Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia.
Melbourne School of Psychological Sciences, The University of Melbourne, Australia.
Schizophr Res. 2022 May;243:276-284. doi: 10.1016/j.schres.2020.04.028. Epub 2020 May 10.
The factors contributing to declining psychotic disorder transition rates in ultra-high-risk populations remain unclear. We examined the contribution of longitudinal changes in standard clinical treatment ('treatment as usual') to this decline.
An audit was conducted on 105 clinical files of patients who received standard care at a specialised ultra-high-risk service. The session notes of these files were quantified, allowing examination of treatment quantity, targets, psychotherapy, and medication. Differences in these aspects across patients' year of clinic entry were assessed. Variables with significant differences across years were examined using cox regression to assess their contribution to psychosis transition rates.
Findings were that, as a function of patients' year of clinic entry, there were increases in: patients' number of sessions, cognitive behavioural therapy (CBT), problem and solving therapy. There was a relationship between baseline year cohort and psychosis transition rate, with lower rates observed in more recent cohorts. When changes in treatment between cohorts were adjusted for, the relationship between baseline year cohort and transition rate disappeared. The relationship between baseline year and transition rate was attenuated most by increases in CBT.
Changes in standard treatment, particularly increases in CBT, may have contributed to the decline in psychosis risk observed in recent ultra-high-risk cohorts, although these variables do not fully explain this trend. Implications for clinical practice, prediction and intervention research are discussed. Future ultra-high-risk research should investigate the impact of other treatment factors, such as therapeutic alliance.
导致超高风险人群精神障碍发生率下降的因素仍不清楚。我们研究了标准临床治疗（“常规治疗”）的纵向变化对此下降的贡献。
对接受专门超高风险服务标准护理的 105 名患者的临床档案进行了审核。对这些档案的会议记录进行了量化，以检查治疗的数量、目标、心理治疗和药物治疗。评估了患者就诊年度的这些方面的差异。使用 Cox 回归评估具有年度差异的变量对精神病转化率的贡献，以评估这些方面的差异。
研究结果表明，随着患者就诊年度的变化，患者的就诊次数、认知行为疗法（CBT）、问题解决疗法均有所增加。基线年度队列与精神病转化率之间存在关系，最近的队列中观察到的转化率较低。当调整队列间治疗变化时，基线年度队列与转化率之间的关系消失了。CBT 的增加对基线年度和转化率之间的关系的衰减作用最大。
标准治疗的变化，特别是 CBT 的增加，可能导致最近超高风险队列中观察到的精神病风险下降，但这些变量并不能完全解释这一趋势。讨论了对临床实践、预测和干预研究的影响。未来的超高风险研究应调查其他治疗因素（如治疗联盟）的影响。
