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Clinical Research Updates 临床研究更新
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-18 DOI: 10.1111/camh.12725
Marinos Kyriakopoulos, Charvi Saraswat, Lucy Snelson, Marios Stathopoulos
<p>Lucy Snelson</p><p>South London and Maudsley NHS Foundation Trust</p><p>Bullying is considered one of the most robust, preventable risk factors for the development of psychiatric disorders. It is recognised by the World Health Organisation as a major public health concern. Those with neurodevelopmental and psychiatric conditions may be at increased risk of being involved in bullying due to being perceived as different by their peers.</p><p>Abregú-Crespo et al. (2024) conducted a systematic review and meta-analysis to explore the overall prevalence of bullying in those with neurodevelopmental and psychiatric conditions. The authors identified 212 studies which reported bullying in children and adolescents (N = 126,717; 37.6% female) aged 4–17 (mean age: 12.3 years) with a neurodevelopmental or psychiatric condition. They distinguished between traditional bullying, which included physical, verbal and relational bullying (actions which intend to harm an individuals' reputation), and cyber bullying, defined as repeated harm inflicted online (for example on social media). They noted that this was the first meta-analysis in this population to differentiate between different types of bullying, including the relatively recent phenomenon of cyberbullying.</p><p>The authors found that 42.2% of young people with neurodevelopmental or psychiatric conditions were victims, 24.4% were perpetrators and 14% were both victims and perpetrators of traditional bullying. Those with conduct disorders, autism and ADHD showed the highest prevalence rates for involvement in traditional bullying. Prevalence rates were lower for involvement in cyber bullying, with 21.8% of the population being victims and 19.6% perpetrators. Interestingly, the rate of those who were both victims and perpetrators were higher for cyberbullying (20.7%) than traditional bullying. Furthermore, when compared with controls (N = 504,806; 47.5% female; mean age 12.5 years), this population experienced increased bullying victimisation (2.85-fold), perpetration (2.45-fold) and perpetration–victimisation (3.66-fold). The authors suggested that difficulties in social communication, behaviour and emotional regulation may lead young people in this population to be perceived as being different to their peers and, therefore, more vulnerable to being involved in bullying. Lastly, they found that victims of traditional bullying with neurodevelopmental or psychiatric conditions scored higher on mental health measures including internalising, externalising, general psychopathology and suicidality compared to controls.</p><p>A key strength of the study is that the authors used a thorough screening method to minimise risk of bias and to increase the validity of the results. All articles were screened twice across three screening phases with five researchers reviewing articles independently. They performed additional sensitivity analyses removing cases with conduct disorders to avoid skewing their results, in r
露西-斯尼尔森(Lucy Snelson)南伦敦和莫兹利 NHS 基金会信托基金会欺凌被认为是导致精神疾病的最重要、最可预防的风险因素之一。世界卫生组织认为这是一个重大的公共卫生问题。Abregú-Crespo 等人(2024 年)进行了一项系统回顾和荟萃分析,以探讨神经发育和精神疾病患者遭受欺凌的总体发生率。作者确定了 212 项研究,这些研究报告了 4-17 岁(平均年龄:12.3 岁)患有神经发育或精神疾病的儿童和青少年(N=126717;37.6% 为女性)中发生的欺凌事件。他们对传统欺凌和网络欺凌进行了区分,传统欺凌包括肢体、语言和关系欺凌(意在损害个人名誉的行为),网络欺凌则是指在网上(如社交媒体上)反复实施的伤害行为。作者发现,42.2%患有神经发育障碍或精神疾病的青少年是传统欺凌的受害者,24.4%是施暴者,14%既是受害者又是施暴者。患有行为障碍、自闭症和多动症的青少年参与传统欺凌的比例最高。参与网络欺凌的比例较低,21.8%的人是受害者,19.6%的人是施暴者。有趣的是,网络欺凌的受害者和施暴者比例(20.7%)均高于传统欺凌。此外,与对照组(N = 504 806;47.5% 为女性;平均年龄为 12.5 岁)相比,这些人群的欺凌受害率(2.85 倍)、施暴率(2.45 倍)和施暴-受害率(3.66 倍)均有所上升。作者认为,社交沟通、行为和情绪调节方面的困难可能会导致该群体中的青少年被认为与同龄人不同,因此更容易卷入欺凌事件。最后,他们发现,与对照组相比,患有神经发育或精神疾病的传统欺凌受害者在心理健康测量指标上的得分更高,这些指标包括内化、外化、一般精神病理学和自杀倾向。在三个筛选阶段中,所有文章都经过两次筛选,由五位研究人员独立审阅。他们还进行了额外的敏感性分析,剔除了有行为障碍的病例,以避免结果出现偏差,因为他们发现这类人群中参与欺凌的比例较高。不足之处在于,他们报告的大多数结果都没有区分神经发育障碍和精神疾病。不同精神病患者的经历和症状差异很大,尤其是神经发育障碍患者,他们的社会交流差异是其显著特点。这可能会使医护人员在为患有不同病症的青少年提供支持时难以确定实际影响。作者还承认,分析中包含的许多研究描述不清且缺乏细节。Abregú-Crespo, R., Garriz-Luis, A., Ayora, M., Martín-Martínez, N., Cavone, V., Carrasco, M. Á., ... &amp; Díaz-Caneja, C. M. (2024)。患有神经发育和精神疾病的儿童和青少年的校园欺凌:系统回顾和荟萃分析》。The Lancet Child &amp; Adolescent Health, 8, 122-134.Charvi SaraswatSouth London and Maudsley NHS Foundation Trust 精神病经历(PEs)是精神病易感性的人群指标,其病因与各种遗传、神经生物学、药物相关、感染相关和社会因素有关。DeVylder 等人(2024 年)在东京青少年队列研究(Tokyo Teen Cohort study,TTC)中探讨了青少年自 10 岁起自我报告的 PE 的存在情况,该研究是东京都内一项正在进行的纵向研究。东京青少年队列研究随机抽取了 2002 年 9 月 1 日至 2004 年 8 月 31 日期间出生的青少年,并收集了他们在 10 岁(T1)、12 岁(T2)、14 岁(T3)和 16 岁(T4)前后的数据。在参加 T1 的 3171 对青少年和家长中,有 2616 对在 16 岁前继续接受了跟踪调查,跟踪调查率为 82.5%。
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引用次数: 0
Editorial: Open science and methods review for Child and Adolescent Mental Health 社论:儿童和青少年心理健康的开放科学和方法审查。
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-18 DOI: 10.1111/camh.12726
Thees F. Spreckelsen, Lewis W. Paton

This editorial introduces the journal's new open data policy for original articles using quantitative data. It discusses key opportunities from data and code sharing. It further briefly sets out the new methods review that articles which use quantitative analysis will automatically undergo. With both changes we hope to strengthen our review process and contribute to a better evidence base in the field.

这篇社论介绍了期刊针对使用定量数据的原创文章的新开放数据政策。它讨论了数据和代码共享带来的重要机遇。它还简要介绍了使用定量分析的文章将自动接受的新方法审查。我们希望通过这两项改变来加强我们的审稿流程,并为该领域建立更好的证据基础做出贡献。
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引用次数: 0
Editorial: Socio-economic inequality and child and adolescent mental health 社论:社会经济不平等与儿童和青少年心理健康。
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-18 DOI: 10.1111/camh.12699
Kate E. Pickett, Richard G. Wilkinson
<p>It would be hard to find anyone, including politicians anywhere on the political spectrum, who would not agree that a society should look after its children well – giving them a good start in life, protecting their interests and their health and wellbeing, and promoting their development and education. Our children are our future – our long-term societal well-being depends on them. And there is widespread contemporary concern for the mental health of children and adolescents, following the global COVID-19 pandemic.</p><p>In this context, it is perhaps surprising that it is so difficult to compare different societies in terms of child and adolescent mental health, but it remains the case that there are no sources of high quality, internationally comparable data on mental illness in children and young people. Even within countries, there are surprisingly few sources of data – no data on child mental illness could be included in the recent Child and Adolescent Thriving Index 1.0 in the USA (Pickett, <span>2022</span>). To try and understand both variation in child and adolescent mental health, and the causes of such variation, we have to use proxy measures, such as life satisfaction, or measures such as the adolescent suicide rate that represent a very extreme tip of an iceberg of mental distress. In their most recent report on child well-being in high income countries, the United Nations Children's Fund (UNICEF), created an index of mental well-being that includes the percentage of 15 year olds reporting high life satisfaction and the suicide rate for 15–19 year olds (https://www.unicef-irc.org/publications/pdf/Report-Card-16-Worlds-of-Influence-child-wellbeing.pdf). On this index, the Netherlands ranks top and New Zealand bottom, and there is much variation in both measures. Over 90% of children in the Netherlands have high life satisfaction, but only 64% of UK children say the same. In Greece, the teenage suicide rate is 1.4 per 100,000 adolescents, in New Zealand that figure is 10 times higher at 14.9 per 100,000.</p><p>Nevertheless, there are now a number of studies suggesting that income inequality, the gap between rich and poor in a society, is robustly associated with measures of mental well-being in children and young people (Alemán-Díaz et al., <span>2016</span>), whether that is child mental illness in relation to income inequality across the 50 US states (Wilkinson & Pickett, <span>2009</span>), happiness and psychological distress across regions of China (Du, Chi, & King, <span>2019</span>) or psychological symptoms across 17 high income countries (Dierckens et al., <span>2020</span>). We have also shown that changes in income inequality are related to changes in child well-being – as countries become more or less equal their child well-being rises or falls (Pickett & Wilkinson, <span>2015</span>).</p><p>Within countries, socio-economic position has a well-described and profound impact on all aspects of child and adolesce
研究表明,在更加不平等的社会中,虐待儿童的发生率更高。不平等也会影响儿童自身直接受到不平等的影响,例如,欺凌程度更高,普遍信任程度更低(Wilkinson &amp; Pickett, 2017, 2018)。威康信托基金会将社会关系视为心理健康的 "积极成分",认为尤其对于青少年而言,社会关系可以在他们形成社会身份的关键阶段为他们提供支持,并提供资源以增强他们对抑郁和焦虑的复原力。然而,对于今天的儿童和青少年来说,社交关系,包括与同龄人的社交关系,越来越多地发生在数字平台上。97%的年轻人至少使用一个社交媒体平台。这使得他们比以往任何一代人都更容易受到网络欺凌和他人评价的影响,而这恰恰会加剧身份焦虑。对许多年轻人来说,社交媒体也可以成为社交接触的积极来源,这种支持有助于他们中的许多人度过 COVID-19 大流行期间所经历的孤独;关于社交媒体对儿童和年轻人心理健康影响的研究结果喜忧参半,尽管最近对 126 项研究进行的系统回顾和对 76 项研究进行的荟萃分析表明,社交媒体对青少年与健康有关的不良行为有影响,如酗酒和吸毒(Purba, Henderson, Baxter, Katikireddi, &amp; Pearce, 2023)。当然,儿童和青少年并不只是被动地接受影响其心理健康的更广泛的社会决定因素。他们如何看待不平等,如何看待自己和家人在社会中的社会地位,也会影响他们的心理健康和幸福。研究表明,那些认为自己的家庭比朋友家更贫穷的年轻人,其心理健康状况会更 差,人际交往方面的困难也会更多。令人担忧的是,对不平等现象的日益敏感可能实际上会增加研究这些现象的难度。在一项正在进行的针对英格兰北部青少年的队列研究中,共同生产工作显示,青少年不愿意自我报告相对的主观社会地位,他们表示不喜欢被要求将自己与他人进行比较(Moss, Kelly, Bird, Nutting, &amp; Pickett, 2023)。然而,对于那些关注社会正义的人来说,令人欣慰的是,虽然儿童和青少年可能正在遭受不平等的后果,但他们也可以成为积极变革的重要倡导者。英国最近的一项研究表明,年轻人比年长者更有可能意识到并关注不平等问题。世界各地也有年轻人作为积极公民参与反对不平等运动的正面例子(Bruselius-Jensen, Pitti, &amp; Tisdall, 2021)。这种参与不仅有助于推动变革,还可以通过赋予年轻人社会联系和团结意识,以及目的感和能动性,减轻不平等对心理健康的影响。
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引用次数: 0
Editorial: The Cass Review – implications and reassurance for practitioners 社论:卡斯评论》--对从业人员的影响和保证。
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-18 DOI: 10.1111/camh.12723
Hilary Cass

This editorial perspective summarises the key findings of the independent review of gender identity services for children and young people commissioned by the National Health Service (NHS) in England (the Cass Review). Although the evidence underpinning endocrine interventions in this group of young people remains weak, there is much that mental health practitioners can do to improve their well-being and support their families. The controversies surrounding this group of young people have disempowered local professionals, who have lost confidence in their ability to provide care for them. The reality is that CAMHS professionals already have all the necessary transferrable skills and with a small amount of top up training, they can make a profound difference to the lives of this vulnerable group, which has been marginalised in our healthcare system.

这篇社论总结了英国国民健康服务(NHS)委托进行的儿童和青少年性别认同服务独立审查(卡斯审查)的主要发现。尽管对这部分青少年进行内分泌干预的证据仍然薄弱,但心理健康工作者可以做很多事情来改善他们的福祉并为他们的家庭提供支持。围绕这部分青少年的争议使当地的专业人员丧失了能力,他们对自己为这部分青少年提供护理的能力失去了信心。现实情况是,儿童心理健康服务(CAMHS)的专业人员已经掌握了所有必要的可转移技能,只需接受少量的补充培训,他们就能为这一弱势群体的生活带来深远的影响,而这一群体在我们的医疗保健系统中一直被边缘化。
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引用次数: 0
Letter to the Editor: Addressing the escalating trend of nonmedical use of benzodiazepines and Z-hypnotics among adolescents – a call for gender-sensitive interventions and policy reforms 致编辑的信:应对青少年非医疗使用苯并二氮杂卓和 Z-催眠药的升级趋势--呼吁采取对性别问题有敏感认识的干预措施和政策改革。
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-16 DOI: 10.1111/camh.12731
Lien-Chung Wei, Hsien-Jane Chiu
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引用次数: 0
Commentary: Can a modernised psychiatric unit space reduce the use of coercive measures in child and adolescent psychiatry? A commentary on Czernine et al. (2024). 评论:现代化的精神科空间能否减少儿童和青少年精神病学中强制措施的使用?对 Czernine 等人(2024 年)的评论。
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-16 DOI: 10.1111/camh.12732
Keri Ka-Yee Wong

The environment influences the way we act, react and adapt to our surroundings whether it is consciously or unconsciously. Though it is widely accepted that multiple interacting systems influence human behaviour and development across the life span, the reality of teasing these factors apart is difficult and challenging. In this brief commentary on Czernine and colleagues' important and timely paper, 'Can a modernised psychiatric unit space reduce the use of coercive measures in child and adolescent psychiatry?', I evaluate and build on the evidence presented by making constructive suggestions on ways of improving the status quo healthcare and treatment conditions for children and adolescents today. The underlying assumption is that by furthering this complex yet important area of research in the field of psychiatry and adjacent disciplines, we can improve existing healthcare systems and processes that are aligned with meeting child and adolescent needs.

无论是有意识还是无意识,环境都会影响我们的行为、反应和适应环境的方式。尽管人们普遍认为,多种相互作用的系统会影响人的行为和一生的发展,但要将这些因素区分开来却很困难,也很有挑战性。在这篇简短的评论中,我对切尔尼及其同事发表的重要而及时的论文《现代化的精神科空间能否减少儿童青少年精神病学中强制措施的使用?我的基本假设是,通过在精神病学领域及邻近学科进一步开展这一复杂而重要的研究,我们可以改善现有的医疗保健系统和流程,以满足儿童和青少年的需求。
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引用次数: 0
Narrative Matters: When does the history of ADHD not begin? 评论:多动症的历史何时开始?
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-15 DOI: 10.1111/camh.12727
Matthew Smith

This commentary discusses the history of ADHD and how it can inform contemporary debates about the disorder. It critiques retrospective histories of ADHD, which propose earlier origins for the disorder than match the historical evidence. It concludes by indicating when ADHD did emerge as a distinctive disorder and why it did so.

这篇评论讨论了多动症的历史,以及它如何为当代有关该疾病的辩论提供信息。它批判了多动症的回顾性历史,这些历史提出了比历史证据更早的多动症起源。最后,它指出了多动症作为一种独特的疾病出现的时间和原因。
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引用次数: 0
Commentary: Who gets the credit for “discovering” ADHD and what is the question, really? 叙述事项:谁是 "发现 "多动症的功臣?问题到底是什么?
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-13 DOI: 10.1111/camh.12730
Gabrielle A. Carlson

Recognition of hyperactivity, impulsivity, distractibility, and emotional lability as a clinical syndrome is at the heart of identifying whether there is a discoverer of the condition of attention deficit hyperactivity disorder (ADHD). Just as clinics of children diagnosed with ADHD do not capture a homogeneous group of boys and girls, however, history does not either. What different observers/clinicians have chosen to highlight reflects what is important to them and to the times in which they lived. The child/children described by Heinrich Hoffman (of Fidgety Phil fame) and George Still (who highlighted impulsive aggression as a moral defect), for instance, did not come with a list of criteria (with which even now we cannot always agree) to prove unequivocally that they had ADHD. Who cares! It is sufficient that they recognized the importance of certain co-occurring behaviors and shared their observations with us such that we can conclude our clinic's children were recognized by good past observers. ADHD-like children, like the poor, have probably always been with us.

将多动、冲动、注意力分散和情绪不稳视为一种临床综合征,是确定注意力缺陷多动障碍(ADHD)是否存在发现者的核心所在。然而,被诊断为多动症儿童的诊所并不能捕捉到同质的男孩和女孩群体,病史也是如此。不同的观察者/临床医生所选择强调的内容,反映了对他们和他们所生活的时代来说哪些是重要的。例如,海因里希-霍夫曼(Heinrich Hoffman,"浮躁菲尔 "的成名人物)和乔治-斯蒂尔(George Still,强调冲动攻击是一种道德缺陷)所描述的儿童,并没有列出一系列标准(即使现在我们也不能总是同意这些标准)来明确证明他们患有多动症。谁在乎呢?他们认识到了某些并发行为的重要性,并与我们分享了他们的观察结果,因此我们可以得出结论,我们诊所的孩子是被过去优秀的观察者识别出来的,这就足够了。类似多动症的儿童就像穷人一样,可能一直与我们同在。
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引用次数: 0
Staff Perspectives: Why are adolescent inpatients secluded and what causes changes in rates of seclusion on a unit? 工作人员的观点:为什么要对青少年住院病人实施隔离,是什么导致了病房隔离率的变化?
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-08 DOI: 10.1111/camh.12729
Miriam K. Yurtbasi, Michael Gordon, Christine Pavlou, Glenn Melvin

Background

The use of seclusion in Adolescent Inpatient Psychiatric Units is being heavily scrutinised due to its forceful nature and potential to cause harm. This study aimed to understand staff perspectives on reasons for seclusion in an Adolescent Inpatient Psychiatric Unit.

Method

A mixed methods approach that included the Attitudes to Seclusion Survey followed by a semi-structured interview on the reasons for seclusion was used. We recruited 31 participants who worked on the unit of which 27 were involved in seclusion.

Results

The findings showed that the majority of staff view seclusion as undesirable and believe it should only be used out of necessity. However, there was disagreement among staff about the reasons why adolescents were secluded and whether those reasons were justified. Staff identified factors that contributed to increases in seclusion but also provided several ways in which seclusion could be reduced.

Conclusions

These findings highlight a need for precision on what constitutes justifiable use of seclusion to reduce the potential for misuse. It also shows opportunities exist for further reduction in seclusion through teamwork and communication.

背景:由于其强制性质和可能造成的伤害,在青少年精神病住院部使用隔离正在受到严格审查。本研究旨在了解员工对青少年精神病住院部实施隔离的原因的看法:我们采用了一种混合方法,包括隔离态度调查和关于隔离原因的半结构式访谈。我们招募了 31 名在该病房工作的参与者,其中 27 人参与了隔离:调查结果显示,大多数员工认为隔离是不可取的,并认为只有在必要时才应使用隔离。然而,对于隔离青少年的原因以及这些原因是否合理,工作人员之间存在分歧。工作人员指出了导致隔离现象增加的因素,但也提供了几种可以减少隔离现象的方法:这些调查结果表明,有必要明确什么是合理使用隔离,以减少滥用隔离的可能性。研究还表明,通过团队合作和沟通,有机会进一步减少隔离。
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引用次数: 0
Letter to the Editor: Detecting and treating young people at risk for psychosis is essential, but early intervention for those with a psychotic disorder should be a priority for CAMHS 致编辑的信检测和治疗有精神病风险的青少年是至关重要的,但对患有精神病的青少年进行早期干预应该是儿童青少年心理健康服务(CAMHS)的首要任务。
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-08 DOI: 10.1111/camh.12728
Luis Alameda, Philippe Conus
<p>We read the article by Salazar de Pablo and Arango (<span>2023</span>) with great interest. The authors discuss some advantages and limitations from the Clinical high Risk for Psychosis (CHR-P) paradigm; mentioning a few additional perspectives that could be addressed in CAMHS services beyond the current CHR-P model. Among various propositions, they suggest training professionals working in primary care to assess psychosis-like experiences and to propose transdiagnostic cost-effective interventions such as psychoeducation and treatment for those where psychopathology emerges in the form of anxiety and depression. What they propose is very similar to the Head Space model developed in Australia, and which broadens the narrow focus of CHR-P and Early Intervention (EI) for psychosis. Head Space, created in 2006 in Australia, offers support to young people aged 12–25 facing a large range of psychological issues in a low stigma environment. More than 150 centres have now been implemented in Australia, embedded in the community and primary care such as the one proposed by Salazar de Pablo and Arango. Headspace has successfully been granted substantial funding over the last 2 decades and has provided 4.4 million interventions to more than 700,000 young Australians since its creation (McGorry et al., <span>2007</span>; Rickwood et al., <span>2023</span>). It is however worth noting that at this stage, considerable concerns have been raised in terms of evidence-base results on the efficacy of this approach, as well as other problems such as the deficient coordination with the standard governmental healthcare services where patients should be referred in case of established disorder or suicidality, leading to duplication in care (Hilferty, Cassells, Muir, & Katz, <span>2016</span>; Kisely & Looi, <span>2022</span>). These concerns have reduced the broad exportation of the model to other countries (Looi, Allison, Bastiampillai, & Kisely, <span>2021</span>), although similar strategies are currently being developed in some places (https://www.birmingham.ac.uk/research/heroes/youth-mental-health.aspx) which is encouraging. Hopefully, new data from Head Space can further help to expand this model as Salazar de Pablo and Arango propose.</p><p>There is another point we would like to raise. While Salazar de Pablo and Arango focus their paper on the CHR-P paradigm and suggest it should be implemented in CAMHS, we think the necessity for adequate treatment of patients with First Episode Psychosis (FEP) should not be forgotten. Indeed, if implementation of the identification of at risk mental state is an important step towards preventive treatment, patients with FEP definitely need adequate treatment. FEP programmes have now been implemented around the World for more than 30 years and their positive impact on outcome is strongly established. Despite a very strong accumulation of evidence, many countries in Europe and around the World, still do not have
我们饶有兴趣地阅读了 Salazar de Pablo 和 Arango(2023 年)的文章。作者讨论了精神病临床高风险(CHR-P)模式的一些优势和局限性;提到了在当前的 CHR-P 模式之外,可以在 CAMHS 服务中解决的一些其他观点。在各种提议中,他们建议对从事初级保健的专业人员进行培训,以评估类似精神病的经历,并提出具有成本效益的跨诊断干预措施,如针对以焦虑和抑郁形式出现精神病理学的患者进行心理教育和治疗。他们提出的建议与澳大利亚开发的 "头部空间"(Head Space)模式非常相似,该模式拓宽了 "精神疾病早期干预"(CHR-P)和 "早期干预"(EI)对精神病的狭隘关注。2006 年在澳大利亚创立的 "头部空间"(Head Space)为 12-25 岁、面临各种心理问题的青少年提供支持,让他们在一个低耻辱感的环境中成长。目前,澳大利亚已经建立了 150 多个中心,这些中心都设在社区和基层医疗机构,如 Salazar de Pablo 和 Arango 提议建立的中心。在过去的 20 年里,"头部空间 "成功获得了大量资金,自成立以来已为 70 多万澳大利亚青少年提供了 440 万次干预(McGorry 等人,2007 年;Rickwood 等人,2023 年)。然而,值得注意的是,在现阶段,人们对这一方法的有效性的证据基础结果以及其他问题提出了相当大的担忧,例如与标准的政府医疗保健服务之间的协调不足,在患者已经出现失调或自杀倾向的情况下,应将其转介到标准的政府医疗保健服务中,从而导致重复护理(Hilferty、Cassells、Muir、& Katz,2016;Kisely & Looi,2022)。这些担忧减少了该模式向其他国家的广泛输出(Looi, Allison, Bastiampillai, & Kisely, 2021),尽管目前一些地方正在制定类似的战略(https://www.birmingham.ac.uk/research/heroes/youth-mental-health.aspx),这令人鼓舞。希望来自 "头部空间 "的新数据能够进一步帮助扩展这一模式,正如 Salazar de Pablo 和 Arango 所建议的那样。虽然 Salazar de Pablo 和 Arango 将他们的论文重点放在 CHR-P 范式上,并建议在 CAMHS 中实施该范式,但我们认为不应忘记对首发精神病(FEP)患者进行适当治疗的必要性。事实上,如果识别高危精神状态的实施是预防性治疗的重要一步,那么首次发病精神病患者肯定需要适当的治疗。现已在世界各地实施了 30 多年的 "首次精神病治疗计划",其对治疗效果的积极影响已得到有力证实。尽管已经积累了大量的证据,但欧洲和世界上许多国家仍然没有适当的儿童早期干预计划。这一点在儿童心理、情感和健康服务中表现得更为明显,至少在过去,人们对诊断出精神病还有些不情愿。因此,我们建议,当青少年出现精神病的临床表现时,应向他们提供对年轻成人患者有更好疗效的 "早期干预 "策略。
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Child and Adolescent Mental Health
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