National Collaborative Study of Early Psychosis & Suicid

与国防部(DoD)和退伍军人事务部(VA)联合开展的全国早期精神病和自杀合作研究(NCSEPS)调查了在军队中因双相情感障碍、严重抑郁障碍或精神分裂症而住院的现役人员，以及一组控制人员。NCSEPS的最初目标是1)评估因这些疾病住院的人的特征；2)确定这些疾病的发生率；3)检测和减少与这些疾病相关的长期发病率的发生；4)确定对首次出现这些疾病症状的患者进行早期干预有什么好处；以及5)降低受这些疾病影响的人的自杀风险。 军队是研究这些障碍的绝佳环境，因为有证据表明，大多数在服兵役期间受到精神病影响的人在他们的军旅生涯中变得如此之早，而他们患精神分裂症和双相情感障碍的风险最高。这也为研究早期干预的益处提供了机会。此外，受控环境还提供了提供治疗的独特机会，并通过VA系统对这些人进行前瞻性跟踪。 NCSEPS已经收集了大约13,000名患者和超过135,000名对照的住院数据和社会人口学特征。这些数据是一种独特的资源，将提供与美国军方同事的基本比较数据，并可能通过使用相同方法进行额外多年的跟踪来扩大。在清理数据库和创建用于后续分析的码本方面已给予了极大的注意。 已发表的调查结果和正在进行的分析包括以下内容： 身高、体重、BMI和诊断。研究人员调查了身体类型(身高、体重和BMI)与精神疾病的关系。精神障碍患者(N=7500)和对照组(n=86,000)之间无差异[心理医学33：363-368]。 NCSEPS示例对VA服务的使用。对2500名在现役期间因双相情感障碍、严重抑郁障碍或精神分裂症住院并随后退伍的患者进行了人口统计学和诊断变量的检查，以确定使用退伍军人精神卫生门诊服务的模式。患者被跟踪至少两年，并有资格获得退伍军人管理局服务。52%的人接受了门诊治疗。那些患有精神分裂症或双相情感障碍的人、女性和老年人更有可能寻求VA治疗[精神病学服务54：383-388]。 现役军人首次因躁郁症、抑郁症和精神分裂症住院。现役军人双相情感障碍首次住院率为2.0/万，重度抑郁障碍为7.2/万，精神分裂症为1.6/万。这一大样本(n=8,700名患者)为军队中的精神疾病文献提供了重要的补充。 都会导致军队中的死亡和自杀。所有患者和对照样本的死亡率数据被提交给国家死亡指数(NDI)。在那些因严重精神疾病住院的人中，所有原因的死亡率，特别是自杀死亡的人数都大大增加。已经确定，本论文将在更长的后续时间内获得实质性的价值。已经为国家发展倡议准备了重新提交补充数据的文件。 生活事件对精神障碍发展的影响。与沃尔特里德陆军医疗中心(WRAMC)的合作者一起，NCSEPS的研究人员审查了在WRMAC住院的74名患者的医疗委员会，这些人在医疗服务的第一年内出现了一种指标性障碍。80%的人患上了新的精神病。发病发生在任职期间的180天左右。对于这些患者来说，突发性应激源并不明显。这一数据已被汇编并提交给精神分裂症公告。 精神分裂症和出生季节。许多研究表明，出生季节对精神分裂症的发病率有影响。这种疾病患者的大样本将提供一个极好的样本来复制和评估这些早期的发现。 心理测量学和可靠性研究。正在评估用于评估新招募人员和对患者诊断进行多重评估的措施，以确定其心理测量学特性和可靠性。

The National Collaborative Study of Early Psychosis and Suicide (NCSEPS), conducted in conjunction with the Department of Defense (DoD) and the Department of Veterans Affairs (VA), investigates active duty personnel hospitalized for bipolar disorder, major depressive disorder, or schizophrenia while in the military, and a set of control personnel. The initial goals of the NCSEPS were 1) to assess the characteristics of those hospitalized for these disorders; 2) to determine the rates of these illnesses; 3) to detect and decrease the occurrence of long-term morbidity associated with these disorders; 4) to determine what benefits result from early intervention in patients first manifesting the symptoms of these disorders; and 5) to decrease the risk of suicide in those affected by the disorders. The Armed Forces are an excellent context to study these disorders given evidence that mostly of those affected by psychosis during military service become so early in their military careers at an age of highest risk for developing schizophrenia and bipolar disorder. It also provides an opportunity to study the benefits of early intervention. The controlled environment additionally gives a unique opportunity to offer therapy and to follow those individuals prospectively through the VA system. NCSEPS has amassed hospitalization data and sociodemographic characteristics on approximately 13,000 patients and more than 135,000 controls. These data are a unique resource that will provide essential comparative data with US Armed Services colleagues, and may be expanded through additional years of follow up using the same methods. Great care has been given to cleaning the database and creating a codebook to subsequent analysis. Published findings and ongoing analyses include the following: HEIGHT, WEIGHT, BMI, AND DIAGNOSIS. Researchers investigated the relationship between body type (height, weight, and BMI) and psychiatric diagnoses. No differences were found between patients with the psychiatric disorders (N=7500) and controls (n=86,000) [Psychological Medicine 33: 363-368]. USE OF VA SERVICES BY THE NCSEPS SAMPLE. Demographic and diagnostic variables were examined to discern patterns of use of VA mental health outpatient services in 2,500 patients who were hospitalzed with bipolar disorder, major depressive disorder, or schizophrenia while on active duty and subsequently discharged from the military. Patients were followed for at least two years and were eligible for VA services. Fifty-two percent received outpatient care. Those with schizophrenia or bipolar disorder, women, and older individuals were more likely to seek VA care [Psychiatric Services 54: 383-388]. FIRST HOSPITALIZATION FOR BIPOLAR DISORDER, MAJOR DEPRESSIVE DISORDER, AND SCHIZOPHRENIA IN ACTIVE DUTY MILITARY PERSONNEL. The incidence of first hospitalization for these disorders was found to be 2.0 per 10,000 for bipolar disorder, 7.2 per 10,000 for major depressive disorder, and 1.6 per 10,000 for schizophrenia in active duty personnel. This large sample (n=8,700 patients) provides an important addition to the literature of mental illness in the military. ALL CAUSE MORTALITY AND SUICIDE IN THE ARMED FORCES. Data on mortality for all patients and a sample of controls was submitted to the National Death Index (NDI). All cause mortality and especially death by suicide are substantially elevated in those who were hospitalized for severe psychiatric disorders. It has been decided that this paper will gain substantial value with a longer period of follow-up. A resubmittal for the additional data has been prepared for the NDI. THE IMPACT OF LIFE EVENTS ON THE DEVELOPMENT OF PSYCHIATRIC DISORDERS. With collaborators at Walter Reed Army Medical Center (WRAMC), NCSEPS researchers reviewed medical boards for 74 individuals hospitalized at WRMAC who developed one of the index disorders within the first year of their medical service. Eighty percent had a new psychosis. Onset occurred about 180 days into the term of duty. Precipitant stressors were not apparent for these patients. This data has been compiled and submitted to Schizophrenia Bulletin. SCHIZOPHRENIA AND SEASON OF BIRTH. Much research has indicated an effect of season of birth on the incidence of schizophrenia. This large sample of patients with this disorder will provide an excellent sample to replicate and evaluate these early findings. PSYCHOMETRIC AND RELIABILITY STUDIES. Measures used in evaluation of new recruits and multiple assessment of patients' diagnoses are being evaluated for their psychometric properties and reliability.