Vrije Universiteit, Amsterdam Public Health Research, Parnassia Psychiatric Institute, Department of Clinical Psychology, Van der Boechorsttraat 1, 1081 BT Amsterdam, The Netherlands.
Parnassia Psychiatric Institute, Department of Psychosis Research, Zoutkeetsingel 40, 2512 HN The Hague, The Netherlands.
Schizophr Res. 2019 Jan;203:88-93. doi: 10.1016/j.schres.2017.08.018. Epub 2017 Aug 30.
Patients with an 'At risk mental state' (ARMS) for developing psychosis can be treated successfully with CBT to postpone and prevent the transition to a first psychotic episode. A characteristic of individuals that meet ARMS criteria is that they are still open for multiple explanations for extraordinary experiences. CBT aims to normalize extraordinary experiences with education and to prevent delusional explanations. The treatment is not only effective, but also cost-saving in averting psychosis as well as in reducing disability adjusted life years at 18- and 48-month follow-up. Profiling within the ARMS group results in a personalized treatment. The screening and early treatment for ARMS fulfills all the criteria of the World Health Organization and is ready to be routine screening and treatment in mental health care. At the same time, ARMS patients are complex patients with multi-morbid disorders. Especially childhood trauma is associated to ARMS status, together with co-morbid PTSD, depression, substance abuse and anxiety disorders. Psychotic symptoms appear to be severity markers in other non-psychotic disorders. Preventing psychosis in ARMS patients should be broadened to also address other disorders and aim to reduce chronicity of psychopathology and improve social functioning in general. Several mechanisms play a part in psychopathology in ARMS patients such as stress sensitivity as a result of adverse experiences, dopamine sensitivity that is associated with salience and aggravates several cognitive biases, dissociation mediating between trauma and hallucinations, and low self-esteem and self-stigma. New avenues to treat the complexity of ARMS patients will be proposed.
患有精神病前期“（ARMS）的患者可以通过认知行为疗法（CBT）成功治疗，以延缓和预防首次精神病发作。符合 ARMS 标准的个体的一个特征是，他们仍然对异常体验的多种解释持开放态度。CBT 的目的是通过教育使异常体验正常化，并防止妄想解释。这种治疗不仅有效，而且可以节省避免精神病以及减少 18 个月和 48 个月随访时残疾调整生命年的成本。在 ARMS 组内进行分析可以得出个性化的治疗方案。对 ARMS 进行筛查和早期治疗符合世界卫生组织的所有标准，并且已经准备好成为精神卫生保健的常规筛查和治疗。同时，ARMS 患者是患有多种疾病的复杂患者。特别是儿童创伤与 ARMS 状态有关，同时还伴有共病创伤后应激障碍、抑郁、药物滥用和焦虑障碍。精神病症状似乎是非精神病性疾病严重程度的标志。预防 ARMS 患者的精神病应扩大到解决其他疾病，并旨在减少精神病理学的慢性化并普遍改善社会功能。在 ARMS 患者的精神病理学中，有几个机制发挥作用，例如由于不良经历而导致的应激敏感性、与突显相关并加重几种认知偏差的多巴胺敏感性、在创伤和幻觉之间起中介作用的解离、以及低自尊和自我污名。将提出新的方法来治疗 ARMS 患者的复杂性。
