Molina-García Mariola, Fraguas David, Del Rey-Mejías Ángel, Mezquida Gisela, Sánchez-Torres Ana M, Amoretti Silvia, Lobo Antonio, González-Pinto Ana, Andreu-Bernabeu Álvaro, Corripio Iluminada, Vieta Eduard, Baeza Inmaculada, Mané Anna, Cuesta Manuel, de la Serna Elena, Payá Beatriz, Zorrilla Iñaki, Arango Celso, Bernardo Miquel, Rapado-Castro Marta, Parellada Mara
Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Gregorio Marañón Health Research Institute (IiSGM), Hospital General Universitario Gregorio Marañón, Research Networking Center for Mental Health Network (CIBERSAM), School of Medicine, Complutense University of Madrid (UCM), 28007 Madrid, Spain.
Institute of Psychiatry and Mental Health, Hospital Clínico San Carlos (IdISSC), Research Networking Center for Mental Health Network (CIBERSAM), School of Medicine, Complutense University of Madrid (UCM), 28040 Madrid, Spain.
J Clin Med. 2021 Jun 2;10(11):2474. doi: 10.3390/jcm10112474.
premorbid IQ (pIQ) and age of onset are predictors of clinical severity and long-term functioning after a first episode of psychosis. However, the additive influence of these variables on clinical, functional, and recovery rates outcomes is largely unknown.
we characterized 255 individuals who have experienced a first episode of psychosis in four a priori defined subgroups based on pIQ (low pIQ < 85; average pIQ ≥ 85) and age of onset (early onset < 18 years; adult onset ≥ 18 years). We conducted clinical and functional assessments at baseline and at two-year follow-up. We calculated symptom remission and recovery rates using the Positive and Negative Symptoms of Schizophrenia Schedule (PANSS) and the Global Assessment Functioning (GAF or Children-GAF). We examined clinical and functional changes with pair-wise comparisons and two-way mixed ANOVA. We built hierarchical lineal and logistic regression models to estimate the predictive value of the independent variables over functioning or recovery rates.
early-onset patients had more severe positive symptoms and poorer functioning than adult-onset patients. At two-year follow-up, only early-onset with low pIQ and adult-onset with average pIQ subgroups differed consistently, with the former having more negative symptoms ( = 0.59), poorer functioning ( = 0.82), lower remission (61% vs. 81.1%), and clinical recovery (34.1% vs. 62.2%).
early-onset individuals with low pIQ may present persistent negative symptoms, lower functioning, and less recovery likelihood at two-year follow-up. Intensive cognitive and functional programs for these individuals merit testing to improve long-term recovery rates in this subgroup.
病前智商（pIQ）和起病年龄是首次精神病发作后临床严重程度和长期功能的预测指标。然而，这些变量对临床、功能和康复率结果的综合影响在很大程度上尚不清楚。
我们根据pIQ（低pIQ<85；平均pIQ≥85）和起病年龄（早发<18岁；成人起病≥18岁），将255名经历过首次精神病发作的个体分为四个预先定义的亚组。我们在基线和两年随访时进行了临床和功能评估。我们使用精神分裂症阳性和阴性症状量表（PANSS）和总体功能评估（GAF或儿童GAF）计算症状缓解率和康复率。我们通过成对比较和双向混合方差分析来检查临床和功能变化。我们建立了分层线性和逻辑回归模型，以估计自变量对功能或康复率的预测价值。
早发患者比成人起病患者有更严重的阳性症状和更差的功能。在两年随访时，只有低pIQ的早发亚组和平均pIQ的成人起病亚组存在持续差异，前者有更多的阴性症状（=0.59）、更差的功能（=0.82）、更低的缓解率（61%对81.1%）和临床康复率（34.1%对62.2%）。
低pIQ的早发个体在两年随访时可能出现持续的阴性症状、功能较差且康复可能性较低。针对这些个体的强化认知和功能项目值得进行测试，以提高该亚组的长期康复率。
