Early Clinical Phenotypes and Risk for Serious Mental Disorders in Young People: Need for Care Precedes Traditional Diagnoses in Mood and Psychotic Disorders:

摘要: Potentially severe and persistent or recurrent mental disorders pose the major threat to health, happiness, productivity of young people as they emerge from childhood approach threshold adult life. The World Economic Forum has recently revealed that now equal cardiovascular diseases (CVDs) among noncommunicable gross domestic product modern economies.1 This is due largely timing in life cycle onset ill health,2 with 75% emerging by age 25. Universal primary prevention ultimate solution must be actively researched pursued where it works, though difficult assemble solid evidence for this.3 Where still out reach (and mood psychotic one such domain), given we have a range effective treatment strategies psychiatry, there are 2 alternative pathways follow.First, substantially extend coverage current interventions so vast majority who can benefit health care gain access. Currently, even wealthy developed nations, only minority disorder consequent need actually receive it, developing countries access minimal quality poor. why support global campaign health.4·5 Second, crucial, early intervention offers best hope disease modification reduction widespread psychological, social, economic impacts delay poor care.6 strategy cornerstone mainstream care, cancer, diabetes, CVD, yet pre-emptive psychiatry7·8 been extended, deployed, widely endorsed within field. Even so, somewhat surprisingly, small diverse band critics not questioned but also campaigned against concepts reforms. Obviously questioning is, significant extent, healthy quite justifiable, being derived blend genuine scientific conservatism, late adopter phenomenon, valid fear exposing patients harmful stigma overtreatment traditional narrow models which often do more harm than good acknowledge. However, extreme commentary on evidence-poor polemical, fueled vested interests, apologists status quo brand and, ironically, unreconstructed antipsychiatry. Nevertheless, take positive tone intensity debate indicates real change paradigm shift may occurring. To succeed, crucial remains strongly evidence-based.The frontier prodromal subthreshold stage illness when demonstrable diagnostically clear pathognomonic features particular syndrome themselves.9 observation warning signs future illness, lasting months years, could retrospectively identified was made 80 years ago Sullivan10 countless clinicians since then. latter usually experienced sense frustration had come scene during this subtle phase, turned perhaps would possible avert much patients' suffering functional disturbance subsequently ensued.10,11Careful research reconstructing illnesses'215 enabled creation operational criteria used prospectively identify group proved at incipient risk transition psychosis. …