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Cognitive heterogeneity in first-episode psychosis and its relationship with premorbid developmental adjustment
Psychological Medicine ( IF 6.9 ) Pub Date : 2021-03-12 , DOI: 10.1017/s0033291721000738
Eric J. Tan , Susan L. Rossell , Kenneth L. Subotnik , Joseph Ventura , Keith H. Nuechterlein

Background

Patients with schizophrenia spectrum disorders have been increasingly recognised to form cognitive subgroups with differential levels of impairment. Using cluster analytical techniques, this study sought to identify cognitive clusters in a sample of first-episode psychosis (FEP) patients and examine clinical and developmental differences across the resultant groups.

Methods

In total, 105 FEP patients in the University of California Los Angeles Aftercare Research Program were assessed for cognition, symptoms and premorbid developmental adjustment. Hierarchical cluster analysis with Ward's method and squared Euclidean distance was conducted, confirmed by discriminant function analysis and optimised with k-means clustering. The stability of the solution was evaluated through split-sample (random, 80 and 70% samples) and alternate method (average linkage method) replication via Cohen's κ analysis. Controlling for multiple comparisons, one-way analysis of variances examined group differences in symptom severity and premorbid adjustment.

Results

Three groups were identified: severely impaired (n = 27), moderately impaired (n = 41) and relatively intact (n = 37). There were no significant differences in symptom severity across the groups. Significant differences were observed for scholastic performance at three different developmental stages: childhood, early adolescence and late adolescence, with the relatively intact group demonstrating significantly better scholastic performance at all three stages than both the moderately impaired and severely impaired groups (who did not significantly differ from each other).

Conclusions

The findings add to growing evidence that cognitive clusters in FEP mirror that of later-stage schizophrenia. They also suggest that premorbid scholastic performance may not just be a risk factor for developing schizophrenia, but is also related to cognitive impairment severity and potentially to prognosis.



中文翻译:

首发精神病的认知异质性及其与病前发展适应的关系

背景

人们越来越多地认识到精神分裂症谱系障碍患者可以形成具有不同程度损伤的认知亚组。本研究使用聚类分析技术,试图在首发精神病 (FEP) 患者样本中识别认知聚类,并检查由此产生的群体之间的临床和发育差异。

方法

加州大学洛杉矶分校术后护理研究项目总共对 105 名 FEP 患者进行了认知、症状和病前发育调整评估。使用 Ward 方法和平方欧几里德距离进行层次聚类分析,通过判别函数分析确认并使用k均值聚类优化。通过 Cohen 的κ分析,通过拆分样本(随机、80% 和 70% 样本)和替代方法(平均连锁法)复制评估溶液的稳定性。控制多重比较,方差的单向分析检查症状严重程度和病前调整的组差异。

结果

确定了三组:严重受损(n = 27)、中度受损(n = 41)和相对完好(n = 37)。各组的症状严重程度没有显着差异。在三个不同的发育阶段观察到学业成绩存在显着差异:儿童期、青春期早期和青春期后期,相对完整的组在所有三个阶段的学业成绩均明显优于中度受损组和严重受损组(没有显着差异)从彼此)。

结论

这些发现增加了越来越多的证据表明 FEP 中的认知集群反映了晚期精神分裂症的认知集群。他们还表明,病前的学习成绩可能不仅是发展为精神分裂症的危险因素,而且还与认知障碍的严重程度和潜在的预后有关。

更新日期:2021-03-12
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