Shah Jai L, Tandon Neeraj, Montrose Debra M, Mermon Diana, Eack Shaun M, Miewald Jean, Keshavan Matcheri S
Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
Early Interv Psychiatry. 2019 Apr;13(2):297-303. doi: 10.1111/eip.12480. Epub 2017 Sep 7.
While the course of psychopathology has been explored from an index mental health diagnosis onwards, there are few detailed, prospective studies of the occurrence of clinical psychopathology in youth with familial risk for severe mental illnesses such as psychosis. We sought to describe the appearance of Axis I psychopathology in a unique sample of adolescents with a family history of schizophrenia (FHR).
One hundred and sixty two first- and second-degree relatives (mean age 15.7 ± 3.6; range 8-25) of probands with schizophrenia or schizoaffective disorder were assessed at baseline and annual intervals for up to 3 years, focusing on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) Axis I psychopathology.
Fourteen individuals (8.6%) developed a psychotic disorder. One hundred and five subjects (65%) met criteria for an Axis I disorder over the course of the study, the most common of which was a depressive episode (40 subjects; 25%). Of the 148 individuals who did not develop psychosis, 91 (61%) had one or more Axis I disorders compared with 10/14 converters who had a comorbid Axis I disorder (71%). Ordered by increasing age of onset, diagnoses included cognitive and externalizing disorders, anxiety disorders, affective disorders, substance use disorders and psychotic disorders.
In addition to an elevated risk of psychosis, young FHR relatives manifest a broad range of non-psychotic Axis I psychopathology in childhood and adolescence. This breadth of diagnoses has implications for the structure and function of mental health services for young people.
虽然精神病理学的病程已从索引心理健康诊断开始进行探索，但针对有精神病等严重精神疾病家族风险的青少年临床精神病理学发生情况的详细前瞻性研究却很少。我们试图描述在有精神分裂症家族史（FHR）的青少年独特样本中轴I精神病理学的表现。
对162名精神分裂症或分裂情感性障碍先证者的一级和二级亲属（平均年龄15.7±3.6岁；范围8 - 25岁）在基线时进行评估，并每年随访一次，最长随访3年，重点关注《精神障碍诊断与统计手册》第四版，修订版（DSM-IV-TR）轴I精神病理学。
14名个体（8.6%）患上了精神病性障碍。在研究过程中，105名受试者（65%）符合轴I障碍的标准，其中最常见的是抑郁发作（40名受试者；25%）。在未患精神病的148名个体中，91名（61%）有一种或多种轴I障碍，而在14名患精神病的个体中有10名（71%）患有共病轴I障碍。按发病年龄递增排序，诊断包括认知和外化障碍、焦虑障碍、情感障碍、物质使用障碍和精神病性障碍。
除了患精神病的风险增加外，有精神分裂症家族史的年轻亲属在儿童期和青少年期还表现出广泛的非精神病性轴I精神病理学。这种广泛的诊断结果对青少年心理健康服务的结构和功能具有影响。
