VA Capitol Health Care Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, Maryland, USA.
Division of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Early Interv Psychiatry. 2022 Jan;16(1):42-50. doi: 10.1111/eip.13128. Epub 2021 Feb 8.
Early psychosis is typically operationalized as a categorical construct by dividing people into one of three diagnostic statuses: low-risk, clinical high-risk, and first episode psychosis. We empirically assess whether an alternative dimensional approach focused on observed symptom severity may be more desirable for clinical and research purposes.
Participants were 152 help-seeking youths ages 12-22 years old. Structured interview for psychosis risk syndromes interviews were used to obtain dimensional psychosis symptom severity ratings, and to classify participants by categorical psychosis risk status. Twenty-five participants were classified as having a diagnosable psychotic disorder, 52 participants as clinical high-risk, and 75 participants as help-seeking controls. We assessed the relation between categorical and dimensional measurements of psychosis severity, and then compared categorical versus dimensional psychosis severity in their ability to predict social and role functioning.
On average, dimensional psychosis symptom severity increased along with categorical risk status (help-seeking control < clinical high-risk < diagnosable psychotic disorder). There was, however, considerable overlap between categories, with people at clinical high-risk being particularly hard to distinguish from people with diagnosable psychotic disorders on the basis of symptom severity. Dimensional symptom severity was more predictive of functioning than categorical risk status.
Categorical risk status and psychosis symptom severity are related but not interchangeable, and dimensional models of psychosis may be more predictive of functional outcomes. Adopting a dimensional rather than categorical approach to the psychosis risk spectrum may facilitate better predictive models and a richer theoretical understanding of early psychosis.
早期精神病通常通过将人群分为低危、临床高危和首发精神病三种诊断状态来进行分类。我们通过实证评估，关注观察到的症状严重程度的替代维度方法是否更适合临床和研究目的。
参与者为 152 名寻求帮助的 12-22 岁青年。使用精神病风险综合征的结构性访谈来获得维度精神病症状严重程度评分，并根据精神病风险状态对参与者进行分类。25 名参与者被诊断为患有可诊断的精神病障碍，52 名参与者为临床高危，75 名参与者为寻求帮助的对照组。我们评估了精神病严重程度的分类和维度测量之间的关系，然后比较了分类和维度精神病严重程度在预测社会和角色功能方面的能力。
平均而言，维度精神病症状严重程度随着分类风险状态的增加而增加（寻求帮助的对照组<临床高危<可诊断的精神病障碍）。然而，类别之间存在相当大的重叠，临床高危人群的症状严重程度与可诊断的精神病障碍患者特别难以区分。维度症状严重程度比分类风险状态更能预测功能。
分类风险状态和精神病症状严重程度是相关的，但不能互换，精神病的维度模型可能更能预测功能结果。采用维度而不是分类方法来研究精神病风险谱可能有助于建立更好的预测模型，并更深入地理解早期精神病。
