Bipolar and Depressive Disorders Unit, Hospital Clinic, University of Barcelona, Institute of Neuroscience, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Neuroscience Institute, Barcelona, Spain; Department of Medicine, Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CIBERSAM), Barcelona, Spain; August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
Eur Neuropsychopharmacol. 2021 Aug;49:54-68. doi: 10.1016/j.euroneuro.2021.03.015. Epub 2021 Apr 12.
The aim of the present study was to evaluate the contribution of family environment styles and psychiatric family history on functioning of patients presenting first-episode psychosis (FEP). Patients with FEP and healthy controls (HC) were assessed at baseline and after 2 years. The Functional Assessment Short Test (FAST) was used to assess functional outcome and the Family Environment Scale (FES) to evaluate family environment. Linear regressions evaluated the effect that family environment exerts on functioning at baseline and at 2-year follow-up, when FEP patients were diagnosed according to non-affective (NA-PSYCH) or affective psychoses (A-PSYCH). The influence of a positive parents' psychiatric history on functioning was evaluated through one-way between-groups analysis of covariance (ANCOVA) models, after controlling for family environmental styles. At baseline, FEP patients presented moderate functioning impairment, significantly worse than HC (28.65±16.17 versus 3.25±7.92; p<0.001, g = 1.91). At 2-year follow-up, the functioning of NA-PSYCH patients was significantly worse than in A-PSYCH (19.92±14.83 versus 12.46±14.86; p = 0.020, g = 0.50). No specific family environment style was associated with functioning in FEP patients and HC. On the contrary, a positive psychiatric father's history influenced functioning of FEP patients. After 2 years, worse functioning in NA-PSYCH patients was associated with lower rates of active-recreational and achievement orientated family environment and with higher rates of moral-religious emphasis and control. In A-PSYCH, worse functioning was associated with higher rates of conflict in the family. Both family environment and psychiatric history influence psychosocial functioning, with important implications for early interventions, that should involve both patients and caregivers.
本研究旨在评估家庭环境模式和精神疾病家族史对首发精神病（FEP）患者功能的影响。FEP 患者和健康对照组（HC）在基线和 2 年后进行评估。使用功能评估简短测试（FAST）评估功能结果，使用家庭环境量表（FES）评估家庭环境。线性回归评估家庭环境对基线和 2 年随访时功能的影响，此时根据非情感性精神病（NA-PSYCH）或情感性精神病（A-PSYCH）对 FEP 患者进行诊断。通过协方差分析（ANCOVA）模型的单向组间分析，在控制家庭环境模式后，评估阳性父母精神病史对功能的影响。在基线时，FEP 患者的功能障碍程度中等，明显差于 HC（28.65±16.17 与 3.25±7.92；p<0.001，g=1.91）。在 2 年随访时，NA-PSYCH 患者的功能明显差于 A-PSYCH（19.92±14.83 与 12.46±14.86；p=0.020，g=0.50）。没有特定的家庭环境模式与 FEP 患者和 HC 的功能相关。相反，阳性父亲的精神病史会影响 FEP 患者的功能。2 年后，NA-PSYCH 患者的功能较差与较低的积极娱乐和成就导向的家庭环境以及较高的道德宗教强调和控制有关。在 A-PSYCH 中，较差的功能与家庭中的更多冲突有关。家庭环境和精神病史都会影响心理社会功能，这对早期干预有重要意义，早期干预应同时涉及患者和照顾者。
