Department of Psychiatry and Allan Memorial Institute, Clinical Psychopharmacology and Therapeutics Unit, McGill University Health Centre, McGill University, Montreal, Canada.
Harv Rev Psychiatry. 2012 Nov-Dec;20(6):281-97. doi: 10.3109/10673229.2012.747804.
In 2005, the Remission in Schizophrenia Working Group published consensus criteria to define remission. These criteria have been widely accepted and utilized and have provided further insights about schizophrenia management and prognosis. We systematically reviewed studies that utilized these criteria, with the aim of assessing the remission rate in follow-up studies and the variables predicting or associated with remission. Remission has a reported rate of 17% to 78% (weighted mean = 35.6%) in first-episode schizophrenia and 16% to 62% (weighted mean = 37%) in multiple-episode patients, with no statistical difference between the two weighted means (p = .79). Patients who were treated with long-acting injectable risperidone showed high maintenance of remission status. Studies comparing second-generation antipsychotics versus haloperidol showed higher remission rates for the former. The variables most frequently associated with remission were better premorbid function, milder symptoms at baseline (especially negative symptoms), early response to treatment, and shorter duration of untreated psychosis. Variability in the length and frequency of follow-ups, as well as differences in dropout rates, could partially explain the differences in reported rates. Rates of symptomatic remission exceeded reported rates for functional recovery. Moreover, the majority of studies used Remission in Schizophrenia Working Group severity criteria only, neglecting duration. To enhance comparison between future research findings, we suggest further specifiers of the working group's criteria, to better define frequency and duration of follow-up, and proxy measures of remission.
2005 年，缓解精神分裂症工作组发布了共识标准来定义缓解。这些标准得到了广泛的接受和应用，并为精神分裂症的管理和预后提供了进一步的见解。我们系统地回顾了使用这些标准的研究，目的是评估随访研究中的缓解率，以及预测或与缓解相关的变量。首发精神分裂症患者的缓解率报告为 17%至 78%（加权平均值=35.6%），多次发作患者的缓解率为 16%至 62%（加权平均值=37%），两种加权平均值之间无统计学差异（p=.79）。接受长效注射利培酮治疗的患者缓解状态保持较高。比较第二代抗精神病药与氟哌啶醇的研究显示，前者的缓解率更高。与缓解最常相关的变量是更好的病前功能、基线时较轻的症状（特别是阴性症状）、早期治疗反应和未治疗精神病的持续时间较短。随访时间和频率的可变性以及辍学率的差异，可能部分解释了报告率的差异。症状缓解率超过了功能恢复的报告率。此外，大多数研究仅使用缓解精神分裂症工作组的严重程度标准，而忽略了持续时间。为了加强未来研究结果之间的比较，我们建议进一步指定工作组标准的具体标准，以更好地定义随访的频率和持续时间，以及缓解的替代指标。
