首发精神病患者的长期临床康复和治疗阻力:一项为期 10 年的随访研究。

IF 3 Q2 PSYCHIATRY Schizophrenia (Heidelberg, Germany) Pub Date : 2024-08-22 DOI:10.1038/s41537-024-00489-7
Kristin Fjelnseth Wold, Isabel Viola Kreis, Gina Åsbø, Camilla Bärthel Flaaten, Line Widing, Magnus Johan Engen, Siv Hege Lyngstad, Erik Johnsen, Torill Ueland, Carmen Simonsen, Ingrid Melle
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引用次数: 0

摘要

首发精神病(FEP)患者的病情轨迹随着时间的推移而变化很大。确定预测结果的早期病程参数至关重要,但仍需提供长期数据。我们对一个综合性首发精神病(FEP)队列进行了一项为期十年的随访研究,调查十年后临床康复(CR)和治疗阻力(TR)的发生率,以及长期预后的临床、人口学和病前预测因素。102 名患有 FEP DSM-IV 精神分裂症谱系障碍的患者是在接受治疗的第一年内被招募的。精神病治疗反应和抵抗工作组(TRRIP)和精神分裂症缓解工作组(RSWG)的标准分别用于定义TR和CR。在 10 年的随访中,29 名参与者(29%)被归类为 CR,32 名参与者(31%)被归类为 TR。我们还发现了一个较大的中间组(n = 41,40%),由部分康复的参与者组成。在 10 年的随访中,7% 的参与者尝试过氯氮平。逻辑回归分析表明,隐匿起病(OR = 4.16)和基线紊乱症状(OR = 2.96)与罹患 TR 的风险显著相关。病前学习适应良好(OR = 1.60)和急性发病(OR = 3.40)与 CR 发生几率增加有关。通过使用最近达成共识的定义,我们确定了三个长期结果组。我们还发现了评估基线紊乱症状和更密切地监测隐匿性发病患者的潜在重要性。此外,研究结果还表明,临床医生应密切关注早期病程参数,并提供适当的治疗,以改善 FEP 的长期预后。
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Long-term clinical recovery and treatment resistance in first-episode psychosis: a 10-year follow-up study.

Illness trajectories in people with first-episode psychosis (FEP) vary significantly over time. Identifying early-course parameters predicting outcomes is essential, but long-term data still needs to be provided. We conducted a 10-year follow-up study of a comprehensive first-episode psychosis (FEP) cohort investigating the prevalence of clinical recovery (CR) and treatment resistance (TR) after ten years, as well as clinical, demographic, and pre-illness predictors of long-term outcomes. 102 participants with FEP DSM-IV Schizophrenia spectrum disorders were recruited within their first year of treatment. The Treatment Response and Resistance in Psychosis Working Group (TRRIP) and the Remission in Schizophrenia Working Group (RSWG) criteria were used to define TR and CR, respectively. At 10-year follow-up, 29 (29%) of the participants were classified as in CR, while 32 (31%) were classified as TR. We also identified a larger middle group (n = 41, 40%) consisting of participants in partial recovery. 7% of all participants had tried Clozapine at the 10-year follow-up. Logistic regression analyses identified insidious onset (OR = 4.16) and baseline disorganized symptoms (OR = 2.96) as significantly associated with an increased risk of developing TR. Good premorbid academic adjustment (OR = 1.60) and acute onset (OR = 3.40) were associated with an increased chance of CR. We identified three long-term outcome groups by using recent consensus definitions. We also identified the potential importance of assessing baseline disorganized symptoms and monitoring patients with insidious onset more closely. Further, the findings suggest that clinicians should pay close attention to early-course parameters and provide adequate treatment to improve long-term outcomes of FEP.

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