Pluripotential Risk and Clinical Staging: Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach.
Pluripotential Risk and Clinical Staging: Theoretical Considerations and Preliminary Data From a Transdiagnostic Risk Identification Approach.
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DOI：
10.3389/fpsyt.2020.553578
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发表时间：
2020
影响因子：
4.7
通讯作者：
Nelson B
中科院分区：
文献类型：
--
作者：
Hartmann JA;McGorry PD;Destree L;Amminger GP;Chanen AM;Davey CG;Ghieh R;Polari A;Ratheesh A;Yuen HP;Nelson B
大多数精神疾病在青春期和青年期发展，在此之前有一个阶段，在此期间症状明显减弱或发作性症状和功能下降。二十年前，超高风险（UHR）标准的引入为风险识别和预防性精神病学创造了一个新的框架，重点关注作为结果的首发精神病。这一范式的研究表明，新出现的精神病理学具有共病性、弥漫性和高度的发育异位，这表明需要采用更广泛、更不可知论的方法来识别风险。在临床分期原则的指导下，我们引入了多能性高危精神状态的概念。临床高危精神状态（CHARMS）方法拓宽了精神病之外的风险识别，包括多种退出综合征，如躁狂、严重抑郁和人格障碍。它不能在诊断上区分精神病理的早期阶段，而是采用“多能”方法，允许重叠和异型轨迹，并能够识别跨诊断和特定风险因素。由于CHARMS是在临床分期框架内开发的，通过承认临床表型的维度性质，同时保留引入特定干预措施的阈值，可以最大限度地发挥临床效用。我们正在进行的CHARMS队列研究（N = 114）的初步数据显示，完成12个月随访评估（N = 78）的年轻人中有34%从1b期（减重综合征）过渡到2期（完全障碍）。虽然并非没有局限性，但这种更广泛的风险识别方法最终可能允许对处于严重精神疾病早期阶段的年轻人进行可靠的跨诊断识别，为有针对性的早期干预和预防策略提供进一步的机会。
Most psychiatric disorders develop during adolescence and young adulthood and are preceded by a phase during which attenuated or episodic symptoms and functional decline are apparent. The introduction of the ultra-high risk (UHR) criteria two decades ago created a new framework for identification of risk and for pre-emptive psychiatry, focusing on first episode psychosis as an outcome. Research in this paradigm demonstrated the comorbid, diffuse nature of emerging psychopathology and a high degree of developmental heterotopy, suggesting the need to adopt a broader, more agnostic approach to risk identification. Guided by the principles of clinical staging, we introduce the concept of a pluripotent at-risk mental state. The clinical high at risk mental state (CHARMS) approach broadens identification of risk beyond psychosis, encompassing multiple exit syndromes such as mania, severe depression, and personality disorder. It does not diagnostically differentiate the early stages of psychopathology, but adopts a “pluripotent” approach, allowing for overlapping and heterotypic trajectories and enabling the identification of both transdiagnostic and specific risk factors. As CHARMS is developed within the framework of clinical staging, clinical utility is maximized by acknowledging the dimensional nature of clinical phenotypes, while retaining thresholds for introducing specific interventions. Preliminary data from our ongoing CHARMS cohort study (N = 114) show that 34% of young people who completed the 12-month follow-up assessment (N = 78) transitioned from Stage 1b (attenuated syndrome) to Stage 2 (full disorder). While not without limitations, this broader risk identification approach might ultimately allow reliable, transdiagnostic identification of young people in the early stages of severe mental illness, presenting further opportunities for targeted early intervention and prevention strategies.
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影响因子：
5.4
作者：
Cross SPM;Scott J;Hickie IB
通讯作者：
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DOI：
10.1080/17522439.2012.752027
发表时间：
2014-01-02
影响因子：
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DOI：
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发表时间：
2014-01-01
期刊：
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DOI：
10.1146/annurev-clinpsy-050212-185608
发表时间：
2013-01-01
期刊：
ANNUAL REVIEW OF CLINICAL PSYCHOLOGY, VOL 9
影响因子：
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通讯作者：
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DOI：
10.1111/j.1469-7610.2005.00422.x
发表时间：
2005-11-01
影响因子：
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作者：
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通讯作者：
Rathouz, PJ