Lavan Orly, Apter Alan, Benaroya-Milshtein Noa, Fennig Silvana
Department of Psychological Medicine, Schneider Children's Medical Center of Israel, Petah.
Harefuah. 2021 Feb;160(2):104-109.
Psychotic disorders are associated with a severe functional decline and a significant impact on the quality of life. These disorders usually develop gradually, lasting days to months-years. The early phase of psychotic disorders is termed "pre-psychotic" or "prodromal". It is estimated that 30% of the individuals presenting with prodromal symptoms will develop psychosis in three years. This high-risk state is also known as "clinical high risk" (CHR), "ultra-high risk" (UHR), and "at-risk mental state" (ARMS). The diagnostic criteria of high-risk subjects include 3 groups: 1) genetic risk with a functional decline; 2) brief limited intermittent psychotic symptoms group (BLIPS); 3) subthreshold positive psychotic symptoms. In addition to the psychosis risk, these subjects suffer from distress, functional deterioration and psychiatric comorbidities that influence their quality of life. Therefore, many efforts are invested in early identification of the high-risk for psychosis subjects with the primary aim of using interventions to delay or prevent conversion to psychosis. Studies in the field have highlighted specific factors that predict the risk to develop psychosis and even developed predictive models. Interventions including cognitive-behavioral therapy, integrative psychological therapy and pharmacological therapy were found to be associated with postponing the conversion to psychosis. According to current guidelines, cognitive behavioral therapy is the first-choice intervention, and pharmacological interventions should be reserved for patients with comorbidities in need of stabilization of severe and progressive symptoms. Further prospective studies will allow a better identification of high-risk patients and enable the development of interventions for prevention and treatment of this population.
精神障碍与严重的功能衰退及对生活质量的重大影响相关。这些障碍通常逐渐发展，持续数天至数月甚至数年。精神障碍的早期阶段被称为“精神病前”或“前驱期”。据估计，出现前驱症状的个体中有30%会在三年内发展为精神病。这种高风险状态也被称为“临床高危”（CHR）、“超高危”（UHR）和“风险精神状态”（ARMS）。高危受试者的诊断标准包括3组：1）伴有功能衰退的遗传风险；2）短暂有限间歇性精神病性症状组（BLIPS）；3）阈下阳性精神病性症状。除了精神病风险外，这些受试者还遭受痛苦、功能恶化和精神共病，这些都会影响他们的生活质量。因此，人们投入了大量努力来早期识别精神病高危受试者，主要目的是通过干预来延迟或预防转化为精神病。该领域的研究突出了预测发展为精神病风险的特定因素，甚至开发了预测模型。发现包括认知行为疗法、综合心理疗法和药物疗法在内的干预措施与推迟转化为精神病有关。根据当前指南，认知行为疗法是首选干预措施，药物干预应保留给有严重进行性症状需要稳定治疗的共病患者。进一步的前瞻性研究将有助于更好地识别高危患者，并能够开发针对该人群的预防和治疗干预措施。
