Simon Gregory E, Coleman Karen J, Yarborough Bobbi Jo H, Operskalski Belinda, Stewart Christine, Hunkeler Enid M, Lynch Frances, Carrell David, Beck Arne
Dr. Simon, Ms. Operskalski, Dr. Stewart, and Dr. Carrell are with the Group Health Research Institute, Group Health Cooperative, Seattle (e-mail:
Psychiatr Serv. 2017 May 1;68(5):456-461. doi: 10.1176/appi.ps.201600257. Epub 2017 Jan 3.
Increasing evidence supports the effectiveness of comprehensive early intervention at first onset of psychotic symptoms. Implementation of early intervention programs will require population-based data on overall incidence of psychotic symptoms and on care settings of first presentation.
In five large health care systems, electronic health records data were used to identify all first occurrences of psychosis diagnoses among persons ages 15-59 between January 1, 2007, and December 31, 2013 (N=37,843). For a random sample of these putative cases (N=1,337), review of full-text medical records confirmed clinician documentation of psychotic symptoms and excluded those with documented prior diagnosis of or treatment for psychosis. Initial incidence rates (based on putative cases) and confirmation rates (from record reviews) were used to estimate true incidence according to age and setting of initial presentation.
Annual incidence estimates based on putative cases were 126 per 100,000 among those ages 15-29 and 107 per 100,000 among those ages 30-59. Rates of chart review confirmation ranged from 84% among those ages 15-29 diagnosed in emergency department or inpatient mental health settings to 19% among those ages 30-59 diagnosed in general medical outpatient settings. Estimated true incidence rates were 86 per 100,000 per year among those ages 15-29 and 46 per 100,000 among those ages 30-59.
When all care settings were included, incidence of first-onset psychotic symptoms was higher than previous estimates based on surveys or inpatient data. Early intervention programs must accommodate frequent presentation after age 30 and presentation in outpatient settings, including primary care.
越来越多的证据支持在精神病症状首次发作时进行全面早期干预的有效性。实施早期干预项目将需要基于人群的精神病症状总体发病率数据以及首次就诊的护理环境数据。
在五个大型医疗保健系统中，利用电子健康记录数据识别2007年1月1日至2013年12月31日期间15至59岁人群中所有首次出现的精神病诊断病例（N = 37,843）。对于这些疑似病例的随机样本（N = 1,337），通过查阅完整的病历确认临床医生记录的精神病症状，并排除那些有记录的先前精神病诊断或治疗史的病例。根据年龄和首次就诊环境，使用初始发病率（基于疑似病例）和确认率（来自病历审查）来估计真实发病率。
基于疑似病例的年度发病率估计为：15至29岁人群中每10万人中有126例，30至59岁人群中每10万人中有107例。病历审查确认率从在急诊科或住院精神卫生机构诊断的15至29岁人群中的84%到在普通内科门诊诊断的30至59岁人群中的19%不等。估计的真实发病率为：15至29岁人群中每年每10万人中有86例，30至59岁人群中每10万人中有46例。
当纳入所有护理环境时，首次发作精神病症状的发病率高于先前基于调查或住院数据的估计。早期干预项目必须适应30岁以后频繁就诊以及在包括初级保健在内的门诊环境中的就诊情况。
