Pituitary volume and early treatment response in drug-naive first-episode psychosis patients
Pituitary volume and early treatment response in drug-naive first-episode psychosis patients
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DOI：
10.1016/j.schres.2009.05.008
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发表时间：
2009-08-01
影响因子：
4.5
通讯作者：
McGorry, P. D.
中科院分区：
文献类型：
--
作者：
Garner, B.;Berger, G. E.;McGorry, P. D.
背景：精神病患者抗精神病药物治疗的早期反应与更好的病程和结局相关。然而，预测治疗反应的因素还不清楚。精神分裂症和相关疾病的发作与应激水平的增加和下丘脑-垂体-肾上腺（HPA）轴的过度激活有关。本研究探讨了精神病发作时垂体体积是否可能是首发精神病（FEP）患者早期治疗反应的潜在预测因素。我们采用混合模型分析研究了基线垂体体积和12周内对症治疗反应之间的关系，样本包括42名药物初治或早期治疗的FEP患者，他们参加了一项控制剂量的研究，富马酸奎替利的发现性研究。Logistic回归用于检查治疗反应的预测因素。垂体体积测量从磁共振成像扫描时获得进入trial.Results：较大的垂体体积与整体精神病症状（简明精神病评定量表（BPRS）P= 0.031）和阳性症状（BPRS阳性症状分量表P= 0.010）的改善较少。无论性别如何，垂体体积处于第25百分位数的患者（413 mm（3））在第12周时对治疗有反应的可能性比第75百分位数的患者高出约3倍（635毫米（3））（OR = 3.07，CI：0.90-10.48）。基线垂体体积与早期治疗反应的相关性突出了HPA轴在新发精神病中的重要性。早期精神病的治疗策略的潜在影响进行了讨论。(C)2009 Elsevier B. V.保留所有权利。
Background: An early response to antipsychotic treatment in patients with psychosis has been associated with a better course and outcome. However, factors that predict treatment response are not well understood. The onset of schizophrenia and related disorders has been associated with increased levels of stress and hyper-activation of the hypothalamic-pituitary-adrenal (HPA) axis. This study examined whether pituitary volume at the onset of psychosis may be a potential predictor of early treatment response in first-episode psychosis (FEP) patients.Methods: We investigated the relationship between baseline pituitary volume and symptomatic treatment response over 12 weeks using mixed model analysis in a sample of 42 drug-naive or early treated FEP patients who participated in a controlled dose-finding study of quetiapine fumarate. Logistic regression was used to examine predictors of treatment response. Pituitary volume was measured from magnetic resonance imaging scans that were obtained upon entry into the trial.Results: Larger pituitary volume was associated with less improvement in overall psychotic symptoms (Brief Psychiatric Rating Scale (BPRS) P= 0.031) and positive symptoms (BPRS positive symptom subscale P= 0.010). Regardless of gender, patients with a pituitary volume at the 25th percentile (413 mm(3)) were approximately three times more likely to respond to treatment by week 12 than those at the 75th percentile (635 mm(3)) (odds ratio = 3.07, CI: 0.90-10.48).Conclusion: The association of baseline pituitary volumes with early treatment response highlights the importance of the HPA axis in emerging psychosis. Potential implications for treatment strategies in early psychosis are discussed. (C) 2009 Elsevier B.V. All rights reserved.