精神病风险诊疗特色学科介绍

以精神分裂症为代表的重性精神障碍累及1600万中国人口，目前由于缺乏早期风险识别的有效技术和标准，常常错过了预防发病和取得最优疗效的干预时机。近10年来，国际上和SHARP(ShangHai At Risk for Psychosis)项目组前期研究中已发现，高危人群不但可以早期识别，而且生物学特征明显，是早期干预的最佳时间。因此，有必要据此建立具有上海特色的精神病风险识别和控制技术，在人群中更有针对性地布控风险，并建立针对高危人群的精准干预临床方案指南。通过形成精神病风险诊疗特色专科，形成适合中国精神病高危人群早期诊断和治疗的标准和临床路径，建成精神病风险预警体系。

精神病风险诊疗特色学科的建设主要围绕三个方面：

1. 继续维护已有的国内最大的临床高危队列；

2. 转化生物学标记的应用，实现对治疗方案选择的指导性地位；

3. 形成针对高危人群的临床干预路径，验证有效性和实施个体化精准诊疗。

特色学科的主要内容可分为两大块：临床实践的功能和科学研究的基础：

在临床实践上：

继续提升上海地区精神卫生专科对精神病高危人群的识别能力：培养青年骨干医师的临床识别高危人群的水平。该学科将陆续推出基于生物学特征的特色干预方案，将依托上海市心理咨询中心心理风险专病门诊，结合队列研究的随访工作，进一步为高危人群开展诊疗服务。

特色的诊断服务包括：

· 精神病临床风险评估（精神病前驱期临床定式访谈）

· 多维度认知成套测试

· 基于磁共振、脑诱发电位、近红外等脑功能成像

· 眼动追踪检测

· 皮肤烟酸免疫反应多普勒定量分析

特色的干预服务包括：

· 针对脑功能成像结果的重复经颅磁刺激治疗

· 基于眼动追踪结果的直流电刺激治疗

· 基于烟酸反应结果的不饱和脂肪酸/抗氧化剂乙酰半胱氨酸补充

· 基于认知测试结果的手机APP植入式的认知训练

· 个体化的病案管理

在科学研究上：

利用目前国内最大的SHARP项目CHR队列，紧密联系临床团队，提供强大、完善、实时的数据支持，围绕SHARP队列和生物学标记开展机制和临床应用的研究，用更有说服力的科学数据，形成具有上海特色的精神病高危人群的临床诊疗指南。截至2018年12月，SHARP项目组目前已入组CHR共计717例，随访时长最长7年，平均约4-5年。目前依托SHARP项目数据发表的研究论文超过30篇，其中>10分高影响因子的论文已发表2篇，>5分的影响因子的论文已发表5篇，大会发言近20次，SHARP已成为具有一定国际影响力的CHR队列。

Special Specialty of Psychosis Risk Diagnosis and Treatment

Severe psychotic disorders, such as schizophrenia, affect 16 million people in China. At present, due to the lack of effective techniques and standards for early risk identification, the opportunity for intervention to prevent the onset of schizophrenia and achieve the best therapeutic effect is often missed. Over the past 10 years, international and previous studies of our SHARP(ShangHai At Risk for Psychosis) project have found that high-risk groups can not only be identified early, but also have obvious biological characteristics, which is the best time for early intervention. Therefore, it is necessary to establish a Shanghai-specific psychosis risk identification and control technology, more targeted risk distribution and control in the population, and establish a precise intervention clinical program guide for high-risk groups. Through the formation of special specialty of psychosis risk diagnosis and treatment, the criteria and clinical pathways suitable for the early diagnosis and treatment of high-risk psychiatric groups in China will be formed, and the early warning system of psychosis risk will be established.

The construction of the characteristic discipline of psychosis risk diagnosis and treatment mainly centers on three aspects:

1. Continue to maintain the largest clinical high-risk cohort in China;

2. The application of transformed biological markers to guide the selection of therapeutic regimens;

3. Form a clinical intervention path for high-risk groups, verify the effectiveness and implement individualized and precise diagnosis and treatment.

The main contents of characteristic disciplines can be divided into two parts: the function of clinical practice and the basis of scientific research.

In clinical practice:

Continue to improve the mental health specialty in Shanghai to identify high-risk groups of mental illness: to train young backbone physicians to identify high-risk groups of clinical level. The specialty intervention program based on biological characteristics will be introduced one after another, and the clinic of Shanghai Psychological Consultation Center will be relied on to further develop diagnosis and treatment services for high-risk groups in combination with follow-up work of cohort study.

Characteristic diagnostic services include:

· Psychosis Clinical Risk Assessment (Structured Interview for Prodromal Syndromes)

· Multidimensional Cognitive Test Set

· Brain functional imaging based on magnetic resonance, brain evoked potential, near infrared and so on

· Eye tracking

· Doppler quantitative analysis of skin nicotinic acid immune response

Characteristic interventions include:

· Repeated transcranial magnetic stimulation for brain functional imaging results

· Direct Current Stimulation Therapy Based on Eye Tracking Results

· Unsaturated fatty acid/antioxidant acetylcysteine supplementation based on nicotinic acid reaction results

· Implantable Cognitive Training of Mobile App Based on Cognitive Test Results

· Individualized medical record management

In scientific research:

Using the largest CHR cohort of SHARP program in China, closely linking with clinical team, providing powerful, perfect and real-time data support, research on mechanism and clinical application around SHARP cohort and biological markers, and using more convincing scientific data to form clinical diagnosis and treatment guidelines for high-risk patients with Shanghai characteristics. As of December 2018, the SHARP project team had recruited 717 CHRs in total. The longest follow-up period was 7 years, with an average of 4-5 years. At present, more than 30 research papers have been published based on SHARP project data, of which 2 papers have been published with a high impact factor of > 10 points, 5 papers with a high impact factor of > 5 points, and nearly 20 speeches at the conference. SHARP has become a CHR cohort with certain international influence.