Cowan Henry R, Mittal Vijay A, Addington Jean, Bearden Carrie E, Cadenhead Kristin S, Cornblatt Barbara A, Keshavan Matcheri, Mathalon Daniel H, Perkins Diana O, Stone William, Tsuang Ming T, Woods Scott W, Cannon Tyrone D, Walker Elaine F
Psychiatry, The Ohio State University, Columbus, OH, USA.
Psychology, Michigan State University, East Lansing, MI, USA.
Schizophr Bull. 2024 Dec 20;51(1):54-66. doi: 10.1093/schbul/sbae050.
Social and academic adjustment deteriorate in the years preceding a psychotic disorder diagnosis. Analyses of premorbid adjustment have recently been extended into the clinical high risk for psychosis (CHR) syndrome to identify risk factors and developmental pathways toward psychotic disorders. Work so far has been at the between-person level, which has constrained analyses of premorbid adjustment, clinical covariates, and conversion to psychosis.
Growth-curve models examined longitudinal trajectories in retrospective reports of premorbid social and academic adjustment from youth at CHR (n = 498). Interaction models tested whether known covariates of premorbid adjustment problems (attenuated negative symptoms, cognition, and childhood trauma) were associated with different premorbid adjustment trajectories in converters vs non-converters (ie, participants who did/did not develop psychotic disorders within 2-year follow-up).
Converters reported poorer social adjustment throughout the premorbid period. Converters who developed psychosis with an affective component reported poorer academic adjustment throughout the premorbid period than those who developed non-affective psychosis. Tentatively, baseline attenuated negative symptoms may have been associated with worsening social adjustment in the premorbid period for non-converters only. Childhood trauma impact was associated with fewer academic functioning problems among converters. Cognition effects did not differ based on conversion status.
Premorbid social function is an important factor in risk for conversion to psychosis. Negative symptoms and childhood trauma had different relationships to premorbid functioning in converters vs non-converters. Mechanisms linking symptoms and trauma to functional impairment may be different in converters vs non-converters, suggesting possible new avenues for risk assessment.
在精神障碍诊断前的几年里，社交和学业适应能力会逐渐恶化。近期，对病前适应的分析已扩展到精神病临床高危（CHR）综合征，以识别精神障碍的风险因素和发展路径。到目前为止的研究都处于个体间水平，这限制了对病前适应、临床协变量以及向精神病转化的分析。
生长曲线模型研究了CHR青年（n = 498）病前社交和学业适应回顾性报告中的纵向轨迹。交互模型测试了病前适应问题的已知协变量（减弱的阴性症状、认知和童年创伤）在转化者与未转化者（即2年随访期内发展/未发展为精神障碍的参与者）中是否与不同的病前适应轨迹相关。
转化者在整个病前阶段报告的社交适应较差。伴有情感成分而发展为精神病的转化者在整个病前阶段报告的学业适应比发展为非情感性精神病的转化者更差。初步来看，仅对于未转化者，基线减弱的阴性症状可能与病前阶段社交适应的恶化有关。童年创伤的影响与转化者较少的学业功能问题相关。认知效应在转化状态上没有差异。
病前社会功能是转化为精神病风险的一个重要因素。阴性症状和童年创伤在转化者与未转化者中与病前功能的关系不同。症状和创伤与功能损害之间的关联机制在转化者与未转化者中可能不同，这为风险评估提示了可能的新途径。
