Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada.
University of Minnesota, Minneapolis, Minnesota.
J Clin Psychiatry. 2021 Feb 23;82(2):20m13288. doi: 10.4088/JCP.20m13288.
Previous research shows elevated disability in psychotic disorders. However, co-occurring symptomatology has been increasingly highlighted as predictive of clinical outcomes in the psychotic spectrum. The current study investigates how both psychotic and nonpsychotic symptom domains predict functioning across psychotic disorders.
Outpatients (N = 128) with psychotic spectrum diagnoses participated in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5) Field Trials at the Centre for Addiction and Mental Health in Toronto, Canada, in 2011, including the repeated administration of "cross-cutting" brief screening measures that assessed internalizing (eg, anxiety, depression), substance use (eg, alcohol, psychoactive drug use), and psychotic symptoms. Level of functioning was also assessed by self-report and clinician-rated World Health Organization Disability Assessment Schedule 2.0 (WHO-DAS-II). The relation between symptom domains and disability was examined concurrently and prospectively via hierarchical regression.
Psychosis was strongly linked to self-reported disability when considered in isolation (β = 0.22, P < .001; R2 = 0.11). However, when all 3 symptom domains were included in analyses, internalizing symptoms were the strongest concurrent (β = 0.31, P < .001; R2 = 0.17) and prospective (β = 0.29, P < .001; R2 = 0.15) predictor of disability. In the concurrent model, an interaction between internalizing and substance use emerged, wherein high internalizing symptoms were particularly detrimental in persons with high levels of substance use (β = 0.08, P < .05; R2 = 0.014). Results were similar for clinician-rated WHO-DAS-II.
This research supports the potential clinical utility of rapid screening tools available in the newest psychiatric diagnostic manual. The internalizing symptom domain was the strongest predictor of functional outcome for outpatients with psychotic disorders. The results highlight the relevance of a broad range of symptoms, including those that fall outside the primary psychiatric concern, in recovery-oriented clinical work in psychosis.
先前的研究表明精神障碍患者的残疾程度较高。然而，越来越多的研究表明，精神障碍谱系中的共病症状与临床结局具有预测关系。本研究旨在调查精神障碍谱系中精神症状和非精神症状领域如何共同预测功能。
2011 年，128 名患有精神障碍谱系诊断的门诊患者在加拿大多伦多成瘾与心理健康中心参加了《精神障碍诊断与统计手册》第五版（DSM-5）现场试验，包括反复进行“跨领域”简短筛查测量，评估内化症状（如焦虑、抑郁）、物质使用（如酒精、精神活性药物使用）和精神症状。功能水平也通过自我报告和临床医生评定的世界卫生组织残疾评定量表 2.0（WHO-DAS-II）进行评估。通过分层回归同时和前瞻性地检查症状领域与残疾之间的关系。
孤立考虑时，精神病与自我报告的残疾有很强的关联（β=0.22，P<0.001；R2=0.11）。然而，当所有 3 个症状领域都纳入分析时，内化症状是最强的同时（β=0.31，P<0.001；R2=0.17）和前瞻性（β=0.29，P<0.001；R2=0.15）残疾预测因素。在同时性模型中，内化和物质使用之间出现了交互作用，即内化症状高的人在物质使用水平高的人中特别不利（β=0.08，P<0.05；R2=0.014）。临床医生评定的 WHO-DAS-II 也得出了类似的结果。
这项研究支持最新精神科诊断手册中可用的快速筛查工具的潜在临床实用性。内化症状领域是精神障碍门诊患者功能结局的最强预测因素。结果强调了广泛的症状的相关性，包括那些不属于主要精神关注的症状，在精神病的以康复为导向的临床工作中具有重要意义。
