Psychological Sciences, The University of Melbourne, University of Melbourne Psychology Clinic, The University of Melbourne, Victoria, Australia.
Schizophr Res. 2010 Jun;119(1-3):79-88. doi: 10.1016/j.schres.2010.02.1073. Epub 2010 Mar 29.
The prevention of relapse is an important treatment goal in first-episode psychosis. Randomized controlled trials (RCTs) provide the gold standard methodology for evaluating interventions for relapse prevention. Properly designed RCTs which include relapse as a treatment outcome should rigorously operationalize psychotic relapse. The aim of this systematic literature review was to evaluate according to six criteria the operationalization of relapse in RCTs of clinical innovations for the prevention of relapse in first-episode psychosis. Through a systematic literature search of relevant RCTs in first-episode psychosis patients, eight pharmacological and eight non-pharmacological trials, published between 1982 and 2009, were identified. Readmission to a psychiatric hospital was the most common definition of psychotic relapse. Five studies did not measure relapse using any standardized or validated observer-rated instruments. The majority of the studies did not specify a duration criterion for relapse. Only three studies satisfied six criteria for the adequate operationalization of relapse. These results raise concerns regarding the internal and external validity of these research findings. There is an urgent need for a standardized, universally adopted set of criteria for psychotic relapse with appropriate specification of measurement instruments for use in future RCTs.
预防复发是首发精神病治疗的一个重要目标。随机对照试验（RCT）为评估预防复发的干预措施提供了金标准方法。适当设计的 RCT 应将复发作为治疗结果纳入，严格对精神病复发进行操作化定义。本系统文献回顾旨在根据六个标准评估首发精神病预防复发的临床创新 RCT 中复发的操作化定义。通过对首发精神病患者相关 RCT 的系统文献检索，共确定了 8 项药理学和 8 项非药理学试验，这些试验发表于 1982 年至 2009 年之间。精神病复发的最常见定义是重新入院精神病院。五项研究未使用任何标准化或经过验证的观察者评定工具来测量复发。大多数研究没有规定复发的持续时间标准。只有三项研究满足了充分操作化复发的六个标准。这些结果引起了对这些研究结果的内部和外部有效性的关注。目前迫切需要一套标准化的、普遍采用的精神病复发标准，以及用于未来 RCT 的适当测量工具规范。
