Lindgren Maija, Holm Minna, Kieseppä Tuula, Suvisaari Jaana
Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.
Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Front Psychiatry. 2020 Dec 4;11:603933. doi: 10.3389/fpsyt.2020.603933. eCollection 2020.
Cognitive performance at illness onset may predict outcomes in first-episode psychosis (FEP), and the change in cognition may associate with clinical changes. Cognitive testing was administered to 54 FEP participants 2 months after entering treatment and to 39 participants after 1 year. We investigated whether baseline cognition predicted 1-year outcomes beyond positive, negative, and affective symptoms and whether the trajectory of cognition associated with clinical change. Baseline overall neurocognitive performance predicted the 1-year social and occupational level, occupational status, and maintaining of life goals. The domain of processing speed associated with the 1-year remission, occupational status, and maintaining of life goals. Baseline social cognition associated with occupational status a year later and the need for hospital treatment during the 1st year after FEP. Most of the associations were retained beyond baseline positive and affective symptom levels, but when accounting for negative symptoms, cognition no longer predicted 1-year outcomes, highlighting how negative symptoms overlap with cognition. The trajectory of neurocognitive performance over the year did not associate with changes in symptoms or functioning. Cognitive testing at the beginning of treatment provided information on the 1-year outcome in FEP beyond positive and affective symptom levels. In particular, the domains of processing speed and social cognition could be targets for interventions that aim to improve the outcome after FEP.
疾病发作时的认知表现可能预测首发精神病(FEP)的预后,并且认知变化可能与临床变化相关。对54名FEP参与者在进入治疗2个月后以及39名参与者在1年后进行了认知测试。我们调查了基线认知是否能在阳性、阴性和情感症状之外预测1年的预后,以及认知轨迹是否与临床变化相关。基线总体神经认知表现可预测1年的社会和职业水平、职业状况以及生活目标的维持情况。加工速度领域与1年缓解情况、职业状况以及生活目标的维持相关。基线社会认知与1年后的职业状况以及FEP后第1年的住院治疗需求相关。大多数关联在基线阳性和情感症状水平之外仍然存在,但在考虑阴性症状时,认知不再能预测1年的预后,这凸显了阴性症状与认知的重叠程度。一年中神经认知表现的轨迹与症状或功能变化无关。治疗开始时的认知测试提供了超出阳性和情感症状水平的FEP 1年预后信息。特别是,加工速度和社会认知领域可能成为旨在改善FEP后预后的干预目标。