Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Martinistreet 52, 20246 Hamburg, Germany.
Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Germany.
Schizophr Res. 2018 Mar;193:377-383. doi: 10.1016/j.schres.2017.07.036. Epub 2017 Aug 1.
People with psychotic disorders fulfilling criteria of a severe and persistent mental illness (SPMI) display a high risk of somatic comorbidity (SC).
ACCESS II is a prospective, long-term study examining the effectiveness of Integrated Care for people with psychotic disorders fulfilling SPMI criteria. Chronic comorbid somatic disorders were systematically assessed according to ICD-10-GM criteria. Patients treated for ≥4years in ACCESS were categorized as early psychosis (treatment: ≤2years) or non-early psychosis (treatment: >2years) patients.
Of 187 patients treated in ACCESS for ≥4years (mean age=41.8years, males=44.4%), 145 (77.5%) had SC, (mean=2.1±2.1). Overall, 55 different diseases from 15 different ICD-10-GM disease areas were identified. Prevalence of ≥1 SC (p=0.09) and specific types of SC (p=0.08-1.00) did not differ between early and non-early psychosis patients, but non-early psychosis patients had a higher mean number of SC (2.3±2.2 vs. 1.3±1.3, p=0.002). SC patients had higher rates of comorbid mental disorders (93% vs. 81%, p=0.002), specifically posttraumatic stress disorder (23% vs. 7%, p=0.002), and suicide attempts (43% vs. 19%, p<0.001). At the 4-year endpoint, both patients with and without comorbidity displayed major improvements in psychopathology, severity of illness, functioning, quality of life and satisfaction with care.
SC is frequent in patients with severe psychotic disorders, even in the early psychosis phase. The magnitude of the problem underlines the need for regular screening, comprehensive assessment, preventive pharmacotherapy, and targeted SC management.
符合严重和持续性精神疾病（SPMI）标准的精神病患者存在较高的躯体共病（SC）风险。
ACCESS II 是一项前瞻性、长期研究，旨在评估综合护理对符合 SPMI 标准的精神病患者的疗效。根据 ICD-10-GM 标准系统评估慢性共患躯体疾病。根据 ACCESS 的治疗时间，将接受治疗≥4 年的患者分为早期精神病（治疗时间：≤2 年）或非早期精神病（治疗时间：>2 年）患者。
在接受 ACCESS 治疗≥4 年的 187 名患者中（平均年龄为 41.8 岁，男性占 44.4%），145 名（77.5%）患有 SC，（平均=2.1±2.1）。总体而言，从 15 个不同的 ICD-10-GM 疾病领域中识别出 55 种不同的疾病。早期精神病和非早期精神病患者之间的 SC 患病率（p=0.09）和特定类型的 SC（p=0.08-1.00）无差异，但非早期精神病患者的 SC 平均数量更高（2.3±2.2 比 1.3±1.3，p=0.002）。SC 患者的合并精神障碍发生率更高（93%比 81%，p=0.002），特别是创伤后应激障碍（23%比 7%，p=0.002）和自杀企图（43%比 19%，p<0.001）。在 4 年的终点，无论是否合并疾病，患者的精神病理学、疾病严重程度、功能、生活质量和护理满意度均有显著改善。
严重精神病患者中 SC 很常见，即使在早期精神病阶段也是如此。这一问题的严重程度突出表明需要定期筛查、全面评估、预防性药物治疗和针对性的 SC 管理。
