پیش بینی روان پریشی در نمونه روانپزشکی عمومی نوجوان

Introduction Current psychosis risk criteria have often been studied on a pre-selected population at specialized clinics. We investigated whether the Structured Interview for Prodromal Syndromes (SIPS) is a useful tool for psychosis risk screening among adolescents in general psychiatric care. Methods 161 adolescents aged 15–18 with first admission to adolescent psychiatric services in Helsinki were interviewed with the SIPS to ascertain Clinical High-Risk (CHR) state. The participants were followed via the national hospital discharge register, patient files, and follow-up interviews. DSM-IV Axis I diagnoses were made at baseline and 12 months. Register follow-up spanned 2.8–8.9 years, and hospital care for a primary psychotic disorder and any psychiatric disorder were used as outcomes. Results CHR criteria were met by 54 (33.5%) of the adolescents. Three conversions of psychosis as defined by SIPS emerged during follow-up, two of whom belonged to the CHR group. The positive predictive value of the CHR status was weak (1.9%) but its negative predictive value was 98.0%. Using the DSM-IV definition of psychosis, there were five conversions, three of which were in the CHR group. In regression analyses, hospital admissions for primary psychotic disorder were predicted by positive symptom intensity in the baseline SIPS. In addition, CHR status and SIPS positive and general symptoms predicted hospitalization for psychiatric disorder. Discussion Psychosis incidence was low in our unselected sample of adolescent psychiatric patients. CHR status failed to predict SIPS or DSM-IV psychoses significantly at 12 months. However, in a longer follow-up, CHR did predict psychiatric hospitalization.

Psychotic-like symptoms that are milder than in clinical psychotic disorders are common among adolescents (van Os et al., 2009 and Yung et al., 2009) and are usually transitory in nature (Simon et al., 2009 and Ziermans et al., 2011). However, these subclinical psychotic symptoms can also be predictive of later psychosis, especially when persistent (Dominguez et al., 2011) or when linked to negative symptoms and poor global functioning (Addington and Heinssen, 2012). Furthermore, psychotic experiences need clinical attention by themselves, as they are associated with increased risk for other mental disorders and psychiatric hospitalizations (Rössler et al., 2011 and Werbeloff et al., 2012), even when they have not been considered as clinically relevant (van Nierop et al., 2012). Recent studies suggest that it is often possible to identify an individual as having a high risk of psychosis before the onset of the first episode of psychosis (Addington and Heinssen, 2012). A recent meta-analysis found that the psychosis high-risk state, also called clinical high-risk state (CHR), is associated with a 36% risk for psychosis during a three-year follow-up, although the methods to define the high-risk state vary (Fusar-Poli et al., 2012). CHR has been proposed as a valid diagnostic entity, distinct from other psychiatric disorders in terms of symptoms and functioning (Woods et al., 2009). CHR is associated with long-term impairment in social and role functioning (Addington et al., 2011) and disruptive symptoms, also among those CHR individuals who do not develop psychosis (Haroun et al., 2006). However, critical opinions have also arisen, concerning different at-risk criteria, the risk of false positives and the use of psychosis conversion as the only outcome (Larsen et al., 2001, Simon et al., 2011, Schultze-Lutter et al., 2013 and Fusar-Poli et al., 2014). The study population appears to have a large impact on how well the CHR status predicts later psychosis (Yung et al., 2008). Many prospective studies have been made in clinics specialized in treating patients with CHR (Cannon et al., 2008 and Ruhrmann et al., 2010). These clinics choose their patients using different kinds of screening methods, or referral to the clinic may be based on the referring clinician's impression that the patient is at risk of psychosis. Not surprisingly, the proportion of the patients converting to psychosis is high (Fusar-Poli et al., 2014). Due to this pre-selection in high-risk research, the existing results linking CHR status to later psychosis cannot be generalized to all psychiatric patients. The objective of this study was to investigate the validity of CHR in predicting psychosis in general adolescent psychiatric services.