Watson Andrew J, Harrison Lauren, Preti Antonio, Wykes Til, Cella Matteo
Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and South London and Maudsley NHS Foundation Trust, London, UK.
Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
Br J Psychiatry. 2022 Dec;221(6):714-721. doi: 10.1192/bjp.2022.131.
Cognitive impairment is a core feature of schizophrenia, associated with poor functional outcomes. The course of cognitive function in the years following illness onset has remained a subject of debate, with a previous analysis finding no worsening, providing support for the neurodevelopmental model of schizophrenia. Since then, many more studies have reported on longitudinal cognitive performance in early psychosis, with some indicating deterioration, which does not align with this view.
This study aims to quantitatively review the literature on the longitudinal trajectory of cognitive deficits in the years following psychosis onset, in comparison with healthy controls. It is the first to also synthesise longitudinal data on social cognition.
Electronic databases ('PubMed', 'PsycInfo' and 'Scopus') were searched (to end September 2021). Meta-analyses of 25 longitudinal studies of cognition in early psychosis were conducted (1480 patients, 789 health controls). Unlike previous analyses, randomised controlled trials and those with multiple cognitive testing periods within the first year were excluded to minimise bias (PROSPERO, ID: CRD42021241525).
Small improvements were observed for global cognition ( = 0.25, 95% CI 0.17-0.33) and individual cognitive domains, but these were comparable with healthy controls and likely an artefact of practice effects.
There is no evidence of continued cognitive decline or improvement in the early years following psychosis onset, with a need for more studies over longer follow-up periods. Practice effects highlight the importance of including control samples in longitudinal and intervention studies. Further data are needed to evaluate the course of social cognition subdomains.
认知障碍是精神分裂症的核心特征，与功能预后不良相关。疾病发作后数年的认知功能进程一直是一个有争议的话题，先前的一项分析发现没有恶化，这为精神分裂症的神经发育模型提供了支持。从那时起，更多的研究报告了早期精神病患者的纵向认知表现，一些研究表明存在恶化，这与上述观点不一致。
本研究旨在定量综述精神病发作后数年认知缺陷纵向轨迹的相关文献，并与健康对照进行比较。本研究也是首个综合社会认知纵向数据的研究。
检索电子数据库（“PubMed”、“PsycInfo”和“Scopus”）（截至2021年9月底）。对25项早期精神病认知纵向研究进行荟萃分析（1480例患者，789名健康对照）。与先前的分析不同，排除了随机对照试验和第一年有多个认知测试期的研究，以尽量减少偏倚（PROSPERO，标识符：CRD42021241525）。
整体认知（标准化均值差=0.25，95%置信区间0.17 - 0.33）和各个认知领域均观察到小幅改善，但这些改善与健康对照相当，可能是练习效应的假象。
没有证据表明精神病发作后的早期存在持续的认知衰退或改善，需要进行更多更长随访期的研究。练习效应凸显了在纵向研究和干预研究中纳入对照样本重要性。需要进一步的数据来评估社会认知子领域的进程。
