Tedja Amy, Velthorst Eva, van Tricht Mirjam, de Haan Lieuwe
Academic Medical Center, Dept. of Psychiatry, Early Psychosis Unit, Meibergdreef 5, 1105 AZ, Amsterdam.
Icahn School of Medicine at Mount Sinai, Departments of Psychiatry and Preventive medicine, New York, US.
Clin Schizophr Relat Psychoses. 2017 Aug 4. doi: 10.3371/CSRP.ATEV.071317.
Clinical staging for schizophrenia and related disorders might provide an ideal means to overcome some limitations of the current diagnostic system and to facilitate early intervention. This study aims to retrospectively explore 1) the validity of a staging model 2) the stability of staging over time, and 3) the clinical factors associated with transition to more chronic stages. Data were derived from the Genetic Risk and Outcome of Psychosis study, a large cohort study of patients with a schizophrenia spectrum disorder. We assigned patients to a clinical stage, according to methods described by McGorry in 2010, using PANSS and GAF measures at baseline and three-year follow-up. Distinction between the stages was best explained by worse symptomatic, social and neurocognitive functioning in the first ('First Episode of Psychosis'), and last stage ('Severe/Persisting illness') as compared to the intermediate stages. Approximately half of the participants changed stages over time. Transition to more chronic stages was associated with worse premorbid functioning, higher levels of hostility and depressive symptoms and lower quality of life at baseline. We conclude that the clinical staging model was applicable in our sample. However, distinction between the intermediate stages and their prognostic validity could be improved.
精神分裂症及相关障碍的临床分期可能是克服当前诊断系统某些局限性并促进早期干预的理想方法。本研究旨在回顾性探索：1）分期模型的有效性；2）分期随时间的稳定性；3）与向更慢性阶段转变相关的临床因素。数据来自精神病遗传风险与结局研究，这是一项针对精神分裂症谱系障碍患者的大型队列研究。我们根据McGorry在2010年描述的方法，在基线和三年随访时使用阳性和阴性症状量表（PANSS）及大体功能评定量表（GAF）将患者分配到临床阶段。与中间阶段相比，在第一阶段（“精神病首次发作”）和最后阶段（“严重/持续性疾病”），症状、社会和神经认知功能较差最能解释各阶段之间的差异。大约一半的参与者随时间改变了阶段。向更慢性阶段的转变与病前功能较差、较高水平的敌意和抑郁症状以及基线时较低的生活质量相关。我们得出结论，临床分期模型适用于我们的样本。然而，中间阶段之间的区分及其预后有效性可以得到改善。
