Lindgren Maija, Manninen Marko, Kalska Hely, Mustonen Ulla, Laajasalo Taina, Moilanen Kari, Huttunen Matti, Cannon Tyrone D, Suvisaari Jaana, Therman Sebastian
National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, PO Box 30, FIN-00271 Helsinki, Finland; Institute of Behavioural Sciences (Discipline of Psychology), University of Helsinki, PO Box 9, FIN-00014 Helsinki, Finland.
National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, PO Box 30, FIN-00271 Helsinki, Finland; Institute of Behavioural Sciences (Discipline of Psychology), University of Helsinki, PO Box 9, FIN-00014 Helsinki, Finland.
Schizophr Res. 2014 Sep;158(1-3):1-6. doi: 10.1016/j.schres.2014.06.028. Epub 2014 Jul 9.
Current psychosis risk criteria have often been studied on a pre-selected population at specialized clinics. We investigated whether the Structured Interview for Prodromal Syndromes (SIPS) is a useful tool for psychosis risk screening among adolescents in general psychiatric care.
161 adolescents aged 15-18 with first admission to adolescent psychiatric services in Helsinki were interviewed with the SIPS to ascertain Clinical High-Risk (CHR) state. The participants were followed via the national hospital discharge register, patient files, and follow-up interviews. DSM-IV Axis I diagnoses were made at baseline and 12 months. Register follow-up spanned 2.8-8.9 years, and hospital care for a primary psychotic disorder and any psychiatric disorder were used as outcomes.
CHR criteria were met by 54 (33.5%) of the adolescents. Three conversions of psychosis as defined by SIPS emerged during follow-up, two of whom belonged to the CHR group. The positive predictive value of the CHR status was weak (1.9%) but its negative predictive value was 98.0%. Using the DSM-IV definition of psychosis, there were five conversions, three of which were in the CHR group. In regression analyses, hospital admissions for primary psychotic disorder were predicted by positive symptom intensity in the baseline SIPS. In addition, CHR status and SIPS positive and general symptoms predicted hospitalization for psychiatric disorder.
Psychosis incidence was low in our unselected sample of adolescent psychiatric patients. CHR status failed to predict SIPS or DSM-IV psychoses significantly at 12 months. However, in a longer follow-up, CHR did predict psychiatric hospitalization.
目前的精神病风险标准通常是在专科诊所对预先选定的人群进行研究。我们调查了前驱综合征结构化访谈（SIPS）是否是在普通精神科护理中对青少年进行精神病风险筛查的有用工具。
对首次入住赫尔辛基青少年精神科服务的161名15 - 18岁青少年进行SIPS访谈，以确定临床高危（CHR）状态。通过国家医院出院登记册、患者档案和随访访谈对参与者进行跟踪。在基线和12个月时做出DSM-IV轴I诊断。登记随访时间跨度为2.8 - 8.9年，将首次精神病性障碍和任何精神障碍的住院治疗作为结果。
54名（33.5%）青少年符合CHR标准。随访期间出现了3例SIPS定义的精神病转化，其中2例属于CHR组。CHR状态的阳性预测值较弱（1.9%），但其阴性预测值为98.0%。使用DSM-IV对精神病的定义，有5例转化，其中3例在CHR组。在回归分析中，基线SIPS中的阳性症状强度可预测首次精神病性障碍的住院情况。此外，CHR状态以及SIPS阳性和一般症状可预测精神障碍的住院情况。
在我们未经过筛选的青少年精神病患者样本中，精神病发病率较低。CHR状态在12个月时未能显著预测SIPS或DSM-IV定义的精神病。然而，在更长时间的随访中，CHR确实可预测精神科住院情况。
