Salokangas Raimo K R, McGlashan Thomas H
Department of Psychiatry, University of Turku, Turku, Finland.
Nord J Psychiatry. 2008;62(2):92-105. doi: 10.1080/08039480801984008.
The vulnerability and hybrid models for the onset of psychosis are presented. Familial liability, perinatal and developmental factors, and decreased cognitive performance associate with psychosis in adolescence and young adulthood. Genetic predisposition connected with behavioural deviances and/or mental symptoms associate with psychotic development so strongly that monitoring and intervention are indicated. Especially, in families where one or both parents or other family members are severely mentally ill, early family-centred assessments and interventions is needed. Together with familial psychosis, deficits in adolescent and young adult social development indicate thorough assessment, intensive monitoring and often also preventive interventions. During the prodromal phase of psychosis, patients often display unspecific symptoms, such as anxiety and depression, personality disorders, abuse of alcohol or drugs. Social decline, possibly associated with neurocognitive deficits, frequently occurs in the prodromal phase or in the early course of schizophrenia. Among help-seeking patients, occurrence of the Basic Symptoms represent the early initial prodromal state, while the late initial prodome state includes attenuated psychotic symptoms, brief limited intermittent psychotic symptoms, and a first degree relative with psychotic disorder, or a schizotypal personality disorder, together with decrease global functioning. These patients suffer also from other mental symptoms and functional decline, and are clearly in need of psychiatric assessment and treatment. Intervention trials have shown that patients suffering from prodromal syndromes can be successfully treated, and onset of psychosis prevented or delayed. However, more large-scale studies and clinical case descriptions of treatment of patients with sub-threshold psychotic symptoms are needed.
本文介绍了精神病发作的易感性和混合模型。家族易感性、围产期和发育因素以及认知能力下降与青少年和青年期的精神病有关。与行为偏差和/或精神症状相关的遗传易感性与精神病发展密切相关，因此需要进行监测和干预。特别是在父母一方或双方或其他家庭成员患有严重精神疾病的家庭中，需要早期以家庭为中心的评估和干预。除了家族性精神病外，青少年和青年期社会发展的缺陷也表明需要进行全面评估、密切监测，通常还需要进行预防性干预。在精神病的前驱期，患者通常表现出非特异性症状，如焦虑、抑郁、人格障碍、酗酒或吸毒。社会功能衰退可能与神经认知缺陷有关，经常发生在前驱期或精神分裂症的早期病程中。在寻求帮助的患者中，基本症状的出现代表早期初始前驱状态，而晚期初始前驱状态包括精神病性症状减弱、短暂有限的间歇性精神病性症状、患有精神病性障碍的一级亲属或分裂型人格障碍，以及整体功能下降。这些患者还患有其他精神症状和功能衰退，显然需要进行精神科评估和治疗。干预试验表明，患有前驱综合征的患者可以得到成功治疗，精神病的发作可以预防或延迟。然而，还需要更多关于亚阈值精神病性症状患者治疗的大规模研究和临床病例描述。
