Nelson Barnaby, Yuen Hok Pan, Amminger G Paul, Berger Gregor, Chen Eric Y H, de Haan Lieuwe, Hartmann Jessica A, Hickie Ian B, Lavoie Suzie, Markulev Connie, Mossaheb Nilufar, Nieman Dorien H, Nordentoft Merete, Polari Andrea, Riecher-Rössler Anita, Schäfer Miriam R, Schlögelhofer Monika, Smesny Stefan, Tedja Amy, Thompson Andrew, Verma Swapna, Yung Alison R, McGorry Patrick D
Orygen, Melbourne, Victoria, Australia.
Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.
Schizophr Bull Open. 2020 Mar 2;3(1):sgaa006. doi: 10.1093/schizbullopen/sgaa006. eCollection 2022 Jan.
This study examined whether distress in relation to attenuated psychotic symptoms (DAPS) is associated with clinical outcomes in an ultra-high risk (UHR) for psychosis sample. We also investigated whether DAPS is associated with cognitive style (attributional style and cognitive biases) and whether amount of psychosocial treatment provided is associated with reduction in DAPS. The study was a secondary analysis of the "Neurapro" clinical trial of omega-3 fatty acids. Three hundred and four UHR patients were recruited across 10 early intervention services. Data from baseline assessment, regular assessments over 12 months, and medium term follow-up (mean = 3.4 years) were used for analysis. Findings indicated: a positive association between DAPS assessed over time and transition to psychosis; a significant positive association between baseline and longitudinal DAPS and transdiagnostic clinical and functional outcomes; a significant positive association between baseline and longitudinal DAPS and nonremission of UHR status. There was no relationship between severity of DAPS and cognitive style. A greater amount of psychosocial treatment (cognitive-behavioral case management) was associated with an increase in DAPS scores. The study indicates that UHR patients who are more distressed by their attenuated psychotic symptoms are more likely to have a poorer clinical trajectory transdiagnostically. Assessment of DAPS may therefore function as a useful marker of risk for a range of poor outcomes. The findings underline the value of repeated assessment of variables and incorporation of dynamic change into predictive modeling. More research is required into mechanisms driving distress associated with symptoms and the possible bidirectional relationship between symptom severity and associated distress.
本研究考察了与精神病性症状衰减相关的痛苦感（DAPS）是否与精神病超高风险（UHR）样本的临床结局相关。我们还调查了DAPS是否与认知风格（归因风格和认知偏差）相关，以及所提供的心理社会治疗量是否与DAPS的降低相关。该研究是对ω-3脂肪酸的“Neurapro”临床试验的二次分析。在10个早期干预服务机构招募了304名UHR患者。来自基线评估、12个月内的定期评估以及中期随访（平均 = 3.4年）的数据用于分析。研究结果表明：随时间评估的DAPS与向精神病的转变之间存在正相关；基线和纵向DAPS与跨诊断临床和功能结局之间存在显著正相关；基线和纵向DAPS与UHR状态未缓解之间存在显著正相关。DAPS的严重程度与认知风格之间没有关系。更多的心理社会治疗（认知行为个案管理）与DAPS评分的增加相关。该研究表明，因精神病性症状衰减而更痛苦的UHR患者更有可能在跨诊断方面有较差的临床病程。因此，对DAPS的评估可能作为一系列不良结局风险的有用标志物。研究结果强调了对变量进行重复评估以及将动态变化纳入预测模型的价值。需要对驱动与症状相关痛苦感的机制以及症状严重程度与相关痛苦感之间可能的双向关系进行更多研究。
