Orygen Youth Health Centre for Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052, Australia.
Schizophr Res. 2011 Sep;131(1-3):112-9. doi: 10.1016/j.schres.2011.06.009. Epub 2011 Jul 7.
To compare the long-term outcome in individuals with early-onset (before age 18) and adult-onset schizophrenia spectrum disorder who were initially diagnosed and treated in the same clinical center.
A prospective follow-up study of 723 consecutive first-episode psychosis patients (age range 14 to 30 years) on average 7.4 years after initial presentation to an early psychosis service, the Early Psychosis Prevention and Intervention Centre in Melbourne, Australia. The outcome measures included the Brief Psychiatric Rating Scale, the Schedule for the Assessment of Negative Symptoms, the Beck Depression Inventory, the Global Assessment of Functioning Scale, the Social and Occupational Functioning Assessment Scale, and the Quality of Life Scale.
Follow-up interviews were conducted on 66.9% (484/723) individuals, of whom 75.6% (366/484) received a schizophrenia spectrum disorder diagnosis at baseline. Early-onset schizophrenia spectrum disorder was observed in 11.2% (41/366). At follow-up, individuals with early-onset reported significantly fewer positive symptoms and were characterised by significantly superior functioning on measures assessing global functioning, social-occupational functioning, and community functioning than individuals with adult-onset. The early-onset group also achieved significantly better vocational outcomes and had a more favourable course of illness with fewer psychotic episodes over the last two years prior to follow-up. Finally, when investigated as a continuous variable, younger age at onset significantly correlated with better symptomatic and functional outcomes.
These results question the assumption that early-onset schizophrenia typically has a poor outcome. Early detection and specialised treatment for the first psychotic episode appear to be more effective at improving long-term functional outcomes in people with early-onset schizophrenia as in those with adult-onset schizophrenia. This possibility and the reasons for it need further investigation.
比较在同一临床中心最初被诊断和治疗的早发性（18 岁之前）和成年发病的精神分裂症谱系障碍患者的长期结局。
对澳大利亚墨尔本早期精神病预防和干预中心的 723 例首发精神病患者（年龄 14 至 30 岁）进行前瞻性随访研究，这些患者在首次就诊后的平均 7.4 年时接受了评估。结局指标包括简明精神病评定量表、阴性症状评定量表、贝克抑郁量表、总体功能评估量表、社会和职业功能评估量表以及生活质量量表。
对 723 例患者中的 66.9%（484 例）进行了随访访谈，其中 75.6%（366 例）在基线时被诊断为精神分裂症谱系障碍。在随访时，早发性精神分裂症谱系障碍患者占 11.2%（41 例）。与成年发病患者相比，早发性患者的阳性症状明显减少，在评估总体功能、社会职业功能和社区功能的测量中表现出明显更好的功能。早发性组在职业结果方面也取得了明显的改善，并且在随访前的最后两年中，精神病发作次数更少，疾病进程更有利。最后，当作为连续变量进行研究时，发病年龄越小，与症状和功能结局的改善越显著相关。
这些结果对早发性精神分裂症通常预后不良的假设提出了质疑。早期发现和针对首发精神病的专门治疗似乎更能改善早发性精神分裂症患者的长期功能结局，与成年发病的精神分裂症患者一样。需要进一步研究这种可能性及其原因。
