Antidepressant, antipsychotic and psychological interventions in subjects at high clinical risk for psychosis: OASIS 6-year naturalistic study
Antidepressant, antipsychotic and psychological interventions in subjects at high clinical risk for psychosis: OASIS 6-year naturalistic study
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DOI：
10.1017/s003329171400244x
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发表时间：
2015-04-01
影响因子：
6.9
通讯作者：
McGuire, P.
中科院分区：
文献类型：
--
作者：
Fusar-Poli, P.;Frascarelli, M.;McGuire, P.
背景最近的随机对照试验表明，在精神病高危（HR）受试者中进行集中干预有一定疗效。然而，在前驱服务的现实世界中，治疗HR受试者受到几个实际问题的阻碍，这些问题可能会对集中干预的效果产生重大影响。纳入了2001-2012年期间转诊至南伦敦外展和支持（OASIS）并诊断为HR状态的所有受试者（n = 258）。暴露于重点干预与社会人口统计学和临床特征在基线。在随访时，他们与纵向临床和功能结局的相关性得到了解决。平均随访时间为6年（S.D. = 2.5年），观察到18%的转换风险。在样本中，33%的受试者仅接受认知行为疗法（CBT）治疗; 17%的受试者除了接受CBT治疗外，还接受抗精神病药物（AP）治疗。另外17%的受试者除了CBT外还服用抗抑郁药（AD）。在样本中，20%的人接触了多种干预措施。有针对性的干预措施有显着的关系，过渡到精神病。与CBT + AP干预相比，CBT + AD干预与向精神病转变的风险降低相关（风险比= 0.129，95%置信区间0.030-0.565，p = 0.007）。在HR受试者中，除了CBT外，AD v. AP干预与过渡结局存在差异性相关性。这些影响并不继发于症状严重程度的基线差异。
Background. Recent randomized controlled trials suggest some efficacy for focused interventions in subjects at high risk (HR) for psychosis. However, treating HR subjects within the real-world setting of prodromal services is hindered by several practical problems that can significantly make an impact on the effect of focused interventions.Method. All subjects referred to Outreach and Support in South London (OASIS) and diagnosed with a HR state in the period 2001-2012 were included (n = 258). Exposure to focused interventions was correlated with sociodemographic and clinical characteristics at baseline. Their association with longitudinal clinical and functional outcomes was addressed at follow-up.Results. In a mean follow-up time of 6 years (S.D. = 2.5 years) a transition risk of 18% was observed. Of the sample, 33% were treated with cognitive behavioural therapy (CBT) only; 17% of subjects received antipsychotics (APs) in addition to CBT sessions. Another 17% of subjects were prescribed with antidepressants (ADs) in addition to CBT. Of the sample, 20% were exposed to a combination of interventions. Focused interventions had a significant relationship with transition to psychosis. The CBT + AD intervention was associated with a reduced risk of transition to psychosis, as compared with the CBT + AP intervention (hazards ratio = 0.129, 95% confidence interval 0.030-0.565, p = 0.007).Conclusions. There were differential associations with transition outcome for AD v. AP interventions in addition to CBT in HR subjects. These effects were not secondary to baseline differences in symptom severity.