Brenner Ronald, Madhusoodanan Subramoniam, Puttichanda Sharath, Chandra Prakash
St. Johns Episcopal Hospital, Far Rockaway, NY 11691, USA.
Ann Clin Psychiatry. 2010 Nov;22(4):239-48.
The concept of prevention in psychiatry is unique. It includes promotion of mental health, identification of risk factors across the life cycle, and appropriate early interventions. Recent emphasis on intervention early in the development of mental illness has resulted in several preventive programs with varying degrees of success.
We reviewed the literature on primary prevention in mental health, categorizing reports as evidence of universal, selective, or indicated prevention.
Indicated prevention through early intervention is the best-researched area of prevention in the spectrum of psychotic disorders, especially schizophrenia. Pharmacotherapy for ultra high-risk individuals combined with cognitive-behavioral therapy (CBT) has shown promising results in several studies. Strategies that teach younger individuals to cope with stress and provide psychosocial support have been effective in preventing mood and anxiety disorders.
There is evidence that primary prevention may delay the onset of mental illness. Future research on the etiologies of mental illnesses is required to facilitate development of additional primary prevention strategies. These efforts may contribute to reallocation of resources and enactment of public policies that curb the staggering effects of mental illness on society.
精神病学中的预防概念独具特色。它包括促进心理健康、识别生命周期中的风险因素以及进行适当的早期干预。近期对精神疾病早期干预的重视催生了若干预防项目,成效各异。
我们回顾了心理健康初级预防方面的文献,将报告分类为普遍预防、选择性预防或指示性预防的证据。
在精神病性障碍谱系中,尤其是精神分裂症方面,通过早期干预进行的指示性预防是研究最多的预防领域。在多项研究中,针对超高风险个体的药物治疗联合认知行为疗法(CBT)已显示出有前景的结果。教导年轻人应对压力并提供心理社会支持的策略在预防情绪和焦虑障碍方面已见成效。
有证据表明初级预防可能会延迟精神疾病的发作。需要对精神疾病的病因进行进一步研究,以推动更多初级预防策略的发展。这些努力可能有助于资源的重新分配以及制定公共政策,从而遏制精神疾病对社会造成的惊人影响。