University Hospital La Fe, Department of Psychiatry, Valencia, Spain.
Psychiatry Res. 2013 Apr 30;206(2-3):181-7. doi: 10.1016/j.psychres.2012.10.011. Epub 2012 Nov 14.
The aim of the study was to identify predictors associated with a lower likelihood of achieving a clinical remission 1 year after the first break of the illness. Participants were 174 consecutive subjects included in a first episode programme with no prior treatment with antipsychotic medication. Patients were assigned to haloperidol, olanzapine or risperidone in a randomized, open-label, prospective clinical trial. The main outcome variable was the remission criteria developed by the Remission in Schizophrenia Working Group. Clinical variables were included in a logistic regression analysis in order to predict the remission state at 1 year. At 1 year, 31% of patients met criteria for remission. The logistic regression analysis revealed that the strongest predictors of achieving clinical remission 1 year away from a first episode of non-affective psychosis were the length of duration of untreated psychosis (DUP), the severity of negative symptomatology and the educational level attained at baseline. The results suggest that: (1) patients with a lengthy DUP, a greater severity of negative symptomatology at baseline and with a lower education level are in a higher risk of not achieving a clinical remission during the first year of treatment; and (2) early intervention clinical programs should aim to reduce the length of DUP in order to provide a better outcome for patients.
这项研究的目的是确定与疾病首次发作后 1 年内临床缓解可能性降低相关的预测因素。研究纳入了 174 名连续的首发患者，这些患者之前均未接受过抗精神病药物治疗。患者被随机分配至氟哌啶醇、奥氮平或利培酮组，进行开放性、前瞻性临床试验。主要的结局变量是由精神分裂症缓解工作组制定的缓解标准。为了预测 1 年后的缓解状态，将临床变量纳入逻辑回归分析中。1 年后，31%的患者符合缓解标准。逻辑回归分析显示，预测首发非情感性精神病 1 年后达到临床缓解的最强预测因素是未治疗精神病持续时间（DUP）的长短、阴性症状的严重程度和基线时的受教育程度。结果表明：（1）DUP 较长、基线时阴性症状较严重且受教育程度较低的患者，在治疗的第一年达到临床缓解的风险较高；（2）早期干预临床方案应旨在缩短 DUP，为患者提供更好的预后。
