Ganev K
Department of Psychiatry, Medical University of Sofia, Bulgaria.
Soc Psychiatry Psychiatr Epidemiol. 2000 Sep;35(9):389-95. doi: 10.1007/s001270050255.
Relatively few studies describe the long-term course of schizophrenia in well-defined cohorts of patients assessed soon after the illness onset. The aim of this paper is to describe the overall trend of schizophrenia in a 16-year follow-up study of patients and to explore the predictive value of several variables measured at the time of inclusion in the study. The course of the disorder is described along both a 'clinical' and a 'social' dimension.
The sample of 60 patients with a recent onset of a non-affective psychosis was first assessed in 1978-1980 as part of the study, coordinated by the WHO, on Reduction and Assessment of Psychiatric Disability. Data from the last follow-up are used to rate the overall trends of psychotic symptoms and of social disability. Based on a subdivision of the follow-up period into three sub-periods, the trend for the patients is rated for each of the two dimensions as improvement, deterioration, and no change or fluctuating. The associations of these trends with several predictor variables (age at onset, gender, martial status, education level, family history of mental illness, type of illness onset, personality assets) are explored by cross-tabulation (with calculation of the relative risk) and by a logistic regression model.
The predominant pattern for psychotic symptoms is improvement (55% of the subjects), while the predominant pattern for social disability is deterioration (45% of the subjects). A trend of improvement of psychotic symptoms correlated significantly with a negative family history of severe psychiatric disorder and with an acute type of illness onset. Only the first variable entered the logistic regression model. A trend of improvement of social disability correlated significantly with gender, marital status, presence of personality assets, and type of illness onset. All of these predictors entered the logistic regression model, with the exception of marital status; age at onset also entered the logistic regression.
Psychotic symptoms and social disability are relatively autonomous descriptors of the course of schizophrenia. A speculative hypothesis is that symptom course is more closely related to innate factors, while social disability is contingent upon the acquired level of personal and social competence at the time of illness onset. Future studies are needed to assess the effects of psychiatric interventions that could ameliorate the long-term prognosis of social disability in patients with schizophrenia.
相对较少的研究描述了在疾病发作后不久进行评估的明确患者队列中精神分裂症的长期病程。本文的目的是在一项对患者进行的16年随访研究中描述精神分裂症的总体趋势，并探讨在纳入研究时测量的几个变量的预测价值。该疾病的病程从“临床”和“社会”两个维度进行描述。
60例近期发作的非情感性精神病患者样本于1978 - 1980年首次作为由世界卫生组织协调的关于减少和评估精神残疾的研究的一部分进行评估。最后一次随访的数据用于评估精神病症状和社会残疾的总体趋势。基于将随访期细分为三个子时期，对患者在这两个维度上的趋势分别评定为改善、恶化以及无变化或波动。通过交叉表（计算相对风险）和逻辑回归模型探讨这些趋势与几个预测变量（发病年龄、性别、婚姻状况、教育水平、精神疾病家族史、疾病发作类型、人格特质）之间的关联。
精神病症状的主要模式是改善（55%的受试者），而社会残疾的主要模式是恶化（45%的受试者）。精神病症状的改善趋势与严重精神疾病的阴性家族史以及急性疾病发作类型显著相关。只有第一个变量进入了逻辑回归模型。社会残疾的改善趋势与性别、婚姻状况、人格特质的存在以及疾病发作类型显著相关。除婚姻状况外，所有这些预测因素都进入了逻辑回归模型；发病年龄也进入了逻辑回归。
精神病症状和社会残疾是精神分裂症病程相对独立的描述指标。一个推测性的假设是，症状病程与先天因素关系更密切，而社会残疾取决于发病时获得的个人和社会能力水平。需要未来的研究来评估精神科干预措施对改善精神分裂症患者社会残疾长期预后的效果。
