Psikoz İçin Klinik Yüksek Risk Grubu ve Koruyucu Yaklaşımlar
Özet
Psikoz için klinik yüksek risk durumu ilk psikotik epizod geliştirme olasılığı yüksek olan bireylerin belirlenmesini sağlamak amacıyla ortaya atılmıştır ve zayıf psikotik semptomlar, tekrarlayıcı kısa süreli psikotik semptomlar ve genetik risk ve işlevsellikte gerileme olmak üzere üç farklı alt grubu içermektedir. Psikoz için klinik yüksek risk grubunun belirlenmesinin önemi giderek artan biçimde kabul görmüş; bu durum, zayıf psikoz sendromunun DSM-5’te yeni bir tanı kategorisi olarak ele alınmasına kadar uzanmıştır. Bu kategorinin önerilmesindeki amaç, psikotik bozuklukların önlenmesine yönelik tedavilerin geliştirilmesine olanak sağlamaktır. Dolayısıyla, psikoz için klinik yüksek risk grubundaki bireylerin saptanması ve yönetimi önemli bir klinik hedeftir. Kılavuzlar, risk altındaki bireylerin tanımlanmasına yönelik bir tanısal model sunmakta ve özgül klinik müdahalelere ilişkin öneriler sağlamaktadır. Bu müdahaleler arasında psikoterapi, semptom yönetimi, düşük doz antipsikotik tedaviyi içeren farmakolojik yaklaşımlar, omega-3 çoklu doymamış yağ asitleri ve hasta ile ailesine yönelik psikoeğitim sayılmaktadır. Ancak bu müdahalelerin sınırlı etkililik gösterdiği ve bu nedenle yeni nesil önleyici yaklaşımlara gereksinim duyulduğu ortaya koyulmaktadır. Bu grupta geliştirilecek tedavilerin klinik yarar sağlamasının yanında iyi tolere edilebilir ve damgalayıcı etkilerden uzak olması gerektiği vurgulanmaktadır. Bu yazıda psikoz için klinik yüksek risk durumu, psikoza geçiş riski ve koruyucu müdahalelere yer verilmektedir.
The clinical high-risk state for psychosis was proposed to identify individuals who have a high likelihood of developing a first psychotic episode. This condition includes three subgroups: attenuated psychotic symptoms, brief intermittent psychotic symptoms, and genetic risk accompanied by a decline in functioning. The importance of identifying the clinical high-risk group for psychosis has increasingly been recognized, leading to the consideration of attenuated psychosis syndrome as a new diagnostic category in the DSM-5. The purpose of proposing this category is to facilitate the development of treatments aimed at preventing psychotic disorders. Therefore, identifying and managing individuals in the clinical high-risk group for psychosis represent an important clinical objective. Clinical guidelines provide a diagnostic model for identifying individuals at risk and offer recommendations regarding specific clinical interventions. These interventions include psychotherapy, symptom management, pharmacological approaches such as low-dose antipsychotic treatment, omega-3 polyunsaturated fatty acids, and psychoeducation for patients and their families. However, these interventions have shown limited effectiveness, highlighting the need for new preventive approaches. It is also emphasized that treatments developed for this population should not only provide clinical benefit but also be well tolerated and free from stigmatizing effects. This paper discusses the clinical high-risk state for psychosis, the risk of transition to psychosis, and preventive interventions.
Referanslar
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Referanslar
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Fusar-Poli P. (2017). The Clinical High-Risk State for Psychosis (CHR-P), Version II. Schizophrenia bulletin, 43(1), 44–47. https://doi.org/10.1093/schbul/sbw158
Salazar de Pablo, G., Radua, J., Pereira, J., Bonoldi, I., Arienti, V., Besana, F., Soardo, L., Cabras, A., Fortea, L., Catalan, A., Vaquerizo-Serrano, J., Coronelli, F., Kaur, S., Da Silva, J., Shin, J. I., Solmi, M., Brondino, N., Politi, P., McGuire, P., & Fusar-Poli, P. (2021). Probability of Transition to Psychosis in Individuals at Clinical High Risk: An Updated Meta-analysis. JAMA psychiatry, 78(9), 970–978. https://doi.org/10.1001/jamapsychiatry.2021.0830
Fusar-Poli, P., Cappucciati, M., Borgwardt, S., Woods, S. W., Addington, J., Nelson, B., Nieman, D. H., Stahl, D. R., Rutigliano, G., Riecher-Rössler, A., Simon, A. E., Mizuno, M., Lee, T. Y., Kwon, J. S., Lam, M. M., Perez, J., Keri, S., Amminger, P., Metzler, S., Kawohl, W., … McGuire, P. K. (2016). Heterogeneity of Psychosis Risk Within Individuals at Clinical High Risk: A Meta-analytical Stratification. JAMA psychiatry, 73(2), 113–120.
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