Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
Aust N Z J Psychiatry. 2013 Aug;47(8):746-53. doi: 10.1177/0004867413487229. Epub 2013 Apr 23.
Relapses in psychosis are costly and may have irreversible consequences. Relapse prevention is thus critical in the treatment of schizophrenia. Apart from medication discontinuation, a consistent relapse predictor has not been identified due to limitations in previous studies. We aim to investigate relapse predictors in a large cohort of patients with first-episode psychosis.
This is a retrospective cohort study designed to evaluate relapses in first-episode psychosis patients in 3 years. A total of 1400 patients' case records were retrieved from a hospital database. Potential relapse predictors including demographic variables, baseline clinical measures, medication adherence, and residual positive symptoms upon clinical stabilization were collected.
The cumulative relapse rates were 19.3% by year 1, 38.4% by year 2, and 48.1% by year 3. Multivariate Cox-proportional hazards regression analysis revealed that medication non-adherence, smoking, schizophrenia diagnosis, younger age, and shorter baseline hospitalization were associated with an increased risk of relapse in 3 years.
Nearly half of patients relapsed after 3 years following their first-episode psychosis. Smoking as a predictor of relapse is an intriguing new finding supportive of a link between nicotinic receptors and the dopamine system. Their relationship deserves further investigations with potential clinical implications for relapse prevention.
精神病发作的复发会带来高昂的代价，并且可能会产生不可逆转的后果。因此，预防复发是治疗精神分裂症的关键。由于之前研究的局限性，除了药物停用，尚未确定一致的复发预测因素。我们旨在调查首发精神病患者的大量队列中的复发预测因素。
这是一项回顾性队列研究，旨在评估首发精神病患者在 3 年内的复发情况。从医院数据库中检索了 1400 名患者的病历。收集了潜在的复发预测因素，包括人口统计学变量、基线临床指标、药物依从性以及临床稳定时的残留阳性症状。
第 1 年的累积复发率为 19.3%，第 2 年为 38.4%，第 3 年为 48.1%。多变量 Cox 比例风险回归分析显示，药物不依从、吸烟、精神分裂症诊断、年龄较小和基线住院时间较短与 3 年内的复发风险增加有关。
首发精神病后 3 年内，近一半的患者复发。吸烟作为复发的预测因素是一个有趣的新发现，支持烟碱受体和多巴胺系统之间存在联系。它们之间的关系值得进一步研究，这可能对预防复发具有潜在的临床意义。
