Centre for Youth Mental Health, The University of Melbourne, Australia.
Schizophr Res. 2010 Oct;123(1):37-44. doi: 10.1016/j.schres.2010.05.004. Epub 2010 Jun 16.
The onset of psychotic disorders peaks in adolescence and young adulthood. Early interventions during the ultra-high risk and first episode stages of illness are increasingly emphasised given the greater opportunities for clinical and functional recovery during these early phases. As a large volume of such research now exists, there is a need to summarise the extent and distribution of research to ascertain what is, and is not yet known about the evidence-base for preventing and treating early psychotic disorders.
An 'evidence mapping' methodology was used to systematically search for intervention studies published post-1980 in English (participant mean age: 6-30 years). Studies were restricted to systematic reviews, meta-analyses and controlled trials. The Cochrane Central Register of Controlled Trials, PSYCHINFO, MEDLINE and EMBASE were searched. Studies were screened according to these criteria and mapped on pre-defined study characteristics, including intervention types, stage of illness and type of study.
Fifty-eight controlled trials and 8 systematic reviews were identified. The majority pertained to the first episode stage of illness (n=37), indicated prevention (n=9) and relapse prevention (n=9). Most studies involved biological (n=32) or psychological (n=17) interventions. Antipsychotic medication (n=27) and cognitive behavioural therapy (CBT; n=10) were the most common intervention modalities.
The extant research is dominated by trials examining intervention for first episode psychosis with antipsychotic medication. Biological interventions other than antipsychotics are sparse for patients with established psychotic disorders. For at-risk populations, there is a need for high-quality prevention studies of pharmaceutical treatments (e.g. neuroprotective agents) and a broad range of psychosocial interventions, including, but not limited to, CBT.
精神病的发病高峰出现在青少年和青年时期。鉴于在疾病的超高危和首次发作阶段有更多的临床和功能恢复机会，越来越强调在这些早期阶段进行早期干预。由于现在有大量此类研究，因此需要总结研究的范围和分布，以确定预防和治疗早期精神病的证据基础是什么，以及还需要了解什么。
使用“证据映射”方法系统地搜索了 1980 年后发表的英文干预研究（参与者平均年龄：6-30 岁）。研究仅限于系统评价、荟萃分析和对照试验。对 Cochrane 中央对照试验注册库、PSYCHINFO、MEDLINE 和 EMBASE 进行了搜索。根据这些标准筛选研究，并根据预定义的研究特征进行映射，包括干预类型、疾病阶段和研究类型。
确定了 58 项对照试验和 8 项系统评价。大多数研究涉及首次发作阶段的疾病（n=37）、预防性干预（n=9）和复发预防（n=9）。大多数研究涉及生物学（n=32）或心理学（n=17）干预。抗精神病药物（n=27）和认知行为疗法（CBT；n=10）是最常见的干预方式。
现有的研究主要集中在检验抗精神病药物治疗首发精神病的试验上。对于已确诊的精神病患者，除抗精神病药物以外的生物学干预措施很少。对于高危人群，需要进行高质量的药物预防研究（例如神经保护剂）和广泛的心理社会干预，包括但不限于 CBT。
