Department of Psychosis Studies, Institute of Psychiatry, London, UK.
Braz J Psychiatry. 2011 Oct;33 Suppl 2:s161-74. doi: 10.1590/s1516-44462011000600004.
Recent research suggests that early intervention in psychosis might improve the chances of recovery and may even be able to prevent the onset of psychotic disorders. Clinical intervention in subjects at ultra high risk (UHR) of psychosis can have three different objectives. The first aim is to improve the 'prodromal' symptoms and problems that subjects usually present with. The second is to reduce the risk of the subsequent onset of frank psychosis. The third objective is to minimize the delay before the initiation of antipsychotic treatment in the subgroup of UHR subjects that go on to develop a first episode of psychosis. Both pharmacological and psychological interventions appear to be effective in reducing the severity of presenting symptoms in UHR subjects. Clinical trials of the impact of these interventions on the risk of subsequent transition to psychosis have been positive, but have involved small samples, and thus the issue of whether the effects persist in the long term remains to be determined. The monitoring of UHR subjects for the first signs of frank psychosis is an effective means of reducing the delay between the onset of the first episode and the start of antipsychotic treatment. Follow-up studies are required to test whether the reduction in this delay leads to an improved long term outcome. To date, the majority of the interventions that have been used in UHR subjects, such as case management, antipsychotic medication, and cognitive behavior therapy have previously been employed in patients with established psychosis. However, it is possible that treatments that are not normally used in patients with psychotic disorders may prove effective when applied at this stage.
最近的研究表明，早期干预精神病可能会提高康复的机会，甚至可以预防精神病的发生。对处于精神病超高风险（UHR）的受试者进行临床干预可以有三个不同的目标。第一个目标是改善受试者通常出现的“前驱”症状和问题。第二个目标是降低随后出现明显精神病的风险。第三个目标是尽量减少随后发展为精神病首次发作的 UHR 受试者亚组开始使用抗精神病药物治疗的延迟。药物和心理干预似乎都能有效减轻 UHR 受试者出现的症状严重程度。这些干预措施对随后向精神病过渡的风险影响的临床试验是积极的，但涉及的样本较小，因此，这些效果是否能长期持续仍有待确定。监测 UHR 受试者出现明显精神病的最初迹象是减少首发症状和开始抗精神病治疗之间延迟的有效手段。需要进行随访研究，以检验这种延迟的减少是否会导致长期结果的改善。迄今为止，在 UHR 受试者中使用的大多数干预措施，如病例管理、抗精神病药物和认知行为疗法，以前都曾用于已确诊的精神病患者。然而，在这个阶段，通常不用于精神病患者的治疗方法也可能有效。
