Ferraro Laura, Di Forti Marta, La Barbera Daniele, La Cascia Caterina, Morgan Craig, Tripoli Giada, Jongsma Hannah, Seminerio Fabio, Sartorio Crocettarachele, Sideli Lucia, Tarricone Ilaria, Carloni Anna Lisa, Szoke Andrei, Pignon Baptiste, Bernardo Miguel, de Haan Lieuwe, Arango Celso, Velthorst Eva, Gayer-Anderson Charlotte, Kirkbride James, Rutten Bart P F, Lasalvia Antonio, Tosato Sarah, Del Ben Cristina Marta, Menezes Paulo Rossi, Bobes Julio, Arrojo Manuel, Tortelli Andrea, Jones Peter, Selten Jean-Paul, van Os Jim, Murray Robin, Quattrone Diego, Vassos Evangelos
Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Psychiatry Section, University of Palermo, Palermo, Italy.
Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London.
Psychol Med. 2025 Feb 5;55:e12. doi: 10.1017/S0033291724003507.
Previous studies identified clusters of first-episode psychosis (FEP) patients based on cognition and premorbid adjustment. This study examined a range of socio-environmental risk factors associated with clusters of FEP, aiming a) to compare clusters of FEP and community controls using the Maudsley Environmental Risk Score for psychosis (ERS), a weighted sum of the following risks: paternal age, childhood adversities, cannabis use, and ethnic minority membership; b) to explore the putative differences in specific environmental risk factors in distinguishing within patient clusters and from controls.
A univariable general linear model (GLS) compared the ERS between 1,263 community controls and clusters derived from 802 FEP patients, namely, low (n = 223) and high-cognitive-functioning (n = 205), intermediate (n = 224) and deteriorating (n = 150), from the EU-GEI study. A multivariable GLS compared clusters and controls by different exposures included in the ERS.
The ERS was higher in all clusters compared to controls, mostly in the deteriorating (=2.8, 95% CI 2.3 3.4 η = 0.049) and the low-cognitive-functioning cluster (=2.4, 95% CI 1.9 2.8, η = 0.049) and distinguished them from the cluster with high-cognitive-functioning. The deteriorating cluster had higher cannabis exposure (mean = 0.48, 95% CI 0.49 0.91) than the intermediate having identical IQ, and more people from an ethnic minority (mean = 0.77, 95% CI 0.24 1.29) compared to the high-cognitive-functioning cluster.
High exposure to environmental risk factors might result in cognitive impairment and lower-than-expected functioning in individuals at the onset of psychosis. Some patients' trajectories involved risk factors that could be modified by tailored interventions.
既往研究基于认知和病前适应情况对首发精神病（FEP）患者进行了聚类分析。本研究调查了一系列与FEP聚类相关的社会环境风险因素，旨在：a）使用精神病的莫兹利环境风险评分（ERS）比较FEP聚类与社区对照，该评分是以下风险因素的加权总和：父亲年龄、童年逆境、大麻使用和少数族裔成员身份；b）探讨在区分患者聚类内部以及与对照之间时特定环境风险因素的假定差异。
采用单变量一般线性模型（GLS）比较了1263名社区对照与来自欧盟基因与环境研究（EU-GEI）中802名FEP患者聚类的ERS，这些聚类包括低认知功能（n = 223）和高认知功能（n = 205）、中等（n = 224）和恶化（n = 150）聚类。采用多变量GLS通过ERS中包含的不同暴露因素比较聚类与对照。
与对照相比，所有聚类的ERS均更高，主要是在恶化聚类（=2.8，95%可信区间2.3 - 3.4，η = 0.049）和低认知功能聚类（=2.4，95%可信区间1.9 - 2.8，η = 0.049），并将它们与高认知功能聚类区分开来。恶化聚类的大麻暴露量（均值 = 0.48，95%可信区间0.49 - 0.
