de Filippis Renato, Carbone Elvira Anna, Rania Marianna, Aloi Matteo, Segura-Garcia Cristina, De Fazio Pasquale
Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy.
Outpatient Unit for Clinical Research and Treatment of Eating Disorders, University Hospital Renato Dulbecco, Catanzaro, Italy.
Front Psychiatry. 2024 Jul 16;15:1387913. doi: 10.3389/fpsyt.2024.1387913. eCollection 2024.
Clinical staging, already widespread in medicine, represents a new frontier in psychiatry. Our goal was to convert the existing theoretical staging model for schizophrenia into a feasible tool to have a timely assessment of patients' health status applicable in any psychiatric facility.
We assessed the empirical soundness of a staging model for schizophrenia spectrum disorders (SSDs), primarily centered on their current status. This model delineated six sequential stages (1, 2A, 2B, 3A, 3B, and 4) based on factors like symptom recurrence, persistence, and progression, including functional decline. Our analysis involved data from 137 individuals affected by SSDs. We examined 22 baseline variables, 23 construct-related variables, and 31 potentially modifiable clinical variables.
The latter stages demonstrated significantly poorer outcomes compared to the early stages across various measures, indicating medium to large effect sizes and a dose-response pattern. This pattern confirmed the validity of the model. Notably, stages 2 and 3A exhibited pronounced differences in comparison to other stages, although variables from each validation category also distinguished between consecutive stages, particularly 3A and beyond.
Baseline predictors, such as familial predisposition to schizophrenia, neurodevelopmental impairment, childhood adversities, treatment delay, negative symptoms, neurological impairment, and inadequate early response to treatment, independently largely explained the staging variance. The clinical staging model, grounded in the extended course of psychosis, exhibited sound validity and feasibility, even without the use of biological or neuroimaging markers, which could greatly improve the sensitivity of the model. These findings provide insights into stage indicators and predictors of clinical stages from the onset of psychosis.
临床分期在医学领域已广泛应用，如今在精神病学中成为一个新的前沿领域。我们的目标是将现有的精神分裂症理论分期模型转化为一种可行的工具，以便及时评估适用于任何精神科机构的患者健康状况。
我们评估了精神分裂症谱系障碍（SSD）分期模型的实证合理性，主要关注其当前状态。该模型基于症状复发、持续性和进展（包括功能衰退）等因素划分了六个连续阶段（1、2A、2B、3A、3B和4）。我们的分析涉及137名受SSD影响个体的数据。我们考察了22个基线变量、23个与结构相关的变量以及31个潜在可改变的临床变量。
与早期阶段相比，后期阶段在各项指标上的结果明显更差，表明效应大小为中等至较大，且呈现剂量反应模式。这种模式证实了该模型的有效性。值得注意的是，尽管每个验证类别中的变量也能区分连续阶段，特别是3A及以后的阶段，但2期和3A期与其他阶段相比仍存在显著差异。
基线预测因素，如精神分裂症的家族易感性、神经发育障碍、童年逆境、治疗延迟、阴性症状、神经功能障碍以及对治疗的早期反应不足，在很大程度上独立解释了分期差异。基于精神病病程扩展的临床分期模型，即使不使用生物或神经影像学标记物，也表现出良好的有效性和可行性，而这些标记物可大大提高模型的敏感性。这些发现为精神病发作后临床阶段的阶段指标和预测因素提供了见解。
