A review of negative symptom assessment strategies in youth at clinical high-risk for psychosis.
A review of negative symptom assessment strategies in youth at clinical high-risk for psychosis.
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DOI：
10.1016/j.schres.2020.04.019
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发表时间：
2020-08
影响因子：
4.5
通讯作者：
Mittal VA
中科院分区：
文献类型：
--
作者：
Strauss GP;Pelletier-Baldelli A;Visser KF;Walker EF;Mittal VA
试图解构精神分裂症和减弱型精神病综合征异质性的研究一致发现，阴性症状是一个核心维度，与疾病的其他方面不同（例如，积极和混乱的症状）。阴性症状也高度预测基于社区的不良功能结局，表明它们是关键的治疗目标。不幸的是，对阴性症状的药物和心理治疗效果有限。为了解决这一关键的未满足的治疗需求，NIMH赞助了一个共识发展会议，以划定该领域的研究重点，并刺激治疗发展。本次会议的主要结论是，应开发下一代阴性症状评定量表，以解决现有工具的方法和概念局限性。虽然第二代评定量表是为成年精神分裂症患者开发的，但这一领域的进展落后于临床高风险青年（即符合前驱综合征标准的青年）。鉴于阴性症状是高度预测的过渡到可诊断的精神病，提高我们的能力，以检测阴性症状的青少年是至关重要的。本文讨论了现有量表固有的概念和方法上的局限性，评估阴性症状的青少年。这些限制的理论和临床意义进行了评估。它的结论是，新的尺度专门设计用于评估阴性症状的青少年需要准确地绘制精神疾病的轨迹，并确定何时，何地，以及如何进行干预。最近的努力，以发展下一代的措施，专门为青年，以满足这一迫切需要在外地进行了讨论。这些新办法为解决早期比额表固有的问题提供了重大进展。
Studies attempting to deconstruct the heterogeneity of schizophrenia and the attenuated psychosis syndrome consistently find that negative symptoms are a core dimension that is distinct from other aspects of the illness (e.g., positive and disorganized symptoms). Negative symptoms are also highly predictive of poor community-based functional outcomes, suggesting they are a critical treatment target. Unfortunately, pharmacological and psychosocial treatments for negative symptoms have demonstrated limited effectiveness. To address this critical unmet therapeutic need, the NIMH sponsored a consensus development conference to delineate research priorities for the field and stimulate treatment development. A primary conclusion of this meeting was that next-generation negative symptom rating scales should be developed to address methodological and conceptual limitations of existing instruments. Although second-generation rating scales were developed for adults with schizophrenia, progress in this area has lagged behind for youth at clinical-high risk (CHR) for developing psychosis (i.e. those meeting criteria for a prodromal syndrome). Given that negative symptoms are highly predictive of the transition to diagnosable psychotic illness, enhancing our ability to detect negative symptoms in CHR youth is paramount. The current paper discusses conceptual and methodological limitations inherent to existing scales that assess negative symptoms in CHR youth. The theoretical and clinical implications of these limitations are evaluated. It is concluded that new scales specifically designed to assess negative symptoms in CHR youth are needed to accurately chart mental illness trajectories and determine when, where, and how to intervene. Recent efforts to develop next-generation measures designed specifically for CHR youth to meet this urgent need in the field are discussed. These new approaches offer significant progress for addressing issues inherent to earlier scales.
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