Selten Jean-Paul, Veen Natalie D, Hoek Hans W, Laan Winfried, Schols Diede, van der Tweel Ingeborg, Feller Wilma, Kahn René S
Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, Utrecht, the Netherlands.
Schizophr Res. 2007 Dec;97(1-3):79-87. doi: 10.1016/j.schres.2007.07.008. Epub 2007 Aug 1.
To describe the early course of psychotic disorders in general and to examine whether certain variables can predict the early course of schizophrenic disorders (DSM-IV: schizophrenia, schizophreniform or schizoaffective disorder).
Follow-up and re-diagnosis of a highly representative Dutch incidence cohort (N=181), thirty months after first contact with a physician for a psychotic disorder. Poor course was defined as a continuous psychotic illness or a score of less than 39 on the Global Assessment of Functioning scale.
The follow-up rate was 92%. 125 Subjects were diagnosed with a schizophrenic disorder. Poor course was present in 70 of these subjects (56%). Univariable analysis showed that male sex, heavy cannabis use during the follow-up period (sometimes or often more than one joint a day) and long duration of dysfunctioning before psychosis onset (>1 month) were predictors of poor course, while age at onset, ethnicity, socioeconomic status and duration of untreated psychosis (trend, p=0.08) were not. The effect of cannabis was confounded by sex. Multivariable analysis showed that male sex was the sole significant and independent predictor of poor course and explained 13% of the variation. The odds ratio for males, adjusted for duration of pre-psychotic dysfunctioning and cannabis use during the follow-up period, was 3.0 (95% CI, 1.0-8.9). STRENGTHS AND LIMITATIONS: This is the first study to examine the influence of cannabis in an epidemiological, highly representative sample. A limitation was the sample size.
Male sex is an independent risk factor for an unfavorable early course in schizophrenia.
总体描述精神障碍的早期病程，并研究某些变量是否能够预测精神分裂症谱系障碍（《精神疾病诊断与统计手册》第四版：精神分裂症、分裂样精神障碍或分裂情感性障碍）的早期病程。
对一个具有高度代表性的荷兰发病队列（N = 181）进行随访及重新诊断，该队列在首次因精神障碍就诊于医生30个月后接受评估。病情转归不佳定义为持续性精神疾病或功能总体评定量表得分低于39分。
随访率为92%。125名受试者被诊断为精神分裂症谱系障碍。其中70名受试者（56%）病情转归不佳。单变量分析显示，男性、随访期间大量使用大麻（有时或经常每天超过1支）以及精神病发作前功能障碍持续时间长（>1个月）是病情转归不佳的预测因素，而发病年龄、种族、社会经济地位及未治疗精神病持续时间（趋势，p = 0.08）则不是。大麻使用的影响受性别因素的混淆。多变量分析显示，男性是病情转归不佳的唯一显著且独立的预测因素，可解释13%的变异。在对精神病前功能障碍持续时间和随访期间大麻使用情况进行校正后，男性的比值比为3.0（95%可信区间，1.0 - 8.9）。优点与局限性：这是第一项在具有高度代表性的流行病学样本中研究大麻影响的研究。局限性在于样本量。
男性是精神分裂症早期病程转归不良的独立危险因素。
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