Department of Mental Health and Pathological Addiction, Child and Adolescent Neuropsychiatry Service, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
Department of Biomedical and Neuromotor Sciences, Università di Bologna, Italy.
Asian J Psychiatr. 2024 Oct;100:104142. doi: 10.1016/j.ajp.2024.104142. Epub 2024 Jul 22.
The construct of Clinical-High Risk for Psychosis (CHR-P) identifies young help-seeking subjects in putative prodromal stages of psychosis and is a central component of the Early Intervention (EI) paradigm in Mental Health, aimed at facilitating rapid entry into appropriate care pathways to prevent the onset of psychosis or mitigate is biopsychosocial consequences. This approach, which promotes an innovative culture of care for early, at risk situations, is inspired by a clinical staging concept as a guide to optimal treatment. The objective of this article is to map the existing guidelines in the field of CHR-P treatment recommendations, examine overlaps and differences, and critically evaluate blind spots to be addressed in future guideline updated. The search identified 9 guidelines focused on CHR-P or schizophrenia and other psychotic conditions but containing a specific section on CHR-P or prodromal psychosis. All guidelines acknowledge that psychosis is preceded by more or less pronounced prodromal stages, and most detail CHR-P criteria. Among guidelines, 8 out of 9 indicate cognitive-behavioural therapy as the best psychotherapeutic option and 7 out of 9 suggest that antipsychotics can be prescribed as second option in case psychosocial and/or other pharmacological interventions prove insufficient or inadequate in reducing clinical severity and subjective suffering. Antidepressants, mood stabilizers, and benzodiazepines were considered for the treatment of comorbid disorders. Only the European Psychiatric Association Guidance paper distinguished treatment recommendations for adults and minors. Agreements in treatment guidelines were discussed in light of recent meta-analytical evidences on pharmacological and non-pharmacological treatments for CHR-P, suggesting the need to provide an updated, age-sensitive consensus on how to manage CHR-P individuals.
临床高风险精神分裂症候群（CHR-P）的构建用于识别有精神分裂症前驱期表现的年轻求助者，是精神卫生早期干预（EI）模式的核心组成部分，旨在促进快速进入适当的护理途径，以预防精神病的发生或减轻其生物心理社会后果。这种方法提倡一种针对早期、高危情况的创新护理文化，其灵感来自临床分期概念，作为最佳治疗的指南。本文的目的是绘制 CHR-P 治疗建议领域现有的指南，检查重叠和差异，并批判性地评估未来指南更新中需要解决的盲点。搜索确定了 9 项专注于 CHR-P 或精神分裂症和其他精神病状况的指南，但包含专门针对 CHR-P 或前驱精神病的部分。所有指南都承认精神病之前存在或多或少明显的前驱期，并且大多数详细说明了 CHR-P 标准。在这些指南中，有 8 项指南表明认知行为疗法是最佳的心理治疗选择，有 7 项指南表明在心理社会和/或其他药物干预不足以或不适当降低临床严重程度和主观痛苦的情况下，可以开抗精神病药物作为二线治疗。抗抑郁药、心境稳定剂和苯二氮䓬类药物被认为可用于治疗共病障碍。只有欧洲精神病学协会指导文件区分了成人和未成年人的治疗建议。根据 CHR-P 的药物和非药物治疗的最新荟萃分析证据，讨论了治疗指南中的一致性，表明需要就如何管理 CHR-P 个体提供更新的、年龄敏感的共识。
