Lundin Nancy B, Blouin Alexandra M, Cowan Henry R, Moe Aubrey M, Wastler Heather M, Breitborde Nicholas J K
Early Psychosis Intervention Center, Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA.
Department of Psychology, Michigan State University, East Lansing, MI, USA.
Psychol Res Behav Manag. 2024 Mar 21;17:1365-1383. doi: 10.2147/PRBM.S423865. eCollection 2024.
Early detection of psychotic-spectrum disorders among adolescents and young adults is crucial, as the initial years after psychotic symptom onset encompass a critical period in which psychosocial and pharmacological interventions are most effective. Moreover, clinicians and researchers in recent decades have thoroughly characterized psychosis-risk syndromes, in which youth are experiencing early warning signs indicative of heightened risk for developing a psychotic disorder. These insights have created opportunities for intervention even earlier in the illness course, ideally culminating in the prevention or mitigation of psychosis onset. However, identification and diagnosis of early signs of psychosis can be complex, as clinical presentations are heterogeneous, and psychotic symptoms exist on a continuum. When a young person presents to a clinic, it may be unclear whether they are experiencing common, mild psychotic-like symptoms, early warning signs of psychosis, overt psychotic symptoms, or symptoms better accounted for by a non-psychotic disorder. Therefore, the purpose of this review is to provide a framework for clinicians, including those who treat non-psychotic disorders and those in primary care settings, for guiding identification and diagnosis of early psychosis within the presenting clinic or via referral to a specialty clinic. We first provide descriptions and examples of first-episode psychosis (FEP) and psychosis-risk syndromes, as well as assessment tools used to diagnose these conditions. Next, we provide guidance as to the differential diagnosis of conditions which have phenotypic overlap with psychotic disorders, while considering the possibility of co-occurring symptoms in which case transdiagnostic treatments are encouraged. Finally, we conclude with an overview of early detection screening and outreach campaigns, which should be further optimized to reduce the duration of untreated psychosis among youth.
在青少年和青年中早期发现精神病性谱系障碍至关重要，因为精神病性症状发作后的最初几年包含一个关键时期，在此期间社会心理和药物干预最为有效。此外，近几十年来临床医生和研究人员已经全面描述了精神病风险综合征，即青少年正在经历预示着发展为精神病性障碍风险增加的早期预警信号。这些见解为在病程中更早进行干预创造了机会，理想情况下最终实现预防或减轻精神病性障碍的发作。然而，精神病早期症状的识别和诊断可能很复杂，因为临床表现具有异质性，且精神病性症状存在一个连续谱。当一个年轻人到诊所就诊时，可能不清楚他们是正在经历常见的、轻度的类似精神病性的症状、精神病的早期预警信号、明显的精神病性症状，还是由非精神病性障碍更好解释的症状。因此，本综述的目的是为临床医生提供一个框架，包括那些治疗非精神病性障碍的医生和基层医疗环境中的医生，以指导在当前诊所内或通过转诊至专科诊所来识别和诊断早期精神病。我们首先描述并举例说明首发精神病（FEP）和精神病风险综合征，以及用于诊断这些病症的评估工具。接下来，我们提供有关与精神病性障碍存在表型重叠的病症的鉴别诊断指导，同时考虑共病症状的可能性，在这种情况下鼓励采用跨诊断治疗。最后，我们概述早期检测筛查和外展活动，应进一步优化这些活动以缩短青少年未治疗精神病的持续时间。
