Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, Institute Clinic of Neurosciences, University of Barcelona, Barcelona, 2009-SGR-1119, Generalitat de Catalunya, Barcelona, Spain.
Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Madrid, Spain.
J Child Psychol Psychiatry. 2015 Jul;56(7):747-755. doi: 10.1111/jcpp.12332. Epub 2014 Sep 26.
The affective dimension has scarcely been studied in early-onset psychosis. Our aims were to investigate the prevalence and type of affective symptoms in the prodromal and acute phases of early-onset psychosis and to examine their relationship with suicide. We also sought to establish whether the presence of premorbid antecedents or the presence of affective symptoms during the prodromal and acute phase might predict a later diagnosis of bipolar disorder (BP) or schizophrenia (SZ).
Participants were 95 youths, aged 9-17 years, experiencing a first episode of a psychotic disorder (FEP) according to DSM-IV criteria. Prodromal affective symptoms in the year prior to the onset of full-blown psychosis were assessed by means of the K-SADS. Affective symptoms during the acute episode were evaluated using the Hamilton Depression Rating Scale and the Young Mania Rating Scale. Suicidality was assessed during the acute episode and at 6 and 12 months.
Half of the patients experienced affective symptoms during the prodrome, with depressive symptoms being the most frequently reported. During the acute episode, 23.2% presented depressive, 41.4% mixed and 18.9% manic symptoms. After logistic regression analysis, only the presence of depressive symptoms was significantly associated with suicidality during the 12 months following the FEP. Neither early premorbid antecedents nor the prevalence or type of affective symptoms during the FEP predicted a diagnosis of BP or SZ at 12 months. However, both depressive and manic prodromal symptoms were associated with a later diagnosis of BP.
The FEP of both SZ and BP is preceded by an identifiable prodromal phase. Early detection programs should target young people at clinical risk for the extended psychosis phenotype. The high prevalence of affective symptoms during the early phases of psychosis may encourage clinicians to identify and treat them in order to prevent suicide behaviour.
情感维度在早发性精神病中几乎没有被研究过。我们的目的是调查早发性精神病的前驱期和急性期情感症状的患病率和类型，并研究其与自杀的关系。我们还试图确定前驱期或前驱期和急性期是否存在情感症状是否可能预测以后被诊断为双相障碍（BP）或精神分裂症（SZ）。
参与者为 95 名年龄在 9-17 岁之间的青年，根据 DSM-IV 标准患有首发精神病性障碍（FEP）。使用 K-SADS 在前精神病发作的前一年评估前驱期的情感症状。使用汉密尔顿抑郁评定量表和 Young 躁狂评定量表评估急性发作期的情感症状。在急性发作期和 6 个月和 12 个月时评估自杀意念。
一半的患者在前驱期经历了情感症状，其中抑郁症状是最常见的。在急性发作期，23.2%出现抑郁症状，41.4%出现混合症状，18.9%出现躁狂症状。经过逻辑回归分析，只有在 FEP 后 12 个月期间存在抑郁症状与自杀意念显著相关。前驱期的早期症状或 FEP 期间情感症状的患病率或类型均不能预测 12 个月时 BP 或 SZ 的诊断。然而，抑郁和躁狂前驱症状均与以后被诊断为 BP 有关。
SZ 和 BP 的 FEP 之前都有一个可识别的前驱期。早期检测计划应针对具有扩展精神病表型临床风险的年轻人。精神病早期阶段情感症状的高患病率可能促使临床医生识别和治疗这些症状，以预防自杀行为。
