背景:精神分裂症是一种使人衰弱的疾病,影响很大一部分人群,并导致功能受损和长期挑战。第一次精神病发作(FEP)是改善长期结果的关键干预阶段。GAPi计划在圣保罗建立,巴西将提供早期干预服务,并评估FEP患者的生物标志物。本文描述了GAPi计划的目标,详述其创新研究方案,检查取得的临床结果,并讨论在其运营的最初十年中遇到的运营挑战。
方法:该研究包括年龄在16至35岁之间的首次精神病患者的抗精神病药物初治患者的前瞻性队列。参与者是从圣保罗的一家公共精神病院招募的。强调倡议对早期干预的承诺,在基线和两个月时进行了系统的临床评估,一年,两年,和五年的治疗,以捕捉短期和中期的结果。利用了各种评估工具,包括结构化面试,症状量表,成瘾严重程度指数,和功能评估。
结果:共有232名患者被纳入队列。其中,65.95%完成了为期2个月的随访。大多数患者表现为精神分裂症谱系障碍,其次是具有精神病特征的双相情感障碍和重度抑郁障碍。在不同时间点评估治疗反应率和缓解率,观察到有希望的结果。该计划还评估了社会人口因素,物质使用,家族史,以及遗传和生物标志物概况,为研究提供有价值的数据。
结论:GAPi计划已成为拉丁美洲最大的抗精神病药首次发作精神病队列,有助于了解低收入和中等收入国家的早期精神病。尽管面临运营挑战,该计划已证明在减少未治疗精神病的持续时间和改善临床结局方面有效.多学科方法,包括药物治疗,心理社会干预,和家庭参与,有助于提高治疗依从性和长期预后。
结论:GAPi计划代表了早期干预首发精神病的有价值的模型,并提供了对病理生理学的见解,治疗,以及精神分裂症和相关疾病患者的长期结果。持续的研究和资源分配对于应对低收入和中等收入国家的业务挑战和扩大早期干预服务至关重要。
BACKGROUND: Schizophrenia is a debilitating disorder that affects a significant proportion of the population and leads to impaired functionality and long-term challenges. The first episode of psychosis (FEP) is a critical intervention stage for improving long-term outcomes. The GAPi program was established in São Paulo, Brazil to provide early intervention services and evaluate biomarkers in individuals with FEP. This article delineates the objectives of the GAPi program, detailing its innovative research protocol, examining the clinical outcomes achieved, and discussing the operational challenges encountered during its initial decade of operation.
METHODS: The study comprised a prospective cohort of antipsychotic-naïve individuals with first-episode psychosis aged between 16 and 35 years. Participants were recruited from a public psychiatric facility in São Paulo. Emphasizing the initiative\'s commitment to early intervention, clinical assessments were systematically conducted at baseline and at two months, one year, two years, and five years of treatment to capture both short- and medium-term outcomes. Various assessment tools were utilized, including structured interviews, symptom scales, the Addiction Severity Index, and functional assessments.
RESULTS: A total of 232 patients were enrolled in the cohort. Among them, 65.95 % completed the 2-month follow-up. Most patients presented with schizophrenia spectrum disorders, followed by bipolar disorder and major depressive disorder with psychotic features. Treatment response rates and remission rates were evaluated at different time points, with promising outcomes observed. The program also assessed socio-demographic factors, substance use, family history, and genetic and biomarker profiles, providing valuable data for research.
CONCLUSIONS: The GAPi program has emerged as the largest ongoing cohort of antipsychotic-naïve first-episode psychosis in Latin America, contributing to the understanding of early psychosis in low- and middle-income countries. Despite operational challenges, the program has demonstrated efficacy in reducing the duration of untreated psychosis and in improving clinical outcomes. A multidisciplinary approach, including pharmacological treatment, psychosocial interventions, and family involvement, has been instrumental in enhancing treatment adherence and long-term prognosis.
CONCLUSIONS: The GAPi program represents a valuable model for early intervention in first-episode psychosis and provides insights into the pathophysiology, treatment, and long-term outcomes of individuals with schizophrenia and related disorders. Continued research and resource allocation are essential for addressing operational challenges and expanding early intervention services in low- and middle-income countries.