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精神分裂症门诊护理中的缓解与复发:精神分裂症门诊健康结局研究的三年结果

Remission and relapse in the outpatient care of schizophrenia: three-year results from the Schizophrenia Outpatient Health Outcomes study.

作者信息

Haro Josep Maria, Novick Diego, Suarez David, Alonso Jordi, Lépine Jean Pierre, Ratcliffe Mark

机构信息

Sant Joan de Deu-SSM, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.

出版信息

J Clin Psychopharmacol. 2006 Dec;26(6):571-8. doi: 10.1097/01.jcp.0000246215.49271.b8.

Abstract

Remission and relapse are clinical outcomes of increasing interest in schizophrenia. We analyzed remission and relapse, and the sociodemographic and clinical factors associated with these outcomes, in the usual care of schizophrenia using the 3-year, follow-up data from a large cohort of outpatients with schizophrenia taking part in the prospective, observational, European Schizophrenia Outpatient Health Outcomes study. Of the 6516 patients analyzed for remission, 4206 (64.6%) achieved remission during the 3-year, follow-up period. Logistic regression analysis revealed that being female, having a good level of social functioning at study entry, and a shorter duration of illness were factors significantly associated with achieving remission. Treatment with olanzapine was also associated with a higher frequency of remission compared with other antipsychotic agents. A Kaplan-Meier survival curve estimated that relapse occurred in approximately 25% of the patients who achieved remission, with the risk of relapse remaining constant during the follow-up period. Shorter duration of illness, having hostile behaviors, and substance abuse were factors associated with a higher risk of relapse, whereas good level of social functioning and the use of olanzapine and clozapine were associated with a lower risk of relapse. In conclusion, the 3-year results of the Schizophrenia Outpatient Health Outcomes study indicate that the likelihood of remission decreases over the longitudinal course of schizophrenia, but risk of relapse is maintained even after 3 years of achieving remission severity levels. Results suggest that treatment with olanzapine is associated with a better chance of achieving remission than other antipsychotics. Moreover, the use of olanzapine and clozapine is associated with a lower risk of relapse compared with risperidone, quetiapine, and typical antipsychotics. The results should be interpreted conservatively because of the observational, nonrandomized study design.

摘要

缓解和复发是精神分裂症领域越来越受关注的临床结局。我们利用来自一大群参与前瞻性观察性欧洲精神分裂症门诊健康结局研究的门诊精神分裂症患者的3年随访数据,分析了精神分裂症常规治疗中的缓解和复发情况,以及与这些结局相关的社会人口学和临床因素。在分析缓解情况的6516例患者中,4206例(64.6%)在3年随访期内实现缓解。逻辑回归分析显示,女性、研究开始时社会功能水平良好以及病程较短是与实现缓解显著相关的因素。与其他抗精神病药物相比,使用奥氮平治疗也与更高的缓解频率相关。Kaplan-Meier生存曲线估计,在实现缓解的患者中约25%会复发,随访期间复发风险保持不变。病程较短、有敌对行为和药物滥用是与较高复发风险相关的因素,而良好的社会功能水平以及使用奥氮平和氯氮平与较低的复发风险相关。总之,精神分裂症门诊健康结局研究的3年结果表明,精神分裂症病程中缓解的可能性会降低,但即使在达到缓解严重程度水平3年后,复发风险依然存在。结果表明,与其他抗精神病药物相比,使用奥氮平实现缓解的机会更大。此外,与利培酮、喹硫平和典型抗精神病药物相比,使用奥氮平和氯氮平与较低的复发风险相关。由于本研究为观察性、非随机研究设计,这些结果应谨慎解读。

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