Zhang TianHong, Raballo Andrea, Zeng JiaHui, Gan RanPiao, Wu GuiSen, Wei YanYan, Xu LiHua, Tang XiaoChen, Hu YeGang, Tang YingYing, Liu HaiChun, Chen Tao, Li ChunBo, Wang JiJun
Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai Intelligent Psychological Evaluation and Intervention Engineering Technology Research Center (20DZ2253800), Shanghai Key Laboratory of Psychotic Disorders, Shanghai, 200030, People's Republic of China.
Department of Medicine, Section of Psychiatry, Clinical Psychology and Rehabilitation, University of Perugia, Perugia, Italy.
Schizophrenia (Heidelb). 2022 May 4;8(1):48. doi: 10.1038/s41537-022-00254-8.
The current concept of clinical high-risk(CHR) of psychosis relies heavily on "below-threshold" (i.e. attenuated or limited and intermittent) psychotic positive phenomena as predictors of the risk for future progression to "above-threshold" positive symptoms (aka "transition" or "conversion"). Positive symptoms, even at attenuated levels are often treated with antipsychotics (AP) to achieve clinical stabilization and mitigate the psychopathological severity. The goal of this study is to contextually examine clinicians' decision to prescribe AP, CHR individuals' decision to take AP and psychosis conversion risk in relation to prodromal symptoms profiles. CHR individuals (n = 600) were recruited and followed up for 2 years between 2016 and 2021. CHR individuals were referred to the participating the naturalistic follow-up study, which research procedure was independent of the routine clinical treatment. Clinical factors from the Structured Interview for Prodromal Syndromes (SIPS) and global assessment of function (GAF) were profiled via exploratory factor analysis (EFA), then the extracted factor structure was used to investigate the relationship of prodromal psychopathology with clinicians' decisions to AP-prescription, CHR individuals' decisions to AP-taking and conversion to psychosis. A total of 427(71.2%) CHR individuals were prescribed AP at baseline, 532(88.7%) completed the 2-year follow-up, 377(377/532, 70.9%) were taken AP at least for 2 weeks during the follow-up. EFA identified six factors (Factor-1-Negative symptoms, Factor-2-Global functions, Factor-3-Disorganized communication & behavior, Factor-4-General symptoms, Factor-5-Odd thoughts, and Factor-6-Distorted cognition & perception). Positive symptoms (Factor-5 and 6) and global functions (Factor-2) factors were significant predictors for clinicians' decisions to AP-prescription and CHR individuals' decisions to assume AP, whereas negative symptoms (Factor-1) and global functions (Factor-2) factors predicted conversion. While decisions to AP-prescription, decisions to AP-taking were associated to the same factors (positive symptoms and global functions), only one of those was predictive of conversion, i.e. global functions. The other predictor of conversion, i.e. negative symptoms, did not seem to be contemplated both on the clinician and patients' sides. Overall, the findings indicated that a realignment in the understanding of AP usage is warranted.
当前关于精神病临床高危（CHR）的概念在很大程度上依赖于“阈下”（即减弱的、有限的和间歇性的）精神病性阳性症状，以此作为未来发展为“阈上”阳性症状（即“转变”或“转化”）风险的预测指标。即使是减弱程度的阳性症状，也常常使用抗精神病药物（AP）进行治疗，以实现临床稳定并减轻精神病理学严重程度。本研究的目的是结合前驱症状特征，考察临床医生开具AP的决策、CHR个体服用AP的决策以及精神病转化风险。在2016年至2021年期间招募了600名CHR个体并对其进行了为期2年的随访。CHR个体被转介至参与的自然主义随访研究，该研究程序独立于常规临床治疗。通过探索性因素分析（EFA）对来自前驱综合征结构化访谈（SIPS）的临床因素和功能总体评估（GAF）进行剖析，然后使用提取的因素结构来研究前驱精神病理学与临床医生开具AP处方的决策、CHR个体服用AP的决策以及转化为精神病之间的关系。共有427名（71.2%）CHR个体在基线时被开具了AP，532名（88.7%）完成了2年随访，377名（377/532，70.9%）在随访期间至少服用AP达2周。EFA识别出六个因素（因素1 - 阴性症状、因素2 - 总体功能、因素3 - 言语及行为紊乱、因素4 - 一般症状、因素5 - 怪异思维、因素6 - 认知及感知扭曲）。阳性症状（因素5和6）和总体功能（因素2）因素是临床医生开具AP处方决策和CHR个体服用AP决策的显著预测指标，而阴性症状（因素1）和总体功能（因素2）因素预测了转化情况。虽然开具AP处方的决策、服用AP的决策与相同因素（阳性症状和总体功能）相关，但其中只有一个因素可预测转化，即总体功能。转化的另一个预测指标，即阴性症状，在临床医生和患者双方似乎都未被考虑到。总体而言，研究结果表明有必要重新调整对抗精神病药物使用的理解。
