Department of Psychiatry, University of Arizona, Tucson, Arizona 85724-5002, USA.
Early Interv Psychiatry. 2009 Nov;3(4):259-65. doi: 10.1111/j.1751-7893.2009.00148.x.
Given the growing interest in the study of first-episode psychosis, clinical and research programmes would benefit from a conceptual clarification of how to operationalize 'first-episode psychosis'. We review the variety of definitions in use and discuss their relative merits with respect to both clinical (e.g. early treatment) and research (e.g. obtaining meaningfully homogeneous populations) agendas.
We completed a selective review of the literature to investigate how first-episode psychosis was operationally defined.
Operational definitions for 'first-episode psychosis' fall largely into three categories: (i) first treatment contact; (ii) duration of antipsychotic medication use; and (iii) duration of psychosis. Each definitional category contains a number of underlying assumptions that contribute to the strengths and weaknesses of the definition.
The term 'first-episode psychosis' as used within clinical and research settings is misleading regardless of which operational definition is used. This term is typically used to refer to individuals early in the course of a psychotic illness or treatment rather than individuals who are truly in the midst of a first 'episode' of illness. The alternative of 'recent-onset psychosis' with related definitions based on 'duration of psychosis' is proposed. Based on this review, we provide suggestions with regard to the overarching pragmatic consideration of setting up a clinical service that can attract and assemble a population of early psychosis patients for the related purposes of treatment and research.
鉴于人们对首发精神病研究的兴趣日益浓厚，临床和研究计划将受益于对如何操作“首发精神病”的概念进行澄清。我们回顾了目前使用的各种定义，并讨论了它们在临床（例如早期治疗）和研究（例如获得有意义的同质人群）目标方面的相对优点。
我们对文献进行了选择性回顾，以调查如何操作定义“首发精神病”。
“首发精神病”的操作定义主要分为三类：（i）首次治疗接触；（ii）抗精神病药物使用时间；和（iii）精神病持续时间。每个定义类别都包含一些假设，这些假设对定义的优缺点有影响。
无论使用哪种操作定义，“首发精神病”这一术语在临床和研究环境中都是具有误导性的。该术语通常用于指精神病或治疗早期的个体，而不是真正处于疾病首次“发作”阶段的个体。我们提出了用“发病急骤的精神病”来替代，并根据“精神病持续时间”相关定义。基于本次审查，我们就建立一个能够吸引和汇集早期精神病患者的临床服务，以满足治疗和研究相关目的，提供了一些关于总体实用考虑的建议。
