VISN 4 Mental Illness Research Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Schizophr Bull. 2022 Jun 21;48(4):893-901. doi: 10.1093/schbul/sbac048.
Quantitative models of psychopathology can empirically guide subclassification of heterogeneous clinical presentations such as psychosis; they are particularly well-equipped to capture the nuanced symptomatology observed in first-episode psychosis. As well, components may be better aligned with biological variables. The current study sought to confirm and extend knowledge of the hierarchical structure of psychosis symptoms in first-episode psychosis. Based on past hierarchical work, we hypothesized that a 4 component level would be most closely associated with longitudinal disability.
Participants with early-stage psychosis (N = 370) underwent clinical assessment with the scale for the assessment of positive symptoms (SAPS), scale for assessment of negative symptoms (SANS), and global assessment scale(GAS). A subset was assessed at 6 months (N = 221) and 1 year (N = 207). Hierarchical symptom components were extracted at 12 levels. The predictive utility of the components for global functioning was tested.
As predicted, the 4-component model (reality distortion, thought disorder, inexpressivity, apathy/asociality) provided a superior prediction of functioning over other levels of the hierarchy. Baseline apathy/asociality longitudinally predicted functioning beyond the shared variance of the components at 6 months (b = -4.83, t(216) = -5.37, p < .001, R2adj = 0.12) and 1-year (b = -4.49, t(202) = -4.38, p < .001, R2adj = 0.09).
The hierarchical structure of psychotic symptomatology and its external validity have been robustly established in independent, longitudinal first-episode psychosis samples. The established model incorporates multiple levels of granularity that can be flexibly applied based on the level that offers the greatest predictive utility for external validators.
精神病理学的定量模型可以从经验上指导对精神分裂症等异质临床表现的细分；它们特别适合捕捉首次发作精神分裂症中观察到的微妙症状。此外，这些成分可能与生物学变量更好地对齐。本研究旨在证实并扩展首次发作精神分裂症中精神病症状的层次结构知识。基于过去的层次结构工作，我们假设 4 个成分水平与纵向残疾最密切相关。
370 名早期精神病患者接受了阳性症状评估量表（SAPS）、阴性症状评估量表（SANS）和总体评估量表（GAS）的临床评估。一部分在 6 个月（n=221）和 1 年（n=207）时进行了评估。在 12 个水平提取分层症状成分。测试了这些成分对整体功能的预测能力。
正如预测的那样，4 成分模型（现实扭曲、思维障碍、表达障碍、冷漠/社交障碍）比层次结构的其他水平提供了对功能更好的预测。基线冷漠/社交障碍在 6 个月（b=-4.83，t(216)=-5.37，p<0.001，R2adj=0.12）和 1 年（b=-4.49，t(202)=-4.38，p<0.001，R2adj=0.09）时，纵向预测功能，超出了成分的共同方差。
在独立的、纵向的首次发作精神分裂症样本中，精神病症状的层次结构及其外部有效性已经得到了稳健的建立。该既定模型包含多个粒度级别，可以根据为外部验证器提供最大预测效用的级别灵活应用。
