Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea.
Schizophr Bull. 2018 Feb 15;44(2):276-285. doi: 10.1093/schbul/sbx173.
Recent evidence has suggested that psychosis could develop not only in people at clinical high risk for psychosis (CHR-P) but also in those with clinical risk syndromes for emergent nonpsychotic mental disorders. The proportion of people with these clinical risk syndromes who will develop psychosis rather than to other nonpsychotic mental disorders is undetermined. Electronic databases were searched for studies reporting on clinical risk syndromes for the development of emergent nonpsychotic mental disorders. Incidence of emerging psychotic and nonpsychotic mental disorders defined on the ICD or DSM. Of a total of 9 studies relating to 3006 nonpsychotic at-risk individuals were included. Within prospective studies (n = 4, sample = 1051), the pooled incidence of new psychotic disorders across these clinical risk syndromes was of 12.9 per 1000 person-years (95% CI: 4.3 to 38.6) and that of nonpsychotic disorders (n = 3, sample = 538) was of 43.5 per 1000 person-years (95% CI: 30.9 to 61.3). Psychotic disorders may emerge outside the CHR-P paradigm, from clinical risk syndromes for incident nonpsychotic disorders, albeit at lower rates than in the CHR-P group. The clinical risk syndromes for emerging nonpsychotic disorders may exhibit a pluripotential risk of developing several types of mental disorders compared with CHR-P. If substantiated by future research, the current findings suggest that it may be useful to move beyond the current strategy of identifying individuals meeting CHR-P criteria only.
最近的证据表明，精神病不仅可能发生在有精神病临床高风险（CHR-P）的人群中，也可能发生在有临床风险综合征的急性非精神病性精神障碍人群中。这些有临床风险综合征的人群中，有多少人会发展为精神病，而不是其他非精神病性精神障碍，目前还不确定。电子数据库中检索了报告关于急性非精神病性精神障碍发展的临床风险综合征的研究。ICD 或 DSM 定义的新发精神病和非精神病性精神障碍的发病率。共有 9 项涉及 3006 名非精神病高危个体的研究被纳入。在前瞻性研究（n=4，样本=1051）中，这些临床风险综合征新发精神病障碍的累积发病率为每 1000 人年 12.9 例（95%CI：4.3 至 38.6），非精神病障碍（n=3，样本=538）的发病率为每 1000 人年 43.5 例（95%CI：30.9 至 61.3）。精神病可能发生在 CHR-P 范式之外，源于急性非精神病性障碍的临床风险综合征，尽管发病率低于 CHR-P 组。与 CHR-P 相比，新发非精神病性障碍的临床风险综合征可能表现出多种精神障碍的多潜能风险。如果未来的研究得到证实，目前的发现表明，超越目前仅识别符合 CHR-P 标准的个体的策略可能是有用的。
