Prodromal interventions for schizophrenia vulnerability: the risks of being "at risk"
Prodromal interventions for schizophrenia vulnerability: the risks of being "at risk"
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DOI：
10.1016/j.schres.2004.05.021
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发表时间：
2005-03-01
影响因子：
4.5
通讯作者：
Hercher, L
中科院分区：
文献类型：
--
作者：
Corcoran, C;Malaspina, D;Hercher, L
鉴于治疗精神病（包括精神分裂症）的发病率和难度，人们已经开始努力识别和治疗临床上似乎处于精神病风险或“前驱期”的青少年和年轻人。该领域现在在识别方面具有更高的特异性，1-2 年内有 40-50% 的转化为明显的精神病。有进一步的证据表明，药物和其他治疗可能对“前驱期”患者有一定疗效，但副作用各异。然而，关于前驱研究中的一些固有风险仍然存在争议，例如药物暴露和假阳性的耻辱。在本文中，我们通过对更成熟的预测基因检测领域的前驱研究的伦理学分析来补充这一讨论。人们提出的问题包括信息对患者、家庭和机构的影响，以及未来的可保性、保密性的限制（因为它依赖于患者和家属的自由裁量权）、有精神症状的未成年人的自主权，甚至是真阳性患者的风险。 (C) 2004 Elsevier B.V. 保留所有权利。
Given the morbidity and difficulty of treating psychotic disorders, including schizophrenia, there has been a move toward identifying and treating adolescents and young adults who appear to be clinically at risk or "prodromal", to psychosis. The field now has greater specificity in identification, with rates of 40-50% conversion to frank psychosis within 1-2 years. There is further evidence that medications and other treatments may have some efficacy for "prodromal" patients, though with variable side effects. However, controversy remains about some of the inherent risks in prodromal research, such as medication exposure and stigma among false-positives. In this paper, we add to this discussion through an analysis of ethics in prodromal research from the more established field of predictive genetic testing. Issues are raised about the effects of information on patients, families, and institutions, as well as future insurability, the limits of confidentiality (as it relies on discretion of patients and families), the autonomy of minors with psychiatric symptoms, and even the risks for the true-positive patient. (C) 2004 Elsevier B.V. All rights reserved.