Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder
Predictors of relapse following response from a first episode of schizophrenia or schizoaffective disorder
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DOI：
10.1001/archpsyc.56.3.241
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发表时间：
1999-03-01
影响因子：
--
通讯作者：
Lieberman, JA
中科院分区：
文献类型：
--
作者：
Robinson, D;Woerner, MG;Lieberman, JA
背景资料：我们研究复发后的第一次发作的精神分裂症或baboaffective disorder.Methods：首次发作的精神分裂症患者进行了评估的精神病理学变量，认知，社会功能和生物学变量的措施，并根据一个标准化的算法治疗。复发分析的样本包括104例对治疗有反应的患者，他们的指数发作和复发的风险。结果：5年后，首次复发率为81.9%（95%置信区间[CI]，70.6%-93.2%），第二次复发率为78.0%（95%CT，46.5%-100.0%）。从第二次复发中恢复后4年，累积第三次复发率为86.2%（95%CI，61.5%-100.0%）。停止抗精神病药物治疗使复发风险增加近5倍（首次复发的风险比为4.89 [99%CI，2.49-9.60];第二次复发的风险比为4.57 [99%CI，1.49-14.02]）。随后控制抗精神病药物使用的分析表明，病前对学校适应不良和病前社交退缩的患者复发较早。性别、诊断、产科并发症、治疗前精神病病程、基线症状、神经内分泌指标、盐酸哌甲酯激发反应、神经心理学和磁共振成像指标、首次发作反应时间、治疗期间不良反应和首次发作后残留症状的存在与复发时间无显著相关性。精神分裂症和情感性精神障碍首次发作后5年内复发率很高。这种风险可通过抗精神病药物维持治疗来降低。
Background: We examined relapse after response to a first episode of schizophrenia or schizoaffective disorder.Methods: Patients with first-episode schizophrenia were assessed on measures of psychopathologic variables, cognition, social functioning, and biological variables and treated according to a standardized algorithm. The sample for the relapse analyses consisted of 104 patients who responded to treatment of their index episode and were at risk for relapse.Results: Five years after initial recovery, the cumulative first relapse rate was 81.9% (95% confidence interval [CI], 70.6%-93.2%); the second relapse rate was 78.0% (95% CT, 46.5%-100.0%). By 4 years after recovery from a second relapse, the cumulative third relapse rate was 86.2% (95% CI, 61.5%-100.0%). Discontinuing antipsychotic drug therapy increased the risk of relapse by almost 5 times (hazard ratio for an initial relapse, 4.89 [99% CI, 2.49-9.60]; hazard ratio for a second relapse, 4.57 [99% CI, 1.49-14.02]). Subsequent analyses controlling for antipsychotic drug use showed that patients with poor premorbid adaptation to school and premorbid social withdrawal relapsed earlier. Sex, diagnosis, obstetric complications, duration of psychotic illness before treatment, baseline symptoms, neuroendocrine measures, methylphenidate hydrochloride challenge response, neuropsychologic and magnetic resonance imaging measures, time to response of the initial episode, adverse effects during treatment, and presence of residual symptoms after the initial episode were not significantly related to time to relapse.Conclusions: There is a high rate of relapse within 5 years of recovery from a first episode of schizophrenia and schizoaffective disorder. This risk is diminished by maintenance antipsychotic drug treatment.