Conrad Agatha M, Lewin Terry J, Sly Ketrina A, Schall Ulrich, Halpin Sean A, Hunter Mick, Carr Vaughan J
BMC Psychiatry. 2014 Nov 18;14:318. doi: 10.1186/s12888-014-0318-4.
Despite strong research interest in psychosis risk identification and the potential for early intervention, few papers have sought to document the implementation and evaluation of specialised psychosis related services. Assessment of Ultra High Risk (UHR) has been given priority, but it is equally as important to identify appropriate comparison groups and other baseline differences. This largely descriptive service evaluation paper focuses on the 'baseline characteristics' of referred clients (i.e., previously assessed characteristics or those identified within the first two months following service presentation).
Data are reported from a 10-year layered service audit of all presentations to a 'Psychological Assistance Service' for young people (PAS, Newcastle, Australia). Baseline socio-demographic and clinical characteristics (N =1,997) are described (including clients' psychosis and UHR status, previous service contacts, hospitalisation rates, and diagnostic and comorbidity profiles). Key groups are identified and comparisons made between clients who received ongoing treatment and those who were primarily assessed and referred elsewhere.
Clients averaged 19.2 (SD =4.5) years of age and 59% were male. One-tenth of clients (9.6%) were categorised as UHR, among whom there were relatively high rates of attenuated psychotic symptoms (69.1%), comorbid depression (62.3%), anxiety (42.9%), and attentional and related problems (67.5%). Overall, one-fifth (19.8%) experienced a recent psychotic episode, while a further 14.5% were categorised as having an existing psychosis (46.7% with a schizophrenia diagnosis), amongst whom there were relatively high rates of comorbid substance misuse (52.9%), psychosocial (70.2%) and physical health (37.7%) problems. The largest group presenting to PAS were those with non-psychotic disorders (43.7%), who provide a valuable comparison group against which to contrast the health trajectories of those with UHR and recent psychosis. Ongoing treatment by PAS was preferentially given to those experiencing or at risk for psychosis and those reporting greater current distress or dysfunction.
Whether or not UHR clients transition to psychosis, they displayed high rates of comorbid depression and anxiety at service presentation, with half receiving ongoing treatment from PAS. Although international comparisons with similar services are difficult, the socio-demographic and comorbidity patterns observed here were viewed as largely consistent with those reported elsewhere.
尽管对精神病风险识别及早期干预潜力有着浓厚的研究兴趣，但很少有论文致力于记录与精神病相关的专门服务的实施与评估情况。超高风险（UHR）评估已被列为优先事项，但确定合适的对照组及其他基线差异同样重要。这篇主要为描述性的服务评估论文聚焦于转诊客户的“基线特征”（即先前评估的特征或在服务就诊后的头两个月内确定的特征）。
报告的数据来自对澳大利亚纽卡斯尔“青少年心理援助服务”（PAS）的所有就诊情况进行的为期10年的分层服务审计。描述了基线社会人口统计学和临床特征（N = 1997）（包括客户的精神病和UHR状态、先前的服务接触、住院率以及诊断和共病情况）。确定了关键群体，并对接受持续治疗的客户与主要接受评估并转诊至其他地方的客户进行了比较。
客户的平均年龄为19.2岁（标准差 = 4.5），59%为男性。十分之一的客户（9.6%）被归类为UHR，其中精神病性症状衰减率（69.1%）、共病抑郁症（62.3%）、焦虑症（42.9%）以及注意力和相关问题（67.5%）的发生率相对较高。总体而言，五分之一（19.8%）的客户近期经历过精神病发作，另有14.5%被归类为患有现患精神病（46.7%为精神分裂症诊断），其中共病物质滥用（52.9%）、心理社会问题（70.2%）和身体健康问题（37.7%）的发生率相对较高。就诊于PAS的最大群体是患有非精神病性障碍的客户（43.7%），他们为对比UHR客户和近期精神病患者的健康轨迹提供了一个有价值的对照组。PAS优先为那些经历精神病或有精神病风险以及报告当前痛苦或功能障碍程度较高的客户提供持续治疗。
无论UHR客户是否会发展为精神病，他们在就诊时共病抑郁症和焦虑症的发生率都很高，其中一半接受了PAS的持续治疗。尽管很难与类似服务进行国际比较，但此处观察到的社会人口统计学和共病模式在很大程度上被认为与其他地方报告的情况一致。
