Baldwin Patrizia, Browne David, Scully Paul J, Quinn John F, Morgan Maria G, Kinsella Anthony, Owens John M, Russell Vincent, O'Callaghan Eadbhard, Waddington John L
Stanley Research Unit, Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, Ireland.
Schizophr Bull. 2005 Jul;31(3):624-38. doi: 10.1093/schbul/sbi025. Epub 2005 Jun 8.
The epidemiology of first-episode psychosis is poorly understood because of the paucity of systematic studies, yet it constitutes the fundamental basis for understanding the disorder and the foundations on which clinical, biological, therapeutic, and long-term outcome studies are built. A particular need is to clarify the diagnostic breadth of first-episode psychosis and, on this basis, to undertake systematic comparisons across representative populations of the psychoses, to include comparisons with first-episode mania. Considered here is the new generation of prospective studies that may be able to inform in some way on these issues. Attainment of the above goals requires prolonged accrual of "all" cases of nonaffective, affective, and any other psychotic illness, including first-episode mania, to derive the required representative populations. To illustrate some of the challenges, the structure of the Cavan-Monaghan prospective first episode study is described and its interim findings are outlined, as rural Ireland provides psychiatric care based on strict catchment areas and is characterized by substantive ethnic and socioeconomic homogeneity and stability. It is argued that there are 3 primary diagnostic nodes (schizophrenia spectrum psychosis, bipolar disorder, and major depressive disorder with psychotic features) around which there exist numerous additional, overlapping, and well-populated diagnostic categories that are distinct only in terms of their operational definition. Only through systematic, epidemiologically based studies that access this intrinsic diversity are we likely to understand fully the origins and pathobiology of first-episode psychosis.
由于系统性研究匮乏，首发精神病的流行病学情况尚未得到充分了解，但它构成了理解该疾病的基本基础，以及临床、生物学、治疗和长期预后研究的基石。特别需要明确首发精神病的诊断范围，并在此基础上，对各类精神病的代表性人群进行系统比较，包括与首发躁狂症的比较。本文探讨了新一代前瞻性研究，这些研究或许能在某些方面为这些问题提供信息。要实现上述目标，需要长期积累“所有”非情感性、情感性及其他任何精神疾病的病例，包括首发躁狂症，以获得所需的代表性人群。为说明其中一些挑战，本文描述了卡万 - 莫纳汉前瞻性首发研究的结构，并概述了其初步结果，因为爱尔兰农村地区基于严格的服务区提供精神科护理，且具有显著的种族和社会经济同质性与稳定性。本文认为，存在三个主要诊断节点（精神分裂症谱系精神病、双相情感障碍和伴有精神病性特征的重度抑郁症），围绕这些节点存在众多其他相互重叠且病例数众多的诊断类别，它们仅在操作定义上有所不同。只有通过基于流行病学的系统性研究来探究这种内在多样性，我们才有可能充分理解首发精神病的起源和病理生物学。
