Abstract：
Cluster studies identified a subgroup of patients with psychosis whose premorbid adjustment deteriorates before the onset, which may reflect variation in genetic influence. However, other studies reported a complex relationship between distinctive patterns of cannabis use and cognitive and premorbid impairment that is worthy of consideration. We examined whether: (1) premorbid social functioning (PSF) and premorbid academic functioning (PAF) in childhood and adolescence and current intellectual quotient (IQ) define different clusters in 802 first-episode of psychosis (FEP) patients; resulting clusters vary in (2) polygenic risk scores (PRSs) for schizophrenia (SCZ_PRS), bipolar disorder (BD_PRS), major depression (MD_PRS), and IQ (IQ_PRS), and (3) patterns of cannabis use, compared to 1,263 population-based controls. Four transdiagnostic clusters emerged (BIC = 2268.5): (1) high-cognitive-functioning (n = 205), with the highest IQ (Mean = 106.1, 95% CI: 104.3, 107.9) and PAF, but low PSF. (2) Low-cognitive-functioning (n = 223), with the lowest IQ (Mean = 73.9, 95% CI: 72.2, 75.7) and PAF, but normal PSF. (3) Intermediate (n = 224) (Mean_IQ = 80.8, 95% CI: 79.1, 82.5) with low-improving PAF and PSF. 4) Deteriorating (n = 150) (Mean_IQ = 80.6, 95% CI: 78.5, 82.7), with normal-deteriorating PAF and PSF. The PRSs explained 7.9% of between-group membership. FEP had higher SCZ_PRS than controls [F(4,1319) = 20.4, P < .001]. Among the clusters, the deteriorating group had lower SCZ_PRS and was likelier to have used high-potency cannabis daily. Patients with FEP clustered according to their premorbid and cognitive abilities. Pronounced premorbid deterioration was not typical of most FEP, including those more strongly predisposed to schizophrenia, but appeared in a cluster with a history of high-potency cannabis use.
摘要：
集群研究确定了精神病患者的一个亚组，其病前调整在发病前恶化，这可能反映了遗传影响的变化。然而,其他研究报告了大麻使用的独特模式与认知和病前损害之间的复杂关系，值得考虑。我们研究了是否：（1）儿童和青春期的病前社会功能（PSF）和病前学业功能（PAF）以及当前的智商（IQ）在802例首发精神病（FEP）患者中定义了不同的聚类；（2）精神分裂症的多基因风险评分（PRS）（SCZ_PRS），双相情感障碍（BD_PRS），抑郁症（MD_PRS），和智商(IQ_PRS)，和（3）大麻使用模式，与1,263个基于人群的对照相比。出现了四个诊断簇（BIC=2268.5）：（1）高认知功能（n=205），智商最高(平均值=106.1，95%CI：104.3，107.9)和PAF，但PSF低。（2）认知功能低下（n=223），智商最低（平均值=73.9，95%CI：72.2，75.7）和PAF，但PSF正常.(3)具有低改善PAF和PSF的中间体(n=224)(Mean_IQ=80.8,95%CI:79.1,82.5)。4）恶化（n=150）（平均智商=80.6，95%CI：78.5，82.7），正常恶化的PAF和PSF。PRS解释了7.9%的组间成员。FEP的SCZ_PRS高于对照组[F(4,1319)=20.4,P<.001]。在集群中，恶化组的SCZ_PRS较低,更有可能每天使用高效大麻.FEP患者根据病前和认知能力进行聚类。明显的病前恶化不是大多数FEP的典型特征，包括那些更倾向于精神分裂症的人，但出现在具有高效大麻使用史的集群中。
