Marqués de Valdecilla University Hospital, IFIMAV, Department of Psychiatry, School of Medicine, University of Cantabria, Santander, Spain.
J Psychiatr Res. 2012 Aug;46(8):1099-105. doi: 10.1016/j.jpsychires.2012.05.001. Epub 2012 Jun 19.
Preventing relapse during the first years of illness has a critical impact on lifelong outcomes in schizophrenia. A better understanding and improvement in factors which influence relapse should diminish the risk of relapse and consequently improve the outcome of the illness.
To identify factors associated with relapse after 3 years of a first episode in a sample of non-affective psychosis patients who are representative of clinical practice in an epidemiological catchment.
We analyzed socio-demographic and clinical data from a cohort of patients who were treated in a specialized early intervention service and who were at risk of relapse during a 3-year follow-up. Univariate analyses, logistic regression and survival analyses were performed. The analyzed variables included gender, age at onset, duration of untreated psychosis, clinical severity at baseline, insight at baseline, premorbid functioning, substance use, family history of psychosis and adherence to medication.
Of the 140 patients considered to be at risk for relapse, 91 (65%) individuals relapsed at least once over the three-year period. The relapse rates at 1 year and 2 years were 20.7% and 40.7%, respectively. Adherence to medication was the only significant predictor of relapse after a three-year follow-up [hazard ratio (HR) 4.8, 95% confidence interval (CI) 2.9-7.7; p < 0.001]. Comparison of the mean time of relapse between adherent and non-adherent patients also revealed statistically significant differences (933 and 568 days, respectively). 50% of patients will relapse despite being categorized as treatment adherents.
Non-adherence to medication is the biggest predictive factor of relapse after a first episode of psychosis.
在疾病的最初几年预防复发对精神分裂症的终身结局具有关键影响。更好地理解和改善影响复发的因素，应降低复发的风险，从而改善疾病的结局。
在一个具有代表性的流行病学捕获样本中，识别首发非情感性精神病患者在 3 年后复发的相关因素。
我们分析了在专门的早期干预服务中接受治疗且在 3 年随访期间有复发风险的患者队列的社会人口统计学和临床数据。进行了单变量分析、逻辑回归和生存分析。分析的变量包括性别、发病年龄、未治疗精神病的持续时间、基线时的临床严重程度、基线时的洞察力、发病前的功能、物质使用、精神病家族史和药物依从性。
在 140 名被认为有复发风险的患者中，有 91 名（65%）患者在三年内至少复发一次。1 年和 2 年的复发率分别为 20.7%和 40.7%。药物依从性是 3 年随访后复发的唯一显著预测因素[风险比（HR）4.8，95%置信区间（CI）2.9-7.7；p<0.001]。比较依从和不依从患者的平均复发时间也显示出统计学上的显著差异（分别为 933 天和 568 天）。尽管被归类为治疗依从者，仍有 50%的患者会复发。
药物依从性差是首发精神病后复发的最大预测因素。
