Department of Psychology & Neuroscience, Temple University, Philadelphia, PA, USA.
Curr Top Behav Neurosci. 2023;63:205-240. doi: 10.1007/7854_2022_378.
Risk for psychosis begins to accumulate as early as the fetal period through exposure to obstetric complications like fetal hypoxia, maternal stress, and prenatal infection. Stressors in the postnatal period, such as childhood trauma, peer victimization, and neighborhood-level adversity, further increase susceptibility for psychosis. Cognitive difficulties are among the first symptoms to emerge in individuals who go on to develop a psychotic disorder. We review the relationship between pre-, perinatal, and early childhood adversities and cognitive outcomes in individuals with psychosis. Current evidence shows that the aforementioned environmental risk factors may be linked to lower overall intelligence and executive dysfunction, beginning in the premorbid period and persisting into adulthood in individuals with psychosis. It is likely that early life stress contributes to cognitive difficulties in psychosis through dysregulation of the body's response to stress, causing changes such as increased cortisol levels and chronic immune activation, which can negatively impact neurodevelopment. Intersectional aspects of identity (e.g., sex/gender, race/ethnicity), as well as gene-environment interactions, likely inform the developmental cascade to cognitive difficulties throughout the course of psychotic disorders and are reviewed below. Prospective studies of birth cohorts will serve to further clarify the relationship between early-life environmental risk factors and cognitive outcomes in the developmental course of psychotic disorders. Specific methodological recommendations are provided for future research.
精神病的风险早在胎儿期就开始积累，原因是胎儿缺氧、母体压力和产前感染等产科并发症。出生后的压力源，如儿童时期的创伤、同伴侵害和邻里逆境，进一步增加了精神病的易感性。认知困难是那些最终发展为精神病的个体最早出现的症状之一。我们回顾了产前、围产期和儿童早期逆境与精神病患者认知结果之间的关系。目前的证据表明，上述环境风险因素可能与智力整体水平降低和执行功能障碍有关，这种情况始于发病前阶段，并在精神病患者成年后持续存在。很可能是早期生活压力通过调节身体对压力的反应而导致认知困难，例如增加皮质醇水平和慢性免疫激活，从而对神经发育产生负面影响。身份的交叉方面（例如，性别/性别、种族/民族）以及基因-环境相互作用，可能会影响到精神病的整个发展过程中的认知困难的发展级联，下面将对此进行回顾。对出生队列的前瞻性研究将有助于进一步阐明精神病发展过程中早期环境风险因素与认知结果之间的关系。为未来的研究提供了具体的方法学建议。
