Department of Psychology, Yale University, New Haven, CT, USA.
Department of Psychiatry, Hotchkiss Brain Institute, Calgary, Canada.
Psychol Med. 2023 Jun;53(8):3644-3651. doi: 10.1017/S0033291722000277. Epub 2022 Feb 11.
While comorbidity of clinical high-risk for psychosis (CHR-P) status and social anxiety is well-established, it remains unclear how social anxiety and positive symptoms covary over time in this population. The present study aimed to determine whether there are more than one covariant trajectory of social anxiety and positive symptoms in the North American Prodrome Longitudinal Study cohort (NAPLS 2) and, if so, to test whether the different trajectory subgroups differ in terms of genetic and environmental risk factors for psychotic disorders and general functional outcome.
In total, 764 CHR individuals were evaluated at baseline for social anxiety and psychosis risk symptom severity and followed up every 6 months for 2 years. Application of group-based multi-trajectory modeling discerned three subgroups based on the covariant trajectories of social anxiety and positive symptoms over 2 years.
One of the subgroups showed sustained social anxiety over time despite moderate recovery in positive symptoms, while the other two showed recovery of social anxiety below clinically significant thresholds, along with modest to moderate recovery in positive symptom severity. The trajectory group with sustained social anxiety had poorer long-term global functional outcomes than the other trajectory groups. In addition, compared with the other two trajectory groups, membership in the group with sustained social anxiety was predicted by higher levels of polygenic risk for schizophrenia and environmental stress exposures.
Together, these analyses indicate differential relevance of sustained remitting social anxiety symptoms in the CHR-P population, which in turn may carry implications for differential intervention strategies.
虽然临床精神病高危（CHR-P）状态和社交焦虑的共病已得到充分证实，但在该人群中，社交焦虑和阳性症状随时间如何变化仍不清楚。本研究旨在确定北美前驱纵向研究队列（NAPLS 2）中是否存在社交焦虑和阳性症状的多个共变轨迹，如果存在，那么不同的轨迹亚组在精神病障碍的遗传和环境风险因素以及一般功能结局方面是否存在差异。
共有 764 名 CHR 个体在基线时接受了社交焦虑和精神病风险症状严重程度的评估，并在接下来的 2 年内每 6 个月随访一次。基于社交焦虑和阳性症状的共变轨迹，应用基于群组的多轨迹建模来辨别出三个亚组。
其中一个亚组表现出随着时间的推移社交焦虑持续存在，尽管阳性症状有中度恢复，而另外两个亚组表现出社交焦虑恢复到临床显著阈值以下，同时阳性症状严重程度适度到中度恢复。与其他轨迹组相比，持续存在社交焦虑的轨迹亚组的长期总体功能结局较差。此外，与其他两个轨迹组相比，持续存在社交焦虑的轨迹组的精神分裂症多基因风险水平和环境应激暴露水平更高，预示着其成员身份。
综上所述，这些分析表明，在 CHR-P 人群中，持续缓解的社交焦虑症状具有不同的相关性，这可能对不同的干预策略具有影响。
