Dangerfield Mark, Brotnow Decker Line
Vidal and Barraquer University Institute of Mental Health, Ramon Llull University, Barcelona, Spain.
Yale Child Study Center, Yale University, New Haven, CT, United States.
Front Psychiatry. 2023 Jul 4;14:1206511. doi: 10.3389/fpsyt.2023.1206511. eCollection 2023.
Early intervention may significantly improve the prognosis associated with psychotic disorders in adulthood.
The present study examined the acceptability and effectiveness of a standalone intensive, in-home, mentalization-based treatment (MBT) for extremely high-risk, non-help-seeking youth on the psychotic spectrum [Equipo Clínico de Intervención a Domicilio (ECID), Home Intervention Clinical Team].
Despite previously being unable to participate in treatment, more than 90% of youth engaged and those on the psychotic spectrum demonstrated slightly higher engagement than the general high-risk group (95% and 85%, respectively, = 4.218, = 0.049). Generalized estimating equation (GEE) models revealed no main group effect on the likelihood of reengaging with school over the first 12 months of treatment ( = 1.015, = 0.314) when controlling for the duration of school absenteeism at intake. Overall, the percentage of school engagement rose from 12 to 55 over this period, more than 40% of the total sample experienced clinically reliable change and an additional 50% appeared clinically stable. No statistically significant difference was observed between the groups in the average change in HoNOSCA total severity score ( = 0.249, = 0.618) or the distribution of youth into categories of clinical change during the first year of treatment ( = 0.068, = 0.795).
The present findings suggest that a mentalization based intervention may be able to engage extremely high-risk youth in treatment and have clinically meaningful impact on symptom severity and functioning after 12 months.
早期干预可能会显著改善成年期精神障碍的预后。
本研究考察了一种独立的、强化的、基于家庭的心理化治疗（MBT）对处于精神病谱系的极高风险、不寻求帮助的青少年的可接受性和有效性[家庭干预临床团队（ECID）]。
尽管此前无法参与治疗，但超过90%的青少年参与了治疗，且处于精神病谱系的青少年的参与度略高于一般高风险组（分别为95%和85%，χ² = 4.218，p = 0.049）。广义估计方程（GEE）模型显示，在控制入组时缺课时长的情况下，治疗的前12个月内，两组在重新上学可能性方面无主要组间效应（χ² = 1.015，p = 0.314）。总体而言，在此期间，上学参与率从12%上升至55%，超过40%的总样本经历了临床可靠的变化，另有50%表现为临床稳定。在治疗的第一年，两组在HoNOSCA总严重程度评分的平均变化（χ² = 0.249，p = 0.618）或青少年临床变化类别分布方面均未观察到统计学显著差异（χ² = 0.068，p = 0.795）。
本研究结果表明，基于心理化的干预可能能够让极高风险的青少年参与治疗，并在12个月后对症状严重程度和功能产生具有临床意义的影响。
