BACKGROUND The nature of symptoms in the prodromal period of first episode psychosis (FEP) remains unclear. The objective was to determine the patterns of symptoms recorded in primary care in the 5 years before FEP diagnosis. METHODS The study was set within 568 practices contributing to a UK primary care health record database (Clinical Practice Research Datalink). Patients aged 16-45 years with a first coded record of FEP, and no antipsychotic prescription more than 1 year prior to FEP diagnosis (n = 3045) was age, gender, and practice matched to controls without FEP (n = 12,180). Fifty-five symptoms recorded in primary care in the previous 5 years, categorised into 8 groups (mood-related, 'neurotic', behavioural change, volition change, cognitive change, perceptual problem, substance misuse, physical symptoms), were compared between cases and controls. Common patterns of symptoms prior to FEP diagnosis were identified using latent class analysis. RESULTS Median age at diagnosis was 30 years, 63% were male. Non-affective psychosis (67%) was the most common diagnosis. Mood-related, 'neurotic', and physical symptoms were frequently recorded (> 30% of patients) before diagnosis, and behavioural change, volition change, and substance misuse were also common (> 10%). Prevalence of all symptom groups was higher in FEP patients than in controls (adjusted odds ratios 1.33-112). Median time from the first recorded symptom to FEP diagnosis was 2-2.5 years except for perceptual problem (70 days). The optimal latent class model applied to FEP patients determined three distinct patient clusters: 'no or minimal symptom cluster' (49%) had no or few symptoms recorded; 'affective symptom cluster' (40%) mainly had mood-related and 'neurotic' symptoms; and 'multiple symptom cluster' (11%) consulted for three or more symptom groups before diagnosis. The multiple symptom cluster was more likely to have drug-induced psychosis, female, obese, and have a higher morbidity burden. Affective and multiple symptom clusters showed a good discriminative ability (C-statistic 0.766; sensitivity 51.2% and specificity 86.7%) for FEP, and many patients in these clusters had consulted for their symptoms several years before FEP diagnosis. CONCLUSIONS Distinctive patterns of prodromal symptoms may help alert general practitioners to those developing psychosis, facilitating earlier identification and referral to specialist care, thereby avoiding potentially detrimental treatment delay.

中文翻译：

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在诊断出首发精神病之前的症状模式：对英国初级保健电子健康记录的潜在分类分析。

背景技术首发性精神病（FEP）的前驱期中症状的性质仍不清楚。目的是确定FEP诊断前5年在初级保健中记录的症状类型。方法该研究是根据568种实践进行的，该实践有助于英国的初级保健健康记录数据库（Clinical Practice Research Datalink）。年龄，性别和实践与年龄在16-45岁，首次进行FEP编码且在FEP诊断前超过1年（n = 3045）没有抗精神病药的患者匹配，而没有FEP的对照组（n = 12,180）。前5年在初级保健中记录的55种症状分为8组（情绪相关，“神经病”，行为改变，意志改变，认知改变，知觉问题，药物滥用，身体症状），在病例和对照之间进行比较。FEP诊断之前常见的症状模式是使用潜在类别分析确定的。结果诊断时的中位年龄为30岁，其中63％为男性。非情感性精神病（67％）是最常见的诊断。在诊断之前，经常记录与情绪有关的“神经病”和身体症状（占患者的30％以上），行为改变，意志改变和滥用药物也很常见（> 10％）。FEP患者的所有症状组的患病率均高于对照组（校正比值比1.33-112）。从首次记录的症状到FEP诊断的中位时间为2-2.5年，除了知觉问题（70天）。适用于FEP患者的最佳潜在类别模型确定了三个不同的患者群：“无或最小症状群” （49％）没有或仅有很少症状记录；“情感症状群”（40％）主要有与情绪有关的症状和“神经病”症状；和“多症状群”（11％）在诊断前咨询了三个或更多症状组。多症状群更容易发生药物性精神病，女性，肥胖，并具有较高的发病率负担。情感和多个症状群对FEP表现出良好的判别能力（C统计量为0.766；敏感性为51.2％，特异性为86.7％），并且这些群中的许多患者在FEP诊断之前就已经咨询了症状。结论前驱症状的独特模式可能有助于提醒全科医师注意那些正在发展的精神病患者，从而有助于及早发现并转诊至专科医师，