정신증고위험군의 임상적 특성 및 진단 = Ultra-High Risk for Psychosis : Clinical Characteristics and Diagnosis

다국어 초록 (Multilingual Abstract)

Early detection is a crucial milestone in the prevention and treatment of schizophrenia spectrum psychosis, which might alter the course of schizophrenia. Currently, there are two complementary approaches to characterizing the clinical-high risk state of psychosis : the ultra-high risk (UHR) and basic symptoms criteria. Individuals at UHR have two phase-specific problems : heightened risk for the potential pathology of schizophrenia spectrum psychosis and the symptoms, distress and psychosocial functional impairment, which make them seek help. The clinical characteristics of UHR are similar to those of overt psychotic disorders in terms of psychopathological symptoms
dimensions, psychosocial disability, neurocognitive and socio-cognitive impairments, history of trauma and abuse experience, lack of protective factors and dysfunctional metacognitive beliefs, and the comorbidity of psychiatric illness. Regarding the risk, the pretest risk probability of a psychotic disorder in each high-risk clinic is considered an important factor for predicting the power of an early detection strategy. For the distress and psychosocial disability, the strategies of the therapeutic intervention will be a focus of clinical attention. On the follow-up, one of third of the UHR individuals have sufficient positive symptom to fulfil the at-risk criteria. Most of the UHR individuals have suffered from comorbid psychiatric illness at the times of both baseline and follow-up, and there is no improvement of psychosocial functioning. Currently, it is essential to optimize the early detection and intervention strategy according to the referring and recruitment characteristics of each high-risk clinic in Korean practice situations.

목차 (Table of Contents)

• 서론
• 고위험군 및 관련 용어의 개념
• 임상적고위험군의 단계-특이성
• 조기진단 전략
• 정신증고위험군의 임상 양상
• 임상적고위험군의 진단
• 정신증고위험군의 경과
• 결 론

참고문헌 (Reference)

1 백명재, "현상학적 정신병리학" 대한신경정신의학회 50 (50): 97-115, 2011

2 유소영, "정신분열병의 임상적 고위험군의 특징 : '서울청년클리닉'의 자연 추적 관찰 에비연구" 대한신경정신의학회 46 (46): 19-28, 2007

3 Fusar-Poli P, "Why ultra high risk criteria for psychosis prediction do not work well outside clinical smaples and what to do about it" 16 : 212-213, 2017

4 Fusar-Poli P, "Why transition risk to psychosis is not declining at the OASIS ultra high risk service : the hidden role of stable pretest risk enrichment" 192 : 385-390, 2018

5 Falkenberg I, "Why are help-seeking subjects at ultra-high risk for psychosis help-seeking?" 228 : 808-815, 2015

6 Brew B, "What impact does trauma have on the at-risk mental state? A systematic literature review" 12 : 115-124, 2018

7 Chung YC, "What factors are related to delayed treatment in individuals at high risk for psychosis?" 4 : 124-131, 2010

8 Cotter J, "What drives poor functioning in the at-risk mental state? A systematic review" 159 : 267-277, 2014

9 Nelson B, "Ultrahigh risk(UHR)for psychosis criteria : are there different levels of risk for transition to psychosis?" 125 : 62-68, 2011

10 Kraan T, "Trauma and recent life events in individuals at ultra-high risk for psychosis : review and meta-analysis" 161 : 143-149, 2015

11 Van Os J, "Toward a world consensus on prevention of schizophrenia" 7 : 53-67, 2005

12 이슬비, "Theory of Mind as a Mediator of Reasoning and Facial Emotion Recognition: Findings from 200 Healthy People" 대한신경정신의학회 11 (11): 105-111, 2014

13 McGorry PD, "The"close-in"or ultra high-risk model : a safe and effective strategy for research and clinical intervention in prepsychotic mental disorder" 29 : 771-790, 2003

14 Pinkham AE, "The social cognition psychometric evaluation study : results of the expert survey and RAND panel" 40 : 813-823, 2014

15 Guloksuz S, "The slow death of the concept of schizophrenia and the painful birth of the psychosis spectrum" 48 : 229-244, 2018

16 Chapman LJ, "The search for symptoms predictive of schizophrenia" 13 : 497-503, 1987

17 Corcoran CM, "The relationship of social function to depressive and negative symptoms in individuals at clinical high risk for psychosis" 41 : 251-261, 2011

18 Kim KR, "The relationship between psychosocial functioning and resilience and negative symptoms in individuals at ultra-high risk for psychosis" 47 : 762-771, 2013

19 Klosterkötter J, "The meaning of basic symptoms for the genesis of the schizophrenic nuclear syndrome" 46 : 609-630, 1992

20 Fusar-Poli P, "The dark side of the moon : meta-analytical impact of recruitment strategies on risk enrichment in the clinical high risk state for psychosis" 42 : 732-743, 2016

21 Lee TY, "Symptomatic and functional remission of subjects at clinical high risk for psychosis : a 2-year naturalistic observation study" 156 : 266-271, 2014

22 Bang M, "Suicidal ideation in individuals at ultra-high risk for psychosis and its association with suspiciousness independent of depression" 2017

23 Schultze-Lutter F, "Subjective symptoms of schizophrenia in research and the clinic : the basic symptom concept" 35 : 5-8, 2009

24 McGlashan T, "Structured interview for prodromal syndromes (version 4.0)" PRIME Research Clinic, Yale School of Medicine 2003

25 Pruessner M, "Stress and protective factors in individuals at ultra-high risk for psychosis, first episode psychosis and healthy controls" 129 : 29-35, 2011

26 Thompson KN, "Stress and HPA-axis functioning in young people at ultra high risk for psychosis" 41 : 561-569, 2007

27 Xu Z, "Stigma and suicidal ideation among young people at risk of psychosis after one year" 243 : 219-224, 2016

28 Rapado-Castro M, "Sources of clinical distress in young people at ultra high risk of psycosis" 165 : 15-21, 2015

29 Lee TY, "Social cognitive functioning in prodromal psychosis : a meta-analysis" 164 : 28-34, 2015

30 Glenthøj LB, "Social cognition in patients at ultra-high risk for psychosis : what is the relation to social skillsand functioning?" 5 : 21-27, 2016

31 van Donkersgoed RJ, "Social cognition in individuals at ultra-high risk for psychosis:a meta-analysis" 10 : e0141075-, 2015

32 Kim HS, "Social cognition and neurocognition as predictors of conversion to psychosis in individuals at ultra-high risk" 130 : 170-175, 2011

33 Kwapil TR, "Social anhedonia as a predictor of the development of schizophrenia-spectrum disorders" 107 : 558-565, 1998

34 Parnas J, "Self-experience in the early phases of schizophrenia : 5-year follow-up of the Copenhagen Prodromal Study" 10 : 200-204, 2011

35 Lenzenweger MF, "Schizotypy : an organizing framework for schizophrenia research" 15 : 162-166, 2006

36 Meehl PE, "Schizotaxia, schizotypy, schizophrenia" 17 : 827-838, 1962

37 Schultze-Lutter F, "Schizophrenia proneness instrument adult version (SPI-A)" Giovanni Fioriti 2007

38 Walker EF, "Schizophrenia : a neural diathesis-stress model" 104 : 667-685, 1997

39 Kilcommons AM, "Relationships between trauma and psychosis : an exploration of cognitive and dissociative factors" 112 : 351-359, 2005

40 Huber G, "Reine Defeksyndrome und basisstadien endogener psychosen" 34 : 409-426, 1966

41 Mrazek PJ, "Reducing risks for mental disorders: frontiers for preventive intervention research" National Academies Press 19-29, 1994

42 McGlashan TH, "Recruitment and treatment practices for helpseeking"prodromal"patients" 33 : 715-726, 2007

43 Chapman LJ, "Putatively psychosis-prone subjects 10 years later" 103 : 171-183, 1994

44 Bang M, "Psychotic conversion of individuals at ultra-high risk for psychosis: the potential roles of schizotypy and basic symptoms" 2017

45 Yung AR, "Psychosis prediction : 12-month follow up of a highrisk("prodromal")group" 60 : 21-32, 2003

46 Kapur S., "Psychosis as a state of aberrant salience: a framework linking biology, phenomenology, and pharmacology in schizophrenia" 160 : 13-23, 2003

47 Bentall RP, "Prospects for a cognitive-developmental account of psychotic experiences" 46 : 155-173, 2007

48 Cordes J, "Prevalence of metabolic syndrome in female and male patients at risk of psychosis" 181 : 38-42, 2017

49 Dannevang AL, "Premorbid adjustment in individuals at ultra-high risk for developing psychosis: a case-control study" 2016

50 Cornblatt BA, "Preliminary findings for two new measures of social and role functioning in the prodromal phase of schizophrenia" 33 : 688-702, 2007

51 Brandizzi M, "Predictors of functional outcome in individuals at high clinical risk for psychosis at six years follow-up" 65 : 115-123, 2015

52 Cannon TD, "Prediction of psychosis in youth at high clinical risk : a multisite longitudinal study in North America" 65 : 28-37, 2008

53 Ruhrmann S, "Prediction of psychosis in adolescents and young adults at high risk : results from the prospective European prediction of psychosis study" 67 : 241-251, 2010

54 Fusar-Poli P, "Predicting psychosis : meta-analysis of transition outcomes in individuals at high clinical risk" 69 : 220-229, 2012

55 Schultze-Lutter F, "Predicting first-episode psychosis by basic symptom criteria" 4 : 11-22, 2007

56 McEwen BS, "Physiology and neurobiology of stress and adaptation : central role of the brain" 87 : 873-904, 2007

57 Rutigliano G, "Persistence or recurrence of non-psychotic comorbid mental disorders associated with 6-year poor functional outcomes in patients at ultra high risk for psychosis" 203 : 101-110, 2016

58 Lin A, "Outcomes of nontransitioned cases in a samle at ultra-high risk for psychosis" 172 : 249-258, 2015

59 Carol EE, "Normative adolescent experience may confound assessment of positive symptoms in youth at ultra-high risk for psychosis" 166 : 358-359, 2015

60 Seidman LJ, "Neuropsychology of the prodrome to psychosis in the NAPLS consortium : relationship to family history and conversion to psychosis" 67 : 578-588, 2010

61 Hauser M, "Neuropsychological test performance to enhance identification of subjects at clinical high risk for psychosis and to be most promising for predictive algorithms for conversion to psychosis: a meta-analysis" 78 : e28-e40, 2017

62 Pukrop R, "Neurocognitive indicators for a conversion to psychosis : comparison of patients in a potentially initial prodromal state who did or did not convert to a psychosis" 92 : 116-125, 2007

63 Bang M, "Neurocognitive impairments in individuals at ultra-high risk for psychosis : who will really convert" 49 : 462-470, 2015

64 Morrison AP, "Negative cognition, affect, metacognition and dimensions of paranoia in people at ultra-high riskof psychosis: a multi-level modelling analysis" 45 : 2675-2684, 2015

65 Bell RQ, "Multiple-risk cohorts and segmenting risk as solutions to the problem of false positives in risk for the major psychoses" 55 : 370-381, 1992

66 Cotter J, "Metacognitive beliefs in the at-risk mental state : a systematic review and meta-analysis" 90 : 25-31, 2017

67 Bora E, "Meta-analysis of cognitive deficits in ultra-high risk to psychosis and first-episode psychosis: do the cognitive deficits progress over, or after, the onset of psychosis?" 40 : 744-755, 2014

68 Schmidt SJ, "Mediators linking childhood adversities and trauma to suicidality in individuals at risk for psychosis" 8 : 242-, 2017

69 Fusar-Poli P, "Lessons learned from the psychosis high-risk state : towards a general staging model of prodromal intervention" 44 : 17-24, 2014

70 Woods BT, "Is schizophrenia a progressive neurodevelopmental disorder? Toward a unitary pathogenetic mechanism" 155 : 1661-1670, 1998

71 Schultze-Lutter F, "Improving the clinical prediction of psychosis by combining ultra-high risk crietria and cognitive basic sympoms" 154 : 100-106, 2014

72 Lee SY, "Impaired facial emotion recognition in individuals at ultra-high risk for psychosis and with first-episode schizophrenia, and their associations with neurocognitive deficits and self-reported schizotypy" 165 : 60-65, 2015

73 이소정, "Impaired Social and Role Function in Ultra-High Risk for Psychosis and First-Episode Schizophrenia: Its Relations with Negative Symptoms" 대한신경정신의학회 14 (14): 539-545, 2017

74 Lim J, "Impact of psychiatric comorbidity in individuals at Ultra High Risk of psychosis-findings from the Longitudinal Youth at Risk Study(LYRIKS)" 164 : 8-14, 2015

75 Elkind D, "Imaginary audience behavior in children and adolescents" 15 : 38-, 1979

76 Cannon TD, "How schizophrenia develops : cognitive and brain mechanisms underlying onset of psychosis" 19 : 744-756, 2015

77 Fusar-Poli P, "Heterogeneity of psychosis risk within individuals at clinical high risk : a meta-analytical stratification" 73 : 113-120, 2016

78 Lencz T, "Generalized and specific neurocognitive deficits in prodromal schizophrenia" 59 : 863-871, 2006

79 Carrión RE, "From the psychosis prodrome to the first-episode of psychosis : no evidence of a cognitive decline" 96 : 231-238, 2018

80 Hye Yoon Park, "Fragile Self and Malevolent Others: Biased Attribution Styles in Individuals at Ultra-High Risk for Psychosis" 대한신경정신의학회 15 (15): 796-804, 2018

81 Yang Z, "Factor structure of the positive and negative syndrome scale (PANSS) in people at ultra high risk (UHR) for psychosis" 2018

82 Cotter J, "Exploring functional impairment in young people at ultra-high risk for psychosis:a qualitative study" 2018

83 Carney R, "Examining the physical health and lifestyle of young people at ultra-high risk for psychosis:a qualitative study involving service users, parents and clinicians" 255 : 87-93, 2017

84 Cotter J, "Examining the association between social cognition and functioning in individuals at ultra-high risk for psychosis" 51 : 83-92, 2017

85 Rausch F, "Evaluation of the ‘Jumping to conclusions’ bias in different subgroups of the at-risk mental state : from cognitive basic symptoms to UHR criteria" 46 : 2071-2081, 2016

86 McGorry PD, "Early intervention in psychosis:concepts, evidence and future directions" 7 : 148-156, 2008

87 Kwon JS, "Early intervention in psychosis : insights from Korea" 5 : 98-105, 2012

88 Schultze-Lutter F, "Early detection and treatment of psychosis : the Bern child and adolescent psychiatric perspective" 2014 : 1-16, 2014

89 Schultze-Lutter F, "EPA guidance on the early detection of clinical high risk states of psychoses" 30 : 405-416, 2015

90 Parnas J, "EASE : examination of anomalous self-experience" 38 : 236-258, 2005

91 Kaymaz N, "Dosub threshold psychotic experiences predict clinical outcomes in unselected non-help-seeking population-based samples? A systematic review and meta-analysis, enriched with new results" 42 : 2239-2253, 2012

92 Fusar-Poli P, "Diagnostic and progronostic significance of DSM-5 attenuated psychosis syndrome in services for individuals at ultra high risk for psychosis" 44 : 264-275, 2018

93 American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders (DSM-5)" American Psychiatric Publishing 2013

94 Klosterkötter J, "Diagnosing schizophrenia in the initial prodromal phase" 58 : 158-164, 2001

95 Debbané M, "Developing psychosis and its risk states through the lens of schizotypy" 41 (41): S396-S407, 2015

96 Yung AR, "Declining transition rate in ultra-high risk(prodromal)services : dilution or reduction of risk?" 33 : 673-681, 2007

97 Cowan HR, "Core beliefs in healthy youth and youth at ultra high-risk for psychosis: dimensionality and links to depression, anxiety, and attenuated psychotic symptoms" 6 : 1-14, 2018

98 Kang M, "Coping styles in individuals at ultra-high risk for psychosis : associations with cognitive appraisals" 264 : 162-168, 2018

99 Mian L, "Coping strategies in individuals at ultra-high risk of psychosis: a systemic review" 2017

100 Fusar-Poli P, "Comorbid depressive and anxiety disorders in 509 individuals with an at-risk mental state : impact on psychopathology and transition to psychosis" 40 : 120-131, 2014

101 de Paula AL, "Cognition in at-risk mental states for psychosis" 57 : 199-208, 2015

102 Kraan TC, "Child maltreatment and clinical outcome in individuals at ultra-high risk for psychosis in the EU-GEI high risk study" 44 : 584-592, 2018

103 Carney R, "Cardiometabolic risk factors in young people at ultra-high risk for psychosis : a systematic review and metaanalysis" 170 : 290-300, 2016

104 Nelson B, "Basic self-disturbance predicts psychosis onset in the ultra high risk for psychosis"prodromal"population" 38 : 1277-1287, 2012

105 An SK, "Attribution bias in ultra-high risk for psychosis and first-episode schizophrenia" 118 : 54-61, 2010

106 Taylor PJ, "Are people at risk of psychosis also at risk of suicide and self-harm? A systematic review and meta-analysis" 45 : 911-926, 2015

107 Minzenberg MJ, "American psychiatric publishing textbook of psychiatry" American Psychiatric Publishing, Inc 407-449, 2008

108 van Os J, "A systematic review and meta-analysis of the psychosis continuum : evidence for a psychosis proneness-persistence-impairment model of psychotic disorder" 39 : 179-195, 2009