首次发作精神病缓解后瞬间心理状态与并发社会功能之间的关联：一项HAMLETT生态瞬间评估研究。

Associations between momentary mental states and concurrent social functioning after remission from first episode psychosis: A HAMLETT ecological momentary assessment study.

作者信息

Djordjevic Matej, Jongsma Hannah E, Simons Claudia J P, Oomen Priscilla P, de Haan Lieuwe, Boonstra Nynke, Kikkert Martijn, Koops Sanne, Geraets Chris N W, Begemann Marieke J H, Marcelis Machteld, Veling Wim

机构信息

University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Hanzeplein 1, PO Box 30.001, 9700 GZ, Groningen, the Netherlands.

University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Hanzeplein 1, PO Box 30.001, 9700 GZ, Groningen, the Netherlands; Center for Transcultural Psychiatry Veldzicht, Ommerweg 67, Balkbrug, 7707 AT, the Netherlands.

出版信息

J Psychiatr Res. 2025 Jan;181:560-569. doi: 10.1016/j.jpsychires.2024.12.002. Epub 2024 Dec 9.

DOI:10.1016/j.jpsychires.2024.12.002

PMID:39708772

Abstract

BACKGROUND

Symptom severity and social functioning are important outcomes after first episode psychosis (FEP), yet current evidence about associations between them is inconsistent and lacks (subclinical) momentary insights.

METHODS

The current Ecological Momentary Assessment (EMA) study was conducted in 58 people in remission from FEP, as part of the HAMLETT (Handling Antipsychotic Medication: Long-term Evaluation of Targeted Treatment) trial. At baseline, participants were prompted to report momentary mental states and social context 10x/day for eight consecutive days, including psychotic experiences (PEs), motivation/drive and negative affect, that may indicate proxies of (subclinical) psychotic, negative and general affective symptoms, respectively. We employed multilevel mixed-effects regressions to investigate associations between self-reported mental states and concurrent activity or social company and subjective appraisal thereof. We also conducted retrospective clinical assessments of symptoms (PANSS) and social functioning (WHODAS 2.0) and investigated their cross-sectional associations using multivariable linear regression.

RESULTS

Analyses of 3101 EMA-questionnaires showed that lower motivation/drive was associated with more passive activity and less company (OR = 0.96 [95%CI: 0.96; 0.97], OR = 0.95 [95%CI: 0.93; 0.96], N.B. ORs per 1-point symptom-score change). PEs and negative affect were associated with more proactive activity (OR = 1.02 [95%CI: 1.00; 1.03], OR = 1.02 [95%CI: 1.01; 1.03]). All three mental state domains were associated with lower activity appraisal overall, though activity-specific associations differed. PEs and negative affect were associated with lower company appraisal (B = -0.25 [95%CI: -0.36; -0.14], B = -0.15 [95%CI: -0.23; -0.06]). When assessed retrospectively, only PANSS general psychopathology was associated with poorer social functioning (B = 2.52 [95%CI: 1.69; 3.34]).

CONCLUSION

Self-reported PEs, momentary motivation/drive and general affective symptoms are associated with daily-life functioning after remission from FEP. Retrospective observer-rated and momentary self-report assessment methods do not measure the same aspects or intensity of psychopathology.

摘要

背景

症状严重程度和社会功能是首次发作精神病（FEP）后的重要预后指标，但目前关于它们之间关联的证据并不一致，且缺乏（亚临床）即时洞察。

方法

作为HAMLETT（抗精神病药物治疗：靶向治疗的长期评估）试验的一部分，当前的生态瞬时评估（EMA）研究纳入了58名FEP缓解期患者。在基线时，参与者被要求连续八天每天报告10次即时心理状态和社会背景，包括精神病性体验（PEs）、动机/驱力和消极情绪，这些可能分别指示（亚临床）精神病性、消极和一般情感症状的替代指标。我们采用多层次混合效应回归来研究自我报告的心理状态与同时进行的活动或社交陪伴及其主观评价之间的关联。我们还对症状（阳性和阴性症状量表，PANSS）和社会功能（世界卫生组织残疾评定量表2.0版，WHODAS 2.0）进行了回顾性临床评估，并使用多变量线性回归研究它们的横断面关联。

结果

对3101份EMA问卷的分析表明，较低的动机/驱力与更多的被动活动和更少的陪伴相关（比值比[OR]=0.96[95%置信区间：0.96；0.97]，OR=0.95[95%置信区间：0.93；0.96]，注意：每1分症状评分变化的OR值）。PEs和消极情绪与更多的主动活动相关（OR=1.02[95%置信区间：1.00；1.03]，OR=1.02[95%置信区间：1.01；_1.03]）。所有三个心理状态领域总体上与较低的活动评价相关，尽管特定活动的关联有所不同。PEs和消极情绪与较低的陪伴评价相关（B=-0.25[95%置信区间：-0.36；-0.14]，B=-0.15[%;置信区间：-0.23；-0.06]）。回顾性评估时，只有PANSS的一般精神病理学与较差的社会功能相关（B=2.52[95%置信区间：1.69；3.34]）。