Unmet needs for treatment in 102 individuals with brief and limited intermittent psychotic symptoms (BLIPS): implications for current clinical recommendations
Unmet needs for treatment in 102 individuals with brief and limited intermittent psychotic symptoms (BLIPS): implications for current clinical recommendations
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DOI：
10.1017/s2045796019000635
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发表时间：
2020-01-01
影响因子：
8.1
通讯作者：
McGuire, Philip
中科院分区：
文献类型：
--
作者：
Fusar-Poli, Paolo;De Micheli, Andrea;McGuire, Philip
目标。目的：研究临床高危精神病患者的临床结局和未满足的需求，这些患者表现为短暂和有限的间歇性精神病症状（BLIPS）。前瞻性自然主义长期（长达9年）队列研究，在南伦敦（OASIS）的外展和支持中符合BLIPS标准的个体中进行，直至2016年4月。测量基线社会人口统计学和临床特征、特定BLIPS特征、接受的预防性治疗和临床结局（精神病性和非精神病性）。分析包括Kaplan Meier生存估计和考克斯回归方法。对102名BLIPS患者进行了长达9年的随访。在BLIPS病例中，35%的病例突然发病; 32%与急性应激有关，45%与终身创伤有关，20%与同时使用非法药物有关。绝大多数（80%）的BLIPS个体，尽管系统地提供了精神病认知行为治疗，但没有完全参与其中，也没有接受最低有效剂量。只有3%的BLIPS患者接受了适当剂量的认知行为疗法。在4年的随访中，52%的BLIPS患者出现精神障碍，34%的患者入院治疗，16%的患者被强制入院。在3年随访时，52%的患者接受了抗精神病药物治疗;在4年随访时，26%的患者接受了抗抑郁药物治疗。存在严重紊乱和危险的特征是一个强有力的不良预后因素。BLIPS个体显示出严重的临床结果，超出了他们患精神病的非常高的风险，并显示出对预防性认知行为治疗的依从性差。BLIPS患者有严重的治疗需求，目前的预防策略无法满足。
Aims. To investigate clinical outcomes and unmet needs in individuals at Clinical High Risk for Psychosis presenting with Brief and Limited Intermittent Psychotic Symptoms (BLIPS).Methods. Prospective naturalistic long-term (up to 9 years) cohort study in individuals meeting BLIPS criteria at the Outreach And Support In South-London (OASIS) up to April 2016. Baseline sociodemographic and clinical characteristics, specific BLIPS features, preventive treatments received and clinical outcomes (psychotic and non-psychotic) were measured. Analyses included Kaplan Meier survival estimates and Cox regression methods.Results. One hundred and two BLIPS individuals were followed up to 9 years. Across BLIPS cases, 35% had an abrupt onset; 32% were associated with acute stress, 45% with lifetime trauma and 20% with concurrent illicit substance use. The vast majority (80%) of BLIPS individuals, despite being systematically offered cognitive behavioural therapy for psychosis, did not fully engage with it and did not receive the minimum effective dose. Only 3% of BLIPS individuals received the appropriate dose of cognitive behavioural therapy. At 4-year follow-up, 52% of the BLIPS individuals developed a psychotic disorder, 34% were admitted to hospital and 16% received a compulsory admission. At 3-year follow-up, 52% of them received an antipsychotic treatment; at 4-year follow-up, 26% of them received an antidepressant treatment. The presence of seriously disorganising and dangerous features was a strong poor prognostic factor.Conclusions. BLIPS individuals display severe clinical outcomes beyond their very high risk of developing psychosis and show poor compliance with preventive cognitive behavioural therapy. BLIPS individuals have severe needs for treatment that are not met by current preventive strategies.