Recenzija, Prikaz slučaja

ASSESSMENT AND TREATMENT OF THE RISK OF PSYCHOSIS IN ADOLESCENTS – A REVIEW

Nicolas Zdanowicz ; Université Catholique de Louvain, CHU Mont-Godinne, Psychosomatic Unit, Yvoir, Belgium
Laurence Mees ; Université Catholique de Louvain, CHU Mont-Godinne, Psychosomatic Unit, Yvoir, Belgium
Denis Jacques ; Université Catholique de Louvain, CHU Mont-Godinne, Psychosomatic Unit, Yvoir, Belgium
David Tordeurs ; Université Catholique de Louvain, CHU Mont-Godinne, Psychosomatic Unit, Yvoir, Belgium
Christine Reynaert ; Université Catholique de Louvain, CHU Mont-Godinne, Psychosomatic Unit, Yvoir, Belgium

Sažetak

Background: When psychosis first presents, and particularly in the case of schizophrenia, the guidelines recommend rapid
institution of treatment with atypical antipsychotics. Two different clinical pictures can be observed: psychoses with acute onset and
those with insidious onset. Acute cases (60% of the total) have a favourable course in 85% of young patients but where onset is
insidious and the symptoms are predominantly negative, the course is poor in 25% of subjects. Since acute symptoms are relatively
easy to diagnose, it is diagnosis of the “insidious/negative” cases that represents a major challenge. Is such a diagnosis possible
yet? How can we limit the number of false negatives and false positives with the attendant risk of stigma? What treatment should be
administered?
Methods: Review of the literature (PubMed, PsycARTICLES, PsycINFO) and comparison with clinical practice here.
Results: Young people with a high risk of developing psychosis can be identified using scales such as SOPS (Scale of Prodromal
Symptoms), PACE (Personal Assessment and Crisis Evaluation) or from the presence of neuroanatomical and genetic characteristics.
Unfortunately, these tools are more specific for positive symptoms, and therefore identify a sub-population of young people at
risk: those at Ultra-High Risk (UHR). It can be argued that effective treatment is available for these UHR young people to prevent
the condition from developing into schizophrenia. On the other hand, the problem persists for young people presenting an insidious
onset and predominantly negative symptoms: to date we have no real way of either screening them or assessing the efficacy of a
treatment.
Conclusion: “Ultra-High Risk” patients are starting to represent a separate nosological entity. This entity is made up of young
patients, most of whom have positive symptoms. If left untreated, the course will lead to seriously compromised social and
psychological functioning. Rapid diagnosis and treatment for UHRs is therefore essential. In the future we need to refine our
diagnostic tools to make them sufficiently specific and sensitive but also so that the widest category of “Risk Syndrome for
Psychosis” includes young patients with mostly negative symptoms.

Ključne riječi

adolescence – ultra-high risk – UHR – psychosis – schizophrenia

Hrčak ID:

162058

URI

https://hrcak.srce.hr/162058

Datum izdavanja:

17.6.2014.

Posjeta: 826 *