Czernikiewicz Andrzej, Szulc Agata
Klinika Psychiatrii AM w Białymstoku.
Psychiatr Pol. 2007 Jan-Feb;41(1):5-15.
Early intervention in psychotic disorders, particularly schizophrenia, has been increasingly recognized as important by clinicians. The benefits of early intervention in schizophrenia to patients include prevention of neurobiological changes, minimization of secondary morbidity and prevention of relapse. Other benefits of prepsychotic intervention include the capacity to research the onset phase of psychosis. We would like to support in our paper a statement by Maeres: What is needed is not diagnosing the early stages of schizophrenia but the diagnosis of prepsychotic schizophrenia. We are interested in recognizing the schizophrenia 'prodrome' prospectively using to concepts: subjects 'at risk mental state' (ARMS) and subjects from 'ultra high risk' (UHR) group. For clinical reasons that involves both some clinical features of pre-psychotic states (attenuated psychotic symptoms) and some "trait factors", i.e. schizotypal personality or family predisposition factors. Recent data revealed that some characteristics of pre-psychotic states had stronger predictive value: longer symptoms duration, lower level of GAF (< 40), and presence of attenuated psychotic symptoms. The possibility of providing intervention prior to the onset of psychosis has risen from recent interest in early intervention in these pre-psychotic states.
临床医生越来越认识到对精神障碍,尤其是精神分裂症进行早期干预的重要性。早期干预精神分裂症对患者的益处包括预防神经生物学变化、将继发性发病率降至最低以及预防复发。精神病前期干预的其他益处包括研究精神病发作阶段的能力。我们希望在本文中支持马雷斯的一项声明:需要的不是诊断精神分裂症的早期阶段,而是诊断精神病前期精神分裂症。我们有兴趣前瞻性地利用两个概念来识别精神分裂症的“前驱期”:“处于风险中的精神状态”(ARMS)受试者和“超高风险”(UHR)组受试者。出于临床原因,这涉及到精神病前期状态的一些临床特征(精神病性症状减弱)和一些“特质因素”,即分裂型人格或家族易患因素。最近的数据显示,精神病前期状态的一些特征具有更强的预测价值:症状持续时间更长、总体功能评估量表(GAF)得分更低(<40)以及存在精神病性症状减弱。由于最近对这些精神病前期状态的早期干预感兴趣,在精神病发作前提供干预的可能性增加了。