van Os Jim, Reininghaus Uli
Department of Psychiatry and Psychology, Maastricht University Medical Centre, P.O. Box 616 (DOT12), 6200 MD Maastricht, The Netherlands.
King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK.
World Psychiatry. 2016 Jun;15(2):118-24. doi: 10.1002/wps.20310.
A large body of research indicates that weak expressions of positive psychotic symptoms ("psychotic experiences") can be measured in the general population, and likely represent the behavioural manifestation of distributed multifactorial (genetic and non-genetic) risk for psychosis. Psychotic experiences are a transdiagnostic phenomenon: the majority of individuals with these experiences have a diagnosis of non-psychotic disorder, particularly common mental disorder, in which psychotic experiences predict greater illness severity and poorer treatment response. Some of the people with common mental disorder and psychotic experiences will present to mental health services meeting criteria for "clinical high risk". Treatment of the transdiagnostic dimension of psychosis in individuals with common mental disorder who meet "clinical high risk" criteria thus may improve outcome (which cannot be interpreted as prevention of "schizophrenia"). Subthreshold psychotic experiences are transitory in about 80% of individuals, while around 20% go on to develop persistent psychotic experiences and 7% a psychotic disorder, with an annual transition rate of 0.5-1%. Persistence is associated, on the one hand, with environmental exposures, particularly childhood trauma, and, on the other, with network-type dynamic interactions between psychotic experiences themselves (e.g., interactions between hallucinatory experiences and delusional ideation) and between symptom dimensions (e.g., interactions between affective symptoms and psychotic experiences, or interactions between subthreshold negative symptoms and psychotic experiences). The study of psychotic experiences is helping to elucidate the mechanisms by which environmental and genetic influences shape the transdiagnostic expression of psychosis proneness, that is mostly transitory but may first become persistent over time and eventually give rise to transition to a psychotic disorder.
大量研究表明，在普通人群中可以测量出阳性精神病性症状（“精神病性体验”）的微弱表现，并且这些表现可能代表了精神病多因素（遗传和非遗传）风险的行为表现。精神病性体验是一种跨诊断现象：大多数有这些体验的个体被诊断为非精神病性障碍，尤其是常见精神障碍，在这类障碍中，精神病性体验预示着更严重的疾病程度和更差的治疗反应。一些患有常见精神障碍和精神病性体验的人会因符合“临床高危”标准而寻求心理健康服务。因此，对符合“临床高危”标准的患有常见精神障碍的个体的精神病跨诊断维度进行治疗，可能会改善治疗结果（但这不能被解释为预防“精神分裂症”）。亚阈值精神病性体验在约80%的个体中是短暂的，而约20%的个体则会发展为持续性精神病性体验，7%的个体发展为精神病性障碍，年转变率为0.5%-1%。一方面，持续性与环境暴露有关，尤其是童年创伤；另一方面，与精神病性体验自身之间的网络型动态相互作用（例如，幻觉体验与妄想观念之间的相互作用）以及症状维度之间的相互作用（例如，情感症状与精神病性体验之间的相互作用，或亚阈值阴性症状与精神病性体验之间的相互作用）有关。对精神病性体验的研究有助于阐明环境和遗传影响塑造精神病易感性跨诊断表现的机制，这种表现大多是短暂的，但随着时间的推移可能首先会变得持续，最终导致向精神病性障碍的转变。
