Всемирная психиатрия. №2 2020

Ассоциация предшествующих состояний риска психоза и непсихотических расстройств с уровнем заболеваемости психозами в общей популяции: проспективное исследование в когорте NEMESIS-2

Sinan Guloksuz1,2, Lotta-Katrin Pries1 , Margreet ten Have3 , Ron de Graaf3 , Saskia van Dorsselaer3 , Boris Klingenberg1 , Maarten Bak1 , Bochao D. Lin4 , Kristel R. van Eijk5 , Philippe Delespaul1 , Therese van Amelsvoort1 , Jurjen J. Luykx4,6,7, Bart P.F. Rutten1 , Jim van Os1,5,6,8

Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands; 2 Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; 3 Department of Epidemiology, Netherlands Institute of Mental Health and Addiction, Utrecht,The Netherlands; 4 Department of Translational Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands; 5 Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands; 6 Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands; 7 GGNet Mental Health, Apeldoorn, The Nether- lands; 8 Department of Psychosis Studies, King’s College London, Institute of Psychiatry, London, UK

Стр. 199-205

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Опубликовано: 1 июня 2020

Аннотация / Abstract

Вопрос раннего вмешательства при психотических расстройствах активно разрабатывается психиатрической наукой на протяжении последних двадцати пяти лет. Неопровержимые данные указывают на то, что специализированные службы раннего вмешательства при первом психотическом эпизоде дают лучшие краткосрочные клинические результаты во всех измеримых областях по сравнению с обычным лечением1. Кроме того, высказывалось предположение, что сокращение продолжительности нелеченного психоза приводит к лучшему прогнозу в отношении дальнейшего течения болезни2. Следующим шагом в этом направлении стала идея вмешаться в процесс на еще более ранних этапах, обнаружив психоз на доклинической фазе «ультравысокого риска» (UHR), также известного как «высокий клинический риск» (CHR). В течение последнего десятилетия обоснованность и клиническая применимость парадигмы CHR широко исследовались у индивидов, которые обратились за соответствующей помощью и были отобраны в клинических условиях как имеющие факторы риска3. В идентификации состояний высокого риска и определении риска перехода в психоз парадигма CHR ориентируется на частоту и выраженность позитивных симптомов психоза3. В ранних исследованиях сообщалось, что в психоз переходит до 40% состояний CHR, но этот показатель постоянно снижался по мере накопления данных и в последних мета-анализах оценки составляет менее половины от первоначально зарегистрированных уровней: 15% за усредненный период в 38 месяцев4 или 4,7% за год. Такое значительное снижение показателей перехода в психоз может быть связано с эффектом разбавления, который в свою очередь происходит из повышенной осведомленности о субклинических психотических состояниях и более широкого охвата служб раннего вмешательства, из-за чего учащаются самостоятельные обращения пациентов и чаще ставится ложноположительный диагноз CHR в исследованиях более позднего периода. После публикации наших критических статей о концепции CHR3,5 начались интенсивные дебаты, участники которых разде...

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