Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States; Institute of Behavioral Science, Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY, United States; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, United States.
Division of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York 11549, United States.
Schizophr Res. 2021 Jan;227:44-51. doi: 10.1016/j.schres.2020.09.006. Epub 2020 Oct 31.
While an established clinical outcome of high importance, social functioning has been emerging as possibly having a broader significance to the evolution of psychosis and long term disability. In the current study we explored the association between social decline, conversion to psychosis, and functional outcome in individuals at clinical high risk (CHR) for psychosis.
585 subjects collected in the North American Prodrome Longitudinal Study (NAPLS2) were divided into 236 Healthy Controls (HCs), and CHR subjects that developed psychosis (CHR + C, N = 79), or those that did not (Non-Converters, CHR-NC, N = 270). CHR + C subjects were further divided into those that experienced an atypical decline in social functioning prior to baseline (beyond typical impairment levels) when in min-to-late adolescence (CHR + C-SD, N = 39) or those that did not undergoing a decline (CHR + C-NSD, N = 40).
Patterns of poor functional outcomes varied across the CHR subgroups: CHR-NC (Poor Social 36.3%, Role 42.2%) through CHR + C-NSD (Poor Social 50%, Poor Role 67.5%) to CHR + C-SD (Poor Social 76.9%, Poor Role 89.7%) functioning. The two Converter subgroups had comparable positive symptoms at baseline. At 12 months, the CHR + C-SD group stabilized, but social functioning levels remained significantly lower than the other two subgroups.
The current study demonstrates that pre-baseline social decline in mid-to-late adolescence predicts psychosis. In addition, we found that this social decline in converters is strongly associated with especially poor functional outcome and overall poorer prognosis. Role functioning, in contrast, has not shown similar predictor potential, and rather appears to be an illness indicator that worsens over time.
虽然社会功能作为一个重要的临床结果已经逐渐显现出来，但它可能对精神病的发展和长期残疾具有更广泛的意义。在目前的研究中，我们探讨了社会衰退与向精神病转化和个体临床高风险（CHR）的功能结果之间的关系。
北美前驱期纵向研究（NAPLS2）共纳入 585 名受试者，分为健康对照组（HC）236 例，CHR 发生精神病（CHR+C，N=79）和未发生精神病（非转化者，CHR-NC，N=270）。CHR+C 进一步分为在青少年晚期（CHR+C-SD，N=39）或无衰退（CHR+C-NSD，N=40）之前经历过社会功能异常下降的亚组。
CHR 亚组的功能结局不良模式不同：CHR-NC（社会功能差 36.3%，角色功能差 42.2%），CHR+C-NSD（社会功能差 50%，角色功能差 67.5%），CHR+C-SD（社会功能差 76.9%，角色功能差 89.7%）。两个转化亚组在基线时具有相似的阳性症状。在 12 个月时，CHR+C-SD 组稳定，但社会功能水平仍明显低于其他两个亚组。
目前的研究表明，青少年中期的基线前社会衰退预测精神病。此外，我们发现，这种转化者的社会衰退与功能结局差和总体预后差密切相关。相比之下，角色功能没有表现出类似的预测潜力，而是随着时间的推移，似乎是一种恶化的疾病指标。
