Long-term trajectories of positive and negative symptoms in first episode psychosis: A 10 year follow-up study in the OPUS cohort
Long-term trajectories of positive and negative symptoms in first episode psychosis: A 10 year follow-up study in the OPUS cohort
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DOI：
10.1016/j.schres.2015.07.021
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发表时间：
2015-10-01
影响因子：
4.5
通讯作者：
Nordentoft, Merete
中科院分区：
文献类型：
--
作者：
Austin, Stephen F.;Mors, Ole;Nordentoft, Merete
目的：了解病程可以帮助临床医生制定有效的干预措施并改善治疗结果。本研究的目标是根据 10 年来在首发精神病患者队列中收集的结构化临床评估来构建阳性和阴性症状轨迹。方法：最初为 OPUS 研究（1998-2000）招募并在社区精神病服务机构接受治疗的 496 名首发精神病患者（ICD-10、F20-28）队列在 10 年间的 5 个不同场合对临床症状进行了评估。使用阳性和阴性症状评估量表对精神病理学进行评估。使用潜在类别分析构建症状轨迹。结果：确定了阳性症状的五种不同轨迹（有反应 -47%、延迟反应 -12%、复发 -15%、无反应 -13% 和偶发反应 -13%）。阴性症状有四种不同的轨迹（有反应 -28%、延迟反应 -19%、复发 -26% 和无反应 -27%）。基线特征的多变量回归分析发现，未经治疗的精神病持续时间较长（OR 1.27-1.47，p < 0.05）和药物滥用（OR 3.47-5.90，p < 0.01）与较差的阳性症状轨迹（较高水平的精神病症状）相关，而社交功能较差（OR 1.34-5.55，p < 0.05），紊乱的症状（OR 1.34-5.55，p < 0.05） 2.01-2.38，p < 0.05）和精神分裂症诊断（OR 5.70-8.86，p < 0.05）与较差的阴性症状轨迹（较高水平的阴性症状）相关。一部分人在诊断几年后症状出现显着变化。结论：首发精神病患者的阳性和阴性症状的疾病轨迹是不同的。阳性症状随着时间的推移呈现出减少和稳定的总体模式，而阴性症状通常在十年内表现出较小的变化。结果对首发精神病干预的重点、时机和持续时间具有影响。 (C) 2015 Elsevier B.V. 保留所有权利。
Objective: Knowledge about course of illness can help clinicians to develop effective interventions and improve treatment outcomes. The goal of this study was to construct positive and negative symptom trajectories based on structured clinical assessments collected over 10 years within a cohort of people with first episode psychosis.Method: A cohort of 496 people with first episode psychosis (ICD-10, F20-28) originally recruited for the OPUS study (1998-2000) and treated in community psychiatric services were rated on clinical symptoms at 5 different occasions across ten years. Psychopathology was assessed using the Scales for Assessment of Positive and Negative Symptoms. Symptom trajectories were constructed using Latent Class Analysis.Results: Five distinct trajectories were identified for positive symptoms (response -47%, delayed response -12%, relapse -15%, non-response -13% and episodic response -13%). Four distinct trajectories were identified for negative symptoms (response -28%, delayed response -19%, relapse -26% and non-response-27%). Multivariable regression analysis of baseline characteristics identified that longer duration of untreated psychosis (OR 1.27-1.47, p < 0.05) and substance abuse (OR 3.47-5.90, p < 0.01) were associated with poorer positive symptom trajectories (higher levels of psychotic symptoms) while poor social functioning (OR 1.34-5.55, p < 0.05), disorganized symptoms (OR 2.01-2.38, p < 0.05) and schizophrenia diagnosis (OR 5.70-8.86, p < 0.05) were associated with poorer negative symptom trajectories (higher levels of negative symptoms). A proportion of people displayed significant changes in symptoms several years after diagnosis.Conclusions: Trajectories of illness for positive and negative symptoms were heterogeneous among people with first episode psychosis. Positive symptoms showed a general pattern of reduction and stabilization over time while negative symptoms typically showed less variation over the ten years. Results have implications for the focus, timing and length of interventions in first episode psychosis. (C) 2015 Elsevier B.V. All rights reserved.