Robinson Delbert G, Woerner Margaret G, McMeniman Marjorie, Mendelowitz Alan, Bilder Robert M
Department of Psychiatry Research, the Zucker Hillside Hospital, Glen Oaks, NY 11004, USA.
Am J Psychiatry. 2004 Mar;161(3):473-9. doi: 10.1176/appi.ajp.161.3.473.
Follow-up studies have found that a substantial number of patients with schizophrenia achieve full recovery (i.e., sustained improvement in both symptoms and social/vocational functioning) when examined decades after an index admission. This study addressed recovery during the crucial early course of the illness.
Subjects in their first episode of schizophrenia or schizoaffective disorder (N=118) were assessed at baseline and then treated according to a medication algorithm. Full recovery required concurrent remission of positive and negative symptoms and adequate social/vocational functioning (fulfillment of age-appropriate role expectations, performance of daily living tasks without supervision, and engagement in social interactions).
After 5 years, 47.2% (95% CI=36.0%-58.4%) of the subjects achieved symptom remission, and 25.5% (95% CI=16.1%-34.7%) had adequate social functioning for 2 years or more. Only 13.7% (95% CI=6.4%-20.9%) of subjects met full recovery criteria for 2 years or longer. Better cognitive functioning at stabilization was associated with full recovery, adequate social/vocational functioning, and symptom remission. Shorter duration of psychosis before study entry predicted both full recovery and symptom remission. More cerebral asymmetry was associated with full recovery and adequate social/vocational functioning; a schizoaffective diagnosis predicted symptom remission.
Although some patients with first-episode schizophrenia can achieve sustained symptomatic and functional recovery, the overall rate of recovery during the early years of the illness is low.
随访研究发现，相当一部分精神分裂症患者在首次入院数十年后接受检查时实现了完全康复（即症状和社会/职业功能持续改善）。本研究关注疾病关键早期阶段的康复情况。
对首次发作的精神分裂症或分裂情感性障碍患者（N = 118）进行基线评估，然后根据药物治疗方案进行治疗。完全康复要求阳性和阴性症状同时缓解，以及具备足够的社会/职业功能（符合与年龄相符的角色期望、在无监督的情况下完成日常生活任务、参与社交互动）。
5年后，47.2%（95%置信区间 = 36.0% - 58.4%）的患者实现了症状缓解，25.5%（95%置信区间 = 16.1% - 34.7%）具备2年或更长时间的足够社会功能。只有13.7%（95%置信区间 = 6.4% - 20.9%）的患者达到2年或更长时间的完全康复标准。病情稳定时更好的认知功能与完全康复、足够的社会/职业功能以及症状缓解相关。研究入组前精神病病程较短可预测完全康复和症状缓解。更多的脑不对称与完全康复和足够的社会/职业功能相关；分裂情感性障碍诊断可预测症状缓解。
虽然一些首次发作的精神分裂症患者可以实现症状和功能的持续康复，但疾病早期的总体康复率较低。
