Two-year follow-up of a Chinese sample at clinical high risk for psychosis: timeline of symptoms, help-seeking and conversion
Two-year follow-up of a Chinese sample at clinical high risk for psychosis: timeline of symptoms, help-seeking and conversion
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DOI：
10.1017/s2045796016000184
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发表时间：
2017-06-01
影响因子：
8.1
通讯作者：
Wang, J. J.
中科院分区：
文献类型：
--
作者：
Zhang, T. H.;Li, H. J.;Wang, J. J.
背景。中国的精神科医生逐渐开始关注那些被认为是精神病临床高危人群（CHR）的人；然而，目前尚不清楚那些来自不同国家背景的被确定为CHR的个体是否会转变为精神病。本研究的目的是检查基线特征和症状发作的时间，寻求帮助，或在中国2年期间过渡到精神病。在参与者第一次到精神卫生服务机构就诊时，通过前驱症状的结构化访谈（SIPS）来确定CHR的存在。117名CHR参与者中有86名（73.5%）完成了至少2年的临床随访。转换是用精神病症状的存在标准来确定的（在SIPS中）。分析检查了精神病的基线人口学和临床预测因素以及症状随时间的发展轨迹。采用生存分析（Kaplan-Meier）方法和Log-rank检验来说明基线数据与随时间的转换或非转换之间的关系。通过2年随访，采用Cox回归来确定转换的基线预测因素。在随访过程中，86名完成者中有25人（29.1%）转变为精神障碍。在CHR样本中，从症状减轻到寻求专业帮助的平均时间约为4个月，转化者在症状出现后约12个月出现完全精神病症状。与那些在研究过程中风险综合征得到缓解的CHR参与者相比，转换者在第一次寻求专业帮助时的延迟时间明显更长（p = 0.029）。在基线评估中，转换亚组更年轻，功能更差，SIPS总阳性症状评分更高，前驱症状未经治疗的持续时间更长，并且更经常被诊断为精神病相关，随后在临床中使用抗精神病药物。主要通过新型临床筛查方法确定的中国CHR的2年转换率与世界范围内的专业求助样本相当。对这些精神症状减轻但功能恶化的临床人群进行早期临床干预，是在中国应用CHR结构的下一步。
Background. Chinese psychiatrists have gradually started to focus on those who are deemed to be at clinical high-risk (CHR)' for psychosis; however, it is still unknown how often those individuals identified as CHR from a different country background than previously studied would transition to psychosis. The objectives of this study are to examine baseline characteristics and the timing of symptom onset, help-seeking, or transition to psychosis over a 2-year period in China.Method. The presence of CHR was determined with the Structured Interview for Prodromal Syndromes (SIPS) at the participants' first visit to the mental health services. A total of 86 (of 117) CHR participants completed the clinical follow-up of at least 2 years (73.5%). Conversion was determined using the criteria of presence of psychotic symptoms (in SIPS). Analyses examined baseline demographic and clinical predictors of psychosis and trajectory of symptoms over time. Survival analysis (Kaplan-Meier) methods along with Log-rank tests were performed to illustrate the relationship of baseline data to either conversion or non-conversion over time. Cox regression was performed to identify baseline predictors of conversion by the 2-year follow-up.Results. In total 25 (29.1%) of 86 completers transitioned to a psychotic disorder over the course of follow-up. Among the CHR sample, the mean time between attenuated symptom onset and professional help-seeking was about 4 months on average, and converters developed fully psychotic symptoms about 12 months after symptom onset. Compared with those CHR participants whose risk syndromes remitted over the course of the study, converters had significantly longer delays (p = 0.029) for their first visit to a professional in search of help. At baseline assessment, the conversion subgroup was younger, had poorer functioning, higher total SIPS positive symptom scores, longer duration of untreated prodromal symptoms, and were more often given psychosis-related diagnoses and subsequently prescribed antipsychotics in the clinic.Conclusions. Chinese CHR identified primarily by a novel clinical screening approach had a 2-year transition rate comparable with those of specialised help-seeking samples world-wide. Early clinical intervention with this functionally deteriorating clinical population who are suffering from attenuated psychotic symptoms, is a next step in applying the CHR construct in China.