Ruhrmann Stephan, Schultze-Lutter Frauke, Schmidt Stefanie J, Kaiser Nathalie, Klosterkötter Joachim
Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Strasse 62, 50924, Cologne, Germany,
Eur Arch Psychiatry Clin Neurosci. 2014 Nov;264 Suppl 1:S9-16. doi: 10.1007/s00406-014-0541-5. Epub 2014 Sep 26.
Prevention of psychoses has been intensively investigated within the past two decades, and particularly, prediction has been much advanced. Depending on the applied risk indicators, current criteria are associated with average, yet significantly heterogeneous transition rates of ≥30 % within 3 years, further increasing with longer follow-up periods. Risk stratification offers a promising approach to advance current prediction as it can help to reduce heterogeneity of transition rates and to identify subgroups with specific needs and response patterns, enabling a targeted intervention. It may also be suitable to improve risk enrichment. Current results suggest the future implementation of multi-step risk algorithms combining sensitive risk detection by cognitive basic symptoms (COGDIS) and ultra-high-risk (UHR) criteria with additional individual risk estimation by a prognostic index that relies on further predictors such as additional clinical indicators, functional impairment, neurocognitive deficits, and EEG and structural MRI abnormalities, but also considers resilience factors. Simply combining COGDIS and UHR criteria in a second step of risk stratification produced already a 4-year hazard rate of 0.66. With regard to prevention, two recent meta-analyses demonstrated that preventive measures enable a reduction in 12-month transition rates by 54-56 % with most favorable numbers needed to treat of 9-10. Unfortunately, psychosocial functioning, another important target of preventive efforts, did not improve. However, these results are based on a relatively small number of trials; and more methodologically sound studies and a stronger consideration of individual profiles of clinical needs by modular intervention programs are required.
在过去二十年中，对精神病的预防进行了深入研究，尤其是预测方面有了很大进展。根据所应用的风险指标，目前的标准与三年内平均但显著异质的≥30%的转化率相关，随着随访期延长，转化率进一步增加。风险分层为推进当前的预测提供了一种有前景的方法，因为它有助于降低转化率的异质性，并识别具有特定需求和反应模式的亚组，从而实现有针对性的干预。它也可能适用于改善风险富集。目前的结果表明，未来可实施多步风险算法，将通过认知基本症状（COGDIS）和超高风险（UHR）标准进行的敏感风险检测与通过依赖于进一步预测因素（如额外临床指标、功能损害、神经认知缺陷以及脑电图和结构磁共振成像异常）的预后指数进行的额外个体风险估计相结合，但也要考虑恢复力因素。在风险分层的第二步中简单地将COGDIS和UHR标准相结合，已经产生了4年0.66的风险率。关于预防，最近的两项荟萃分析表明，预防措施可使12个月的转化率降低54 - 56%，最有利的治疗所需人数为9 - 10。不幸的是，预防努力的另一个重要目标——心理社会功能并未得到改善。然而，这些结果基于相对较少的试验；需要更多方法学上合理的研究以及模块化干预项目对临床需求个体概况的更强考虑。
