Bar Ilan University, Ramat Gan, Israel.
J Clin Psychopharmacol. 2011 Feb;31(1):75-81. doi: 10.1097/JCP.0b013e31820568c6.
Premorbid functioning may be associated with treatment response, but this is confounded by a lack of prospective longitudinal data and controls for medication compliance. This study tested the hypothesis that good premorbid functioning will be associated with better antipsychotic treatment response after controlling for drug adherence by using a long-acting injectable antipsychotic. This was a 6-month, open label, multicenter, phase IV trial in recent-onset schizophrenia treated with flexible doses of risperidone long-acting injectable (25-50 mg every 14 days). Premorbid functioning was assessed with the Premorbid Adjustment Scale (PAS)-Structured Interview; efficacy was evaluated with clinician-rated Positive and Negative Syndrome Scale, Clinical Global Impression scale of Severity of Illness, Clinical Global Impression scale of Change, Global Assessment of Functioning Scale, and trial participant completed SF-36. Analyses controlled for baseline scores and demographics. With the use of a priori PAS scoring criteria, the participants' premorbid functioning was categorized as stable-good (n = 142), stable-poor (n = 116), and deteriorating (n = 36). At baseline, the stable-good group had the best functioning on most efficacy measures. All groups showed significant improvement on efficacy measures with treatment. Improvement was significantly higher for the stable-good group. The PAS global assessment of highest level of functioning scale (excellent, n = 75; good, n = 117; fair, n = 78; and poor, n = 31) showed a strong association with baseline functioning and improvement and had a significant linear association with meeting Remission in Schizophrenia Working Group symptom criteria at baseline (P = 0.003) and attained and sustained remission for 3 months during study (47.7%, 49.3%, 29.6%, and 22.2%; P = 0.006). Good premorbid functioning corresponds with better treatment response in recent-onset psychosis as captured on both clinician and patient-reported measures.
病前功能可能与治疗反应有关，但由于缺乏前瞻性纵向数据和药物依从性的对照，这一点受到了混淆。本研究通过使用长效注射抗精神病药物来检验这一假设，即在控制药物依从性的情况下，良好的病前功能将与更好的抗精神病治疗反应相关。这是一项为期 6 个月、开放性、多中心、IV 期试验，入组的是近期发病的精神分裂症患者，给予利培酮长效注射剂（25-50mg，每 14 天一次）的灵活剂量治疗。病前功能使用病前调整量表（PAS）-结构化访谈进行评估；疗效使用临床医生评定的阳性和阴性综合征量表、疾病严重程度的临床总体印象量表、疾病变化的临床总体印象量表、总体功能评估量表和试验参与者完成的 SF-36 进行评估。分析中控制了基线评分和人口统计学因素。根据预先设定的 PAS 评分标准，将参与者的病前功能分为稳定良好（n = 142）、稳定不良（n = 116）和恶化（n = 36）。在基线时，稳定良好组在大多数疗效测量中表现出最佳功能。所有组在治疗后均表现出显著的疗效改善。稳定良好组的改善程度显著更高。PAS 最高功能水平的总体评估量表（优秀，n = 75；良好，n = 117；尚可，n = 78；差，n = 31）与基线功能和改善情况密切相关，并且与基线时达到缓解精神分裂症工作组症状标准（P = 0.003）以及在研究期间 3 个月内达到和维持缓解（47.7%、49.3%、29.6%和 22.2%；P = 0.006）有显著的线性关联。在近期发病的精神病中，良好的病前功能与更好的治疗反应相对应，这在临床医生和患者报告的测量中都得到了体现。
