Abstract

Introduction

Diagnoses of anxiety and/or depression are common in subjects at Ultra-High Risk for Psychosis (UHR) and associated with extensive functional impairment. Less is known about the impact of affective comorbidities on the prospective course of attenuated psychotic symptoms (APS).

Method

Latent class mixed modelling identified APS trajectories in 331 UHR subjects assessed at baseline, 6, 12, and 24 months follow-up. The prognostic value of past, baseline, and one-year DSM-IV depressive or anxiety disorders on trajectories was investigated using logistic regression, controlling for confounders. Cox proportional hazard analyses investigated associations with transition risk.

Results

46.8% of participants fulfilled the criteria for a past depressive disorder, 33.2% at baseline, and 15.1% at one-year follow-up. Any past, baseline, or one-year anxiety disorder was diagnosed in 42.9%, 37.2%, and 27.0%, respectively. Participants were classified into one of three latent APS trajectory groups: (1) persistently low, (2) increasing, and (3) decreasing. Past depression was associated with a higher risk of belonging to the increasing trajectory group, compared to the persistently low (OR = 3.149, [95%CI: 1.298–7.642]) or decreasing group (OR = 3.137, [1.165–8.450]). In contrast, past (OR = .443, [.179–1.094]) or current (OR = .414, [.156–1.094]) anxiety disorders showed a trend-level association with a lower risk of belonging to the increasing group compared to the persistently low group. Past depression was significantly associated with a higher risk of transitioning to psychosis (HR = 2.123, [1.178–3.828]).

Conclusion

A past depressive episode might be a particularly relevant risk factor for an unfavorable course of APS in UHR individuals. Early affective disturbances may be used to advance detection, prognostic, and clinical strategies.

中文翻译：

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共病情感障碍对精神病超高风险个体纵向临床结果的影响

摘要

介绍

焦虑和/或抑郁的诊断在精神病超高风险 (UHR) 的受试者中很常见，并且与广泛的功能障碍有关。关于情感合并症对减轻精神病症状 (APS) 预期病程的影响知之甚少。

方法

潜在类别混合模型确定了在基线、6、12 和 24 个月随访时评估的 331 名 UHR 受试者的 APS 轨迹。使用逻辑回归研究了过去、基线和一年 DSM-IV 抑郁症或焦虑症在轨迹上的预后价值，并控制了混杂因素。Cox 比例风险分析调查了与过渡风险的关联。

结果

46.8% 的参与者符合既往抑郁症的标准，基线时为 33.2%，一年随访时为 15.1%。任何过去、基线或一年的焦虑症分别被诊断为 42.9%、37.2% 和 27.0%。参与者被分为三个潜在的 APS 轨迹组之一：（1）持续低，（2）增加，和（3）减少。与持续低 (OR = 3.149, [95%CI: 1.298–7.642]) 或下降组 (OR = 3.137, [1.165–8.450]) 相比，过去的抑郁症与属于递增轨迹组的风险较高相关. 相比之下，过去 (OR = .443, [.179–1.094]) 或当前 (OR = .414, [.156–1.094]) 焦虑症显示出趋势水平关联，与属于增加组的风险较低与持续低迷的群体相比。

结论

过去的抑郁发作可能是 UHR 个体 APS 不利过程的一个特别相关的风险因素。早期情感障碍可用于推进检测、预后和临床策略。