Early intervention and a five year follow up in young adults with a short duration of untreated psychosis: ethical implications
Early intervention and a five year follow up in young adults with a short duration of untreated psychosis: ethical implications
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DOI：
10.1016/s0920-9964(01)00239-0
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发表时间：
2001-08-01
影响因子：
4.5
通讯作者：
Lenior, M
中科院分区：
文献类型：
--
作者：
Linszen, D;Dingemans, P;Lenior, M
在一项荷兰治疗干预研究中，对76名首次精神分裂症发作的患者进行了测试，假设是与其他研究相比，急性精神分裂症发作后的早期差别治疗是否未改善结果。患者未经治疗的精神病持续时间相对较短。未发现两种治疗条件对复发率有显著影响。为期15个月的干预计划将精神病复发率保持在15%的低水平；低于可比研究。因此，初步结果支持假设。在15个月的研究完成后，患者被转介到其他机构，并进行了5年的跟踪调查。随访结果显示，低复发率难以维持。在最初样本的其余71名患者中，52%的患者有一次或多次精神病复发，25%的患者出现慢性阳性症状，23%的患者没有另一次精神病发作。此外，社会功能水平也很低：大多数患者依赖父母，很少有技术或有报酬的工作，他们的生活质量似乎也很低，结果表明，早期干预可能会改善精神分裂症的短期结果，但不能改善长期结果。我们的结果还表明，干预后转诊到其他精神卫生机构是不够的。门诊护理的连续性，包括专业关系的连续性，对家庭的持续支持，以及对疾病、药物和压力的持续管理，可能是精神分裂症患者发病后头五年的一个关键问题。早期识别和干预对预后可能远不如护理和护理人员的连续性那么重要。然而，目前人们仍然怀疑，对未经治疗的精神病病程较短的首发患者进行早期干预计划，是否有可能在没有持续的综合治疗计划的情况下改变精神分裂症的病程。(C)2001 Elsevier Science B.V.保留所有权利。
In a Dutch treatment intervention study of patients (n = 76) with first psychotic episodes of schizophrenia the hypothesis tested was whether early differential treatment after an acute psychotic break unproved outcome as compared with other studies. Patients had a relatively short duration of untreated psychosis. No significant effect between two treatment conditions on relapse rate was found. The 15-month intervention program kept the psychotic relapse rate as low as 15%; lower than comparable studies. Thus, the initial results were in support of the hypothesis.After completion of the 15 months study, patients were referred to other agencies and followed for five years. Results of the follow up study showed that the low relapse rate could not be maintained. Of the remaining 71 patients of the initial sample, 52% had one or more psychotic relapses, 25% developed chronic positive symptoms and 23 % did not have another psychotic episode. In addition, the level of social functioning turned out to be low: the majority of patients were dependent upon their parents, few held down a skilled or paid job and also their quality of life seemed low, results indicate that early intervention may improve short term but not long term outcome in schizophrenia.Our results also suggest that referral to other mental health agencies after intervention is not sufficient. Continuity of outpatient care, including continuity of a professional relationship, continuity of support for the family, and the continuity in management of illness, medication and stress may be a key issue in the first five years after the onset of psychosis in schizophrenia. Early recognition and intervention may not nearly be as important for outcome as continuity in care and caregivers. At present, however, it remains questionable whether early intervention programs in first-episode patients with a short duration of untreated psychosis can offer the prospect of altering the course of schizophrenia without a sustained comprehensive treatment program. (C) 2001 Elsevier Science B.V. All rights reserved.