Maryland Psychiatric Research Center, University of Maryland School of Medicine, P.O. Box 21247, Baltimore, MD 21228, USA.
Compr Psychiatry. 2010 May-Jun;51(3):298-302. doi: 10.1016/j.comppsych.2009.07.003. Epub 2009 Aug 27.
It is recognized that early treatment can improve outcomes and generally improve recovery potential for those with schizophrenia. Data suggest that poor premorbid functioning has been found to be related to more severe symptoms and poor antipsychotic response; however, little is known about premorbid functioning in patients who have no response to clozapine treatment.
This study compares the premorbid functioning among patients who responded to clozapine treatment (20% decrease in total Brief Psychiatric Rating Scale [BPRS] score; n = 35) and those who did not respond (n = 50) to 8 weeks of clozapine treatment. Premorbid functioning was assessed using the Cannon-Spoor Premorbid Adjustment Scale.
Patients who did not respond to clozapine had significantly lower total BPRS scores (P = .01) at baseline, driven primarily by lower ratings in hostility (P = .007) and activation (P = .02), compared with those who responded to clozapine. Responders and nonresponders did not differ in their age, race, level of education, marital status, age of onset, characterization of the deficit syndrome, and positive or negative symptoms. Nonresponders to clozapine did not improve in any area of symptoms or global functioning, whereas there were significant improvements in BPRS total scores (analysis of covariance) and all symptom domains in the responder groups (P < .0001). Level of functioning scores in those who responded to clozapine was significantly higher at end point (P = .02). As for premorbid functioning, there were no differences in scores between responders and nonresponders at the time of early and late adolescence; however, there was a trend toward lower premorbid functioning in the clozapine nonresponders on most childhood measures (before the age of 11 years). Clozapine nonresponders tended to be less social and more withdrawn as compared with those who responded to clozapine (P = .08), as well as tended to have poorer adaptation to school (P = .06) and fewer peer relationships (P = .08). These results did not reach significance. Work and/or school performance changed more insidiously in the nonresponders group before illness onset (P = .045).
Clozapine is beneficial to many patients with treatment-resistant symptoms; however, nonresponse to this medication may represent a subtype of patients who may present differently with symptoms. These findings should encourage further examination of early childhood indicators and opportunities for appropriate and effective intervention.
人们认识到早期治疗可以改善结局，并普遍提高精神分裂症患者的康复潜力。数据表明，较差的病前功能与更严重的症状和较差的抗精神病药物反应有关；然而，对于那些对氯氮平治疗无反应的患者，病前功能知之甚少。
本研究比较了对氯氮平治疗有反应（总简明精神病评定量表[BPRS]评分下降 20%；n = 35）和无反应（n = 50）的患者的病前功能。病前功能使用 Cannon-Spoor 病前调整量表进行评估。
与对氯氮平有反应的患者相比，无反应的患者的总 BPRS 评分（P =.01）在基线时明显较低，主要是由于敌意（P =.007）和激活（P =.02）评分较低。与对氯氮平有反应的患者相比，氯氮平无反应的患者在年龄、种族、教育程度、婚姻状况、发病年龄、缺陷综合征特征、阳性或阴性症状方面无差异。氯氮平无反应者在任何症状或总体功能领域均未改善，而反应者组的 BPRS 总分（协方差分析）和所有症状领域均有显著改善（P <.0001）。对氯氮平有反应的患者在终点时的功能评分明显更高（P =.02）。至于病前功能，在青少年早期和晚期，反应者和无反应者之间的评分没有差异；然而，氯氮平无反应者在大多数儿童测量（11 岁之前）上表现出较低的病前功能趋势。与对氯氮平有反应的患者相比，氯氮平无反应者的社交能力较差，更孤僻（P =.08），适应学校的能力较差（P =.06），同伴关系较少（P =.08）。这些结果没有达到显著性。在疾病发作前，无反应者组的工作和/或学业成绩变化更为隐匿（P =.045）。
氯氮平对许多有治疗抵抗症状的患者有益；然而，对这种药物的无反应可能代表一种具有不同症状的患者亚群。这些发现应该鼓励进一步检查儿童早期的指标，并为适当和有效的干预提供机会。
