Schultze-Lutter Frauke, Resch Franz, Koch Eginhard, Schimmelmann Benno G
Universitätsklinik für Kinder- und Jugendpsychiatrie, Universität Bern, Schweiz.
Z Kinder Jugendpsychiatr Psychother. 2011 Sep;39(5):301-11; quiz 311-2. doi: 10.1024/1422-4917/a000124.
The early detection and treatment of persons at risk for psychosis is currently regarded as a promising strategy in fighting the devastating consequences of psychotic disorders. The two current favored at-risk approaches, i.e., the «ultra high risk» and the «basic symptom» criteria, were developed mainly using adult samples. Initial evidence suggests, however, that they cannot simply be applied to children and adolescents. For «ultra-high risk» criteria, there is indication of some attenuated psychotic symptoms being potentially nonspecific in adolescents, and of brief limited intermittent symptoms being difficult to clinically classify in children when observable behavioral correlates are missing. For basic symptoms, too, only a preliminary indication of their usefulness in children and adolescents exists. Since developmental peculiarities in the assessment of basic symptoms should be considered, a child and youth version of the Schizophrenia Proneness Instrument (SPI-CY) was developed. In conclusion, research on the clinical-prognostic validity of the at-risk criteria and their potential adaption to the special needs of children and adolescents is needed. If a «Prodromal Risk Syndrome for Psychosis» or «Attenuated Psychotic Symptoms Syndrome» are included in the upcoming DSM-5, it should be highlighted that its suitability for children and adolescents is only insufficiently known.
目前,对有精神病风险的人群进行早期检测和治疗被视为对抗精神疾病灾难性后果的一项有前景的策略。当前两种备受青睐的风险评估方法,即“超高风险”和“基本症状”标准,主要是基于成人样本制定的。然而,初步证据表明,它们不能简单地应用于儿童和青少年。对于“超高风险”标准,有迹象表明,一些精神病性症状的减弱在青少年中可能是非特异性的,而且当缺乏可观察到的行为关联时,短暂有限的间歇性症状在儿童中很难进行临床分类。对于基本症状,目前也仅有其在儿童和青少年中有用性的初步迹象。由于在评估基本症状时应考虑发育特点,因此开发了儿童青少年版的精神分裂症易感性量表(SPI-CY)。总之,需要对风险评估标准的临床预后有效性及其针对儿童和青少年特殊需求的潜在适应性进行研究。如果即将发布的《精神疾病诊断与统计手册》第5版(DSM-5)纳入“精神病前驱风险综合征”或“精神病性症状减弱综合征”,则应强调其对儿童和青少年的适用性尚不清楚。