Erzın Gamze, Gülöksüz Sinan
Department of Psychiatry, Dışkapı Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
Department of Psychiatry and Neuropsychology, School of Mental Health and Neurosciences, Maastricht University Medical Center, Maastricht, The Netherlands.
Noro Psikiyatr Ars. 2021 Sep 20;58(Suppl 1):S7-S11. doi: 10.29399/npa.27404. eCollection 2021.
The aim of this review was to discuss early intervention options for clinical high-risk states of psychosis, the limitations of the high-risk concept, and the importance of population-based approaches in preventing psychosis. Interventions for individuals at high risk of psychosis can be classified into two main categories: pharmacological and non-pharmacological. When selecting any of these intervention options, it should be taken into account that only a small proportion of individuals in the high-risk group will have a transition to clinical psychosis. Therefore, it is necessary to avoid aggressive interventions. Pharmacotherapies, particularly antipsychotics, are generally not considered as a treatment of choice for individuals at high risk of psychosis due to their potential side-effect profiles, whereas cognitive behavioral therapies and family-oriented therapies are the leading alternatives with virtually no side effects. However, meta-analyses have shown that none of the interventions are specifically more effective than needs-based treatment (including placebo) in preventing transition to psychosis. These interventions might not be effective in preventing transition to psychosis; however, they may improve the outcomes of psychosis. Accumulating evidence suggests that the targeted prevention approaches focusing on the clinical high risk of psychosis concept have major limitations in terms of the impact on reducing psychosis incidence in the general population compared to the population-based approaches. Recently, psychosis-focused prevention approaches have been replaced by easily accessible youth mental health centers that provide services for transdiagnostic conditions. Future studies on the efficacy of these community-based youth mental health services may provide guidance on how to prevent psychosis.
本综述的目的是讨论精神病临床高危状态的早期干预选项、高危概念的局限性以及基于人群的方法在预防精神病方面的重要性。针对精神病高危个体的干预措施可分为两大类：药物干预和非药物干预。在选择任何一种干预选项时，应考虑到高危组中只有一小部分个体将转变为临床精神病。因此，有必要避免激进的干预措施。药物治疗，尤其是抗精神病药物，由于其潜在的副作用，通常不被视为精神病高危个体的首选治疗方法，而认知行为疗法和以家庭为导向的疗法是几乎没有副作用的主要替代方法。然而，荟萃分析表明，在预防转变为精神病方面，没有一种干预措施比基于需求的治疗（包括安慰剂）更有效。这些干预措施可能无法有效预防转变为精神病；然而，它们可能会改善精神病的治疗结果。越来越多的证据表明，与基于人群的方法相比，专注于精神病临床高危概念的针对性预防方法在降低普通人群中精神病发病率的影响方面存在重大局限性。最近，专注于精神病的预防方法已被为跨诊断疾病提供服务的易于访问的青少年心理健康中心所取代。未来关于这些基于社区的青少年心理健康服务效果的研究可能会为如何预防精神病提供指导。
