Alem Atalay, Kebede Derege, Fekadu Abebaw, Shibre Teshome, Fekadu Daniel, Beyero Teferra, Medhin Girmay, Negash Alemayehu, Kullgren Gunnar
Medical Faculty, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia.
Schizophr Bull. 2009 May;35(3):646-54. doi: 10.1093/schbul/sbn029. Epub 2008 Apr 29.
The established view that schizophrenia may have a favorable outcome in developing countries has been recently challenged; however, systematic studies are scarce. In this report, we describe the clinical outcome of schizophrenia among a predominantly treatment-naive cohort in a rural community setting in Ethiopia. The cohort was identified in a 2-stage sampling design using key informants and measurement-based assessment. Follow-up assessments were conducted monthly for a mean duration of 3.4 years (range 1-6 years). After screening 68 378 adults, ages 15-49 years, 321 cases with schizophrenia (82.7% men and 89.6% treatment naive) were identified. During follow-up, about a third (30.8%) of cases were continuously ill while most of the remaining cohort experienced an episodic course. Only 5.7% of the cases enjoyed a near-continuous complete remission. In the final year of follow-up, over half of the cases (54%) were in psychotic episode, while 17.6% were in partial remission and 27.4% were in complete remission for at least the month preceding the follow-up assessment. Living in a household with 3 or more adults, later age of onset, and taking antipsychotic medication for at least 50% of the follow-up period predicted complete remission. Although outcome in this setting appears better than in developed countries, the very low proportion of participants in complete remission supports the recent observation that the outcome of schizophrenia in developing countries may be heterogeneous rather than uniformly favorable. Improving access to treatment may be the logical next step to improve outcome of schizophrenia in this setting.
关于精神分裂症在发展中国家可能有较好预后的既定观点最近受到了挑战；然而，系统性研究却很匮乏。在本报告中，我们描述了埃塞俄比亚一个农村社区环境中以初治患者为主的队列中精神分裂症的临床预后。该队列是通过使用关键信息提供者和基于测量的评估的两阶段抽样设计确定的。随访评估每月进行一次，平均持续时间为3.4年（范围1 - 6年）。在对68378名15 - 49岁的成年人进行筛查后，确定了321例精神分裂症患者（82.7%为男性，89.6%为初治患者）。在随访期间，约三分之一（30.8%）的病例持续患病，而其余队列中的大多数经历了发作性病程。只有5.7%的病例实现了近乎持续的完全缓解。在随访的最后一年，超过一半（54%）的病例处于精神病发作期，而17.6%处于部分缓解期，27.4%在随访评估前至少一个月处于完全缓解期。生活在有3名或更多成年人的家庭中、发病年龄较大以及在至少50%的随访期内服用抗精神病药物可预测完全缓解。尽管这种情况下的预后似乎比发达国家更好，但完全缓解的参与者比例极低支持了最近的观察结果，即发展中国家精神分裂症的预后可能是异质性的，而非一律良好。改善治疗可及性可能是改善这种情况下精神分裂症预后的合理下一步措施。
