期刊
EPIDEMIOLOGY AND PSYCHIATRIC SCIENCES
卷 30, 期 -, 页码 -出版社
CAMBRIDGE UNIV PRESS
DOI: 10.1017/S204579602100041X
关键词
Epidemiology; prevention; psychosis; risk
类别
资金
- Ministry of Health, Welfare and Sport
- European Community's Seventh Framework Program [HEALTH-F2-2009-241909]
- Netherlands Scientific Organisation [91718336]
- Ophelia research project, ZonMw [636340001]
- MRC [G08005009, MR/L010305/1]
- MRC [MR/L010305/1] Funding Source: UKRI
Research shows that in clinical high-risk states, the co-occurrence of NPD with attenuated psychotic symptoms can influence the risk of developing psychotic disorders, and early psychotic experiences combined with NPD often result in poorer functional outcomes and environmental risks.
Aims Although attenuated psychotic symptoms in the psychosis clinical high-risk state (CHR-P) almost always occur in the context of a non-psychotic disorder (NPD), NPD is considered an undesired 'comorbidity' epiphenomenon rather than an integral part of CHR-P itself. Prospective work, however, indicates that much more of the clinical psychosis incidence is attributable to prior mood and drug use disorders than to psychosis clinical high-risk states per se. In order to examine this conundrum, we analysed to what degree the 'risk' in CHR-P is indexed by co-present NPD rather than attenuated psychosis per se. Methods We examined the incidence of early psychotic experiences (PE) with and without NPD (mood disorders, anxiety disorders, alcohol/drug use disorders), in a prospective general population cohort (n = 6123 at risk of incident PE at baseline). Four interview waves were conducted between 2007 and 2018 (NEMESIS-2). The incidence of PE, alone (PE-only) or with NPD (PE + NPD) was calculated, as were differential associations with schizophrenia polygenic risk score (PRS-Sz), environmental, demographical, clinical and cognitive factors. Results The incidence of PE + NPD (0.37%) was lower than the incidence of PE-only (1.04%), representing around a third of the total yearly incidence of PE. Incident PE + NPD was, in comparison with PE-only, differentially characterised by poor functioning, environmental risks, PRS-Sz, positive family history, prescription of antipsychotic medication and (mental) health service use. Conclusions The risk in 'clinical high risk' states is mediated not by attenuated psychosis per se but specifically the combination of attenuated psychosis and NPD. CHR-P/APS research should be reconceptualised from a focus on attenuated psychotic symptoms with exclusion of non-psychotic DSM-disorders, as the 'pure' representation of a supposedly homotypic psychosis risk state, towards a focus on poor-outcome NPDs, characterised by a degree of psychosis admixture, on the pathway to psychotic disorder outcomes.
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