Fusar-Poli Paolo, Cappucciati Marco, De Micheli Andrea, Rutigliano Grazia, Bonoldi Ilaria, Tognin Stefania, Ramella-Cravaro Valentina, Castagnini Augusto, McGuire Philip
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK;
OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK.
Schizophr Bull. 2017 Jan;43(1):48-56. doi: 10.1093/schbul/sbw151.
Brief Limited Intermittent Psychotic Symptoms (BLIPS) are key inclusion criteria to define individuals at ultra high risk for psychosis (UHR). Their diagnostic and prognostic significance is unclear.
To address the baseline diagnostic relationship between BLIPS and the ICD-10 categories and examine the longitudinal prognostic impact of clinical and sociodemographic factors.
Prospective long-term study in UHR individuals meeting BLIPS criteria. Sociodemographic and clinical data, including ICD-10 diagnoses, were automatically drawn from electronic health records and analyzed using Kaplan-Meier failure function (1-survival), Cox regression models, bootstrapping methods, and Receiver Operating Characteristics (ROC) curve.
Eighty BLIPS were included. At baseline, two-thirds (68%) of BLIPS met the diagnostic criteria for ICD-10 Acute and Transient Psychotic Disorder (ATPD), most featuring schizophrenic symptoms. The remaining individuals met ICD-10 diagnostic criteria for unspecified nonorganic psychosis (15%), mental and behavioral disorders due to use of cannabinoids (11%), and mania with psychotic symptoms (6%). The overall 5-year risk of psychosis was 0.54. Recurrent episodes of BLIPS were relatively rare (11%) but associated with a higher risk of psychosis (hazard ratio [HR] 3.98) than mono-episodic BLIPS at the univariate analysis. Multivariate analysis revealed that seriously disorganizing or dangerous features increased greatly (HR = 4.39) the risk of psychosis (0.89 at 5-year). Bootstrapping confirmed the robustness of this predictor (area under the ROC = 0.74).
BLIPS are most likely to fulfill the ATPD criteria, mainly acute schizophrenic subtypes. About half of BLIPS cases develops a psychotic disorder during follow-up. Recurrent BLIPS are relatively rare but tend to develop into psychosis. BLIPS with seriously disorganizing or dangerous features have an extreme high risk of psychosis.
短暂有限间歇性精神病性症状（BLIPS）是定义精神病超高风险（UHR）个体的关键纳入标准。其诊断和预后意义尚不清楚。
探讨BLIPS与ICD - 10类别之间的基线诊断关系，并研究临床和社会人口学因素的纵向预后影响。
对符合BLIPS标准的UHR个体进行前瞻性长期研究。社会人口学和临床数据，包括ICD - 10诊断，自动从电子健康记录中提取，并使用Kaplan - Meier失败函数（1 - 生存率）、Cox回归模型、自助法和受试者工作特征（ROC）曲线进行分析。
纳入80例BLIPS患者。基线时，三分之二（68%）的BLIPS符合ICD - 10急性和短暂性精神病性障碍（ATPD）的诊断标准，大多数表现为精神分裂症症状。其余个体符合ICD - 10未特定的非器质性精神病（15%）、使用大麻所致精神和行为障碍（11%）以及伴有精神病性症状的躁狂症（6%）的诊断标准。精神病的总体5年风险为0.54。BLIPS的复发相对少见（11%），但在单变量分析中，与单次发作的BLIPS相比，复发与更高的精神病风险相关（风险比[HR] 3.98）。多变量分析显示，严重的紊乱或危险特征使精神病风险大幅增加（HR = 4.39）（5年时为0.89）。自助法证实了该预测指标的稳健性（ROC曲线下面积 = 0.74）。
BLIPS最有可能符合ATPD标准，主要是急性精神分裂症亚型。约一半的BLIPS病例在随访期间发展为精神病性障碍。复发的BLIPS相对少见，但倾向于发展为精神病。具有严重紊乱或危险特征的BLIPS患精神病的风险极高。
