快感缺失严重程度随年龄增加而增加（=6.7，=0.00035；=0.0003），而情感平淡严重程度随年龄增加而降低（=9.8，=0.002；=0.006）。当将父母社会经济地位、智商和疾病持续时间作为协变量纳入时，结果仍然显著。阳性或阴性症状严重程度的变化没有发育效应（所有>0.25）。从 18 岁开始，非知觉和知觉症状的严重程度之间存在统计学上的显著关联。这种关系在成年期不断增强。
结论
这些发现表明，随着成熟的进行，知觉症状减弱，而非知觉症状增强。研究结果强调了病理性脑-行为关系如何随发育而变化。
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