Caton Carol L M, Hasin Deborah S, Shrout Patrick E, Drake Robert E, Dominguez Boanerges, Samet Sharon, Schanzer Bella
New York State Psychiatric Institute and the Department of Psychiatry, Columbia University, USA.
Schizophr Bull. 2006 Oct;32(4):618-25. doi: 10.1093/schbul/sbl007. Epub 2006 Jul 27.
To examine rates and predictors of psychosis remission at 1-year follow-up for emergency admissions diagnosed with primary psychotic disorders and substance-induced psychoses.
A total of 319 patients with comorbid psychosis and substance use, representing 83% of the original referred sample, were rediagnosed at 1 year postintake employing a research diagnostic assessment. Remission of psychosis was defined as the absence of positive and negative symptoms for at least 6 months. Likelihood ratio chi-square tests and multivariate logistic regression were the main means of analysis.
Of those with a baseline diagnosis of primary psychotic disorder, 50% were in remission at 1 year postintake, while of those with a baseline diagnosis of substance-induced psychosis, 77% were in remission at this time point. Lower Positive and Negative Syndrome Scale (PANSS) symptom levels at baseline, better premorbid functioning, greater insight into psychosis, and a shorter duration of untreated psychosis predicted remission at 1 year in both diagnostic groups. No interaction effects of baseline predictors and diagnosis type were observed. A stepwise multivariate logistic regression holding baseline diagnosis constant revealed the duration of untreated psychosis (odds ratio [OR] = 0.97; 95% confidence interval [CI] = 0.95, 0.997), total PANSS score (OR = 0.98; 95% CI = 0.97, 0.987), Premorbid Adjustment Scale score (OR = 0.13; 95% CI = 0.02, 0.88), and Scale to Assess Unawareness of Mental Disorders unawareness score (OR = 0.84; 95% CI = 0.71, 0.993) as key predictors of psychosis remission.
The association of better premorbid adjustment, a shorter duration of untreated psychosis, better insight into psychotic symptoms, and lower severity of psychotic symptoms with improved clinical outcome, reported previously in studies of schizophrenia, generalizes to psychosis remission in psychotic disorders that are substance induced.
研究因原发性精神障碍和物质所致精神障碍而紧急入院的患者在1年随访时的精神病缓解率及预测因素。
共有319例合并精神病和物质使用的患者（占原始转诊样本的83%），在入院1年后采用研究诊断评估进行重新诊断。精神病缓解定义为至少6个月无阳性和阴性症状。似然比卡方检验和多因素逻辑回归是主要分析方法。
基线诊断为原发性精神障碍的患者中，50%在入院1年后缓解，而基线诊断为物质所致精神障碍的患者中，77%在该时间点缓解。两个诊断组中，基线时较低的阳性和阴性症状量表（PANSS）症状水平、较好的病前功能、对精神病的更好洞察力以及较短的未治疗精神病持续时间可预测1年时的缓解情况。未观察到基线预测因素与诊断类型的交互作用。在保持基线诊断不变的逐步多因素逻辑回归分析中，未治疗精神病的持续时间（比值比[OR]=0.97；95%置信区间[CI]=0.95，0.997）、PANSS总分（OR=0.98；95%CI=0.97，0.987）、病前适应量表评分（OR=0.13；95%CI=0.02，0.88）以及精神障碍自知力评估量表的自知力评分（OR=0.84；95%CI=0.71，0.993）是精神病缓解的关键预测因素。
先前在精神分裂症研究中报道的病前适应更好、未治疗精神病持续时间更短、对精神病症状的洞察力更好以及精神病症状严重程度更低与临床结局改善之间的关联，在物质所致精神障碍的精神病缓解中同样适用。
