目的:处于临床高危(CHR)阶段的个体过渡到全面精神病所需的时间可能从几个月到几年不等。这个时间方面,被称为转化为精神病(TCP)的时间表,是精神病发展的一个关键但相对未充分开发的维度。
方法:样本由145名CHR患者组成,他们完成了5年的随访,并在这段时间内确认了向精神病的过渡。临床变量以及功能变量,例如基线时的全局功能评估(GAF)评分(GAF基线)和过去一年中最高评分的GAF下降。TCP定义为从CHR识别到精神病转化的持续时间。根据TCP将参与者分为3组:“短期”(≤6个月,≤33.3%),“中位数”(7-17个月,33.3%-66.6%),和“长”(≥18个月,≥66.6%)。采用分位数回归分析。
结果:总体样本的TCP中位数为11个月。观察到三个TCP组之间存在显着差异,特别是在GAF下降中(χ2=8.806,P=.012),无组织症状(χ2=7.071,P=0.029),一般症状(χ2=6.586,P=.037)。更混乱的症状(比值比[OR]=0.824,P=.009)和GAF下降(OR=0.867,P=.011)与较短的TCP显着相关,而更大的一般症状(OR=1.198,P=0.012)预示着更长的TCP。分位数回归分析显示高于0.7分位数的TCP和GAF基线之间的正相关,以及低于0.5分位数的TCP等级和GAF之间的负相关。
结论:这项研究强调了功能特征在CHR患者中形成TCP的关键作用,强调在早期预防工作中全面考虑时间方面的必要性。
OBJECTIVE: The time taken for an individual who is at the clinical high-risk (CHR) stage to transition to full-blown psychosis may vary from months to years. This temporal aspect, known as the timeframe for conversion to psychosis (TCP), is a crucial but relatively underexplored dimension of psychosis development.
METHODS: The sample consisted of 145 individuals with CHR who completed a 5-year follow-up with a confirmed transition to psychosis within this period. Clinical variables along with functional variables such as the Global Assessment of Function (GAF) score at baseline (GAF baseline) and GAF-drop from the highest score in the past year. The TCP was defined as the duration from CHR identification to psychosis conversion. Participants were categorized into 3 groups based on TCP: \"short\" (≤6 months, ≤33.3%), \"median\" (7-17 months, 33.3%-66.6%), and \"long\" (≥18 months, ≥66.6%). The quantile regression analysis was applied.
RESULTS: The overall sample had a median TCP of 11 months. Significant differences among the three TCP groups were observed, particularly in GAF-drop (χ2 = 8.806, P = .012), disorganized symptoms (χ2 = 7.071, P = .029), and general symptoms (χ2 = 6.586, P = .037). Greater disorganized symptoms (odds ratio [OR] = 0.824, P = .009) and GAF-drop (OR = 0.867, P = .011) were significantly associated with a shorter TCP, whereas greater general symptoms (OR = 1.198, P = .012) predicted a longer TCP. Quantile regression analysis demonstrated a positive association between TCP and GAF baseline above the 0.7 quantile and a negative association between TCP rank and GAF drop below the 0.5 quantile.
CONCLUSIONS: This study underscores the pivotal role of functional characteristics in shaping TCP among individuals with CHR, emphasizing the necessity for a comprehensive consideration of temporal aspects in early prevention efforts.