The National Collaborative Study of Early Psychosis and

早期精神病和自杀的国家合作研究（NCSEPS），与国防部（DoD）和退伍军人事务部（VA）一起进行，调查现役人员住院双相情感障碍，重性抑郁症，或精神分裂症，而在军队，和一组控制人员。NCSEPS的最初目标是：1）评估因这些疾病住院的患者的特征; 2）确定这些疾病的发病率; 3）检测并降低与这些疾病相关的长期发病率; 4）确定对首次出现这些疾病症状的患者进行早期干预的益处;以及5）降低受这些疾病影响的人的自杀风险。 武装部队是研究这些疾病的绝佳背景，因为有证据表明，大多数在服兵役期间受精神病影响的人在他们的军事生涯中变得如此之早，处于发展精神分裂症和双相情感障碍的最高风险年龄。它还提供了一个研究早期干预的好处的机会。受控环境还提供了一个独特的机会，通过VA系统提供治疗和前瞻性地跟踪这些个体。 NCSEPS收集了大约13，000名患者和135，000多名对照的住院数据和社会人口统计学特征。这些数据是一个独特的资源，将提供与美国武装部队同事的基本比较数据，并可能通过使用相同方法进行额外几年的随访来扩展。非常小心地清理数据库并创建代码本以进行后续分析。 已发表的研究结果和正在进行的分析包括以下内容： 身高、体重、BMI和诊断。研究人员调查了体型（身高，体重和BMI）与精神病诊断之间的关系。在精神疾病患者（N=7500）和对照组（n= 86，000）之间没有发现差异[Psychological Medicine 33：363-368]。 您对服务的使用人口统计学和诊断变量进行了检查，以辨别使用VA心理健康门诊服务的2,500例患者谁是住院的双相情感障碍，重性抑郁症，精神分裂症，而在现役，随后从军队出院。患者随访至少两年，并有资格获得VA服务。52%的人接受门诊治疗。精神分裂症或双相情感障碍患者、女性和老年人更有可能寻求VA护理[Psychiatric Services 54：383-388]。 现役军人首次住院治疗双极障碍、重度抑郁症和精神分裂症在现役人员中，双相情感障碍首次住院的发生率为2.0/10，000，重度抑郁障碍为7.2/10，000，精神分裂症为1.6/10，000。这个大样本（n= 8，700例患者）为军队精神疾病文献提供了重要补充。这份手稿已接近完成，即将提交出版。 所有这些都导致了武装部队的死亡和自杀。所有患者和对照组的死亡率数据提交给国家死亡指数（NDI）。在因严重精神疾病住院的人中，全因死亡率，特别是自杀死亡率大幅上升。已经决定，这篇论文将获得实质性的价值与更长的时间的后续行动，并要求将重新提交，以延长在NDI数据库中检索的年数。 生活事件对精神疾病发展的影响。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，这些患者在医疗服务的第一年内患上了其中一种指数疾病。百分之八十的人有新的精神病。发病发生在任职期间约180天。这些患者的应激源不明显。 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很好的样本来复制和评估这些早期发现。 心理测量和可靠性研究。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的心理测量特性和可靠性。

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 sociolodemographic 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. This manuscript is nearly complete for submission for publication. 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, and the request will be resubmitted to extend the number of years searched in the NDI database. 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. 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.