Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany.
Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany.
Schizophr Res. 2014 Feb;152(2-3):478-86. doi: 10.1016/j.schres.2013.04.012. Epub 2013 May 1.
Full and sustained symptom remission is a major treatment objective after a first-episode in schizophrenia. Findings regarding differences in remission between first- and second-generation antipsychotics are inconclusive. This study aimed to provide rates and predictors of remission in first-episode schizophrenia and to identify symptoms that prevent remission.
Prevalence rates of "symptomatic remission" (symptom criteria only) and "enduring remission" (symptom and 6-month time criteria), defined according to Andreasen et al. (2005), were determined in first-episode patients participating in a RCT by the German Research Network on Schizophrenia (GRNS) that compared post-acute, 1-year maintenance treatment with risperidone or haloperidol. Respective predictors at baseline were identified by logistic and Cox regression analysis.
Prevalence rates were 91.5% for symptomatic remission (n=152/166 eligible patients) and 58.6% for enduring remission (n=65 of 111 patients who continued for at least 6 months; 39.2% of all 166 patients included), with no significant differences between risperidone and haloperidol in either type of remission. Enduring remission often was not reached because of negative symptoms: After 6 months, 40.5% of the patients had at least 1 negative symptom, whereas only 10.8% of the patients had "persisting" positive symptoms. Of the different predictors identified in univariate analyses, (lower) negative symptoms and participating in standardized psychological treatment remained significant in multivariate (stepwise forward) analyses for enduring remission.
By far most of the first-episode patients reached a temporary state of full symptomatic remission within 1 year of antipsychotic treatment. However, only about 50% achieved sustained, enduring remission. Negative symptoms are still a major treatment obstacle to enduring remission in schizophrenia.
精神分裂症首次发作后，全面且持续的症状缓解是主要的治疗目标。关于第一代和第二代抗精神病药在缓解方面的差异，研究结果尚无定论。本研究旨在提供首发精神分裂症缓解的发生率和预测因素，并确定阻止缓解的症状。
根据 Andreasen 等人（2005 年）的定义，通过德国精神分裂症研究网络（GRNS）进行的一项 RCT 纳入的首发患者，确定“症状缓解”（仅症状标准）和“持续缓解”（症状和 6 个月时间标准）的发生率，该 RCT 比较了急性后 1 年使用利培酮或氟哌啶醇维持治疗。通过逻辑回归和 Cox 回归分析确定基线时的相应预测因素。
症状缓解的发生率为 91.5%（166 例符合条件的患者中有 152 例），持续缓解的发生率为 58.6%（111 例继续治疗至少 6 个月的患者中有 65 例；占所有纳入的 166 例患者的 39.2%），利培酮和氟哌啶醇在任何一种缓解类型中均无显著差异。由于阴性症状，持续缓解通常无法达到：6 个月后，40.5%的患者至少有 1 项阴性症状，而只有 10.8%的患者有“持续”阳性症状。在单变量分析中确定的不同预测因素中，（较低的）阴性症状和参与标准化心理治疗在多变量（逐步向前）分析中对于持续缓解仍然具有显著性。
在抗精神病药物治疗的 1 年内，迄今为止，大多数首发患者达到了全面的症状缓解的临时状态。然而，只有约 50%的患者达到了持续的、持久的缓解。阴性症状仍然是精神分裂症持续缓解的主要治疗障碍。
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