The "close-in" or ultra high-risk model: A safe and effective strategy for research and clinical intervention in prepsychotic mental disorder
The "close-in" or ultra high-risk model: A safe and effective strategy for research and clinical intervention in prepsychotic mental disorder
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DOI：
10.1093/oxfordjournals.schbul.a007046
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发表时间：
2003-01-01
影响因子：
6.6
通讯作者：
Phillips, LJ
中科院分区：
文献类型：
--
作者：
McGorry, PD;Yung, AR;Phillips, LJ
精神障碍研究和早期干预的新前沿的发展高度依赖于协同临床基础设施的建设。这促进了首次发作精神病的识别、强化治疗和研究的巨大进步，当界限扩展到包括疾病的最早临床阶段、前驱期或精神病前期时，任务甚至更具挑战性。本文介绍了概念和实际的构建块的建设服务模式的干预在发病后的临床阶段之前，达到目前的诊断阈值。这最好被视为有针对性的预防，是一种非常早期的二级预防，它涉及将即时临床护理与以研究为导向的预防性干预相结合。个人评估和危机评估（PACE）诊所在墨尔本的几个发展阶段的经验进行了描述和对比，在欧洲和北美的几个新兴中心。详细介绍了迄今为止取得的进展、汲取的经验教训以及尚未解决的挑战和机遇。它的结论是，服务模式可以开发，是可以接受的，对年轻人和他们的家庭有帮助的，并创造一个独特的环境，为研究坦率的精神障碍的过渡。这种方法的最终临床效用和一般安全性以及有效治疗的范围仍不清楚，将通过更广泛的研究来确定。这种研究必须以合乎逻辑和严谨的方式进行，尽可能采用最佳设计，对消费者和护理人员的投入以及道德考虑保持敏感。
The development of a new frontier for research and early intervention in psychotic disorders is highly dependent on the construction of synergistic clinical infrastructures. This has catalyzed great progress in the recognition, enhanced treatment, and study of first episode psychosis, and the task is even more challenging when the boundaries are extended to include the earliest clinical phase of illness, the prodromal or prepsychotic phase. This article describes the conceptual and practical building blocks for the construction of service models for intervention in the postonset clinical phase prior to the attainment of current diagnostic thresholds. This is best regarded as indicated prevention, a form of very early secondary prevention, which involves a blend of immediate clinical care combined with research-oriented preventive intervention. The experience of the Personal Assessment and Crisis Evaluation (PACE) Clinic in Melbourne across several stages of growth is described and contrasted with that of several emerging centers in Europe and North America. The progress to date, the lessons learned, and the unresolved challenges and opportunities are detailed. It is concluded that service models can be developed that are acceptable and helpful to young people and their families, and that create a unique environment for the study of the transition to frank psychotic disorder. The ultimate clinical utility and general safety of this approach and the range of effective treatments remain unclear, and will be determined by more extensive research. Such research must be conducted in a logical and rigorous manner with the best designs possible, sensitive to input from consumers and caregivers and to ethical considerations.