Paquin Vincent, Malla Ashok K, Iyer Srividya N, Lepage Martin, Joober Ridha, Shah Jai L
Douglas Mental Health University Institute.
J Psychopathol Clin Sci. 2023 Feb;132(2):198-208. doi: 10.1037/abn0000806.
Across subthreshold psychotic and nonpsychotic syndromes, symptoms experienced before the onset of a first episode of psychosis (FEP) may index distinct illness trajectories. We aimed to examine the associations between three types of pre-onset symptoms (self-harm, suicide attempts, and subthreshold psychotic) and outcome trajectories during FEP. Participants with FEP were recruited from PEPP-Montreal, a catchment-based early intervention service. Pre-onset symptoms were systematically assessed through interviews with participants (and their relatives) and reviews of health and social records. Over 2 years of follow-up at PEPP-Montreal, 3-8 repeated measures were collected for positive, negative, depressive, and anxiety symptoms, as well as functioning. We applied linear mixed models to examine associations between pre-onset symptoms and outcome trajectories. We found that on average over follow-up, participants with pre-onset self-harm had more severe positive, depressive, and anxiety symptoms compared with other participants (standardized mean differences: 0.32-0.76), while differences in negative symptoms and functioning were not significant. Associations did not differ by gender and remained similar after adjusting for the duration of untreated psychosis, substance use disorder, or baseline diagnosis of affective psychosis. Over time, depressive and anxiety symptoms improved among individuals with pre-onset self-harm, such that they converged with other individuals by the end of the follow-up. Similarly, pre-onset suicide attempts were associated with elevated depressive symptoms that improved over time. Pre-onset subthreshold psychotic symptoms were not associated with outcomes, except for a slightly different trajectory of functioning. Individuals with pre-onset self-harm or suicide attempts may benefit from early interventions that target their transsyndromic trajectories. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
在阈下精神病性和非精神病性综合征中，首次精神病发作（FEP）之前经历的症状可能预示着不同的疾病轨迹。我们旨在研究三种发作前症状（自我伤害、自杀未遂和阈下精神病性症状）与FEP期间的结局轨迹之间的关联。FEP参与者来自蒙特利尔PEPP，这是一项基于集水区的早期干预服务。通过与参与者（及其亲属）访谈以及查阅健康和社会记录，系统评估发作前症状。在蒙特利尔PEPP进行的2年多随访中，针对阳性、阴性、抑郁和焦虑症状以及功能状况收集了3至8次重复测量数据。我们应用线性混合模型来研究发作前症状与结局轨迹之间的关联。我们发现，在随访期间，平均而言，有发作前自我伤害的参与者与其他参与者相比，有更严重的阳性、抑郁和焦虑症状（标准化均值差异：0.32 - 0.76），而阴性症状和功能状况的差异不显著。关联在性别上没有差异，在调整未治疗精神病的持续时间、物质使用障碍或情感性精神病的基线诊断后仍然相似。随着时间推移，有发作前自我伤害的个体的抑郁和焦虑症状有所改善，以至于在随访结束时与其他个体趋同。同样，发作前自杀未遂与随时间改善的抑郁症状升高有关。发作前阈下精神病性症状与结局无关，除了功能状况的轨迹略有不同。有发作前自我伤害或自杀未遂经历的个体可能会从针对其跨综合征轨迹的早期干预中受益。（PsycInfo数据库记录（c）2023美国心理学会，保留所有权利）
