Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
JAMA Psychiatry. 2013 Aug;70(8):793-802. doi: 10.1001/jamapsychiatry.2013.1270.
The ultra high-risk (UHR) criteria were introduced to prospectively identify patients at high risk of psychotic disorder. Although the short-term outcome of UHR patients has been well researched, the long-term outcome is not known.
To assess the rate and baseline predictors of transition to psychotic disorder in UHR patients up to 15 years after study entry.
Follow-up study of a cohort of UHR patients recruited to participate in research studies between 1993 and 2006.
The Personal Assessment and Crisis Evaluation (PACE) clinic, a specialized service for UHR patients in Melbourne, Australia.
Four hundred sixteen UHR patients previously seen at the PACE clinic.
Transition to psychotic disorder, as measured using the Comprehensive Assessment of At-Risk Mental States, Brief Psychiatric Rating Scale/Comprehensive Assessment of Symptoms and History, or state public mental health records.
During the time to follow-up (2.4-14.9 years after presentation), 114 of the 416 participants were known to have developed a psychotic disorder. The highest risk for transition was within the first 2 years of entry into the service, but individuals continued to be at risk up to 10 years after initial referral. The overall rate of transition was estimated to be 34.9% over a 10-year period (95% CI, 28.7%-40.6%). Factors associated with transition included year of entry into the clinic, duration of symptoms before clinic entry, baseline functioning, negative symptoms, and disorders of thought content.
The UHR patients are at long-term risk for psychotic disorder, with the highest risk in the first 2 years. Services should aim to follow up patients for at least this period, with the possibility to return for care after this time. Individuals with a long duration of symptoms and poor functioning at the time of referral may need closer monitoring. Interventions to improve functioning and detect help-seeking UHR patients earlier also may be indicated.
超高风险 (UHR) 标准被引入，以前瞻性地识别有精神病风险的患者。尽管 UHR 患者的短期预后已得到充分研究，但长期预后尚不清楚。
评估 UHR 患者在研究入组后长达 15 年时向精神病转变的发生率和基线预测因素。
对 1993 年至 2006 年期间参加研究的 UHR 患者队列进行随访研究。
澳大利亚墨尔本的个人评估和危机评估 (PACE) 诊所，这是一个专为 UHR 患者提供的服务。
之前在 PACE 诊所就诊的 416 名 UHR 患者。
使用风险精神状态综合评估、简明精神病评定量表/综合症状和病史评估或州公共精神卫生记录评估向精神病转变。
在随访时间（入组后 2.4-14.9 年）内，416 名参与者中有 114 人已知患有精神病。进入服务的头 2 年内风险最高，但个体在最初转介后 10 年内仍有风险。在 10 年期间，整体转变率估计为 34.9%（95%CI，28.7%-40.6%）。与转变相关的因素包括入组年份、入组前症状持续时间、基线功能、阴性症状和思维内容障碍。
UHR 患者长期存在精神病风险，头 2 年内风险最高。服务应至少在这段时间内对患者进行随访，在此之后有可能需要再次接受护理。在转介时症状持续时间长且功能差的个体可能需要更密切的监测。改善功能和更早发现寻求帮助的 UHR 患者的干预措施也可能是必要的。
