通过对症状前驱期进行干预实现精神病的一级预防：一项务实的挪威超高风险研究
Primary prevention of psychosis through interventions in the symptomatic prodromal phase, a pragmatic Norwegian Ultra High Risk study.
作者信息
Joa Inge, Gisselgård Jens, Brønnick Kolbjørn, McGlashan Thomas, Johannessen Jan Olav
机构信息
Psychiatric Division, Stavanger University Hospital, TIPS- Centre for Clinical Research in Psychosis, Armauer Hansensvei 20, N-4011, Stavanger, Norway.
Network for medical sciences, University of Stavanger, 4036, Stavanger, Norway.
出版信息
BMC Psychiatry. 2015 Apr 22;15:89. doi: 10.1186/s12888-015-0470-5.
BACKGROUND
Evidence has been accumulating that it may be possible to achieve prevention in psychotic disorders. The aim of the Prevention Of Psychosis (POP) study is to reduce the annual incidence of psychotic disorders in a catchment area population through detection and intervention in the prodromal phase of disorder. Prodromal patients will be recruited through information campaigns modelled on the Scandinavian early Treatment and Intervention in Psychosis (TIPS) study and assessed by low-threshold detection teams.
METHODS/DESIGN: The study will use a parallel control design comparing the incidence of first episode psychotic disorders between two Norwegian catchment areas with prodromal detection and treatment (Stavanger and Fonna) with two catchment areas without a prodromal intervention program (Bergen and Østfold). The primary aim of the current study is to test the effect of a Prodromal Detection and Treatment program at the health care systems level. The study will investigate: 1) If the combination of information campaigns and detection teams modelled will help in identifying individuals (age 13-65, fulfilling study inclusion criteria) at high risk of developing psychosis early, and 2) If a graded, multi-modal treatment program will reduce rates of conversion compared to the rates seen in follow-along assessments.
DISCUSSION
Positive results could potentially revolutionize therapy by treating risk earlier rather than disorder later and could open a new era of early detection and intervention in psychosis. Negative results will suggest that the potential for psychosis is determined early in life and that research should focus more on genetically linked neurodevelopmental processes. If we can identify people about to become psychotic with high accuracy, we can track them to understand more about how psychosis unfolds. Appropriate intervention at this stage could also prevent or delay the onset of psychosis and/or subsequent deterioration, i.e., social and instrumental disability, suicide, aggressive behavior, affective- and cognitive deficits.
TRIAL REGISTRATION
Current Controlled Trials ISRCTN20328848 . Registered 02 November 2014.
背景
越来越多的证据表明，有可能实现对精神障碍的预防。预防精神病（POP）研究的目的是通过在疾病前驱期进行检测和干预，降低集水区人群中精神障碍的年发病率。前驱期患者将通过借鉴斯堪的纳维亚精神病早期治疗与干预（TIPS）研究模式的宣传活动招募，并由低门槛检测团队进行评估。
方法/设计：该研究将采用平行对照设计，比较挪威两个设有前驱期检测与治疗的集水区（斯塔万格和丰纳）与两个没有前驱期干预项目的集水区（卑尔根和东福尔）之间首次发作精神障碍的发病率。本研究的主要目的是在医疗保健系统层面测试前驱期检测与治疗项目的效果。该研究将调查：1）宣传活动与检测团队模式的结合是否有助于早期识别有患精神病高风险的个体（年龄13 - 65岁，符合研究纳入标准），以及2）与随访评估中的转化率相比，分级多模式治疗项目是否能降低转化率。
讨论
积极结果可能会通过更早治疗风险而非更晚治疗疾病来彻底改变治疗方法，并可能开启精神病早期检测与干预的新时代。消极结果将表明，精神病的可能性在生命早期就已确定，研究应更多地关注与基因相关的神经发育过程。如果我们能够高精度地识别即将患精神病的人，我们就可以跟踪他们，以更深入地了解精神病的发展过程。在此阶段进行适当干预还可以预防或延迟精神病的发作和/或随后的恶化，即社会和工具性残疾、自杀、攻击行为、情感和认知缺陷。
试验注册
当前受控试验ISRCTN20328848。2014年11月2日注册。
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