Meyer Stephanie E, Bearden Carrie E, Lux Sabrina R, Gordon Jamie L, Johnson Jennifer K, O'Brien Mary P, Niendam Tara A, Loewy Rachel L, Ventura Joseph, Cannon Tyrone D
Division of Child and Adolescent Psychiatry, Neuropsychiatric Institute and Hospital, University of California-Los Angeles, CA 90024, USA.
J Child Adolesc Psychopharmacol. 2005 Jun;15(3):434-51. doi: 10.1089/cap.2005.15.434.
Recently developed research criteria have made it possible to identify adolescents at imminent risk for psychosis. However, the array of symptomatology in these patients is broad and has not yet been systematically characterized using established diagnostic and assessment tools.
The authors characterized 24 adolescent research participants at the UCLA Center for the Assessment and Prevention of Prodromal States (CAPPS) using structured interviews for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, (DSM-IV), the Child Behavior Checklist (CBCL), and information regarding psychiatric treatment histories. Two composite cases are also presented.
The most common DSM-IV diagnosis at study entry was major depression, followed by anxiety disorder not otherwise specified (NOS), and social phobia. Most participants met criteria for at least one subthreshold condition, including obsessive-compulsive disorder (OCD), psychosis, mania or hypomania, and generalized anxiety. CBCL data revealed high rates of affective disturbance and broad-ranging symptomatology, as did participants' diagnostic and treatment histories.
Consistent with retrospective studies of patients with first-episode psychosis, findings revealed frequent mood and anxiety disturbance during the prodromal phase of illness. The DSM-IV does not offer a clear framework for describing the widespread subthreshold symptomatology that characterizes putatively prodromal patients. The authors consider whether the psychosis prodrome merits designation as a recognized clinical entity.
最近制定的研究标准使识别即将面临精神病风险的青少年成为可能。然而，这些患者的症状范围广泛，尚未使用既定的诊断和评估工具进行系统描述。
作者在加州大学洛杉矶分校前驱状态评估与预防中心（CAPPS），使用针对《精神疾病诊断与统计手册》第4版（DSM-IV）的结构化访谈、儿童行为检查表（CBCL）以及有关精神科治疗史的信息，对24名青少年研究参与者进行了特征描述。还介绍了两个综合病例。
研究开始时最常见的DSM-IV诊断是重度抑郁症，其次是未另行规定的焦虑症（NOS）和社交恐惧症。大多数参与者符合至少一种阈下病症的标准，包括强迫症（OCD）、精神病、躁狂或轻躁狂以及广泛性焦虑症。CBCL数据显示情感障碍和广泛症状的发生率很高，参与者的诊断和治疗史也是如此。
与对首发精神病患者的回顾性研究一致，研究结果显示在疾病前驱期经常出现情绪和焦虑障碍。DSM-IV没有提供一个明确的框架来描述表征假定前驱期患者的广泛阈下症状。作者们思考精神病前驱期是否值得被认定为一个公认的临床实体。
