期刊
SCHIZOPHRENIA BULLETIN
卷 48, 期 5, 页码 999-1010出版社
OXFORD UNIV PRESS
DOI: 10.1093/schbul/sbac031
关键词
schizophrenia; transdiagnostic; neurocognitive; developmental psychopathology; clinical staging
类别
资金
- National Institute of Mental Health [T32MH016259, R01MH120090]
- Andrew P. Merrill Memorial Research Fellowship
- Joseph and Susan Gatto Award for Excellence in Imaging, Drug Abuse, and Psychiatric Research
Youth at clinical high-risk for psychosis show cognitive impairments, but these impairments are not significantly different from those seen in peers with other psychopathologies. The excess impairment among clinical high-risk individuals is mainly attributable to those who transition to psychosis, while individuals without transition show similar impairments to clinical comparators.
Background and Hypothesis Youth at clinical high-risk (CHR) for psychosis present with neuropsychological impairments relative to healthy controls (HC), but whether these impairments are distinguishable from those seen among putatively lower risk peers with other psychopathology remains unknown. We hypothesized that any excess impairment among CHR cohorts beyond that seen in other clinical groups is minimal and accounted for by the proportion who transition to psychosis (CHR-T). Study Design We performed a systematic review and meta-analysis of studies comparing cognitive performance among CHR youth to clinical comparators (CC) who either sought mental health services but did not meet CHR criteria or presented with verified nonpsychotic psychopathology. Study Results Twenty-one studies were included representing nearly 4000 participants. Individuals at CHR showed substantial cognitive impairments relative to HC (eg, global cognition: g = -0.48 [-0.60, -0.34]), but minimal impairments relative to CC (eg, global cognition: g = -0.13 [-0.20, -0.06]). Any excess impairment among CHR was almost entirely attributable to CHR-T; impairment among youth at CHR without transition (CHR-NT) was typically indistinguishable from CC (eg, global cognition, CHR-T: g = -0.42 [-0.64, -0.19], CHR-NT: g = -0.09 [-0.18, 0.00]; processing speed, CHR-T: g = -0.59 [-0.82, -0.37], CHR-NT: g = -0.12 [-0.25, 0.07]; working memory, CHR-T: g = -0.42 [-0.62, -0.22], CHR-NT: g = -0.03 [-0.14, 0.08]). Conclusions Neurocognitive impairment in CHR cohorts should be interpreted cautiously when psychosis or even CHR status is the specific clinical syndrome of interest as these impairments most likely represent a transdiagnostic vs psychosis-specific vulnerability.
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