Can We Detect the Undetected? Comparing the Prodromes of Individuals with First Episode Psychosis Detected and Undetected by Clinical High-Risk for Psychosis Services: An Electronic Health Record Study.

IF 5.7 1区医学 Q1 PSYCHIATRY

Schizophrenia Bulletin Pub Date : 2026-08-20 DOI:10.1093/schbul/sbaf201

Maisie Inns, Madison Gill, Maite Arribas, Yanakan Logeswaran, Amedeo Minichino, Thomas J Reilly, Andrea De Micheli, Jai L Shah, Philip McGuire, Paolo Fusar-Poli, Dominic Oliver

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引用次数: 0

Abstract

Background and hypothesis: The majority of first episode psychosis (FEP) patients are undetected (DET-) by clinical high-risk for psychosis (CHR-P) services prior to onset and therefore do not receive preventive care for psychosis. We compared features of the psychosis prodrome (symptoms and substance use) between DET- and FEP patients detected by CHR-P services (DET+) to determine whether they share a common prodromal phase.

Study design: Retrospective Reporting of Studies Conducted Using Observational Routinely Collected Health Data statement-compliant electronic health record cohort study. We extracted 65 prodromal features (symptoms and substance use before FEP onset) using natural language processing to assess the presence, duration, and first presentation of the psychosis prodrome and occurrences of features across the prodrome. Duration and feature occurrences were compared between DET+ and DET- individuals using Mann-Whitney U tests and Wilcoxon Effect Size, while presence and first presentation were compared using logistic regression.

Study results: A total of 1545 FEP patients (n = 119 DET+ [mean age 28.7 years; SD = 9.4; 61.6% male]) were included. There were no significant differences in the presence (DET + =85.0%, DET- = 85.6%, P = .83) or duration (DET + =18.8 months, DET- = 18.4 months, P = .89) of the psychosis prodrome. There were no significant differences in first presentation of psychotic symptoms between groups (Pcorr > .05). Frequency of occurrences of thought broadcasting (r = 0.07, Pcorr = .04) was higher and hostility (r = 0.08, Pcorr = .04) lower in DET+ compared to DET- across the prodrome, though effect sizes were small.

Conclusions: DET+ and DET- individuals experience similar psychosis prodromes prior to FEP onset. DET- individuals can likely be identified earlier if detection strategies are improved.

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我们能发现未被发现的吗？比较临床精神病高危人群发现和未发现的首发精神病患者的前驱症状：一项电子健康记录研究

背景与假设：大多数首发精神病（FEP）患者在发病前未被临床精神病高危服务（chrp）发现（DET-），因此没有接受精神病预防护理。我们比较了CHR-P服务（DET+）检测到的DET-和FEP患者的精神病前驱症状（症状和物质使用）特征，以确定他们是否有共同的前驱期。研究设计：回顾性报告使用观察性常规收集健康数据声明符合电子健康记录队列研究的研究。我们提取了65个前驱特征（FEP发作前的症状和物质使用），使用自然语言处理来评估精神病前驱症状的存在、持续时间和首次表现以及前驱症状中特征的出现。使用Mann-Whitney U检验和Wilcoxon效应大小比较DET+和DET-个体之间的持续时间和特征发生情况，而使用逻辑回归比较存在和首次呈现。研究结果：共纳入1545例FEP患者（n = 119 DET+[平均年龄28.7岁；SD = 9.4；男性61.6%]）。两组间存在差异无统计学意义(DET + =85.0%, DET- = 85.6%, P =。83)或持续时间(侦破侦破,+ = 18.8个月- = 18.4个月,P =。89)精神病前驱症状。两组患者首次出现精神病症状的情况无显著差异（p < 0.05）。思想广播的出现频率(r = 0.07, Pcorr =。04)，敌意(r = 0.08, Pcorr =。04)在前驱症状中DET+比DET-低，尽管效应量很小。结论：DET+和DET-个体在FEP发病前经历相似的精神病前驱症状。如果改进检测策略，DET个体可能会更早被发现。

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来源期刊

Schizophrenia Bulletin 医学-精神病学

CiteScore

11.40

自引率

6.10%

发文量

163

审稿时长

4-8 weeks

期刊介绍： Schizophrenia Bulletin seeks to review recent developments and empirically based hypotheses regarding the etiology and treatment of schizophrenia. We view the field as broad and deep, and will publish new knowledge ranging from the molecular basis to social and cultural factors. We will give new emphasis to translational reports which simultaneously highlight basic neurobiological mechanisms and clinical manifestations. Some of the Bulletin content is invited as special features or manuscripts organized as a theme by special guest editors. Most pages of the Bulletin are devoted to unsolicited manuscripts of high quality that report original data or where we can provide a special venue for a major study or workshop report. Supplement issues are sometimes provided for manuscripts reporting from a recent conference.