Research in people with psychosis risk syndrome: a review of the current evidence and future directions.
Research in people with psychosis risk syndrome: a review of the current evidence and future directions.
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DOI：
10.1111/j.1469-7610.2010.02235.x
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发表时间：
2010-04
期刊：
影响因子：
--
通讯作者：
Cornblatt BA
中科院分区：
文献类型：
--
作者：
Correll CU;Hauser M;Auther AM;Cornblatt BA
经过几十年的研究，精神分裂症和相关的精神障碍仍然是医学上最令人衰弱的疾病之一。大多数人的慢性病病程，第一次发作时较高的治疗反应性，早期疾病阶段灰质的进行性下降，以及对“前驱症状”或早期疾病体征和症状的回顾性描述，构成了对精神病风险综合征的研究的基础，该综合征被不同地称为“临床高风险”(CHR)或“超高风险”(UHR)或“前驱症状”。精神病风险综合征研究的开创性时代侧重于特定评估工具的开发和验证，以及高风险标准的划定。随后，自然而然地检查了精神病风险队列中的转化率，确定了转化为精神病的预测因素，并调查了能够中止或延缓完全精神病发展的干预措施。尽管最初关于精神病风险综合征标准的预测有效性的结果令人鼓舞，但最近关于转换率下降的发现表明需要进一步的研究。干预研究的结果令人鼓舞，主要涉及第二代抗精神病药物和认知行为疗法，但目前仍不足以为这一早期、相对非特定的疾病阶段提供治疗建议。关于精神病风险综合征的下一阶段研究刚刚开始，已经转移到更大规模的“多地点”项目，以增加概括性，并确保纳入足够大的具有精神病真实风险的样本。这些新出现的研究的重点是：1)确定转化为精神病的生物标记物；2)检查非抗精神病药物、神经保护和低风险的药物和非药物干预；3)测试潜在的特定阶段干预；4)检查在精神病风险综合征期间的治疗反应与病程预后之间的关系；5)对尽管早期干预但仍发展为精神分裂症的患者进行随访，并将疾病轨迹与未接受早期干预的患者进行比较；6)描述除精神分裂症谱系障碍以外的其他结果的个体特征，包括双相情感障碍和精神病风险综合征的缓解，包括假阳性病例；7)对有意义的社会和角色功能结果的评估。虽然到目前为止进行的研究已经产生了关键的信息，但在这一点上，将临床可识别的精神病风险综合征的概念转化为临床实践似乎是不合理的。
After decades of research, schizophrenia and related psychotic disorders are still among the most debilitating disorders in medicine. The chronic illness course in most individuals, greater treatment responsiveness during the first episode, progressive grey matter decline during early disease stages, and retrospective accounts of “prodromal” or early illness signs and symptoms formed the basis for research on the psychosis risk syndrome,, known variably as “clinical high risk”(CHR), or “ultra-high risk“ (UHR), or “prodromal”. The pioneering era of research on the psychosis risk syndrome focused on the development and validation of specific assessment tools and the delineation of high risk criteria. This was followed by the examination of conversion rates in psychosis risk cohorts followed naturalistically, identification of predictors of conversion to psychosis, and investigation of interventions able to abort or delay the development of full psychosis. Despite initially encouraging results concerning the predictive validity of the psychosis risk syndrome criteria, recent findings of declining conversion rates demonstrate the need for further investigations. Results from intervention studies, mostly involving second-generation antipsychotics and cognitive behavioral therapy, are encouraging, but are currently still insufficient to make treatment recommendations for this early, relatively non-specific illness phase. The next phase of research on the psychosis risk syndrome just now beginning, has moved to larger, “multi-site” projects to increase generalizability and to ensure that sufficiently large samples at true risk for psychosis are included. Emphasis in these emerging studies is on: 1) identification of biomarkers for conversion to psychosis; 2) examination of non-antipsychotic, neuroprotective and low-risk pharmacologic and non-pharmacologic interventions; 3) testing of potentially phase-specific interventions; 4) examination of the relationship between treatment response during yhre of psychosis risk syundrome and prognosis for the course of illness; 5) follow-up of patients who developed schizophrenia despite early interventions and comparison of illness trajectories with patients who did not receive early interventions; 6) characterization of individuals with outcomes other than schizophrenia spectrum disorders, including bipolar disorder and remission from the psychosis risk syndrome, including false positive cases; 7) assessment of meaningful social and role functioning outcomes. While the research conducted to date has already yielded crucial information, the translation of the concept of a clinically identifiable psychosis risk syndrome into clinical practice does not seem justified at this point.
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影响因子：
4.5
作者：
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通讯作者：
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作者：
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作者：
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通讯作者：
Lidsky, TI
DOI：
10.1007/s00406-008-5009-z
发表时间：
2008-11-01
影响因子：
4.7
作者：
Bauer, Michael;Juckel, Georg;Pfennig, Andrea
通讯作者：
Pfennig, Andrea