首发精神病的预后——为何我们应在各个年龄段尽早干预，而不仅是在青少年时期。
Outcomes following first-episode psychosis - Why we should intervene early in all ages, not only in youth.
作者信息
Lappin Julia M, Heslin Margaret, Jones Peter B, Doody Gillian A, Reininghaus Ulrich A, Demjaha Arsime, Croudace Timothy, Jamieson-Craig Thomas, Donoghue Kim, Lomas Ben, Fearon Paul, Murray Robin M, Dazzan Paola, Morgan Craig
机构信息
School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
出版信息
Aust N Z J Psychiatry. 2016 Nov;50(11):1055-1063. doi: 10.1177/0004867416673454. Epub 2016 Oct 18.
OBJECTIVE
To compare baseline demographics and 10-year outcomes of a first-episode psychosis patient incidence cohort in order to establish whether current youth-focussed age-based criteria for early intervention services are justified by patient needs. The patients in this cohort were treated prior to the establishment of early intervention services. The study aimed to test the hypothesis that those who develop psychosis at a younger age have worse outcomes than those who develop psychosis at an older age.
METHODS
Data on first-episode psychosis patients from the ÆSOP-10 longitudinal follow-up study were used to compare baseline characteristics, and 10-year clinical, functional and service use outcomes between those patients who would and would not have met age-based criteria for early intervention services, in Australia or in the United Kingdom.
RESULTS
In total, 58% men and 71% women with first-episode psychosis were too old to meet current Australian-early intervention age-entry criteria (χ = 9.1, p = 0.003), while 21% men and 34% women were too old for UK-early intervention age-entry criteria (χ = 11.1, p = 0.001). The 10-year clinical and functional outcomes did not differ significantly between groups by either Australian- or UK-early intervention age-entry criteria. Service use was significantly greater among the patients young enough to meet early intervention age-criteria (Australia: incidence rate ratio = 1.35 [1.19, 1.52], p < 0.001; United Kingdom: incidence rate ratio = 1.65 [1.41, 1.93], p < 0.001).
CONCLUSION
Current early intervention services are gender- and age-inequitable. Large numbers of patients with first-episode psychosis will not receive early intervention care under current service provision. Illness outcomes at 10-years were no worse in first-episode psychosis patients who presented within the age range for whom early intervention has been prioritised, though these patients had greater service use. These data provide a rationale to consider extension of early intervention to all, rather than just to youth.
目的
比较首发精神病患者发病队列的基线人口统计学特征和10年结局，以确定当前以青年为重点的基于年龄的早期干预服务标准是否符合患者需求。该队列中的患者在早期干预服务建立之前接受治疗。本研究旨在检验以下假设：年轻时患精神病的患者比年长时患精神病的患者结局更差。
方法
来自澳大利亚精神分裂症首发患者10年纵向随访研究（ÆSOP-10）的数据，用于比较符合和不符合澳大利亚或英国基于年龄的早期干预服务标准的患者之间的基线特征、10年临床、功能和服务使用结局。
结果
总的来说，首发精神病男性患者中有58%、女性患者中有71%年龄太大，不符合当前澳大利亚早期干预的年龄准入标准（χ² = 9.1，p = 0.003），而21%的男性和34%的女性年龄太大，不符合英国早期干预的年龄准入标准（χ² = 11.1，p = 0.001）。根据澳大利亚或英国早期干预年龄准入标准划分的组间，10年临床和功能结局无显著差异。年龄足够小符合早期干预年龄标准的患者服务使用显著更多（澳大利亚：发病率比 = 1.35 [1.19, 1.52]，p < 0.001；英国：发病率比 = 1.65 [1.41, 1.93]，p < 0.001）。
结论
当前的早期干预服务存在性别和年龄不平等。在当前的服务提供模式下，大量首发精神病患者无法获得早期干预护理。在早期干预优先考虑的年龄范围内出现的首发精神病患者，其10年疾病结局并不更差，尽管这些患者的服务使用更多。这些数据为将早期干预扩展到所有患者而不仅仅是年轻人提供了理论依据。
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