Early detection and secondary prevention of psychosis:: facts and visions
Early detection and secondary prevention of psychosis:: facts and visions
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DOI：
10.1007/s00406-004-0508-z
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发表时间：
2004-04-01
影响因子：
4.7
通讯作者：
Wölwer, W
中科院分区：
文献类型：
--
作者：
Häfner, H;Maurer, K;Wölwer, W
由于缺乏有效和实用的初级和普遍预防精神病的办法，干预工作针对精神分裂症的早期阶段，以预防（通过二级预防）或推迟精神病发作，减轻疾病的严重程度或至少减轻所涉及的社会后果。早期干预需要对高危人群进行早期发现和早期识别（诊断），并对精神病进行早期预测。在德国精神分裂症研究网络内，正在德国几个城市开展提高认识方案，这些努力已经改善了高危人群对早期识别和早期预测服务的利用。本研究将探讨发展两阶段早期认知量表的实证基础与应用策略。该工具由一组认知测试补充，在GRNS中进行了前瞻性验证。对两年期数据的初步分析结果表明，该清单和认知测试是容易接受的。当用于非专业机构和下一级，即早期识别中心的筛查时，它们似乎可以识别高危人员。早期干预正在1）一项随机对照多中心试验中进行测试，该试验包括在早期（精神病前）前驱状态中专门开发的认知行为疗法，以及2）在晚期前驱（早期精神病）状态中使用适当剂量的氨磺必利进行额外治疗。研究1涵盖16.3个月的初步数据显示，与接受正常临床治疗的对照组相比，研究2的阳性和阴性症状减少，总体功能改善。因此，早期再认量表加认知测验和两种治疗策略都是可行的。我们希望，初步数据显示的有利趋势将在计划于2005年进行的最终分析中得到证实，并将实现对精神病及其后果进行有效和切实的二级预防的目标。
As effective and practical approaches to primary and universal prevention of psychosis are lacking, intervention efforts are targeted at the early stages of schizophrenia to prevent (by way of secondary prevention) or postpone psychosis onset, reduce severity of illness or at least ameliorate the social consequences involved. Early intervention requires early detection and early recognition (diagnosis) of persons at risk and early prediction of psychosis. Within the German Research Network on Schizophrenia (GRNS) awareness programmes are being carried out in several German cities, and these efforts are already improving utilisation of early-recognition and early-prediction services by at risk persons. The empirical basis of developing a two-step early-recognition inventory and strategies of application will be discussed. This instrument is supplemented by a set of cognitive tests, prospectively validated in the GRNS. Results from preliminary analysis of data covering a two-year period demonstrate that the inventory and the cognitive tests are readily accepted. When used for screening in non-specialist settings and at the next level, i.e. at early-recognition centres, they seem to permit identification of at-risk persons. Early intervention is being tested 1) in a randomised controlled multi-centre trial consisting of a specially developed cognitive-behavioural therapy in the early (prepsychotic) prodromal state and 2) on additional treatment with appropriate doses of amisulpride in the late prodromal (early psychotic) state. Preliminary data from Study 1 covering 16.3 months show significantly fewer transitions to psychosis and from Study 2 reduced positive and negative symptoms and improved global functioning compared with controls who had received normal clinical treatment. As a result, both the early-recognition inventory plus cognitive tests and the two therapy strategies are feasible. We hope that the favourable trend indicated by the preliminary data will be confirmed in the final analysis planned for 2005 and the objective of implementing effective and practical secondary prevention of psychosis and its consequences will be attained.