School of Psychological Sciences, University of Manchester, UK.
Clin Psychol Rev. 2013 Jul;33(5):637-53. doi: 10.1016/j.cpr.2013.04.001. Epub 2013 Apr 11.
Relapse of psychosis is common and has profound adverse consequences. Early signs interventions assume that timely prediction of relapse allows preventative action to reduce the chance of full relapse. The utility of early signs in this context is critically reviewed. Cohort studies suggest that early signs (e.g. anxiety, insomnia) appear in the few weeks before relapse and have modest predictive validity (sensitivity 10%-80%, median 61%; specificity 38%-100%, median 81%), indicating that accuracy of relapse prediction needs improvement. Trials using early signs to target interventions show that targeted antipsychotic medication is less effective than adequately dosed maintenance medication but relapse rates are lower than when intervention is delayed until relapse. The relative value of more complex interventions including psycho-education and relapse prevention strategies is not yet clearly established because there are few trials, some with important design limitations. Basic symptoms are subtle, subjective, qualitative changes in experience claimed to precede psychosis. One retrospective cohort study and studies of "at risk mental states'" transition to psychosis indicate some predictive validity. We suggest that basic symptoms are potentially valuable additions to the range of early signs and deserve further investigation in the effort to enhance the predictive validity of the early signs syndrome.
精神病复发是常见的，且会产生严重的不良后果。早期症状干预假设及时预测复发可以采取预防措施，降低全面复发的几率。本文批判性地回顾了早期症状在此背景下的作用。队列研究表明，复发前数周出现早期症状（如焦虑、失眠），且具有中等程度的预测有效性（敏感性 10%-80%，中位数 61%；特异性 38%-100%，中位数 81%），表明复发预测的准确性有待提高。使用早期症状进行干预的试验表明，靶向抗精神病药物不如足量维持药物有效，但与干预延迟至复发相比，复发率较低。包括心理教育和预防复发策略在内的更复杂干预措施的相对价值尚未明确确定，因为试验较少，有些设计存在重要的局限性。基本症状是指在精神病发作前出现的、微妙的、主观的、体验上的定性变化，据称这是精神病的前兆。一项回顾性队列研究和对“高危精神状态”向精神病过渡的研究表明，这些基本症状具有一定的预测有效性。我们认为，基本症状可能是早期症状的有效补充，并值得进一步研究，以提高早期症状综合征的预测有效性。
