中国科学院心理健康重点实验室知识库

精神病临床高危(clinicalhigh-riskforpsychosis,CHR-P)人群的症状和功能发展存在异质性,澄清这个群体症状和功能的改变及联系,有利于精神病早期预防。元分析纳入54篇文献,探究CHR-P人群各维度临床症状和功能的纵向改变、基线症状对随访功能的预测作用、调节效应。结果发现,CHR-P人群轻微阳性症状、阴性症状、瓦解症状、情感症状、一般精神病理症状、整体功能和角色功能随时间显著改善,社会功能没有显著改善;基线阴性症状显著负向预测随访的整体功能、社会功能、角色功能,基线的瓦解症状、情感症状、一般精神病理症状与随访的整体功能显著负相关;受教育程度显著调节轻微阳性症状和阴性症状的纵向变化,年龄、轻微阳性症状亚组比例和短暂间歇性精神病性症状亚组比例显著调节情感症状的纵向变化。这揭示阴性症状改善少和社会功能损害是CHR-P人群的核心特征,提示未来可针对阴性症状研发干预措施,进而改善社会功能。

The symptoms and functional development of individuals at clinical high-risk for psychosis (CHR-P) exhibit considerable heterogeneity. It is important to understand the changes in symptoms and functional outcomes as well as their relationships in this population for early prevention of psychosis. This study conducted a three-level meta-analysis of 54 studies to comprehensively examine the longitudinal changes in various clinical symptoms and functional outcome among CHR-P individuals. We explored the predictive role of baseline symptoms on follow-up functional outcome. The results indicated significant improvements over time in attenuated positive symptoms, negative symptoms, disorganized symptoms, affective symptoms, general symptoms, global function, and role function. However, social function did not show significant improvement. Baseline negative symptoms significantly and negatively predicted follow-up global function, social function, and role function. Baseline disorganized symptoms, affect symptoms and general symptoms significantly and negatively predicted follow-up global function. Moderation analysis revealed that education level significantly moderated the longitudinal changes of attenuated positive symptoms and negative symptoms. Moreover, age, proportion of attenuated positive symptoms (APS) subgroup, and proportion of brief limited intermittent psychotic symptoms (BLIPS) subgroup significantly moderated the longitudinal changes in affective symptoms. This is the first study to examine the changes in specific function and the longitudinal predictive value of symptoms on functioning in CHR-P individuals. Persistence of negative symptoms and the social function impairments are core features of CHR-P individuals. It is necessary to target at negative symptoms in CHR-P individuals for improving their social functioning.

科技创新2030项目(2021ZD0200800);; Philip K.H.Wong基金的资助