Latent Trajectories of Positive, Negative Symptoms and Functioning in Early Intervention Services for First-Episode Psychosis: A 2-Year Follow-Up Study

IF 5.3 1区医学 Q1 PSYCHIATRY

Schizophrenia Bulletin Pub Date : 2025-05-04 DOI:10.1093/schbul/sbaf045

Olivier Percie du Sert, Joshua Unrau, Manish Dama, Lena Palaniyappan, Jai Shah, Ridha Joober, Delphine Raucher-Chéné, Ashok Malla, Martin Lepage

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引用次数: 0

Abstract

Background From the first episode (FEP), the course of psychosis is marked by substantial heterogeneity of clinical and functional outcomes which poses significant challenges in providing prognostic guidance to patients and families. To better understand such heterogeneity within the context of early intervention services (EIS), this study aimed to examine latent trajectories of positive and negative symptoms and functioning among FEP individuals undergoing EIS. Study Design The Prevention and Early Intervention Program for Psychoses (PEPP-Montreal) is a 2-year EIS for FEP that conducted longitudinal assessments of 689 individuals aged 14-35, including sociodemographics, cognition, psychopathology, and functioning. Latent growth mixture modeling was used to identify distinct patterns of clinical and functional trajectories. The inter-relationship between trajectories, and the association of trajectory membership with baseline characteristics and distal outcomes were investigated using the manual 3-step approach. Study Results Two positive symptom trajectories (Stable-low—32%, Fluctuating—68%,), 3 negative symptom trajectories (Decreasing—41%, Fluctuating—15%, and Stable-high—44%), and 2 functioning trajectories (Increasing—57%, Stable-moderate—43%) were identified. Early treatment response, particularly on negative symptoms, consistently and strongly predicted better outcome trajectories (OR = [3.4-5.5]). Trajectories of higher symptom severity were associated with trajectory of worse functioning (RR = [1.5-2.2]), which exhibited lower rates of clinical and functional remission. Conclusion These findings offer insights into clinically meaningful subgroups of individuals that could inform the prognosis of FEP and the development of individually tailored EIS. Individuals who do not show early improvement in negative symptoms may benefit from earlier psychosocial interventions specifically targeting actionable factors that contribute to secondary negative symptoms.

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首发精神病早期干预服务中阳性、阴性症状和功能的潜在轨迹：一项为期2年的随访研究

背景从首次发作（FEP）开始，精神病的病程就以临床和功能结果的巨大异质性为特征，这对为患者和家属提供预后指导提出了重大挑战。为了更好地了解早期干预服务（EIS）背景下的这种异质性，本研究旨在检查接受EIS的FEP个体的阳性和阴性症状和功能的潜在轨迹。精神病预防和早期干预项目（PEPP-Montreal）是一项针对FEP的为期2年的EIS，对689名14-35岁的个体进行了纵向评估，包括社会人口统计学、认知、精神病理学和功能。潜在生长混合物模型用于识别临床和功能轨迹的不同模式。轨迹之间的相互关系以及轨迹隶属度与基线特征和远端结果的关联使用手动三步法进行了研究。研究结果确定了2个阳性症状轨迹（稳定-低32%，波动- 68%，），3个阴性症状轨迹（下降- 41%，波动- 15%，稳定-高44%）和2个功能轨迹（增加- 57%，稳定-中等- 43%）。早期治疗反应，特别是阴性症状，一致且强烈地预示着更好的结局轨迹（OR =[3.4-5.5]）。较高症状严重程度的轨迹与较差的功能轨迹相关（RR =[1.5-2.2]），较低的临床和功能缓解率。结论这些发现为临床有意义的个体亚组提供了见解，可以为FEP的预后和个性化EIS的发展提供信息。未表现出阴性症状早期改善的个体可能受益于早期的社会心理干预，特别是针对导致继发性阴性症状的可操作因素。

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来源期刊

Schizophrenia Bulletin 医学-精神病学

CiteScore

11.40

自引率

6.10%

发文量

163

审稿时长

4-8 weeks

期刊介绍： Schizophrenia Bulletin seeks to review recent developments and empirically based hypotheses regarding the etiology and treatment of schizophrenia. We view the field as broad and deep, and will publish new knowledge ranging from the molecular basis to social and cultural factors. We will give new emphasis to translational reports which simultaneously highlight basic neurobiological mechanisms and clinical manifestations. Some of the Bulletin content is invited as special features or manuscripts organized as a theme by special guest editors. Most pages of the Bulletin are devoted to unsolicited manuscripts of high quality that report original data or where we can provide a special venue for a major study or workshop report. Supplement issues are sometimes provided for manuscripts reporting from a recent conference.