Zhang TianHong, Cui HuiRu, Wei YanYan, Tang XiaoChen, Xu LiHua, Hu YeGang, Tang YingYing, Liu HaiChun, Wang ZiXuan, Chen Tao, Li ChunBo, Wang JiJun
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Engineering Research Center of Intelligent Psychological Evaluation and Intervention, Shanghai Key Laboratory of Psychotic Disorders, Shanghai, PR China.
Department of Automation, Shanghai Jiao Tong University, Shanghai, China.
JAMA Netw Open. 2024 Jan 2;7(1):e2353426. doi: 10.1001/jamanetworkopen.2023.53426.
The possible association between the duration of untreated prodromal symptoms (DUPrS) and cognitive functioning in individuals at clinical high risk (CHR) for psychosis remains underexplored.
To investigate the intricate interplay between DUPrS, cognitive performance, and conversion outcomes, shedding light on the potential role of DUPrS in shaping cognitive trajectories and psychosis risk in individuals at CHR for psychosis.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study of individuals at CHR for psychosis was conducted at the Shanghai Mental Health Center in China from January 10, 2016, to December 29, 2021. Participants at CHR for psychosis typically exhibit attenuated positive symptoms; they were identified according to the Structured Interview for Prodromal Syndromes, underwent baseline neuropsychological assessments, and were evaluated at a 3-year clinical follow-up. Data were analyzed from August 25, 2021, to May 10, 2023.
Duration of untreated prodromal symptoms and cognitive impairments in individuals at CHR for psychosis.
The primary study outcome was conversion to psychosis. The DUPrS was categorized into 3 groups based on percentiles (33rd percentile for short [≤3 months], 34th-66th percentile for median [4-9 months], and 67th-100th percentile for long [≥10 months]). The DUPrS, cognitive variables, and the risk of conversion to psychosis were explored through quantile regression and Cox proportional hazards regression analyses.
This study included 506 individuals (median age, 19 [IQR, 16-21] years; 53.6% [n = 271] women). The mean (SD) DUPrS was 7.8 (6.857) months, and the median (IQR) was 6 (3-11) months. The short and median DUPrS groups displayed poorer cognitive performance than the long DUPrS group in the Brief Visuospatial Memory Test-Revised (BVMT-R) (Kruskal-Wallis χ2 = 8.801; P = .01) and Category Fluency Test (CFT) (Kruskal-Wallis χ2 = 6.670; P = .04). Quantile regression analysis revealed positive correlations between DUPrS rank and BVMT-R scores (<90th percentile of DUPrS rank) and CFT scores (within the 20th-70th percentile range of DUPrS rank). Among the 506 participants, 20.8% (95% CI, 17.4%-24.5%) converted to psychosis within 3 years. Cox proportional hazards regression analysis identified lower educational attainment (hazard ratio [HR], 0.912; 95% CI, 0.834-0.998), pronounced negative symptoms (HR, 1.044; 95% CI, 1.005-1.084), and impaired performance on the Neuropsychological Assessment Battery: Mazes (HR, 0.961; 95% CI, 0.924-0.999) and BVMT-R (HR, 0.949; 95% CI, 0.916-0.984) tests as factors associated with conversion.
The finding of this cohort study suggest the intricate interplay between DUPrS, cognitive performance, and conversion risk in individuals at CHR for psychosis. The findings emphasize the importance of considering both DUPrS and cognitive functioning in assessing the trajectory of these individuals.
精神病临床高危（CHR）个体中未治疗的前驱症状持续时间（DUPrS）与认知功能之间的潜在关联仍未得到充分研究。
探讨DUPrS、认知表现和转化结果之间的复杂相互作用，以阐明DUPrS在塑造CHR个体的认知轨迹和精神病风险方面的潜在作用。
设计、地点和参与者：这项针对CHR个体的队列研究于2016年1月10日至2021年12月29日在中国上海精神卫生中心进行。CHR个体通常表现出减弱的阳性症状；他们通过前驱综合征结构化访谈进行识别，接受基线神经心理学评估，并在3年临床随访中进行评估。数据于2021年8月25日至2023年5月10日进行分析。
CHR个体中未治疗的前驱症状持续时间和认知障碍。
主要研究结局是转化为精神病。DUPrS根据百分位数分为3组（短[≤3个月]为第33百分位数，中[4 - 9个月]为第34 - 66百分位数，长[≥10个月]为第67 - 100百分位数）。通过分位数回归和Cox比例风险回归分析探讨DUPrS、认知变量和转化为精神病的风险。
本研究纳入506名个体（中位年龄为19岁[四分位间距，16 - 21岁]；53.6%[n = 271]为女性）。DUPrS的平均（标准差）为7.8（6.857）个月，中位（四分位间距）为其6（3 - 11）个月。在修订的简短视觉空间记忆测试（BVMT - R）（Kruskal - Wallis χ2 = 8.801；P = 0.01）和类别流畅性测试（CFT）（Kruskal - Wallis χ2 = 6.670；P = 0.04）中，短和中DUPrS组的认知表现比长DUPrS组差。分位数回归分析显示DUPrS排名与BVMT - R分数（DUPrS排名<第90百分位数）和CFT分数（DUPrS排名在第20 - 70百分位数范围内）之间呈正相关。在506名参与者中，20.8%（95%置信区间，17.4% - 24.5%）在3年内转化为精神病。Cox比例风险回归分析确定较低的教育程度（风险比[HR]，0.912；95%置信区间，0.834 - 0.998）、明显的阴性症状（HR，1.044；95%置信区间，1.005 - 1.084）以及神经心理评估电池：迷宫测试（HR，0.961；95%置信区间，0.924 - 0.999）和BVMT - R测试（HR，0.949；95%置信区间，0.916 - 0.984）表现受损是与转化相关的因素。
这项队列研究的结果表明CHR个体中DUPrS、认知表现和转化风险之间存在复杂的相互作用。这些发现强调了在评估这些个体的病程时同时考虑DUPrS和认知功能的重要性。
