Cuesta Manuel J, Gil-Berrozpe Gustavo J, Sánchez-Torres Ana M, Moreno-Izco Lucía, García de Jalón Elena, Peralta Víctor
Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain.
Navarra Institute for Health Research (IdiSNA), Pamplona, Spain.
Psychol Med. 2025 Feb 6;55:e29. doi: 10.1017/S0033291724003465.
Few studies have examined the long-term outcomes of first-episode psychosis (FEP) among patients beyond symptomatic and functional remission. This study aimed to broaden the scope of outcome indicators by examining the relationships between 12 outcomes of FEP patients at 20.9 years after their initial diagnosis.
At follow-up, 220 out of 550 original patients underwent a new assessment. Twelve outcomes were assessed via semistructured interviews and complementary scales: symptom severity, functional impairment, personal recovery, social disadvantage, physical health, number of suicide attempts, number of episodes, current drug use, dose-years of antipsychotics (DYAps), cognitive impairment, motor abnormalities, and DSM-5 final diagnosis. The relationships between these outcome measures were investigated using Spearman's correlation analysis and exploratory factor analysis, while the specific connections between outcomes were ascertained using network analysis.
The outcomes were significantly correlated; specifically, symptom severity, functioning, and personal recovery showed the strongest correlations. Exploratory factor analysis of the 12 outcomes revealed two factors, with 11 of the 12 outcomes loading on the first factor. Network analysis revealed that symptom severity, functioning, social disadvantage, diagnosis, cognitive impairment, DYAps, and number of episodes were the most interconnected outcomes.
Network analysis provided new insights into the heterogeneity between outcomes among patients with FEP. By considering outcomes beyond symptom severity, the rich net of interconnections elucidated herein can facilitate the development of interventions that target potentially modifiable outcomes and generalize their impact on the most interconnected outcomes.
很少有研究考察首发精神病（FEP）患者在症状缓解和功能恢复之外的长期预后。本研究旨在通过考察FEP患者初次诊断后20.9年时12项预后指标之间的关系，拓宽预后指标的范围。
在随访时，550名原始患者中有220名接受了重新评估。通过半结构化访谈和补充量表评估12项预后指标：症状严重程度、功能损害、个人康复、社会不利地位、身体健康、自杀未遂次数、发作次数、当前药物使用情况、抗精神病药物剂量-年数（DYAps）、认知损害、运动异常和DSM-5最终诊断。使用Spearman相关分析和探索性因素分析研究这些预后指标之间的关系，同时使用网络分析确定各指标之间的具体联系。
这些预后指标显著相关；具体而言，症状严重程度、功能和个人康复之间的相关性最强。对这12项预后指标进行探索性因素分析，发现了两个因素，12项指标中的11项加载在第一个因素上。网络分析显示，症状严重程度、功能、社会不利地位、诊断、认知损害、DYAps和发作次数是相互联系最紧密的预后指标。
网络分析为FEP患者预后指标之间的异质性提供了新的见解。通过考虑症状严重程度之外的预后指标，本文阐明的丰富联系网络有助于开发针对潜在可改变预后指标的干预措施，并推广其对相互联系最紧密的预后指标的影响。
