Lim Kyung-Ok, Lee Tae Young, Kim Minah, Chon Myong-Wuk, Yun Je-Yeon, Kim Sung Nyun, Kwon Jun Soo
Department of Neuropsychiatry, Seoul National University Hospital, Republic of Korea.
Department of Psychiatry, Seoul National University College of Medicine, Republic of Korea.
Early Interv Psychiatry. 2018 Aug;12(4):596-604. doi: 10.1111/eip.12363. Epub 2016 Sep 7.
A clinical high risk (CHR) for psychosis is regarded as the state of being at risk of developing psychosis. However, the rate of transition to psychosis among CHR subjects has been declining over time. We aimed to investigate the effects of the possible causes of the declining transition rate.
A total of 129 CHR subjects were divided into two groups according to the date of enrollment: the 2005-2009 group and the 2009-2013 group. Baseline demographic and clinical characteristics, including medication prescription, were compared. The duration of untreated prodromal positive symptoms (DUPP) was used to account for early referral.
The transition rate to psychosis in the 2009-2013 group was significantly lower than that in the 2005-2009 group (χ = 4.664, P = 0.031), although the risk factors of transition, intelligence quotient and prodromal positive symptoms did not differ between the two groups. When the DUPP was added to the follow-up duration, the between-group difference in the transition rates was no longer significant; however, the P-value was low (χ = 2.761, P = 0.097). After adjusting for axis II comorbidities other than schizotypal personality disorder, the effect of group division on the transition rate disappeared; however, the P-value was also low (P = 0.072). The mean olanzapine equivalent dose and the proportion of subjects prescribed with antidepressant or anxiolytic did not differ between the two groups.
Early referral and axis II comorbidities other than schizotypal personality disorder were associated with the declining transition rate.
临床精神病高危状态（CHR）被视为有发展为精神病风险的状态。然而，随着时间推移，CHR受试者发展为精神病的转化率一直在下降。我们旨在研究转化率下降可能原因的影响。
根据入组日期将129名CHR受试者分为两组：2005 - 2009组和2009 - 2013组。比较了包括用药处方在内的基线人口统计学和临床特征。未治疗前驱期阳性症状持续时间（DUPP）用于说明早期转诊情况。
2009 - 2013组发展为精神病的转化率显著低于2005 - 2009组（χ = 4.664，P = 0.031），尽管两组之间转化的风险因素、智商和前驱期阳性症状并无差异。当将DUPP纳入随访持续时间时，两组之间转化率的组间差异不再显著；然而，P值较低（χ = 2.761，P = 0.097）。在调整除分裂型人格障碍以外的轴II共病后，分组对转化率的影响消失；然而，P值也较低（P = 0.072）。两组之间奥氮平等效剂量均值以及开具抗抑郁药或抗焦虑药的受试者比例并无差异。
早期转诊以及除分裂型人格障碍以外的轴II共病与转化率下降有关。
