McLean OnTrack: a transdiagnostic program for early intervention in first-episode psychosis.
McLean OnTrack: a transdiagnostic program for early intervention in first-episode psychosis.
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DOI：
10.1111/eip.12299
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发表时间：
2017-02
影响因子：
2
通讯作者：
Öngür D
中科院分区：
文献类型：
--
作者：
Shinn AK;Bolton KW;Karmacharya R;Lewandowski KE;Yuksel C;Baker JT;Chouinard VA;Pingali SM;Bye H;Cederbaum K;Öngür D
在美国，大多数专门治疗首发精神病的项目都集中在精神分裂症上。然而，许多早期精神病患者并不适合这一诊断类别。在这里，我们描述了姆克林OnTrack，一个密集的门诊治疗计划，接受所有的人与首次发作的精神病。我们评估了项目启动后2.5年内患者的基线特征。我们研究了初始转诊诊断与当前诊断的比较，计算了诊断变化的比例。在2.5年时，姆克林OnTrack中的患者包括30名（33.0%）原发性精神障碍患者，40名（44.0%）情感性精神病患者，19名（20.9%）不符合任一类别全部标准的精神障碍NOS患者，以及2名（2.2%）无精神病患者。虽然情感性精神病患者有较高的病前功能，但所有三类精神病患者的既往住院率和物质使用率相似。精神病性障碍NOS组的留存率低于情感性和原发性精神病性障碍。最后，50.5%的患者在治疗过程中诊断发生变化。诊断异质性似乎是首发精神病患者的常态，诊断通常在病程中演变。疾病严重程度的基线指数在不同类别之间相似，表明无论具体诊断如何，都需要早期干预。我们讨论的好处和挑战的跨诊断的方法，早期干预首发精神病，治疗病人谁共享许多，但不是所有的特征。
Most programs specializing in the treatment of first-episode psychosis in the United States focus on schizophrenia. However, many early psychosis patients do not fit into this diagnostic category. Here we describe McLean OnTrack, an intensive outpatient treatment program that accepts all-comers with first-episode psychosis. We assessed baseline characteristics of patients in the 2.5 years since program initiation. We examined how initial referral diagnoses compare to current diagnoses, calculating the proportion of diagnostic changes. At 2.5 years, patients in McLean OnTrack consist of 30 (33.0%) individuals with primary psychotic disorder, 40 (44.0%) with affective psychosis, 19 (20.9%) with psychotic disorder NOS who do not meet full criteria for either category, and two (2.2%) individuals with no psychosis. While patients with affective psychosis had higher pre-morbid functioning, all three categories of psychosis had similar rates of prior hospitalizations and substance use. The retention rate in the psychotic disorder NOS group was lower than that in affective and primary psychotic disorders. Finally, diagnoses changed over the course of treatment in 50.5% of patients. Diagnostic heterogeneity appears to be the norm among patients with first-episode psychosis, and diagnoses commonly evolve over the illness course. Baseline indices of illness severity were similar across categories and suggest the need for early intervention, irrespective of specific diagnosis. We discuss the benefits and challenges of a trans-diagnostic approach to early intervention in first episode psychosis, treating patients who share many but not all characteristics.