Scott J, Henry C
Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle-upon-Tyne, United Kingdom.
Institut pasteur, unité perception et mémoire, F-75015 Paris, France - Université Paris-Est, UMR S955, UPEC, F-94000 Créteil, France - AP-HP, Hôpital Henri-Mondor, Albert-Chenevier, pôle de psychiatrie, F-94000 Créteil, France.
Encephale. 2018 Dec;44(6S):S30-S33. doi: 10.1016/S0013-7006(19)30076-4.
In psychiatry, clinical staging raises awareness of the need to understand disease trajectories and heterotypic continuity; it draws attention to individuals at risk of developing disorders, such as those with a family history or subsyndromal presentations; and it actively promotes greater attention to prevention strategies and interventions for individuals at ultra-high risk of developing a severe mental disorder. Staging paradigms have been increasingly applied in early intervention in psychoses, but there are issues in broadening the scope of clinical staging to the more prevalent affective disorders. For example, it is potentially more complex to devise a model that considers the varying clinical presentations of the late prodromal stage of bipolar disorder and where to locate depressive episodes that precede the first manic episode and how to describe subthreshold manic syndromes, especially hypomania. The above issues might be resolved if we had a greater understanding of the risk factors, biomarkers or endophenotypes for the onset and progression of bipolar disorder. This level of understanding is not yet available in psychiatry, but clinical staging may help us improve our knowledge of the pathophysiological correlates of disease progression and reduce our over-reliance on cross-sectional assessments of symptoms in bipolar disorders.
在精神病学中，临床分期提高了对理解疾病轨迹和异型连续性必要性的认识；它使人们关注有患精神障碍风险的个体，例如那些有家族病史或亚综合征表现的个体；并且它积极促进对处于发展为严重精神障碍超高风险的个体的预防策略和干预措施给予更多关注。分期范式已越来越多地应用于精神病的早期干预，但在将临床分期的范围扩大到更常见的情感障碍方面存在问题。例如，设计一个考虑双相情感障碍晚期前驱期不同临床表现的模型可能更复杂，以及如何定位首次躁狂发作之前的抑郁发作，如何描述阈下躁狂综合征，尤其是轻躁狂。如果我们对双相情感障碍的发病和进展的危险因素、生物标志物或内表型有更深入的了解，上述问题可能会得到解决。在精神病学中尚未达到这种理解水平，但临床分期可能有助于我们提高对疾病进展的病理生理相关性的认识，并减少我们对双相情感障碍症状横断面评估的过度依赖。
