Recovery in Schizophrenia: Longitudinal Course

描述(申请人提供)：最近，关于精神分裂症患者随着年龄的增长，是否会出现病程和结局的变化，一直存在争议。一些人或许多人可能会随着年龄的增长而恢复，这涉及到症状的潜在缓解和全球功能的改善。如果这些变化发生，它们可能与生物学理论有关，即随着年龄的增长，多巴胺会随着年龄的增长而下降。这项研究对早发性精神分裂症患者和两个对照样本进行了长达27年的前瞻性跟踪调查。这些患者最初是在疾病的早期进行评估的。自早期急性期评估以来，在20年的时间里对它们进行了6次系统研究。 我们20年的纵向数据表明，精神病开始下降，随着年龄的增长，精神分裂症患者恢复的比例有所改善。这一变化始于15年和20年的后续行动，在一些主要领域(如全球运作)具有统计意义。对于这种改善是否会在27年的随访中达到平台期、持续甚至加速，仍然是一个悬而未决的问题，因为最初起病的精神分裂症患者达到了50岁，也就是生命的后半段。尽管关于精神分裂症的不良病程和结局是否会持续下去，或者随着年龄的增长，精神病症状是否会有所改善或“耗尽”，以及一些或许多人是否完全恢复，在很长一段时间内，还没有系统的前瞻性多项随访纵向研究，尽管对精神分裂症的病程和结果是否持续存在不同的看法和重要性。目前的应用程序旨在帮助填补我们对精神分裂症症状的潜在变化和随着年龄的增长而可能恢复的知识空白。这项为期27年的多次随访将提供现代精神分裂症患者在一年或更长时间内完全康复的累积百分比的数据。 这项拟议的为期27年的纵向研究，随着这些患者达到50岁，即生命的后半段，重点将放在改善和显示随着年龄增加而恢复的百分比上。将研究三组特定的假说：a)关于精神分裂症患者开始变老时精神症状潜在的“倦怠”的假说；b)关于精神分裂症随着年龄的增长而改善和恢复的假说；以及c)关于精神分裂症的特定亚型的假说，这可能是随着他们年龄的增长而导致病程和结果改善的主要原因。

DESCRIPTION (provided by applicant): Recently there has been controversy concerning whether as schizophrenia patients get older there are changes in course and outcome. Some or many may recover as they begin to get older, with this involving potential reductions in symptoms and improved global functioning. If these changes occur they could be linked to biological theory about age-related declines in dopamine as people get older. The research involves a 27 year prospectively designed follow-up of a large sample of early onset schizophrenia patients and two control samples. These patients were originally assessed early in their disorder. Since their early acute phase assessment they have been studied systematically 6 times over a 20-year period. Our 20-year longitudinal data indicate the beginning of a decline in psychosis, and an improvement in the percent of schizophrenia patients showing recovery as they begin to get older. This change began at the 15 and 20-year follow-ups, and is statistically significant in some major areas (e.g., global functioning). It is still an open issue as to whether this improvement will reach a plateau, continue or even accelerate at the 27 year follow-up as the originally early onset schizophrenia patients reach 50 years, the second half of life. There has not been a systematic prospective multi-follow-up longitudinal study over a prolonged period despite the different views and the importance to theory about whether poor schizophrenia course and outcome continues or whether there is improvement or "burn out" of psychotic symptoms and complete recovery in some or many as they get older. The current application was designed to help fill this gap in our knowledge about potential changes in schizophrenia symptoms and potential recovery as they get older. This 27-year multi-follow-up will provide data on the cumulative percent of modern-day schizophrenia patients who ever show complete recovery for a period of one of more years. The focus of this proposed 27-year longitudinal study as these patients reach 50 years of age, the second half of life, will be on improvement and on the percent showing recovery as a function of increasing age. Three specific sets of hypotheses will be studied: a) hypotheses about a potential "burn out" of psychotic symptoms as schizophrenia patients begin to age, b) hypotheses about improvement and recovery in schizophrenia as they begin to get older, and c) hypotheses about a specific subtype of schizophrenia which may account for much of the improvement in course and outcome as they get older.