Stayer Catherine, Sporn Alexandra, Gogtay Nitin, Tossell Julia W, Lenane Marge, Gochman Peter, Greenstein Deanna, Sharp Wendy, Rapoport Judith L
Child Psychiatry Branch at the National Institute of Mental Health, Bethesda, MD 20892, USA.
J Child Adolesc Psychopharmacol. 2005 Jun;15(3):510-9. doi: 10.1089/cap.2005.15.510.
Long-term outcomes in children with atypical psychosis have been poorly studied. Four to 6 weeks of inpatient observation and up to 11 years (mean, 4.0 +/- 1.3 years) of follow- up have afforded us some experience with this probably heterogeneous group of transiently psychotic patients commonly mislabeled as schizophrenic. Despite severe preadmission morbidity, some patients have successfully remained neuroleptic-free since discharge. Predictors of good versus poor outcome were sought.
Of roughly 150 patients admitted with the presumptive diagnosis of schizophrenia, 32 patients were discharged meeting criteria for psychosis not otherwise specified (NOS), otherwise labeled by the NIMH team as "multidimensionally impaired" (MDI). Admission and biannual follow-up data included a semistructured clinical interview with the Schedule for Affective Disorders and Schizophrenia for School Age Children (K-SADS), IQ testing, clinical rating scales (e.g., Clinical Global Impression Scale (CGI), Children's Global Assessment Scale (C-GAS), Brief Psychiatric Rating Scale (BPRS), Scales for the Assessment Negative and Positive Symptoms (SANS and SAPS), and Bunney-Hamburg (B-H)). At follow-up (as of February 2005) 38% of patients (12 of 32) met criteria for bipolar 1 disorder, 12% (4 of 23) for major depressive disorder (MDD), and 3% (1 of 32) for schizoaffective disorder. The remaining 47% of patients (15 of 32) were divided into two groups on the basis of whether they were in remission and neuroleptic-free ("good outcome," n = 5) or still severely impaired and/or psychotic regardless of pharmacotherapy ("poor outcome," n = 10) at follow-up.
Good-outcome patients had a significantly higher baseline level of functioning (on admission and on medications). This was demonstrated by better scores on CGI (3.5 +/- 0.6 versus 4.8 +/- 0.8; p = 0.03) and C-GAS (66.3 +/- 6.3 versus 38.6 +/- 11.5; p = 0.01). Groups were otherwise comparable in demographic data (gender, race, socioeconomic status, age at onset), months of neuroleptic exposure, severity of psychotic symptoms, and level of premorbid functioning.
C-GAS (which correctly classified 85.7% of good-outcome subjects) and CGI at baseline appear to predict outcome. On other variables, MDI subgroups were remarkably similar.
关于非典型精神病患儿的长期预后研究较少。通过4至6周的住院观察以及长达11年（平均4.0±1.3年）的随访，我们对这一可能异质性的短暂性精神病患者群体有了一些经验，这些患者常被误诊为精神分裂症。尽管入院前病情严重，但部分患者出院后成功停用了抗精神病药物。我们探寻了预后良好与不良的预测因素。
在大约150例初步诊断为精神分裂症的入院患者中，32例患者出院时符合未特定的精神病（NOS）标准，美国国立精神卫生研究所团队将其标记为“多维度受损”（MDI）。入院及每半年一次的随访数据包括使用儿童情感障碍和精神分裂症量表（K-SADS）进行的半结构式临床访谈、智商测试、临床评定量表（如临床总体印象量表（CGI）、儿童总体评定量表（C-GAS）、简明精神病评定量表（BPRS）、阴性与阳性症状评定量表（SANS和SAPS）以及邦尼 - 汉堡量表（B-H））。在随访时（截至2005年2月），38%的患者（32例中的12例）符合双相I型障碍标准，12%（23例中的4例）符合重度抑郁症（MDD）标准，3%（32例中的1例）符合分裂情感性障碍标准。其余47%的患者（32例中的15例）根据随访时是否缓解且停用抗精神病药物（“良好预后”，n = 5）或无论药物治疗仍严重受损和/或有精神病症状（“不良预后”，n = 10）分为两组。
预后良好的患者在基线时（入院时及用药时）功能水平显著更高。这在CGI评分（3.5±0.6对4.8±0.8；p = 0.03）和C-GAS评分（66.3±6.3对38.6±11.5；p = 0.01）上表现得更为明显。两组在人口统计学数据（性别、种族、社会经济地位、起病年龄）、抗精神病药物暴露月数、精神病症状严重程度以及病前功能水平方面具有可比性。
基线时的C-GAS（正确分类了85.7%的良好预后受试者）和CGI似乎可预测预后。在其他变量方面，MDI亚组非常相似。
