Integrated Program in Neuroscience, McGill University, Montréal, QC, Canada.
Prevention and Early Intervention Program for Psychoses (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, QC, Canada.
Schizophr Bull. 2021 Apr 29;47(3):604-614. doi: 10.1093/schbul/sbaa183.
Prospective population studies suggest that psychotic syndromes may be an emergent phenomenon-a function of severity and complexity of more common mental health presentations and their nonpsychotic symptoms. Examining the relationship between nonpsychotic and subthreshold psychotic symptoms in individuals who later developed the ultimate outcome of interest, a first episode of psychosis (FEP), could provide valuable data to support or refute this conceptualization of how psychosis develops. We therefore conducted a detailed follow-back study consisting of semistructured interviews with 430 patients and families supplemented by chart reviews in a catchment-based sample of affective and nonaffective FEP. The onset and sequence of 27 pre-onset nonpsychotic (NPS) or subthreshold psychotic (STPS) symptoms was systematically characterized. Differences in proportions were analyzed with z-tests, and correlations were assessed with negative binomial regressions. Both the first psychiatric symptom (86.24% NPS) and the first prodromal symptom (66.51% NPS) were more likely to be NPS than STPS. Patients reporting pre-onset STPS had proportionally more of each NPS than did those without pre-onset STPS. Finally, there was a strong positive correlation between NPS counts (reflecting complexity) and STPS counts (β = 0.34, 95% CI [0.31, 0.38], P < 2 e-16). Prior to a FEP, NPS precede STPS, and greater complexity of NPS is associated with the presence and frequency of STPS. These findings complement recent arguments that the emergence of psychotic illness is better conceptualized as part of a continuum-with implications for understanding pluripotential developmental trajectories and strengthening early intervention paradigms.
前瞻性人群研究表明，精神病综合征可能是一种新兴现象——是更常见的心理健康表现及其非精神病症状的严重程度和复杂性的一种功能。在那些后来出现感兴趣的最终结果（首次精神病发作[FEP]）的个体中，检查非精神病和亚精神病症状之间的关系，可以提供有价值的数据来支持或反驳这种精神病发展的概念化。因此，我们进行了一项详细的回溯研究，对基于样本的情感和非情感 FEP 进行了 430 名患者和家属的半结构化访谈，并辅以图表审查。系统地描述了 27 种发病前非精神病（NPS）或亚精神病（STPS）症状的发作和顺序。通过 z 检验分析比例差异，并通过负二项式回归评估相关性。第一精神病症状（86.24% NPS）和第一前驱症状（66.51% NPS）都更有可能是 NPS 而不是 STPS。报告发病前 STPS 的患者比没有发病前 STPS 的患者每个 NPS 的比例更高。最后，NPS 计数（反映复杂性）与 STPS 计数之间存在很强的正相关（β=0.34，95%CI[0.31，0.38]，P<2e-16）。在 FEP 之前，NPS 先于 STPS，并且 NPS 的复杂性与 STPS 的存在和频率相关。这些发现补充了最近的观点，即精神病的出现更好地被概念化为连续体的一部分——这对理解多潜能发展轨迹和加强早期干预模式具有重要意义。
