Larsen Tor K, Melle Ingrid, Auestad Bjørn, Friis Svein, Haahr Ulrik, Johannessen Jan Olav, Opjordsmoen Stein, Rund Bjørn Rishovd, Simonsen Erik, Vaglum Per, McGlashan Thomas
Psychiatric Clinic, University of Stavanger, Armauer Hansensv. 20, PB 8100, N-4068 Stavanger, Norway.
Schizophr Bull. 2006 Oct;32(4):758-64. doi: 10.1093/schbul/sbl005. Epub 2006 Jun 29.
Early intervention is assumed to improve outcome in first-episode psychosis, but this has not been proven.
To study whether 1-year outcome will be better in a health care sector with early detection (ED) of psychosis compared with sectors with no early detection (no-ED).
A quasi-experimental study with ED in 2 experimental sectors and no-ED in 2 control sectors. ED was achieved through low-threshold ED teams and information campaigns about psychosis for the public, schools, and primary health care providers. The ED and no-ED health care areas offered an equivalent assessment and treatment program during the first year. Two hundred and eighty-one patients were included; 88% were reassessed after 1 year.
The ED-area patients (N = 141) had a median duration of untreated psychosis of 5 weeks at baseline compared with 16 weeks for patients in the no-ED area (N = 140). Positive and general symptoms, global assessment of functioning, quality of life, time to remission, and course of psychosis at 1 year after the start of treatment were not different between ED and no-ED groups. Outcome was significantly better for the ED area for negative symptoms.
The ED, no-ED differences at baseline become attenuated by 1 year but not the difference in negative symptoms, suggesting secondary prevention in this domain of psychopathology. However, this possibility requires further testing by follow-up and replication.
早期干预被认为可改善首发精神病的预后，但这尚未得到证实。
研究与无早期检测（无ED）的医疗保健部门相比，在有精神病早期检测（ED）的医疗保健部门中，1年的预后是否会更好。
一项准实验研究，2个实验部门进行ED，2个对照部门不进行ED。通过低门槛的ED团队以及针对公众、学校和初级卫生保健提供者开展的关于精神病的宣传活动来实现ED。在第一年，ED和无ED的医疗保健区域提供了同等的评估和治疗方案。纳入了281名患者；88%的患者在1年后接受了重新评估。
ED区域的患者（N = 141）在基线时未治疗精神病的中位持续时间为5周，而无ED区域的患者（N = 140）为16周。治疗开始1年后，ED组和无ED组在阳性和一般症状、功能的整体评估、生活质量、缓解时间以及精神病病程方面没有差异。ED区域在阴性症状方面的预后明显更好。
基线时ED组和无ED组之间的差异在1年后有所减弱，但阴性症状方面的差异没有减弱，这表明在这一精神病理学领域存在二级预防。然而，这种可能性需要通过随访和重复研究进一步验证。
