Brain & Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia.
Early Interv Psychiatry. 2012 Aug;6(3):256-64. doi: 10.1111/j.1751-7893.2012.00364.x. Epub 2012 Jun 12.
Although the use of illness-staging models in clinical medicine has proved particularly useful, the concept has not been widely applied in mental health. Here, we apply a clinical staging framework to a population of help-seeking young people presenting with social anxiety. The goal was to provide a detailed description of common clinical stage of those presenting for treatment of social anxiety, and to delineate the associations between symptom type, severity and clinical stage.
The results of a structured clinical interview along with background clinical information formed the basis for consensus-derived decisions regarding clinical stage. Subjects also completed self-report measures to assess anxiety and depressive symptoms. Comparisons were conducted largely between those subjects who were considered to have reached a critical clinical threshold for discrete or progressive disorders (i.e., those staged at two and beyond) and those with 'attenuated syndromes' (stage 1b - 69% of subjects).
One hundred forty-three subjects (63% male, mean age = 22.1 years) were clinically assessed prior to entry into active treatment programmes. Subjects assigned to stage two or above reported more psychological distress, higher depression scores and more alcohol use. However, these subjects did not report more severe anxiety symptoms. A higher incidence of substance misuse was a significant feature of those in later clinical stages.
The study suggests that those who present with social anxiety are characterized by a broad range of symptom severity, with a small, though significant proportion representing individuals whose mental health problems have already progressed to a stage characterized by greater co-morbidity and risk of chronicity. Our data specifically suggest that depressive symptoms and substance abuse/dependence may differentiate those in earlier and later clinical stages.
尽管疾病分期模型在临床医学中的应用已被证明特别有用，但这一概念在心理健康领域尚未得到广泛应用。在这里，我们将临床分期框架应用于寻求帮助的年轻社交焦虑患者群体。目的是详细描述接受社交焦虑治疗的患者的常见临床分期，并阐明症状类型、严重程度与临床分期之间的关系。
结构化临床访谈的结果以及背景临床信息是基于共识的临床分期决策的基础。受试者还完成了自我报告的焦虑和抑郁症状评估。主要比较了那些被认为达到离散或进展性障碍临界临床阈值的受试者（即分期为 2 级及以上的受试者）和那些具有“减弱综合征”（1b 期-占受试者的 69%）的受试者之间的差异。
143 名受试者（63%为男性，平均年龄 22.1 岁）在进入积极治疗项目之前接受了临床评估。被分配到 2 级及以上分期的受试者报告了更多的心理困扰、更高的抑郁评分和更多的酒精使用。然而，这些受试者并未报告更严重的焦虑症状。物质滥用的发生率更高是处于晚期临床阶段的显著特征。
该研究表明，患有社交焦虑症的患者表现出广泛的症状严重程度，尽管比例较小，但其中一些人的心理健康问题已经进展到更严重的共病和慢性风险阶段。我们的数据特别表明，抑郁症状和物质滥用/依赖可能区分早期和晚期临床阶段的患者。
