La tabella 9 mostra le variazioni longitudinali della PAS dall’infanzia alla prima adolescenza per i tre gruppi, i risultati delle ANCOVA e dei confronti post- hoc.
L’ANCOVA ha rivelato differenze tra i tre gruppi nei punteggi PAS globale, sociale, e dell’adattamento scolastico. In particolare, i confronti post-hoc suggeriscono un progressivo declino per i pazienti SZ, mentre il gruppo di controllo procede verso un’evoluzione migliorativa.
Tabella 9. Variazione dei punteggi PAS tra l’infanzia (5-11 anni) e la fase iniziale dell’adolescenza (12-16 anni)
SZ BD HC Statistic Comparisons χ SD Χ SD χ SD F p
Change
in total PAS 0,04 0,15 0,03 0,11 -0,00 0,08 4,60 <0,05 Controlli<SZ* Change in
academicPas
0,08 0,14 0,07 0,14 0,36 0,12 1,05 0,356 Change in
social PAS 0,04 0,20 0,017 0,12 -0,02 0,10 4,38 <0,05 Controlli<SZ* Change in PAS1 0,34 1,49 0,18 0,82 -0,02 0,75 1,67 0,195 Change in PAS2 0,11 1,43 0,07 0,90 -0,10 0,66 0,88 0,419 Change in PAS3 0,26 0,80 0,46 1,07 0,31 0,98 0,86 0,417 Change in PAS4 0,64 1,30 0,37 0,84 0,12 0,59 4,37 <0,05 Controlli<SZ*
SZ=schizofrenia; BD=disturbo bipolare; SES=status socio-economico. F = Risultati dell’ANCOVA one-way; risultati significativi in grassetto. χ²=Risultati del test chi-quadro; SD=Deviazione standard
N=campione dello studio; NS=non significativo
Change=differenza tra i risultati in Infanzia (I) ed Adolescenza (A); total PAS=PAS globale; academic PAS =PAS accademica; Social-PAS=PAS sociale; PAS1=socievolezza e ritiro, PAS2=relazioni con i coetanei, PAS3=rendimento scolastico e PAS4=adattamento scolastico. Confronti post-hoc di Bonferroni per dati appaiati
* p<0.05 **p<0.01 ***p<0.001
87
5.3 OSSERVAZIONI
Osservando questi risultati comprendiamo come lo sviluppo comporti differenze significative nel funzionamento premorboso dei pazienti SZ sia rispetto ai CS che ai DB.
In pratica, il paziente schizofrenico subisce un declino palese sia nel funzionamento globale che in quello sociale e scolastico (quest’ultimo non era evidenziabile a livello infantile e pertanto riveste un ruolo minore all’interno del studio) rispetto al DB ed, ancor di più, rispetto ai CS.
6. DISCUSSIONE
Questi dati confermano la nostra ipotesi ovvero una differenza apprezzabile non solo tra i pazienti SZ ed i controlli sani ma pure tra SZ e DB. I pazienti SZ hanno infatti un FPM molto più deficitario rispetto ai DB, permettendoci di affermare che il funzionamento premorboso è un ottimo marker fenotipico per distinguere queste due dissimili categorie di pazienti seppur accomunate (overlap) da analoghi sintomi psicotici.
Il funzionamento premorboso, quindi, risulta esser un valido strumento per:
1) individuare in modo precoce i soggetti a rischio di spettro psicotico (ad esempio, se maggiormente suscettibili in funzione dell’ereditarietà genetica: UHR), dato che l’esordio della malattia è conseguente ad un periodo premorboso (prodromi) valutabile mediante PAS;
2) seguirli nel tempo, fondamentale nei casi ancora asintomatici ma ad alto rischio d’insorgenza; anche per poter agire precocemente all’esordio di patologia;
88 3) stratificare i diversi pazienti psicotici: ovvero quelli in cui si delinea un
cedimento funzionale globale e palese del soggetto (definiti SZ) da quelli che, pur presentando sintomatologia psicotica, NON hanno un declino funzionale analogo (classificati DB);
4) quantificare, in un certo senso, il grado di patologia permettendoci di trattare il paziente in modo mirato, in funzione del suo stato clinico ed a dosi farmacologiche adeguate: ovvero ad un maggiore rischio d’evoluzione psicotica, corrisponde un trattamento più intenso ed aggressivo.
Come emerge da questo studio, il FPM può esser considerato come un marker fenotipico per distinguere due categorie di pazienti all’interno della dimensione psicotica:
- i soggetti con un declino globale, cognitivo palese e soprattutto sociale (definiti SZ);
- i soggetti con un funzionamento, comunque, considerevolmente conservato sia perché superiore a quello degli SZ; sia perché – almeno in alcuni campi – ancora paragonabile a quello dei controlli sani;
Potremo, pertanto, utilizzare il funzionamento premorboso come strumento predittivo e preventivo (McNamara, Strawn et al. 2012) mediante l’applicazione dello strumento PAS.
Questo ci permetterebbe non solo di distinguere il decorso psicopatologico dei due disturbi ma anche di basarci su di esso nel tentativo di diagnosticare precocemente la patologia; evitando l’evolversi del disturbo o l’assenza di un trattamento che causerebbero un outcome ed una prognosi significativamente peggiori.
89
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