Considerations for providing feedback to patients and families regarding clinical high-risk for psychosis status.
Considerations for providing feedback to patients and families regarding clinical high-risk for psychosis status.
复制标题
向患者和家属提供有关精神病状态临床高风险的反馈的考虑因素。
DOI：
10.1016/j.schres.2022.01.059
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发表时间：
2022
影响因子：
4.5
通讯作者：
Woods,ScottW
中科院分区：
文献类型：
--
作者：
Schiffman,Jason;Horton,LeslieE;Landa,Yulia;Woods,ScottW
在精神病的风险阶段的早期识别和干预提供了促进积极的临床和功能结果的希望（Woods等人，2021年）。近年来，该领域取得了快速发展，部分原因是SAMHSA的2018年精神病临床高风险青年和年轻人社区外展和干预计划拨款计划（CHR-P计划）。目前仅在美国就有大约500家首发诊所和100家精神病风险诊所。此外，今年NIMH还资助了国际合作，以建立临床高风险精神病研究网络。由于精神障碍和相关术语可能是污名化的（例如，Lasalvia等人，2021; Mesholam-Gately等人，2021），而“风险”的概念往往被误解（例如，斯特恩和Fineberg，2012），许多这些计划正在努力解决有关是否以及如何实施有关精神病风险的反馈的问题。由于缺乏针对这一过程的既定临床最佳实践，临床医生无法与患者和家属讨论这一可能令人困惑的诊断和主题。如果没有深思熟虑的方法，临床医生的不当沟通可能会对患者产生不利影响，并导致自我耻辱，沮丧，绝望和逃避治疗。相反，有效的风险沟通可能会激发希望和赋权，因为反馈是充分知情护理的重要组成部分。（2021）研究了精神病高危患者在接受关于其精神病状态的正式临床反馈之前和之后的情感和污名相关体验。这可能是第一项研究，比较反馈的影响，情绪或污名相关的经验，在这一人群之前和之后，使用定量和定性的方法。在其他研究结果中，作者报告说，在被告知他们的风险状态后，患者的负面情绪减少，没有证据表明参与者认为他们应该保持他们的状态隐私。此外，大多数参与者对反馈过程有积极的评价，尽管参与者倾向于在事后对自我认知和他人对他们的期望的诊断可能产生的影响感到负面。这项工作扩展了定量和定性研究的新生体，该研究表明，除其他发现外，耻辱感更多地源于具有症状的经历，而不是接受诊断（Yang et al.，2015）;无论是否给出诊断，焦虑症状都可能导致污名化（Anglin等人，2014）; CHR特异性污名与非精神病诊断相关的污名相似（Lee et al.，2016）;通过了解精神病减轻了耻辱感（Parrish et al.，2019）;并且一些患者在从专业人员那里了解他们的诊断时感到宽慰（Uttinger等人，2018年）。
Early identification and intervention in the at-risk phase of psychosis offers promise towards facilitating positive clinical and functional outcomes (Woods et al., 2021). Recent years have seen rapid growth in this field, spurred in part by SAMHSA’s 2018 Community Programs for Outreach and Intervention with Youth and Young Adults at Clinical High Risk for Psychosis Grant Program (CHR-P Program). There are now approximately 500 first-episode clinics and 100 psychosis risk clinics in the US alone. Further, this year the NIMH has funded international collaborations to establish clinical high-risk for psychosis research networks. As psychotic disorders and associated terms can be stigmatizing (eg, Lasalvia et al., 2021; Mesholam-Gately et al., 2021), and the concept of “risk” is often misunderstood (eg, Stern & Fineberg, 2012), many of these programs are grappling with the questions about if and how to implement feedback about identified risk for psychosis. With a lack of established clinical best-practices for this process, clinicians are left ill-equipped to discuss this potentially confusing diagnosis and topic with patients and families. Without a thoughtful approach, inappropriate communication from clinicians may adversely impact patients, and lead to self-stigma, discouragement, hopelessness, and avoidance of treatment. Conversely, effective risk communication can potentially inspire hope and empowerment, as feedback is an essential part of fully informed care.In their paper, Woodberry et al.(2021) examined the emotional and stigma-related experiences of patients at high-risk for psychosis (CHR) before and after receiving formal clinical feedback about their CHR status. This is likely the first study to compare the impact of feedback for CHR on emotions or stigma-related experiences in this population pre and post, using both quantitative and qualitative methods. Among other findings, the authors reported less negative emotion in patients after being informed of their risk status, and no evidence to suggest that participants felt that they should keep their status private. Additionally, most participants had positive comments regarding the process of feedback, although there was a tendency for participants to feel negatively afterward about the possible impact of a CHR diagnosis on selfperceptions and others’ expectations about them. This work extends a nascent body of quantitative and qualitative research that suggests, among other findings, that stigma stems more from the experience of having CHR symptoms than from receiving a diagnosis (Yang et al., 2015); that CHR symptoms may result in stigma irrespective of whether a diagnosis is given (Anglin et al., 2014); that CHR-specific stigma is experienced as similar to that associated with non-psychotic diagnoses (Lee et al., 2016); that stigma is mitigated by knowledge about psychosis (Parrish et al., 2019); and that some patients feel a sense of relief in learning about their diagnosis from a professional (Uttinger et al., 2018).