Estudo sobre pródromos

Estudos sobre o delineamento da pesquisa enfocam a importância de definir com rigor as questões iniciais - a partir delas, serão delineadas todas as etapas posteriores (método de coleta ou construção de dados, de análise, perspectiva da conclusão etc). Por mais que minha querida supervisora tenha dito que estas são questões que seguirão por toda uma carreira científica, eu gostaria de fortalecer o máximo possível minhas considerações teóricas, minhas escolhas.
Uma das questões importantes é o objetivo da pesquisa e os construtos a serem investigados. Estou questionando a descrição operacional de pródromos, não sei se gosto deste conceito.
Estudos interessantes que li hoje...

"Initial onset of psychotic symptoms often seems to be related to an inability to generate alternative (culturally acceptable)explanations,frequently due to a lack of trusting or supportive social relationships that would facilitate the normallization of such interpretations". (acredita que eu perdi a referência deste artigo?? aff ¬¬)
Behavioral cognitive therapeuts making me feel proud!

But not so fast...
Addington, Jean & Mancuso, Enza. (2009) Cognitive-Behavioral Therapy for Individuals at High Risk of Developing Psychosis. Journal of Clinical Psychology: In Session, vol. 65(8), 879-890. TORONTO

"CHR for psychosis: recent-onset functional decline plus genetic risk, recent-onset subthreshold, or brief-threshold psychotic symptoms (Yung & McGorry, 1996).
The reliability of these criteria has been excellent, and studies using these criteria support the view that prodromal people are symptomatic and at high and imminent risk for psychosis (Cannon et al., 2008)".

Psychiatists... It´s likely that psychiatrists from Australia, Canada, Switzerland - all international great centers for "first psychotic-like crises" (if such a term applies for them) are from cognitive-approach-psichiatrists.

So say the center from Australia:
Risk factors for psychosis in an ultra high-risk group: psychopathology and clinical features
Alison R. Yung , Lisa J. Phillips , Hok Pan Yuen and Patrick D. McGorry
Department of Psychiatry, University of Melbourne and ORYGEN Research Centre, Australia
Schizophrenia Research
Volume 67, Issues 2-3, 1 April 2004, Pages 131-142

Abstract
The identification of individuals at high risk of developing a psychotic disorder has long been a goal of clinicians because it is thought that early treatment of this group may prevent onset of the disorder. However, little is known of predictive factors of psychosis, even within a high-risk group. This study followed up 104 young people thought to be at ‘ultra high risk’ for schizophrenia and other psychotic disorders by virtue of having a family history of psychotic disorder combined with some functional decline or the presence of subthreshold or self-limiting psychotic symptoms. All subjects were therefore symptomatic, but not psychotic, at intake. Thirty-six subjects (34.6%) developed frank psychotic symptoms within 12 months.
Measures of symptom duration, functioning, disability and psychopathology were made at intake, 6 and 12 months. Poor functioning, long duration of symptoms, high levels of depression and reduced attention were all predictors of psychosis. A combination of family history of psychosis, a recent significant decrease in functioning and recent experience of subthreshold psychotic symptoms was also predictive of psychosis. Combining highly predictive variables yielded a method of psychosis prediction at 12 months with good positive predictive value (80.8%), negative predictive value (81.8%) and specificity (92.6%) and moderate sensitivity (60.0%).
Within our symptomatic high-risk group, therefore, it appears possible to identify those individuals who are at particularly high risk of developing a psychotic disorder such as schizophrenia. Given the very high PPV and low false positive rate with this two-step process, it may be justifiable to target these individuals for intensive monitoring of mental state and even low-dose neuroleptic medication or other biological and psychosocial treatments depending on clinical condition. This indicated prevention approach could be further developed and preventive strategies in the psychoses refined.
Author Keywords: Author Keywords: Psychosis; Schizophrenia; Prevention; Prediction; High-risk; Prodrome.

Psychosis prediction: 12-month follow up of a high-risk (“prodromal”) group
Alison R. Yung, Lisa J. Phillipsa, Hok Pan Yuen, Shona M. Francey, Colleen A. McFarlane, Mats Hallgren and Patrick D. McGorry.
Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
PACE Clinic, Parkville, Victoria, Australia
Youth Program, Mental Health Services for Kids and Youth (MHSKY), Locked Bag 10, Parkville, Victoria 3052, Australia
Schizophrenia Research
Volume 60, Issue 1, 1 March 2003, Pages 21-32

Abstract
Intervention in the prodromal phase of schizophrenia and related psychoses may result in attenuation, delay or even prevention of the onset of psychosis in some individuals. However, a “prodrome” is difficult to recognise prospectively because of its nonspecific symptoms.
This study set out to recruit and follow up subjects at high risk of transition to psychosis with the aim of examining the predictive power for psychosis onset of certain mental state and illness variables.
Symptomatic individuals with either a family history of psychotic disorder, schizotypal personality disorder, subthreshold psychotic symptoms or brief transient psychotic symptoms were assessed and followed up monthly for 12 months or until psychosis onset.
Twenty of 49 subjects (40.8%) developed a psychotic disorder within 12 months. Some highly significant predictors of psychosis were found: long duration of prodromal symptoms, poor functioning at intake, low-grade psychotic symptoms, depression and disorganization. Combining some predictive variables yielded a strategy for psychosis prediction with good sensitivity (86%), specificity (91%) positive predictive value (80%) and negative predictive value (94%) within 6 months.
This study illustrates that it is possible to recruit and follow up individuals at ultra high risk of developing psychosis within a relatively brief follow-up period. Despite low numbers some highly significant predictors of psychosis were found. The findings support the development of more specific preventive strategies targeting the prodromal phase for some individuals at ultra high risk of schizophrenia.
Author Keywords: Psychosis; Schizophrenia; Prevention; Prediction; High risk; Prodrome

Considerações em áudio sobre os "pródromos" encontrados no GIPSI.
https://dl-web.dropbox.com/get/Voice001.amr?w=d9428a03
https://dl-web.dropbox.com/get/Voice002.amr?w=c9232eac
https://dl-web.dropbox.com/get/Voice003.amr?w=848ae230

Pensando pensando pensando.