Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK.
Mol Psychiatry. 2024 Nov;29(11):3305-3315. doi: 10.1038/s41380-024-02533-5. Epub 2024 May 6.
Effective prevention of severe mental disorders (SMD), including non-psychotic unipolar mood disorders (UMD), non-psychotic bipolar mood disorders (BMD), and psychotic disorders (PSY), rely on accurate knowledge of the duration, first presentation, time course and transdiagnosticity of their prodromal stages. Here we present a retrospective, real-world, cohort study using electronic health records, adhering to RECORD guidelines. Natural language processing algorithms were used to extract monthly occurrences of 65 prodromal features (symptoms and substance use), grouped into eight prodromal clusters. The duration, first presentation, and transdiagnosticity of the prodrome were compared between SMD groups with one-way ANOVA, Cohen's f and d. The time course (mean occurrences) of prodromal clusters was compared between SMD groups with linear mixed-effects models. 26,975 individuals diagnosed with ICD-10 SMD were followed up for up to 12 years (UMD = 13,422; BMD = 2506; PSY = 11,047; median[IQR] age 39.8[23.7] years; 55% female; 52% white). The duration of the UMD prodrome (18[36] months) was shorter than BMD (26[35], d = 0.21) and PSY (24[38], d = 0.18). Most individuals presented with multiple first prodromal clusters, with the most common being non-specific ('other'; 88% UMD, 85% BMD, 78% PSY). The only first prodromal cluster that showed a medium-sized difference between the three SMD groups was positive symptoms (f = 0.30). Time course analysis showed an increase in prodromal cluster occurrences approaching SMD onset. Feature occurrence across the prodromal period showed small/negligible differences between SMD groups, suggesting that most features are transdiagnostic, except for positive symptoms (e.g. paranoia, f = 0.40). Taken together, our findings show minimal differences in the duration and first presentation of the SMD prodromes as recorded in secondary mental health care. All the prodromal clusters intensified as individuals approached SMD onset, and all the prodromal features other than positive symptoms are transdiagnostic. These results support proposals to develop transdiagnostic preventive services for affective and psychotic disorders detected in secondary mental healthcare.
有效的严重精神障碍（SMD）预防，包括非精神病性单相心境障碍（UMD）、非精神病性双相心境障碍（BMD）和精神病性障碍（PSY），依赖于对其前驱期的持续时间、首发表现、时间进程和跨诊断性的准确了解。在这里，我们使用电子健康记录，根据 RECORD 指南，呈现了一项回顾性、真实世界的队列研究。自然语言处理算法用于提取 65 种前驱特征（症状和物质使用）的每月发生情况，这些特征分为八个前驱簇。使用单因素方差分析、Cohen's f 和 d 比较 SMD 组之间前驱期的持续时间、首发表现和跨诊断性。使用线性混合效应模型比较 SMD 组之间前驱簇的时间进程（平均发生次数）。26975 名被诊断为 ICD-10 SMD 的个体接受了长达 12 年的随访（UMD=13422；BMD=2506；PSY=11047；中位数[IQR]年龄 39.8[23.7]岁；55%为女性；52%为白人）。UMD 前驱期的持续时间（18[36]个月）短于 BMD（26[35]，d=0.21）和 PSY（24[38]，d=0.18）。大多数个体首发多个前驱簇，最常见的是非特异性（“其他”；88%UMD、85%BMD、78%PSY）。三个 SMD 组之间仅有的第一个前驱簇存在中等大小差异是阳性症状（f=0.30）。时间进程分析显示，前驱簇发生次数在接近 SMD 发病时增加。在整个前驱期，特征发生次数在 SMD 组之间存在较小/可忽略的差异，表明大多数特征是跨诊断的，除了阳性症状（例如妄想，f=0.40）。总之，我们的研究结果表明，在二级精神卫生保健中记录的 SMD 前驱期的持续时间和首发表现差异很小。随着个体接近 SMD 发病，所有前驱簇都加剧，除阳性症状外，所有前驱特征都是跨诊断的。这些结果支持为二级精神卫生保健中检测到的情感和精神病性障碍开发跨诊断预防服务的建议。
