Rabinowitz Jonathan, De Smedt Goedele, Harvey Philip D, Davidson Michael
Department of Social Work, Bar-Ilan University, Ramat-Gan, Israel.
Am J Psychiatry. 2002 Dec;159(12):2021-6. doi: 10.1176/appi.ajp.159.12.2021.
Investigating the relationship between premorbid and prodromal status and the clinical manifestations of the first psychotic episode is relevant for understanding the pathophysiology of psychosis and for improving management of the disease. This study examined patterns of premorbid functioning of persons interviewed during their first episode of psychotic illness and examined the relationship of premorbid characteristics with symptom severity and cognitive functioning during the first illness episode.
The data were derived from the baseline assessments of a multicenter international drug trial that enrolled 535 patients in their first episode of psychosis. Subjects' scores on the Premorbid Adjustment Scale were used to assign them to groups according to whether their premorbid functioning was stable-good, stable-poor, or deteriorating. The three groups' scores on the Positive and Negative Syndrome Scale, Clinical Global Impression (CGI) severity scale, and a cognitive battery were compared.
Almost half of the patients (47.5%) had stable-good premorbid functioning, 37.3% had stable-poor premorbid functioning, and 15.1% had initially good, but later deteriorating, premorbid functioning. Compared to the stable-poor and deteriorating groups, the stable-good group had lower (better) negative syndrome and general psychopathology scores on the Positive and Negative Syndrome Scale and a lower CGI severity scale score. Differences between the stable-poor and stable-good groups were also found on some cognitive measures and on the positive syndrome subscale of the Positive and Negative Syndrome Scale.
More than half of the subjects, who were interviewed during their first episode of psychotic disorder, had evident premorbid behavioral disturbances. Poor premorbid functioning before onset of psychosis was associated with more severe symptoms and more severe cognitive manifestations of illness during the first illness episode.
研究病前及前驱状态与首次精神病发作的临床表现之间的关系，对于理解精神病的病理生理学及改善该疾病的管理具有重要意义。本研究调查了首次精神病发作患者的病前功能模式，并探讨了病前特征与首次发病期间症状严重程度及认知功能之间的关系。
数据来源于一项多中心国际药物试验的基线评估，该试验纳入了535例首次精神病发作的患者。根据患者在病前适应量表上的得分，将他们分为病前功能稳定良好、稳定较差或恶化三组。比较了三组在阳性和阴性症状量表、临床总体印象（CGI）严重程度量表以及一套认知测试中的得分。
近一半的患者（47.5%）病前功能稳定良好，37.3%病前功能稳定较差，15.1%病前功能最初良好但后来恶化。与稳定较差和恶化组相比，稳定良好组在阳性和阴性症状量表上的阴性症状及总体精神病理学得分较低（较好），在CGI严重程度量表上的得分也较低。在一些认知指标以及阳性和阴性症状量表的阳性症状子量表上，也发现了稳定较差组和稳定良好组之间的差异。
在首次精神病发作期间接受访谈的患者中，超过一半有明显的病前行为障碍。精神病发作前病前功能较差与首次发病期间更严重的症状及更严重的认知表现相关。
