Association of preceding psychosis risk states and non-psychotic mental disorders with incidence of clinical psychosis in the general population: a prospective study in the NEMESIS-2 cohort
Association of preceding psychosis risk states and non-psychotic mental disorders with incidence of clinical psychosis in the general population: a prospective study in the NEMESIS-2 cohort
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DOI：
10.1002/wps.20755
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发表时间：
2020-06-01
期刊：
影响因子：
73.3
通讯作者：
van Os, Jim
中科院分区：
文献类型：
--
作者：
Guloksuz, Sinan;Pries, Lotta-Katrin;van Os, Jim
到目前为止，精神病“临床高风险”（CHR）概念的有效性和临床效用仅在临床环境中风险丰富的样本中进行了调查。在这项基于人群的前瞻性研究中，我们首次旨在评估临床精神病的发病率，并估计先前精神病风险状态和DSM-IV诊断的非精神病性精神障碍（情绪障碍、焦虑症、酒精使用障碍和药物使用障碍）的发病率的人群归因分数（PAF）。所有的分析都根据年龄、性别和教育程度进行了调整。临床精神病发病率为63.0 / 10万人-年。相互校正的Cox比例风险模型显示，先前诊断的情绪障碍（风险比，HR=10.67, 95% CI: 3.12-36.49）、精神病高危状态（HR=7.86, 95% CI: 2.76-22.42）和药物使用障碍（HR=5.33, 95% CI: 1.61-17.64）与临床精神病发病率增加相关。在人群临床精神病发病率中，85.5% （95% CI: 64.6 ~ 94.1）可归因于既往精神病理，其中情绪障碍（PAF=66.2, 95% CI: 33.4 ~ 82.9）、精神病高危状态（PAF=36.9, 95% CI: 11.3 ~ 55.1）和药物使用障碍（PAF=18.7, 95% CI: -0.9 ~ 34.6）是最重要的因素。尽管在调整了其他精神病理后，精神病高危状态对临床精神病结局的相对风险较高，但鉴于人群中精神病高危状态的低患病率，PAF相对较低。这些发现为针对性CHR早期干预的“预防悖论”提供了经验证据。在实现以人群为基础的精神障碍预防改进方面，以更广泛的精神病理学为重点的综合预防策略可能比目前以精神病为重点的方法更有效。
The validity and clinical utility of the concept of "clinical high risk" (CHR) for psychosis have so far been investigated only in risk-enriched samples in clinical settings. In this population-based prospective study, we aimed - for the first time - to assess the incidence rate of clinical psychosis and es-timate the population attributable fraction (PAF) of that incidence for preceding psychosis risk states and DSM-IV diagnoses of non-psychotic mental disorders (mood disorders, anxiety disorders, alcohol use disorders, and drug use disorders). All analyses were adjusted for age, gender and education. The incidence rate of clinical psychosis was 63.0 per 100,000 person-years. The mutually-adjusted Cox proportional hazards model indicated that preceding diagnoses of mood disorders (hazard ratio, HR=10.67, 95% CI: 3.12-36.49), psychosis high-risk state (HR=7.86, 95% CI: 2.76-22.42) and drug use disorders (HR=5.33, 95% CI: 1.61-17.64) were associated with an increased risk for clinical psychosis incidence. Of the clinical psychosis incidence in the population, 85.5% (95% CI: 64.6-94.1) was attributable to prior psychopathology, with mood disorders (PAF=66.2, 95% CI: 33.4-82.9), psychosis high-risk state (PAF=36.9, 95% CI: 11.3-55.1), and drug use disorders (PAF=18.7, 95% CI: -0.9 to 34.6) as the most important factors. Although the psychosis high-risk state displayed a high relative risk for clinical psychosis outcome even after adjusting for other psychopathology, the PAF was comparatively low, given the low prevalence of psychosis high-risk states in the population. These findings provide empirical evidence for the "prevention paradox" of targeted CHR early intervention. A comprehensive prevention strategy with a focus on broader psychopathology may be more effective than the current psychosis-focused approach for achieving population-based improvements in prevention of psychotic disorders.