Centre hospitalier de l'Université de Montreal-Hôpital Notre-Dame, Montreal, Quebec.
Can J Psychiatry. 2011 Feb;56(2):92-101. doi: 10.1177/070674371105600204.
Different myths about schizophrenia endorsed by clinicians maintain the pessimism about outcome thus reducing chances of improvement. There are no recent North American studies on the long-term outcome of first-episode schizophrenia to clarify if these beliefs are myths or reality. Our study describes the long-term outcome (10 to 16 years) of a first-episode schizophrenia incidence cohort (n = 142) in a Canadian urban centre between 1983 and 1999.
Clinical and social functioning at different time points were assessed retrospectively from medical files of a catchment area hospital in Montreal. Service use and deaths were noted from provincial databases of physician billings, hospitalization, and vital statistics.
Hospitalization days decreased considerably after the first year, with a small minority still needing it episodically after 4 years. Marital and occupational status were generally stable over time, but autonomy in living arrangements worsened. Thirty-three percent of subjects quit the Catchment Area Specialized Psychiatric Services. This group showed better social functioning while they were followed, were hospitalized less afterwards, and had fewer suicides, therefore indicating a better outcome for them. At the end of our study, 15% of the patients still alive were well enough to function without seeking medical help and 25% were not taking antipsychotic medication. Better outcome was predicted by older age at admission, being married, higher premorbid autonomy in living arrangements, and female sex.
A significant proportion of first-episode schizophrenia patients achieve moderate long-term outcome, and the stability of global functioning is more frequent than deterioration, as shown in most industrialized countries.
临床医生认可的不同精神分裂症神话维持了对结局的悲观态度，从而降低了改善的机会。最近没有关于首发精神分裂症长期结局的北美研究来澄清这些信念是神话还是现实。我们的研究描述了 1983 年至 1999 年间在加拿大一个城市中心的首发精神分裂症发病队列（n = 142）的长期结局（10 至 16 年）。
从蒙特利尔一家收治医院的病历中回顾性评估不同时间点的临床和社会功能。从医生账单、住院和生命统计的省级数据库中记录服务使用情况和死亡情况。
住院天数在第一年显著减少，少数人在 4 年后仍会间歇性住院。婚姻和职业状况总体上保持稳定，但生活安排的自主性恶化。33%的患者退出了特殊精神科服务领域。这组患者在随访期间表现出更好的社会功能，随后住院较少，自杀较少，因此表明他们的结局更好。在我们研究结束时，仍有 15%的存活患者身体状况良好，无需寻求医疗帮助，25%的患者未服用抗精神病药物。更好的结局预测因素包括入院时年龄较大、已婚、较高的病前生活安排自主性和女性性别。
相当一部分首发精神分裂症患者获得了中度的长期结局，正如大多数工业化国家所显示的那样，总体功能的稳定性比恶化更为常见。
