Schimmelmann Benno G, Michel Chantal, Martz-Irngartinger Alexandra, Linder Caroline, Schultze-Lutter Frauke
University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3000 Bern 60, Switzerland.
World Psychiatry. 2015 Jun;14(2):189-97. doi: 10.1002/wps.20216.
Early detection of psychosis is an important topic in psychiatry. Yet, there is limited information on the prevalence and clinical significance of high-risk symptoms in children and adolescents as compared to adults. We examined ultra-high-risk (UHR) symptoms and criteria in a sample of individuals aged 8-40 years from the general population of Canton Bern, Switzerland, enrolled from June 2011 to May 2014. The current presence of attenuated psychotic symptoms (APS) and brief intermittent psychotic symptoms (BLIPS) and the fulfillment of onset/worsening and frequency requirements for these symptoms in UHR criteria were assessed using the Structured Interview for Psychosis Risk Syndromes. Additionally, perceptive and non-perceptive APS were differentiated. Psychosocial functioning and current non-psychotic DSM-IV axis I disorders were also surveyed. Well-trained psychologists performed assessments. Altogether, 9.9% of subjects reported APS and none BLIPS, and 1.3% met all the UHR requirements for APS. APS were related to more current axis I disorders and impaired psychosocial functioning, indicating some clinical significance. A strong age effect was detected around age 16: compared to older individuals, 8-15-year olds reported more perceptive APS, that is, unusual perceptual experiences and attenuated hallucinations. Perceptive APS were generally less related to functional impairment, regardless of age. Conversely, non-perceptive APS were related to low functioning, although this relationship was weaker in those below age 16. Future studies should address the differential effects of perceptive and non-perceptive APS, and their interaction with age, also in terms of conversion to psychosis.
精神病的早期检测是精神病学中的一个重要课题。然而，与成年人相比，关于儿童和青少年高危症状的患病率及临床意义的信息有限。我们对2011年6月至2014年5月从瑞士伯尔尼州普通人群中招募的8至40岁个体样本中的超高危（UHR）症状及标准进行了研究。使用精神病风险综合征结构化访谈评估了目前是否存在精神病性症状衰减（APS）和短暂间歇性精神病性症状（BLIPS），以及这些症状在UHR标准中发病/加重情况和频率要求的满足情况。此外，还区分了感知性和非感知性APS。同时调查了社会心理功能和当前的非精神病性DSM-IV轴I障碍。由训练有素的心理学家进行评估。总体而言，9.9%的受试者报告有APS，无人报告有BLIPS，1.3%的受试者符合APS的所有UHR要求。APS与更多当前的轴I障碍及受损的社会心理功能相关，表明具有一定临床意义。在16岁左右发现了强烈的年龄效应：与年龄较大的个体相比，8至15岁的儿童报告有更多的感知性APS，即异常的感知体验和幻觉衰减。无论年龄大小，感知性APS通常与功能损害的相关性较小。相反，非感知性APS与功能低下相关，尽管这种关系在16岁以下的人群中较弱。未来的研究应探讨感知性和非感知性APS的不同影响，以及它们与年龄的相互作用，包括向精神病转化方面。
