Whitty P, Clarke M, McTigue O, Browne S, Kamali M, Kinsella A, Larkin C, O'Callaghan E
Adelaide and Meath Hospital, Tallaght, Dublin, Ireland.
Psychol Med. 2008 Aug;38(8):1141-6. doi: 10.1017/S003329170800336X. Epub 2008 Apr 30.
The outcome of schizophrenia appears to be more favourable than once thought. However, methodological issues, including the reliance on diagnosis at first presentation have limited the validity of outcome studies to date.
We conducted a first-episode follow-up study of 97 patients with DSM-IV schizophrenia over the first 4 years of illness. First presentation and follow-up assessments were compared using paired t tests and a forced-entry regression analysis was used to determine prognostic variables.
There were significant improvements in positive and negative symptoms and global assessment of functioning between first presentation and follow-up. At first presentation, fewer negative symptoms (t=-3.40, p<0.01), more years spent in education (t=3.25, p<0.01), and a shorter duration of untreated psychosis (DUP) (t=-2.77, p<0.01) significantly predicted a better outcome at follow-up.
The outcome of schizophrenia may not be as pessimistic as once thought and most patients did not display a downward deteriorating course of illness. This study supports the relationship between DUP and outcome beyond the early stages of illness.
精神分裂症的预后似乎比以往认为的更为乐观。然而，包括依赖首次就诊时的诊断在内的方法学问题限制了迄今为止预后研究的有效性。
我们对97例符合《精神疾病诊断与统计手册》第四版（DSM-IV）精神分裂症诊断标准的患者进行了疾病最初4年的首次发作随访研究。使用配对t检验比较首次就诊和随访评估结果，并采用强迫进入回归分析来确定预后变量。
首次就诊与随访之间，阳性和阴性症状以及功能总体评估均有显著改善。首次就诊时，较少的阴性症状（t=-3.40，p<0.01）、受教育年限更长（t=3.25，p<0.01）以及未治疗精神病持续时间较短（DUP）（t=-2.77，p<0.01）显著预示着随访时更好的预后。
精神分裂症的预后可能不像曾经认为的那样悲观，大多数患者并未呈现病情逐渐恶化的病程。本研究支持了未治疗精神病持续时间（DUP）与疾病早期之外的预后之间的关系。
