Risk factors for psychosis in an ultra high-risk group: psychopathology and clinical features
Risk factors for psychosis in an ultra high-risk group: psychopathology and clinical features
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DOI：
10.1016/s0920-9964(03)00192-0
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发表时间：
2004-04-01
影响因子：
4.5
通讯作者：
McGorry, PD
中科院分区：
文献类型：
--
作者：
Yung, AR;Phillips, LJ;McGorry, PD
长期以来，识别精神障碍高危人群一直是临床医生的目标，因为人们认为，对这一群体的早期治疗可以防止疾病的发生。然而，人们对精神病的预测因素知之甚少，即使在高危人群中也是如此。这项研究跟踪了104名年轻人，他们被认为是精神分裂症和其他精神障碍的“超高风险”者，这些人有精神障碍的家族史，并伴有某些功能衰退，或者存在阈值以下或自我限制的精神症状。因此，所有受试者在服用时都有症状，但不是精神病患者。36名受试者(34.6%)在12个月内出现明显的精神病症状。在摄入、6个月和12个月时对症状持续时间、功能、残疾和精神病理学进行测量。功能不佳、症状持续时间长、高度抑郁和注意力减退都是精神病的预测因素。精神病家族史、最近功能显著下降和最近出现阈值以下精神病症状的组合也是精神病的预测因素。结合高预测性变量，12个月后的精神病预测方法具有良好的阳性预测值(80.8%)、阴性预测值(81.8%)、特异度(92.6%)和中等敏感度(60.0%)。因此，在我们的症状性高危人群中，似乎有可能识别出那些发展为精神分裂症等精神障碍的特别高风险的个体。鉴于这种两步过程的PPV非常高，假阳性率很低，因此有理由根据临床情况，针对这些人进行密集的精神状态监测，甚至小剂量的抗精神病药物或其他生物和心理社会治疗。这表明可以进一步发展预防方法，完善精神病患者的预防策略。(C)2003爱思唯尔B.V.保留所有权利。
The identification of individuals at high risk of developing a psychotic disorder has long been a goal of clinicians because it is thought that early treatment of this group may prevent onset of the disorder. However, little is known of predictive factors of psychosis, even within a high-risk group. This study followed up 104 young people thought to be at 'ultra high risk' for schizophrenia and other psychotic disorders by virtue of having a family history of psychotic disorder combined with some functional decline or the presence of subthreshold or self-limiting psychotic symptoms. All subjects were therefore symptomatic, but not psychotic, at intake. Thirty-six subjects (34.6%) developed frank psychotic symptoms within 12 months.Measures of symptom duration, functioning, disability and psychopathology were made at intake, 6 and 12 months. Poor functioning, long duration of symptoms, high levels of depression and reduced attention were all predictors of psychosis. A combination of family history of psychosis, a recent significant decrease in functioning and recent experience of subthreshold psychotic symptoms was also predictive of psychosis. Combining highly predictive variables yielded a method of psychosis prediction at 12 months with good positive predictive value (80.8%), negative predictive value (81.8%) and specificity (92.6%) and moderate sensitivity (60.0%).Within our symptomatic high-risk group, therefore, it appears possible to identify those individuals who are at particularly high risk of developing a psychotic disorder such as schizophrenia. Given the very high PPV and low false positive rate with this two-step process, it may be justifiable to target these individuals for intensive monitoring of mental state and even low-dose neuroleptic medication or other biological and psychosocial treatments depending on clinical condition. This indicated prevention approach could be further developed and preventive strategies in the psychoses refined. (C) 2003 Elsevier B.V. All rights reserved.