Spada Giulia, Molteni S, Pistone C, Chiappedi M, McGuire P, Fusar-Poli P, Balottin U
Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK.
OASIS Prodromal Team, South London and the Maudsley (SLaM) NHS Foundation Trust, London, UK.
Eur Child Adolesc Psychiatry. 2016 Jan;25(1):91-106. doi: 10.1007/s00787-015-0710-8. Epub 2015 Apr 30.
The past 20 years have seen the evolution of the construct of a clinical high-risk (hereafter, HR) state for psychosis. This construct is designed to capture the pre-psychotic phase. Some aspects of this approach, such as its feasibility in children and adolescents, are still under investigation. In the present study, we address the feasibility of implementing prodrome clinics for HR individuals within the framework of Italy's national child and adolescent neuropsychiatry services and the clinical relevance of a HR diagnosis in this population. Using the Comprehensive Assessment of At-Risk Mental States (CAARMS) to identify help-seeking patients meeting at least one HR criterion at baseline (HR+), we recruited 50 subjects for a feasibility study. The results obtained show that the Italian version of the CAARMS is easily administrable, causing patients no substantial discomfort. The prevalence of HR+ in our cohort was 44 %, which increased by an additional 18 % when negative symptoms were considered as an experimental inclusion criterion (HRNeg). The HR+ subjects were significantly more impaired in their social and occupational functioning than their HR- peers (subjects not at HR). The cumulative 1-year transition risk of psychosis of the HR+ group was 26.7 %. When the HRNeg group was added, the 1-year transition risk was 17.3 %. We suggest that administration of the CAARMS to children and adolescents with putative prodromal psychosis is feasible and that this assessment can easily be integrated into existing Italian neuropsychiatry services although clinicians should interpret results with caution as results in this age group still have to be replicated.
在过去20年里，精神病临床高危（以下简称HR）状态这一概念不断演变。该概念旨在捕捉精神病发作前阶段。这种方法的某些方面，比如在儿童和青少年中的可行性，仍在研究之中。在本研究中，我们探讨了在意大利国家儿童和青少年神经精神病学服务框架内为HR个体开设前驱期诊所的可行性，以及HR诊断在该人群中的临床相关性。我们使用高危精神状态综合评估（CAARMS）来识别在基线时至少符合一项HR标准的求助患者（HR+），招募了50名受试者进行可行性研究。所得结果表明，意大利版的CAARMS易于实施，不会给患者带来实质性不适。我们队列中HR+的患病率为44%，若将阴性症状视为实验纳入标准（HRNeg），患病率会额外增加18%。HR+受试者在社交和职业功能方面的受损程度明显高于HR-同龄人（非HR受试者）。HR+组精神病的累积1年转化风险为26.7%。加入HRNeg组后，1年转化风险为17.3%。我们认为，对疑似前驱期精神病的儿童和青少年实施CAARMS评估是可行的，并且这种评估可以轻松融入现有的意大利神经精神病学服务中，不过临床医生在解读结果时应谨慎，因为该年龄组的结果仍需重复验证。
