Mental Health Department. Basurto University Hospital. Biocruces Bizkaia Health Research Institute. Department of Neuroscience, Campus de Leioa, University of the Basque Country, UPV/EHU. Plaza de Cruces 12. 48903, Barakaldo, Bizkaia, Spain.
Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Transl Psychiatry. 2022 May 12;12(1):198. doi: 10.1038/s41398-022-01961-7.
This study aims to meta-analytically characterize the presence and magnitude of within-group variability across neurocognitive functioning in young people at Clinical High-Risk for psychosis (CHR-P) and comparison groups. Multistep, PRISMA/MOOSE-compliant systematic review (PROSPERO-CRD42020192826) of the Web of Science database, Cochrane Central Register of Reviews and Ovid/PsycINFO and trial registries up to July 1, 2020. The risk of bias was assessed using a modified version of the NOS for cohort and cross-sectional studies. Original studies reporting neurocognitive functioning in individuals at CHR-P compared to healthy controls (HC) or first-episode psychosis (FEP) patients were included. The primary outcome was the random-effect meta-analytic variability ratios (VR). Secondary outcomes included the coefficient of variation ratios (CVR). Seventy-eight studies were included, relating to 5162 CHR-P individuals, 2865 HC and 486 FEP. The CHR-P group demonstrated higher variability compared to HC (in descending order of magnitude) in visual memory (VR: 1.41, 95% CI 1.02-1.94), executive functioning (VR: 1.31, 95% CI 1.18-1.45), verbal learning (VR: 1.29, 95% CI 1.15-1.45), premorbid IQ (VR: 1.27, 95% CI 1.09-1.49), processing speed (VR: 1.26, 95% CI 1.07-1.48), visual learning (VR: 1.20, 95% CI 1.07-1.34), and reasoning and problem solving (VR: 1.17, 95% CI 1.03-1.34). In the CVR analyses the variability in CHR-P population remains in the previous neurocognitive domains and emerged in attention/vigilance, working memory, social cognition, and visuospatial ability. The CHR-P group transitioning to psychosis showed greater VR in executive functioning compared to those not developing psychosis and compared to FEP groups. Clinical high risk for psychosis subjects shows increased variability in neurocognitive performance compared to HC. The main limitation of this study is the validity of the VR and CVR as an index of variability which has received debate. This finding should be explored by further individual-participant data research and support precision medicine approaches.
本研究旨在通过荟萃分析，描述处于精神病临床高风险（CHR-P）的年轻人和对照组在神经认知功能方面的组内变异性的存在和程度。这是一项多步骤、符合 PRISMA/MOOSE 标准的系统评价（PROSPERO-CRD42020192826），对 Web of Science 数据库、Cochrane 中央对照试验注册库和 Ovid/PsycINFO 以及试验注册库进行了检索，时间截至 2020 年 7 月 1 日。使用经过修改的 NOS 对队列研究和横断面研究进行了偏倚风险评估。纳入的原始研究报告了 CHR-P 个体与健康对照组（HC）或首发精神病（FEP）患者相比的神经认知功能。主要结局指标是随机效应荟萃分析变异比（VR）。次要结局指标包括变异系数比（CVR）。共纳入 78 项研究，涉及 5162 名 CHR-P 个体、2865 名 HC 和 486 名 FEP。与 HC 相比，CHR-P 组在视觉记忆（VR：1.41，95%CI 1.02-1.94）、执行功能（VR：1.31，95%CI 1.18-1.45）、言语学习（VR：1.29，95%CI 1.15-1.45）、 前病智商（VR：1.27，95%CI 1.09-1.49）、加工速度（VR：1.26，95%CI 1.07-1.48）、视觉学习（VR：1.20，95%CI 1.07-1.34）和推理与问题解决（VR：1.17，95%CI 1.03-1.34）方面表现出更高的变异性。在 CVR 分析中，CHR-P 人群的变异性仍然存在于之前的神经认知领域，并出现在注意力/警觉性、工作记忆、社会认知和视空间能力方面。与未发展为精神病的患者相比，向精神病过渡的 CHR-P 组在执行功能方面表现出更大的 VR，与 FEP 组相比也是如此。与 HC 相比，处于精神病临床高风险的受试者在神经认知表现方面表现出更大的变异性。本研究的主要局限性是 VR 和 CVR 作为变异性指标的有效性存在争议。这一发现应该通过进一步的个体参与者数据研究来探索，并支持精准医学方法。
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