Butler Hospital, Psychosocial Research Program, Providence, RI 02906, USA.
J Clin Psychiatry. 2013 Feb;74(2):149-55. doi: 10.4088/JCP.12m07788. Epub 2012 Oct 2.
Attenuated psychosis syndrome (APS) is being proposed for inclusion in Section III of DSM-5 for those impaired by subthreshold psychotic symptoms that are not better accounted for by another diagnosis and not meeting criteria for a psychotic disorder. The rationale is to identify patients who are at high risk for transition to a psychotic disorder in the near future. However, the potential impact of using this new diagnosis in routine clinical practice settings has not been carefully examined.
As part of the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, a treatment-seeking psychiatric outpatient sample (n = 1,257) recruited from June 1997 to June 2002 completed a self-report measure of psychiatric symptoms and afterward were administered structured clinical interviews. For the current post hoc study, we investigated the prevalence rate of endorsing attenuated psychotic experiences to identify patients who could potentially meet criteria for APS.
After the exclusion of those with lifetime DSM-IV psychotic disorders, psychotic experiences remained highly prevalent in the sample (28% reported at least 1 psychotic experience during the past 2 weeks), and rates were similar across all major DSM-IV diagnostic categories. Only 1 patient (0.08%) reported psychotic experiences but did not meet criteria for another current DSM disorder; however, this individual endorsed other nonpsychotic symptoms of greater severity. Psychotic experience endorsement was positively correlated with nearly all other nonpsychotic symptom domains, and multivariate analysis showed that general clinical severity predicted endorsement of psychotic experiences (P values < .001).
We could not identify any patients who clearly met criteria for APS alone in our sample. Psychotic experiences appear to be common in outpatients and represent nonspecific indicators of psychopathology. Diagnosing APS in the community could result in high rates of false-positives or high rates of APS "comorbidity" with other nonpsychotic disorders, leading to the increased use of antipsychotic medications without clear need. Therefore, the clinical utility of adding APS to the diagnostic system remains highly questionable.
DSM-5 第 3 节提出了“衰减型精神病综合征（APS）”，用于诊断那些存在亚临床精神病症状但未被其他诊断更好解释，且不符合精神病障碍诊断标准的患者。其基本原理是识别出那些在不久的将来极有可能向精神病障碍转变的高危患者。然而，在常规临床实践环境中使用这一新诊断的潜在影响尚未得到仔细检查。
作为罗德岛改善诊断评估和服务（MIDAS）项目的一部分，从 1997 年 6 月至 2002 年 6 月招募了寻求治疗的精神病门诊患者样本（n=1257），他们完成了一份精神病症状自评量表，之后接受了结构化临床访谈。在当前的事后研究中，我们调查了衰减型精神病体验的发生率，以确定那些可能符合 APS 标准的患者。
在排除了有终身 DSM-IV 精神病障碍的患者后，该样本中仍存在高度普遍的精神病体验（28%的患者在过去 2 周内至少报告了 1 次精神病体验），且在所有主要的 DSM-IV 诊断类别中发生率相似。只有 1 名患者（0.08%）报告了精神病体验，但不符合当前 DSM 障碍的另一个标准；然而，该患者报告了其他更严重的非精神病症状。精神病体验的发生与几乎所有其他非精神病症状领域都呈正相关，多元分析表明，一般临床严重程度预测了精神病体验的发生（P 值均<.001）。
我们在样本中没有发现任何符合 APS 标准的患者。精神病体验在门诊患者中很常见，是精神病理学的非特异性指标。在社区中诊断 APS 可能导致假阳性率较高，或与其他非精神病障碍的 APS“共病”率较高，从而导致不必要地增加使用抗精神病药物。因此，将 APS 添加到诊断系统中的临床实用性仍然存在很大的疑问。
