Effective prevention of severe mental disorders (SMD), including non-psychotic unipolar mood disorders (UMD), non-psychotic bipolar mood disorders (BMD), and psychotic disorders (PSY), rely on accurate knowledge of the duration, first presentation, time course and transdiagnosticity of their prodromal stages. Here we present a retrospective, real-world, cohort study using electronic health records, adhering to RECORD guidelines. Natural language processing algorithms were used to extract monthly occurrences of 65 prodromal features (symptoms and substance use), grouped into eight prodromal clusters. The duration, first presentation, and transdiagnosticity of the prodrome were compared between SMD groups with one-way ANOVA, Cohen’s f and d. The time course (mean occurrences) of prodromal clusters was compared between SMD groups with linear mixed-effects models. 26,975 individuals diagnosed with ICD-10 SMD were followed up for up to 12 years (UMD = 13,422; BMD = 2506; PSY = 11,047; median[IQR] age 39.8[23.7] years; 55% female; 52% white). The duration of the UMD prodrome (18[36] months) was shorter than BMD (26[35], d = 0.21) and PSY (24[38], d = 0.18). Most individuals presented with multiple first prodromal clusters, with the most common being non-specific (‘other’; 88% UMD, 85% BMD, 78% PSY). The only first prodromal cluster that showed a medium-sized difference between the three SMD groups was positive symptoms (f = 0.30). Time course analysis showed an increase in prodromal cluster occurrences approaching SMD onset. Feature occurrence across the prodromal period showed small/negligible differences between SMD groups, suggesting that most features are transdiagnostic, except for positive symptoms (e.g. paranoia, f = 0.40). Taken together, our findings show minimal differences in the duration and first presentation of the SMD prodromes as recorded in secondary mental health care. All the prodromal clusters intensified as individuals approached SMD onset, and all the prodromal features other than positive symptoms are transdiagnostic. These results support proposals to develop transdiagnostic preventive services for affective and psychotic disorders detected in secondary mental healthcare.

有效预防严重精神障碍 (SMD)，包括非精神病性单相情感障碍 (UMD)、非精神病性双相情感障碍 (BMD) 和精神病性障碍 (PSY)，依赖于对持续时间、首次就诊、时间的准确了解其前驱阶段的病程和跨诊断性。在这里，我们遵循 RECORD 指南，使用电子健康记录进行回顾性、真实世界的队列研究。使用自然语言处理算法提取每月出现的 65 个前驱特征（症状和物质使用），并将其分为 8 个前驱簇。使用单向方差分析、Cohen's f 和 d 比较 SMD 组之间前驱症状的持续时间、首次表现和跨诊断性。使用线性混合效应模型比较 SMD 组之间前驱簇的时间进程（平均发生次数）。对 26,975 名诊断为 ICD-10 SMD 的个体进行了长达 12 年的随访（UMD = 13,422；BMD = 2506；PSY = 11,047；中位 [IQR] 年龄 39.8[23.7] 岁；55% 女性；52% 白人）。 UMD前驱症状的持续时间（18[36]个月）比BMD（26[35]，d = 0.21）和PSY（24[38]，d = 0.18）短。大多数个体出现多个首发前驱症状群，其中最常见的是非特异性的（“其他”；88% UMD、85% BMD、78% PSY）。三个 SMD 组之间唯一表现出中等程度差异的第一个前驱簇是阳性症状 (f = 0.30)。时程分析显示，接近 SMD 发病的前驱症状群发生率有所增加。整个前驱期的特征出现在 SMD 组之间显示出很小/可以忽略不计的差异，这表明大多数特征是跨诊断的，除了阳性症状（例如偏执狂，f = 0.40）。总而言之，我们的研究结果表明，二级心理保健中记录的 SMD 前驱症状的持续时间和首次出现差异很小。当个体接近 SMD 发病时，所有前驱症状群都会加剧，并且除了阳性症状之外的所有前驱症状都是跨诊断的。这些结果支持针对二级心理保健中发现的情感和精神障碍开发跨诊断预防服务的建议。