O'Donoghue Brian, Oliver Dominic, Geros Hellen, Sizer Holly, Thompson Andrew, McGorry Patrick, Nelson Barnaby
Department of Psychiatry, University College Dublin, Dublin, Ireland.
Department of Psychiatry, Royal College of Surgeons, Dublin, Ireland.
Psychol Med. 2024 Nov 25;54(15):1-9. doi: 10.1017/S0033291724002551.
Transition to psychosis rates within ultra-high risk (UHR) services have been declining. It may be possible to 'enrich' UHR cohorts based on the environmental characteristics seen more commonly in first-episode psychosis cohorts. This study aimed to determine whether transition rates varied according to the accumulated exposure to environmental risk factors at the individual (migrant status, asylum seeker/refugee status, indigenous population, cannabis/methamphetamine use), family (family history or parental separation), and neighborhood (population density, social deprivation, and fragmentation) level.
The study included UHR people aged 15-24 who attended the PACE clinic from 2012 to 2016. Cox proportional hazards models (frequentist and Bayesian) were used to assess the association between individual and accumulated factors and transition to psychosis. UHR status and transition was determined using the CAARMS. Benjamini-Hochberg was used to correct for multiple comparisons in frequentist analyses.
Of the 461 young people included, 55.5% were female and median follow-up was 307 days (IQR: 188-557) and 17.6% ( = 81) transitioned to a psychotic disorder. The proportion who transitioned increased incrementally according to the number of individual-level risk factors present (HR = 1.51, 95% CIs 1.19-1.93, < 0.001, = 0.01). The number of family- and neighborhood-level exposures did not increase transition risk ( > 0.05). Cannabis use was the only specific risk factor significantly associated with transition (HR = 1.89, 95% CIs 1.22-2.93, = 0.03, BF = 6.74).
There is a dose-response relationship between exposure to individual-level psychosis-related environmental risk factors and transition risk in UHR patients. If replicated, this could be incorporated into a novel approach to identifying the highest-risk individuals within clinical services.
超高风险（UHR）服务中心向精神病转变的发生率一直在下降。根据首发精神病队列中更常见的环境特征，有可能对UHR队列进行“富集”。本研究旨在确定转变率是否因个体（移民身份、寻求庇护者/难民身份、原住民、大麻/甲基苯丙胺使用情况）、家庭（家族史或父母离异）和社区（人口密度、社会剥夺和碎片化）层面环境危险因素的累积暴露情况而有所不同。
该研究纳入了2012年至2016年期间在PACE诊所就诊的15至24岁的UHR人群。使用Cox比例风险模型（频率学派和贝叶斯学派）评估个体因素和累积因素与向精神病转变之间的关联。使用CAARMS确定UHR状态和转变情况。在频率学派分析中，使用Benjamini-Hochberg方法校正多重比较。
在纳入的461名年轻人中，55.5%为女性，中位随访时间为307天（四分位间距：188 - 557），17.6%（n = 81）转变为精神障碍。根据存在的个体层面危险因素数量，转变的比例逐渐增加（风险比 = 1.51，95%置信区间1.19 - 1.93，p < 0.001，效应量 = 0.01）。家庭和社区层面的暴露数量并未增加转变风险（p > 0.05）。大麻使用是唯一与转变显著相关的特定危险因素（风险比 = 1.89，95%置信区间1.22 - 2.93，p = 0.03，贝叶斯因子 = 6.74）。
UHR患者中，个体层面与精神病相关的环境危险因素暴露与转变风险之间存在剂量反应关系。如果得到重复验证，这可纳入一种新方法，用于在临床服务中识别最高风险个体。
