Abstract: Early detection of psychotic-spectrum disorders among adolescents and young adults is crucial, as the initial years after psychotic symptom onset encompass a critical period in which psychosocial and pharmacological interventions are most effective. Moreover, clinicians and researchers in recent decades have thoroughly characterized psychosis-risk syndromes, in which youth are experiencing early warning signs indicative of heightened risk for developing a psychotic disorder. These insights have created opportunities for intervention even earlier in the illness course, ideally culminating in the prevention or mitigation of psychosis onset. However, identification and diagnosis of early signs of psychosis can be complex, as clinical presentations are heterogeneous, and psychotic symptoms exist on a continuum. When a young person presents to a clinic, it may be unclear whether they are experiencing common, mild psychotic-like symptoms, early warning signs of psychosis, overt psychotic symptoms, or symptoms better accounted for by a non-psychotic disorder. Therefore, the purpose of this review is to provide a framework for clinicians, including those who treat non-psychotic disorders and those in primary care settings, for guiding identification and diagnosis of early psychosis within the presenting clinic or via referral to a specialty clinic. We first provide descriptions and examples of first-episode psychosis (FEP) and psychosis-risk syndromes, as well as assessment tools used to diagnose these conditions. Next, we provide guidance as to the differential diagnosis of conditions which have phenotypic overlap with psychotic disorders, while considering the possibility of co-occurring symptoms in which case transdiagnostic treatments are encouraged. Finally, we conclude with an overview of early detection screening and outreach campaigns, which should be further optimized to reduce the duration of untreated psychosis among youth.

Keywords: diagnostic assessment, early detection, recent-onset psychosis, clinical high risk for psychosis, psychosis continuum


中文翻译：

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精神病风险的识别和首发精神病的诊断：给临床医生的建议

摘要：早期发现青少年和年轻人中的精神病谱系障碍至关重要，因为精神病症状发作后的最初几年是心理社会和药物干预最有效的关键时期。此外，近几十年来，临床医生和研究人员已经彻底描述了精神病风险综合症，其中青少年正在经历早期预警信号，表明患精神病的风险增加。这些见解为在疾病过程的早期进行干预创造了机会，理想情况下最终可以预防或减轻精神病的发作。然而，精神病早期症状的识别和诊断可能很复杂，因为临床表现多种多样，并且精神病症状连续存在。当年轻人到诊所就诊时，可能不清楚他们是否正在经历常见的轻度精神病样症状、精神病的早期预警信号、明显的精神病症状，还是更能解释为非精神病的症状。因此，本次综述的目的是为临床医生（包括那些治疗非精神病性疾病的医生和初级保健机构的临床医生）提供一个框架，以指导在就诊诊所内或通过转诊至专科诊所来识别和诊断早期精神病。我们首先提供首发精神病 (FEP) 和精神病风险综合征的描述和示例，以及用于诊断这些病症的评估工具。接下来，我们提供与精神障碍表型重叠的疾病的鉴别诊断指南，同时考虑同时出现症状的可能性，在这种情况下鼓励跨诊断治疗。最后，我们总结了早期检测筛查和推广活动的概述，应进一步优化这些活动，以减少青少年中未经治疗的精神病的持续时间。

关键词：诊断评估、早期发现、新发精神病、精神病临床高风险、精神病连续体