Kennedy Leda, Johnson Kelsey A, Cheng Joyce, Woodberry Kristen A
Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Columbia Irving Medical Center, New York State Psychiatric Institute, New York, NY, United States.
Front Psychiatry. 2020 Jan 31;10:1025. doi: 10.3389/fpsyt.2019.01025. eCollection 2019.
Screening for major mental illness in adolescents and young adults has lagged behind screening for physical illness for a myriad of reasons. Existing pediatric behavioral health screening tools screen primarily for disorders of attention, disruptive behaviors, depression, and anxiety. A few also screen for substance use and suicide risk. Although it is now possible to reliably identify young people at imminent risk for a psychotic disorder, arguably the most severe of mental illnesses, general practitioners (GP) rarely screen for psychotic symptoms or recognize when to refer patients for a specialized risk assessment. Research suggests that barriers such as inadequate knowledge or insufficient access to mental health resources can be overcome with intensive GP education and the integration of physical and mental health services. Under the lens of two public health models outlining the conditions under which disease screening is warranted, we examine additional evidence for and against population-based screening for psychosis in adolescents and young adults. We argue that systematic screening within general health settings awaits a developmentally well-normed screening tool that includes probes for psychosis, is written at a sufficiently low reading level, and has acceptable sensitivity and, in particular, specificity for detecting psychosis and psychosis risk in both adolescents and young adults. As integrated healthcare models expand around the globe and psychosis-risk assessments and treatments improve, a stratified screening and careful risk management protocol for GP settings could facilitate timely early intervention that effectively balances the benefit/risk ratio of employing such a screening tool at the population level.
由于众多原因，青少年和青年的严重精神疾病筛查一直落后于身体疾病筛查。现有的儿科行为健康筛查工具主要针对注意力障碍、破坏性行为、抑郁和焦虑症进行筛查。少数工具还会筛查物质使用情况和自杀风险。尽管现在已经能够可靠地识别出即将出现精神障碍风险的年轻人，而精神障碍可以说是最严重的精神疾病，但全科医生（GP）很少筛查精神病症状，也很少意识到何时应将患者转介进行专门的风险评估。研究表明，通过强化全科医生教育以及整合身心健康服务，可以克服诸如知识不足或获得心理健康资源不足等障碍。在两种概述疾病筛查适用条件的公共卫生模型的视角下，我们研究了支持和反对对青少年和青年进行基于人群的精神病筛查的更多证据。我们认为，在一般健康环境中进行系统筛查需要一种发育良好的标准化筛查工具，该工具应包括对精神病的探查，以足够低的阅读水平编写，并且具有可接受的敏感性，特别是对于检测青少年和青年中的精神病及精神病风险具有特异性。随着全球综合医疗模式的扩展以及精神病风险评估和治疗的改善，针对全科医生环境的分层筛查和谨慎的风险管理方案可以促进及时的早期干预，从而有效地平衡在人群层面使用此类筛查工具的效益/风险比。
