Birchwood M, Todd P, Jackson C
Archer Centre, Birmingham.
Br J Psychiatry Suppl. 1998;172(33):53-9.
We consider the evidence for the proposition that the early phase of psychosis (including the period of untreated psychosis) is a critical period in which (a) long-term outcome is predictable, and (b) biological, psychological and psychosocial influences are developing and show maximum plasticity.
First-episode prospective studies, predictors of outcome and the genesis of patients' key appraisals of their psychosis are reviewed.
The data support the notion of the 'plateau effect', first coined by Tom McGlashan, which suggested that where deterioration occurs, it does so aggressively in the first 2-3 years; and that critical psychosocial influences, including family and psychological reactions to psychosis and psychiatric services, develop during this period.
The early phase of psychosis presents important opportunities for secondary prevention. We outline a prototype of intervention appropriate to the critical period. The data challenge the widely held assumption that first-episode psychosis is a benign illness posing little risk.
我们考量以下观点的证据，即精神病的早期阶段（包括未治疗精神病阶段）是一个关键时期，在此期间：（a）长期预后是可预测的；（b）生物学、心理学和社会心理影响正在发展并呈现出最大可塑性。
回顾首发前瞻性研究、预后预测因素以及患者对其精神病关键评估的成因。
数据支持汤姆·麦克格拉斯汉首次提出的“平台效应”概念，该概念表明，若病情恶化，会在最初2至3年内急剧恶化；并且在此期间会产生关键的社会心理影响，包括家庭以及对精神病和精神科服务的心理反应。
精神病的早期阶段为二级预防提供了重要机遇。我们概述了适合这一关键时期的干预原型。这些数据挑战了一种广泛持有的假设，即首发精神病是一种风险极小的良性疾病。
