思觉敏感

思觉敏感或思觉过敏（英语：At-Risk Mental State^[1]^{[註 1]} 或 Clinical High Risk ^[2] 或 Ultra High Risk^[3]）是一种负面的心理状态。一般情况下，大脑能自动调节对环境的敏感度，选择性地接收较重要的信息；但在压力下，调节系统可能失灵令大脑作出过敏反应，使人对环境产生错觉，或误以为受威胁。“思觉过敏”像病变一样，虽然尚未成病，但若不理会，会影响生活或发展成为精神疾病^[4]，需要身边亲友及早察觉并迳行治疗。

名词的由来

根据过往研究资料显示，有些人在精神疾病病发前，会经历一段时间的轻性或短暂病征，虽然当时并未完全发病，却对日常生活逐渐有所影响^[5]。为让大众及早关注自己的精神状态，在香港、中国大陆及台湾，不同医学团队曾提出“酝酿期”与“前驱期”等不同名字^[6]^[7]^[8]，以提高大众精神健康意识，并接受早期介入服务，减低或推迟病发的机会。至2018年，有精神科医生考虑到有关状态不一定会病发^[9]，并同时避免负面标签对早期介入服务的影响^[10]^[11]，在香港开始使用“思觉过敏”这名词。“思觉过敏”是在思想及感官上有轻度或短暂性的困扰经历，情况如鼻敏感、皮肤敏感一样，在致敏原 (如长期生活压力、环境变迁等因素)影响下，而产生过敏反应。若及早正视及接受早期介入治疗，相关征状是有机会消退，以“过敏”起名，可给予人有复元的概念。

过敏征状

思觉过敏包括以下常见征状^[1]：

轻度过敏

在过去一年曾有以下的困扰经历，但情况未达到精神病学诊断标准的严重程度和频率:

偶尔感官失衡(例如听到不存在的声音; 看到不存在的影像; 闻到别人闻不到的臭味; 皮肤下有虫咬的感觉)
莫名其妙的恐惧或担心会有怪事发生，对身边的事物变得多疑敏感
对身边的人起疑心，经常觉得自己被针对
觉得有人无故想伤害自己
觉得身边的人和事疑幻疑真

短暂过敏

在过去一年曾出现短暂思觉失调病征(幻觉、幻听、妄想及言语紊乱)，但只持续了七天内并在没有接受治疗的情况下痊愈。

家族病历及功能下降

近亲患有思觉失调，同时个案在过去一年有明显生活功能下降,包括：

学业成绩或工作表现明显倒退
逐渐疏远朋友和家人，变得孤立
睡眠质素下降，食欲欠佳
忽略个人卫生

其他常见征状

心情低落，焦虑，烦躁
认知功能减退（例如思想混乱，难以集中）
兴趣和动力减低
情感淡漠

预防性治疗

由于“思觉过敏”主要是出现早期征状，个案的思维认知、逻辑推理及自觉反省仍然健全，治疗方向可以不同层面介入。现阶段有三种常见的治疗方法，详情如下：

低剂量抗精神病药物：鉴于“思觉过敏”尚未成病，以抗精神病药物治疗是一个较具争议性的治疗方案，而药物治疗主要是用作减退征状、减轻当中的情绪困扰^[14]。
奥米加3：早年曾有研究指出服用奥米加3可预防严重精神疾病，因当中的不饱和脂肪酸可有助精神健康，然而在近年的研究中，却未发现服用奥米加3有分别性的成效。^[15]
认知行为治疗：此治疗方法属常见的心理治疗，由专业人士如临床心理学家提供，协助受助者认识思想、情绪及行为的关系，加强全面的自我认识，并以学习新方法应对生活压力；治疗过程中没有任何副作用，一般较为大众接受的治疗方向。^[16] ^[17]

注释

^ 简称：ARMS

参考文献

^ ^1.0 ^1.1 Yung, A. R., McGorry, P. D., McFarlane, C. A., Jackson, H. J., Patton, G. C., & Rakkar, A. (1996). Monitoring and care of young people at incipient risk of psychosis. Schizophrenia bulletin, 22(2), 283-303.
^ Cornblatt BA, Lencz T, Smith CW, Olsen R, Auther AM, Nakayama E, Lesser ML, Tai JY, Shah MR, Foley CA, Kane JM, Correll CU. Can antidepressants be used to treat the schizophrenia prodrome? results of a prospective, naturalistic treatment study of adolescents. J Clin Psychiatry. 2007;68(4):546-557.
^ Yung AR, Phillips LJ, Yuen HP, McGorry PD. Risk factors for psychosis in an ultra high-risk group: psychopathology and clinical features. Schizophr Res. 2004;67(2-3):131-142.
^ Cannon TD, Cadenhead K, Cornblatt B, Woods SW, Addington J, Walker E, Seidman LJ, Perkins D, Tsuang M, McGlashan T, Heinssen R. Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America.Arch Gen Psychiatry. 2008;65(1):28-37.
^ Fusar-Poli, P., Deste, G., Smieskova, R., Barlati, S., Yung, A. R., Howes, O., ... & Borgwardt, S. (2012). Cognitive functioning in prodromal psychosis: a meta-analysis. Archives of general psychiatry, 69(6), 562-571.
^ Lee, E. H., Ching, E. Y., Hui, C. L., Lin, J. X., Chang, W. C., Chan, S. K., & Chen, E. Y. (2017). Chinese label for people at risk for psychosis. Early Intervention in Psychiatry, 11: 224-228. doi:10.1111/eip.12232
^ 马维芬, 杨芝菁, & 陈玉夏.(2013).严重精神疾病前驱期高危险群之筛检预防议题分析. 护理杂志, 60(3), 98-104.
^ 徐丽华，张天宏，＆王继军.(2015年).精神病风险综合征并非精神病前驱期。上海精神医学，2015年01，42-44.
^ Fusar-Poli, P., Yung, A. R., McGorry, P., & van Os, J. (2014). Lessons learned from the psychosis high-risk state: Towards a general staging model of prodromal intervention. Psychological Medicine, 44(1), 17-24. doi:http://dx.doi.org.eproxy.lib.hku.hk/10.1017/S0033291713000184
^ Lee, E. H. M., Hui, C. L. M., Ching, E. Y. N., Lin, J., Chang, W. C., Chan, S. K. W., & Chen, E. Y. H. (2016). Public stigma in China associated with schizophrenia, depression, attenuated psychosis syndrome, and psychosis-like experiences. Psychiatric Services, 67(7), 766-770.
^ Rüsch, N. W., Heekeren, K., Theodoridou, A., Dvorsky, D., Müller, M., Paust, T., . . . Walitza, S. (2013). Attitudes towards help-seeking and stigma among young people at risk for psychosis. Psychiatry Research, 210(3), 1313-1315.
^ Fusar-Poli, P., Bonoldi, I., Yung, A. R., Borgwardt, S., Kempton, M. J., Valmaggia, L., ... & McGuire, P. (2012). Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Archives of general psychiatry, 69(3), 220-229.
^ Lam, M. M., Hung, S. F., & Chen, E. Y. (2006). Transition to psychosis: 6-month follow-up of a Chinese high-risk group in Hong Kong. Australian and New Zealand Journal of Psychiatry, 40:414-420.
^ Thompson, A. R., Marwaha, S., & Broome, M. (2016). At-risk mental state for psychosis: Identification and current treatment approaches. BJ Psych Advances, 22(3), 186-193.
^ McGorry PD., Nelson B., Markulev C., Yuen, H.P., Schäfer, M. R., Mossaheb, N., Schlögelhofer, M., Smesny, S., Hickie, IB., Berger, GE., Chen, E. Y., Haan, L., D., Nieman, DH., Nordentoft, M., Rössler, AR., Verma, S., Thompson, A., Yung, A., R., FRANZCP., Amminger, P., (2017). Effectofω-3 Polyunsaturated Fatty Acids inYoung People at Ultra high Risk for Psychotic Disorders. The NEURAPRO Randomized Clinical Trial. JAMA Psychiary, 74(1):19-27 doi:10.1001/jamapaychiatry.2016.29025
^ Morrison, A. P., French, P., Walford, L., Lewis, S. W., Kilcommons, A., Green, J., ... & Bentall, R. P. (2004). Cognitive therapy for the prevention of psychosis in people at ultra-high risk. The British Journal of Psychiatry, 185(4), 291-297.
^ van der Gaag, M., Nieman, D. H., Rietdijk, J., Dragt, S., Ising, H. K., Klaassen, R. M., ... & Linszen, D. H. (2012). Cognitive behavioral therapy for subjects at ultrahigh risk for developing psychosis: a randomized controlled clinical trial. Schizophrenia Bulletin, 38(6), 1180-1188.

外部链接

[2] 简称：ARMS

[#1-1] 1.0 ^1.1 Yung, A. R., McGorry, P. D., McFarlane, C. A., Jackson, H. J., Patton, G. C., & Rakkar, A. (1996). Monitoring and care of young people at incipient risk of psychosis. Schizophrenia bulletin, 22(2), 283-303.

[3] Cornblatt BA, Lencz T, Smith CW, Olsen R, Auther AM, Nakayama E, Lesser ML, Tai JY, Shah MR, Foley CA, Kane JM, Correll CU. Can antidepressants be used to treat the schizophrenia prodrome? results of a prospective, naturalistic treatment study of adolescents. J Clin Psychiatry. 2007;68(4):546-557.

[4] Yung AR, Phillips LJ, Yuen HP, McGorry PD. Risk factors for psychosis in an ultra high-risk group: psychopathology and clinical features. Schizophr Res. 2004;67(2-3):131-142.

[5] Cannon TD, Cadenhead K, Cornblatt B, Woods SW, Addington J, Walker E, Seidman LJ, Perkins D, Tsuang M, McGlashan T, Heinssen R. Prediction of psychosis in youth at high clinical risk: a multisite longitudinal study in North America.Arch Gen Psychiatry. 2008;65(1):28-37.

[6] Fusar-Poli, P., Deste, G., Smieskova, R., Barlati, S., Yung, A. R., Howes, O., ... & Borgwardt, S. (2012). Cognitive functioning in prodromal psychosis: a meta-analysis. Archives of general psychiatry, 69(6), 562-571.

[7] Lee, E. H., Ching, E. Y., Hui, C. L., Lin, J. X., Chang, W. C., Chan, S. K., & Chen, E. Y. (2017). Chinese label for people at risk for psychosis. Early Intervention in Psychiatry, 11: 224-228. doi:10.1111/eip.12232

[8] 马维芬, 杨芝菁, & 陈玉夏.(2013).严重精神疾病前驱期高危险群之筛检预防议题分析. 护理杂志, 60(3), 98-104.

[9] 徐丽华，张天宏，＆王继军.(2015年).精神病风险综合征并非精神病前驱期。上海精神医学，2015年01，42-44.

[10] Fusar-Poli, P., Yung, A. R., McGorry, P., & van Os, J. (2014). Lessons learned from the psychosis high-risk state: Towards a general staging model of prodromal intervention. Psychological Medicine, 44(1), 17-24. doi:http://dx.doi.org.eproxy.lib.hku.hk/10.1017/S0033291713000184

[11] Lee, E. H. M., Hui, C. L. M., Ching, E. Y. N., Lin, J., Chang, W. C., Chan, S. K. W., & Chen, E. Y. H. (2016). Public stigma in China associated with schizophrenia, depression, attenuated psychosis syndrome, and psychosis-like experiences. Psychiatric Services, 67(7), 766-770.

[12] Rüsch, N. W., Heekeren, K., Theodoridou, A., Dvorsky, D., Müller, M., Paust, T., . . . Walitza, S. (2013). Attitudes towards help-seeking and stigma among young people at risk for psychosis. Psychiatry Research, 210(3), 1313-1315.

[13] Fusar-Poli, P., Bonoldi, I., Yung, A. R., Borgwardt, S., Kempton, M. J., Valmaggia, L., ... & McGuire, P. (2012). Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk. Archives of general psychiatry, 69(3), 220-229.

[14] Lam, M. M., Hung, S. F., & Chen, E. Y. (2006). Transition to psychosis: 6-month follow-up of a Chinese high-risk group in Hong Kong. Australian and New Zealand Journal of Psychiatry, 40:414-420.

[15] Thompson, A. R., Marwaha, S., & Broome, M. (2016). At-risk mental state for psychosis: Identification and current treatment approaches. BJ Psych Advances, 22(3), 186-193.

[16] McGorry PD., Nelson B., Markulev C., Yuen, H.P., Schäfer, M. R., Mossaheb, N., Schlögelhofer, M., Smesny, S., Hickie, IB., Berger, GE., Chen, E. Y., Haan, L., D., Nieman, DH., Nordentoft, M., Rössler, AR., Verma, S., Thompson, A., Yung, A., R., FRANZCP., Amminger, P., (2017). Effectofω-3 Polyunsaturated Fatty Acids inYoung People at Ultra high Risk for Psychotic Disorders. The NEURAPRO Randomized Clinical Trial. JAMA Psychiary, 74(1):19-27 doi:10.1001/jamapaychiatry.2016.29025

[17] Morrison, A. P., French, P., Walford, L., Lewis, S. W., Kilcommons, A., Green, J., ... & Bentall, R. P. (2004). Cognitive therapy for the prevention of psychosis in people at ultra-high risk. The British Journal of Psychiatry, 185(4), 291-297.

[18] van der Gaag, M., Nieman, D. H., Rietdijk, J., Dragt, S., Ising, H. K., Klaassen, R. M., ... & Linszen, D. H. (2012). Cognitive behavioral therapy for subjects at ultrahigh risk for developing psychosis: a randomized controlled clinical trial. Schizophrenia Bulletin, 38(6), 1180-1188.

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