J.F. Gleeson , T.B. McGuckian , D.K. Fernandez , M.I. Fraser , A. Pepe , R. Taskis , M. Alvarez-Jimenez , J.F. Farhall , A. Gumley
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引用次数: 0
摘要
背景:早期预警信号(EWS)的识别是预防精神分裂症谱系障碍复发的关键,然而,其准确性受到限制。最近,大量的方法创新被应用于预测精神病复发和个体精神病症状。然而,目前还没有将这两种相关结果整合起来的系统综述,也没有10年来EWS复发的系统综述。方法对精神病复发的EWS和精神病症状恶化的行为前因进行系统回顾。包括传统的生态环境监测和生态瞬时评估/干预研究。我们完成了EWS预测复发的敏感性和特异性的荟萃分析,并预测了个体症状的复发。结果共纳入72项研究,受试者6903人。睡眠、情绪和怀疑是症状恶化的预测因素。EWS预测精神病复发的敏感性和特异性分别为71%和64% (AUC值 = 0.72)。模型预测个体症状复发的合并效应量较大,但无统计学意义(d = 0.81,95% ci = −0.01,1.63)。结论在预测精神分裂症谱系障碍患者精神病性复发方面取得了重要的方法学进展,预测精度明显提高。需要进一步努力将这些进展转化为有效的临床创新。
Systematic review of early warning signs of relapse and behavioural antecedents of symptom worsening in people living with schizophrenia spectrum disorders
Background
Identification of the early warning signs (EWS) of relapse is key to relapse prevention in schizophrenia spectrum disorders, however, limitations to their precision have been reported. Substantial methodological innovations have recently been applied to the prediction of psychotic relapse and to individual psychotic symptoms. However, there has been no systematic review that has integrated findings across these two related outcomes and no systematic review of EWS of relapse for a decade.
Method
We conducted a systematic review of EWS of psychotic relapse and the behavioural antecedents of worsening psychotic symptoms. Traditional EWS and ecological momentary assessment/intervention studies were included. We completed meta-analyses of the pooled sensitivity and specificity of EWS in predicting relapse, and for the prediction of relapse from individual symptoms.
Results
Seventy two studies were identified including 6903 participants. Sleep, mood, and suspiciousness, emerged as predictors of worsening symptoms. Pooled sensitivity and specificity of EWS in predicting psychotic relapse was 71% and 64% (AUC value = 0.72). There was a large pooled-effect size for the model predicting relapse from individual symptom which did not reach statistical significance (d = 0.81, 95%CIs = −0.01, 1.63).
Conclusions
Important methodological advancements in the prediction of psychotic relapse in schizophrenia spectrum disorders are evident with improvements in the precision of prediction. Further efforts are required to translate these advances into effective clinical innovations.
期刊介绍:
Clinical Psychology Review serves as a platform for substantial reviews addressing pertinent topics in clinical psychology. Encompassing a spectrum of issues, from psychopathology to behavior therapy, cognition to cognitive therapies, behavioral medicine to community mental health, assessment, and child development, the journal seeks cutting-edge papers that significantly contribute to advancing the science and/or practice of clinical psychology.
While maintaining a primary focus on topics directly related to clinical psychology, the journal occasionally features reviews on psychophysiology, learning therapy, experimental psychopathology, and social psychology, provided they demonstrate a clear connection to research or practice in clinical psychology. Integrative literature reviews and summaries of innovative ongoing clinical research programs find a place within its pages. However, reports on individual research studies and theoretical treatises or clinical guides lacking an empirical base are deemed inappropriate for publication.