精神病临床高危人群的症状和功能改变：一项系统综述和三水平元分析

doi:10.3724/SP.J.1042.2025.0042

摘要/Abstract

摘要： 精神病临床高危(clinical high-risk for psychosis, CHR-P)人群的症状和功能发展存在异质性, 澄清这个群体症状和功能的改变及联系, 有利于精神病早期预防。元分析纳入54篇文献, 探究CHR-P人群各维度临床症状和功能的纵向改变、基线症状对随访功能的预测作用、调节效应。结果发现, CHR-P人群轻微阳性症状、阴性症状、瓦解症状、情感症状、一般精神病理症状、整体功能和角色功能随时间显著改善, 社会功能没有显著改善; 基线阴性症状显著负向预测随访的整体功能、社会功能、角色功能, 基线的瓦解症状、情感症状、一般精神病理症状与随访的整体功能显著负相关; 受教育程度显著调节轻微阳性症状和阴性症状的纵向变化, 年龄、轻微阳性症状亚组比例和短暂间歇性精神病性症状亚组比例显著调节情感症状的纵向变化。这揭示阴性症状改善少和社会功能损害是CHR-P人群的核心特征, 提示未来可针对阴性症状研发干预措施, 进而改善社会功能。

关键词: 精神病临床高危人群, 纵向改变, 三水平元分析, 阴性症状, 社会功能

Abstract: The symptoms and functional development of individuals at clinical high risk for psychosis (CHR-P) exhibit considerable heterogeneity. Clarifying the changes in symptoms and functioning in this population and their underlying relationships is beneficial for early prevention of psychosis. Previous empirical research has already explored changes in symptoms and functional outcomes in the CHR-P individuals, however, it remains unclear whether there have been recent advances in understanding the longitudinal changes in symptoms and functional outcomes or how symptoms in the CHR-P population may have different longitudinal impacts upon functional domains. Therefore, this study conducted an up-to-date meta-analysis to quantitatively analyze clinical symptoms and functional changes in CHR-P population. The goal was to update the longitudinal findings on clinical symptoms and functioning in CHR-P population, explore potential moderating variables, and clarify the longitudinal impact of CHR-P symptoms on functional outcomes. This study conducted a three-level meta-analysis of 54 studies to comprehensively examine the longitudinal changes in various clinical symptoms and functional outcome among CHR-P individuals and explore the predictive role of baseline symptoms on follow-up functional outcome. The results showed that the CHR-P individuals exhibited significant improvements over time in attenuated positive symptoms (Hedges’ g = -0.78, 95% CI = [-1.12, -0.45]), negative symptoms (Hedges’ g = -0.45, 95% CI = [-0.65, -0.25]), disorganized symptoms (Hedges’ g = -0.40, 95%CI = [-0.78, -0.02]), affective symptoms (Hedges’ g = -0.84, 95% CI = [-1.18, -0.49]), general symptoms (Hedges’ g = -0.43, 95% CI = [-0.71, -0.15]), global functioning (Hedges’ g = 0.47, 95% CI = [0.31, 0.62]), and role functioning (Hedges’ g = 0.28, 95% CI = [0.12, 0.45]), while social functioning (Hedges’ g = 0.66, 95% CI = [-0.08, 1.41]) did not significantly improve. Baseline negative symptoms significantly negatively predicted follow-up global functioning (r = -0.23; p = 0.003), social functioning (r = -0.45; p < 0.001), and role functioning (r = -0.40; p < 0.001). Baseline disorganized symptoms (r = -0.44; p < 0.001) and affect symptoms (r = -0.13; p = 0.010) significantly negatively predicted follow-up global functioning. Moderation analysis revealed that education level significantly moderated the longitudinal changes of attenuated positive symptoms (β = 0.46, F (1,21) = 5.01, p = 0.036) and negative symptoms (β = 0.32, F (1,19) = 4.40, p = 0.050). Moreover, age (β = -0.15, F (1,11) = 8.49, p = 0.014), proportion of attenuated positive symptoms (APS) subgroup (β = -0.05, F (1,7) = 28.75, p = 0.001), and proportion of brief limited intermittent psychotic symptoms (BLIPS) subgroup (β = 0.19, F (1,7) = 21.28, p = 0.002) significantly moderated the longitudinal changes in affective symptoms. The present meta-analysis provides us a more thorough review of the longitudinal development of clinical outcomes in the CHR-P population, which is crucial for understanding precise prognostic trajectories and providing more targeted clinical services. Moreover, it also reviewed the predictive role of baseline symptoms across different dimensions on specific follow-up functional outcomes in the CHR-P population. These findings suggest that persistence of negative symptoms and the social function impairments are the core features of CHR-P individuals. It is necessary to target at negative symptoms in CHR-P individuals for improving their social functioning. The present findings also reveal the significant moderating effects of age, education level, and CHR-P subtypes on functional changes, providing empirical evidence for the potential underlying reasons behind the heterogeneity in symptom and functional changes in the CHR-P population. In conclusion, in the CHR-P population, attenuated positive symptoms and affective symptoms exhibit greater improvement over time, while negative symptoms, disorganized symptoms, general symptoms, global functioning, and role functioning exhibit less improvement. Social functioning does not improve over time, indicating that symptom improvement generally surpasses functional improvement. Baseline negative symptoms significantly predict social functioning at follow-up, suggesting that negative symptoms and social functioning should be key areas of focus during the early stages of psychosis. These findings highlight the importance of developing interventions targeting negative symptoms and enhance social functioning.

Key words: clinical high-risk, longitudinal changes, three-level meta-analysis, negative symptoms, social function

中图分类号:

B845

赵子卿, 余锦婷, 陈嘉彦, 王芸茹, 黄佳, 陈楚侨. (2025). 精神病临床高危人群的症状和功能改变：一项系统综述和三水平元分析. 心理科学进展 , 33(1), 42-61.

ZHAO Ziqing, YU Jinting, CHEN Jiayan, WANG Yunru, HUANG Jia, Raymond C.K. CHAN. (2025). Changes in symptoms and functional outcomes in individuals at clinical high-risk for psychosis: A systematic review and three-level meta-analysis. Advances in Psychological Science, 33(1), 42-61.

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