Psychotic experiences in a mental health clinic sample: implications for suicidality, multimorbidity and functioning
Psychotic experiences in a mental health clinic sample: implications for suicidality, multimorbidity and functioning
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DOI：
10.1017/s0033291713002122
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发表时间：
2014-06-01
影响因子：
6.9
通讯作者：
Cannon, M.
中科院分区：
文献类型：
--
作者：
Kelleher, I.;Devlin, N.;Cannon, M.
背景最近的社区研究表明，精神病经历是精神病理学严重程度的标志。然而，缺乏临床研究。我们希望调查，在一个青少年的临床样本转介到国家资助的精神卫生服务，患病率（减弱或坦率）精神病经历及其与（i）情感、焦虑和行为障碍，（ii）多病精神病理学，（iii）整体功能，方法采用病例-临床对照研究方法，采用半定量分析法，对108例新转诊至州青少年精神卫生服务机构的患者进行结构化研究诊断性精神病评估。（非精神病性）障碍，但特别是多病性精神病理学（Z=3.44，p=0.001）的风险的强标志物。与精神病理学的年轻人谁报告精神病的经验表现出显着较差的社会职业功能比年轻人与精神病理学谁没有报告精神病的经验，这是不能解释的多发病。精神病经历是自杀行为风险的强烈标志。分层分析显示，重度抑郁症患者自杀未遂的几率大大增加[比值比（OR）8.89，95%置信区间（CI）1.59-49.83]，焦虑症患者自杀未遂的几率显著增加[OR）8.89，95%置信区间（CI）1.59-49.83]，（OR 15.4，95% CI 1.85-127.94）或行为障碍（OR 3.13，95%CI 1.11-8.79）与未报告精神病经历的患者相比，也有精神病经历。结论精神病经历在接受精神卫生服务的年轻人中，严重的精神病理学风险，包括多次死亡、功能障碍和自杀行为，是一个重要但未得到充分认识的标志。
Background Recent community-based research has suggested that psychotic experiences act as markers of severity of psychopathology. There has, however, been a lack of clinic-based research. We wished to investigate, in a clinical sample of adolescents referred to a state-funded mental health service, the prevalence of (attenuated or frank) psychotic experiences and the relationship with (i) affective, anxiety and behavioural disorders, (ii) multimorbid psychopathology, (iii) global functioning, and (iv) suicidal behaviour.Method The investigation was a clinical case-clinical control study using semi-structured research diagnostic psychiatric assessments in 108 patients newly referred to state adolescent mental health services.Results Psychotic experiences were prevalent in a wide range of (non-psychotic) disorders but were strong markers of risk in particular for multimorbid psychopathology (Z=3.44, p=0.001). Young people with psychopathology who reported psychotic experiences demonstrated significantly poorer socio-occupational functioning than young people with psychopathology who did not report psychotic experiences, which was not explained by multimorbidity. Psychotic experiences were strong markers of risk for suicidal behaviour. Stratified analyses showed that there was a greatly increased odds of suicide attempts in patients with a major depressive disorder [odds ratio (OR) 8.89, 95% confidence interval (CI) 1.59-49.83], anxiety disorder (OR 15.4, 95% CI 1.85-127.94) or behavioural disorder (OR 3.13, 95% CI 1.11-8.79) who also had psychotic experiences compared with patients who did not report psychotic experiences.Conclusions Psychotic experiences (attenuated or frank) are an important but under-recognized marker of risk for severe psychopathology, including multimorbidity, poor functioning and suicidal behaviour in young people who present to mental health services.