Ergül Ceylan, Binbay Tolga, Kırlı Umut, Elbi Hayriye, Alptekin Köksal, van Os Jim, Drukker Marjan
Department of Psychiatry, Uskudar University, Istanbul, Turkey.
Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
Soc Psychiatry Psychiatr Epidemiol. 2024 Nov 7. doi: 10.1007/s00127-024-02785-0.
The Clinical High Risk (CHR) concept has a limited transition risk to psychotic disorders (PD). This study investigates the association between affective and negative symptoms, currently not included in the CHR concept, and the risk of transition to PD in a community-based population of 2185 participants in Turkey.
Participants were assessed twice over six years using a multistage sampling technique. Two separate linear regression analyses were conducted on data from both assessments, investigating the relationship between affective and negative symptoms, subclinical and clinical psychotic experiences (PE) and progression to PD.
The overall transition rate to PD was 1.3%. The analysis showed no increased risk of developing PD for the 'subclinical PE only' group at follow-up, compared to the 'no PE' group. However, being classified as having 'clinical PE only' (OR: 6.23; p = 0.010) and 'clinical PE + affective/negative symptoms' (OR: 8.48; p = 0.001) at baseline was associated with an increased risk of developing PD at follow-up. The presence of 'affective/negative symptoms' at baseline was associated with an increased risk of incident subclinical PE (RR: 1.98; p = 0.001), incident clinical PE (RR: 3.14; p = 0.001), and incident PD (RR: 4.21; p = 0.030) at follow-up.
The results confirm the significance of the baseline severity of positive symptoms in predicting the transition to PD and suggest that both positive and affective/negative symptoms impact the transition risk to PD and incident psychotic symptoms. This highlights the potential utility of defining CHR groups based on a combination of positive, affective, and negative symptoms.
临床高危（CHR）概念向精神障碍（PD）的转化风险有限。本研究调查了目前未纳入CHR概念的情感症状和阴性症状与土耳其一个基于社区的2185名参与者群体向PD转化风险之间的关联。
采用多阶段抽样技术对参与者进行了为期六年的两次评估。对两次评估的数据进行了两项独立的线性回归分析，研究情感症状和阴性症状、亚临床和临床精神病性体验（PE）与向PD进展之间的关系。
向PD的总体转化率为1.3%。分析表明，与“无PE”组相比，随访时“仅亚临床PE”组发生PD的风险没有增加。然而，在基线时被归类为“仅临床PE”（比值比：6.23；p = 0.010）和“临床PE + 情感/阴性症状”（比值比：8.48；p = 0.001）与随访时发生PD的风险增加相关。基线时“情感/阴性症状”的存在与随访时发生亚临床PE（风险比：1.98；p = 0.001）、临床PE（风险比：3.14；p = 0.001）和PD（风险比：4.21；p = 0.030）的风险增加相关。
结果证实了阳性症状基线严重程度在预测向PD转化中的重要性，并表明阳性症状和情感/阴性症状均会影响向PD的转化风险和新发精神病性症状。这突出了基于阳性、情感和阴性症状组合定义CHR组的潜在效用。
