Duration of unspecific prodromal and clinical high risk states, and early help-seeking in first-admission psychosis patients
Duration of unspecific prodromal and clinical high risk states, and early help-seeking in first-admission psychosis patients
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DOI：
10.1007/s00127-015-1093-3
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发表时间：
2015-12-01
影响因子：
4.4
通讯作者：
Klosterkoetter, Joachim
中科院分区：
文献类型：
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作者：
Schultze-Lutter, Frauke;Rahman, Jonas;Klosterkoetter, Joachim
精神病的预防需要存在临床高危(CHR)标准和早期寻求帮助。以前对未经治疗的疾病持续时间(即前驱症状加精神病)的回顾研究没有区分有无CHR症状的前驱状态。因此，我们研究了CHR症状的发生和首次求助的情况，从而考虑了发病年龄的影响。对126名首次入院的成年精神病患者的早期病程和首次求助的特征进行了回顾评估。1 09名患者报告了先兆，58名患者有CHR症状。在18岁之前起病的患者(n=45)，疾病和精神病的持续时间延长，与成人起病的患者相比，慢性阻塞性肺疾病症状更常见(68.9%比33.3%)。只有29名患者报告在前驱症状中寻求帮助；这主要是自发的，特别是在起病较早的患者。在出现首发精神症状后，求助主要由他人发起。独立于状态和年龄的精神卫生专业人员是主要的第一个就诊点(54.0%)。在18岁之前出现早期、隐蔽症状的成人首次入院精神病患者更有可能回忆起CHR症状作为其前驱症状的一部分。根据目前的精神病风险标准，这些CHR症状原则上可以及早发现精神病。此外，与成人发病的患者相比，早期发病的患者也更有可能自行寻求帮助。因此，未来提高CHR检测的意识策略可能主要与年轻人和自我感觉到的微妙症状有关。
Prevention of psychosis requires both presence of clinical high risk (CHR) criteria and early help-seeking. Previous retrospective studies of the duration of untreated illness (i.e. prodrome plus psychosis) did not distinguish between prodromal states with and without CHR symptoms. Therefore, we examined the occurrence of CHR symptoms and first help-seeking, thereby considering effects of age at illness-onset.Adult patients first admitted for psychosis (n = 126) were retrospectively assessed for early course of illness and characteristics of first help-seeking.One-hundred and nine patients reported a prodrome, 58 with CHR symptoms. In patients with an early illness-onset before age 18 (n = 45), duration of both illness and psychosis were elongated, and CHR symptoms more frequent (68.9 vs. 33.3 %) compared to those with adult illness-onset. Only 29 patients reported help-seeking in the prodrome; this was mainly self-initiated, especially in patients with an early illness-onset. After the onset of first psychotic symptoms, help-seeking was mainly initiated by others. State- and age-independently, mental health professionals were the main first point-of-call (54.0 %).Adult first-admission psychosis patients with an early, insidious onset of symptoms before age 18 were more likely to recall CHR symptoms as part of their prodrome. According to current psychosis-risk criteria, these CHR symptoms, in principle, would have allowed the early detection of psychosis. Furthermore, compared to patients with an adult illness-onset, patients with an early illness-onset were also more likely to seek help on their own account. Thus, future awareness strategies to improve CHR detection might be primarily related to young persons and self-perceived subtle symptoms.