認知障礙是精神疾病的強力預測因子


  【24drs.com】一篇具有指標意義的研究認為,神經認知障礙—特別是涉及注意力與記憶時—是精神病臨床高風險(clinical high risk,CHR)者的強力預測因子,尤其是那些後來轉而發生精神病的人。
  
  第一作者、麻塞諸塞州波士頓哈佛醫學院貝斯以色列女執事醫療中心Larry J. Seidman博士等研究者寫道,我們的研究結果支持理論模型假設:注意力和工作記憶能力障礙,甚至,更強烈地,受損的陳述性記憶能力是臨床高風險的核心。
  
  這篇研究線上發表於11月2日JAMA Psychiatry期刊。
  
  這篇分析的資料來自「North American Prodrome Longitudinal Study (NAPLS-2)」第二階段,包括689名因為精神病臨床高風險而尋求照護者,以及264名健康對照組,臨床高風險者有89人(12.9%)在2年內發生臨床精神病。
  
  整體比較時,相較於對照組,臨床高風險者在注意力與操作記憶(P < .001)以及陳述性記憶(P < .001)等方面顯著受損,在19項神經心理測試中,有14項顯著較差。但是,這19項神經心理測試的平均影響程度小(effect size,ES)(Cohen d = 0.30)。
  
  不過,轉變成精神疾病的89名臨床高風險者中,注意力與操作記憶以及陳述性記憶都比對照組有更大幅度的缺損(Cohen d,約 0.80),且這些測量也比沒有轉變成精神病的臨床高風險者顯著更糟(Cohen d分別是0.28與0.48)。
  
  研究者表示,這些結果沒有考慮一般認知能力、當前的憂鬱症狀態、或使用藥物、酒精或大麻。
  
  Seidman博士在聲明中表示,就我們所知,這是有關發生精神病/精神分裂症前的高風險期認知的最大型與最明確的研究。這是變換方式的一部份,我們專注於疾病的早期、前驅階段,致力於找出最可能發展為精神病的人。
  
  各個領域間的表現顯著不同, 特別是那些後來發生轉變的臨床高風險者,他們指出,這代表,在早期精神病階段,特定型式的神經認知受到影響,並且預示著隨後發生的精神病。
  
  研究者結論表示,神經認知測試與其他臨床和心理生理測量一起使用,可以增強精神病或功能結果的預測。
  
  在編輯評論中,英國倫敦國王學院的Josephine Mollon、紐約市西奈山伊坎醫學院精神科Abraham Reichenberg博士指出,這篇研究是一篇全面性和重要的報告,然而,不可避免地,作者只有有限的空間來呈現和討論文章本身的發現。
  
  透過闡明與前驅症狀相關的神經認知缺陷樣貌,以及它們作為轉化成臨床精神病之風險標誌的潛力,這些結果為臨床醫生和研究人員提供了一個新的參考點。
  
  如果本篇邀請評論可向讀者提出一個建議,那就是:必須如同閱讀主文一般詳讀補充資料。補充資料幾乎與主文本身相關,這是相當罕見的。
  
  資料來源:http://www.24drs.com/
  
  Native link:Cognitive Trouble a 'Robust' Predictor of Psychosis

Cognitive Trouble a 'Robust' Predictor of Psychosis

By Megan Brooks
Medscape Medical News

Neurocognitive impairment, particularly involving attention and memory, is a "robust" characteristic of individuals at clinical high risk (CHR) for psychosis, especially those who transition to psychosis later on, a landmark study suggests.

"Our findings support theoretical models hypothesizing attention and working memory abilities impairments and, even more strongly, impaired declarative memory abilities as central to the CHR stage," the investigators, with first author Larry J. Seidman, PhD, of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, Massachusetts, write.

The study was published online November 2 in JAMA Psychiatry.

Landmark Study

The analysis included data from the second phase of the North American Prodrome Longitudinal Study (NAPLS-2) and included 689 care-seeking individuals at CHR for psychosis and 264 healthy control persons. Eighty-nine (12.9%) of the CHR individuals developed clinical psychosis within 2 years.

As a group, CHR individuals were significantly impaired compared with control persons with respect to attention and working memory (P < .001) and declarative memory (P < .001) and performed significantly worse on 14 of 19 neuropsychological tests. But the mean effect size (ES) across the 19 neuropsychological tests was small (Cohen d = 0.30).

However, the 89 CHR individuals who experienced conversion to psychosis had large deficits in attention and working memory and declarative memory (Cohen d, approximately 0.80) compared with control persons and performed significantly worse on these measures than CHR individuals who did not experience conversion to psychosis (Cohen d, 0.28 and 0.48, respectively).

These results were not accounted for by general cognitive ability, current depression, or use of medication, alcohol, or cannabis, the researchers say.

"To our knowledge, this is the largest and most definitive study of cognition in the high-risk period before onset of psychosis/schizophrenia," Dr Seidman said in a statement. "This is part of a paradigm shift in the way we are focusing on the earlier, prodromal phase of the disorder in an effort to identify those most likely to develop psychosis."

The distinct profile of performance across domains, especially in those at CHR who subsequently experienced conversion, suggests that "at the incipient psychotic phase, specific forms of neurocognition are affected and are predictive of later psychosis," they add.

"Neurocognitive tests used in concert with other clinical and psychobiological measures may enhance prediction of psychosis or functional outcome," the researchers conclude.

New Reference Point

In an accompanying commentary, Abraham Reichenberg, PhD, Department of Psychiatry, Icahn School of Medicine at Mount Sinai in New York City, and Josephine Mollon, King's College London, United Kingdom, note the study is "a comprehensive and significant report. Yet, unavoidably, the authors only have limited space to present and discuss findings in the article itself.

"The results provide a new reference point for clinicians and researchers by elucidating the profile of neurocognitive deficits associated with the prodrome as well as their potential as risk markers for conversion to clinical psychosis," they write.

"If this Invited Commentary may make one recommendation to readers, it is that the supplementary material should be read with the same level of interest as the main article. This may be one of those rare occasions when the supplementary material is almost as relevant as the article itself," they write.

The study was supported by the National Institute of Mental Health. The study authors and the authors of the commentary have disclosed no relevant financial relationships.

JAMA Psychiatry. Published online November 2, 2016.

    
相關報導
精神疾病歧視:一個全球性的問題
2016/9/14 下午 04:32:41
新遺傳證據顯示精神分裂症不是單一種疾病
2016/5/19 上午 09:18:59
獨特的腦部體能計畫可以強化認知、腦容量
2015/7/31 上午 11:07:49

上一頁
   1   2   3   4   5   6   7   8   9   10  




回上一頁