Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Statistics, Monitoring and Evaluation, National Board of Health and Welfare, Stockholm, Sweden.
Schizophr Res. 2013 Oct;150(1):205-10. doi: 10.1016/j.schres.2013.07.011. Epub 2013 Jul 27.
It is not clear which patients with a first psychotic episode will develop schizophrenia. We performed a diagnostic follow-up of patients treated for a first time non-affective, non-schizophrenia psychosis and explored potential predictors of a subsequent schizophrenia or schizoaffective diagnosis.
This register-based cohort study comprises individuals born between 1973 and 1978 in Sweden, with a first hospital-treated psychosis excluding schizophrenia, schizoaffective disorder, bipolar disorder and depressive disorder with psychotic symptoms (n=1840). The patients were followed for five years regarding subsequent diagnoses. Psychiatric, social, family history of psychiatric illness, premorbid intellectual level, head injuries and obstetrical complications were investigated by logistic regression as predictors of schizophrenia or schizoaffective diagnosis.
During the follow-up, 18% were diagnosed with schizophrenia or schizoaffective disorder, 5% were diagnosed with bipolar disorder, whereas 29% were not re-admitted to a psychiatric clinic. Patients with a first-degree relative hospitalized for schizophrenia and/or bipolar disorder had an increased risk of subsequent diagnosis for schizophrenia or schizoaffective disorder (odds ratio 1.9 and 95% confidence interval 1.1 to 3.0)), whereas previous severe criminality was associated with a decreased risk (odds ratio 0.5, 95% confidence interval 0.3-0.8).
Diagnostic outcome was diverse after a first non-schizophrenia and non-affective psychosis. Family history of severe mental illness and no previous conviction for severe criminality were the strongest risk factors for a future schizophrenia or schizoaffective diagnosis.
目前尚不清楚首发精神病患者中哪些会发展为精神分裂症。我们对首次非情感性、非精神分裂症性精神病患者进行了诊断随访，并探讨了后续精神分裂症或分裂情感性障碍诊断的潜在预测因素。
本基于登记的队列研究包括瑞典 1973 年至 1978 年间出生的个体，这些个体患有首次经医院治疗的精神病，不包括精神分裂症、分裂情感性障碍、双相情感障碍和伴有精神病症状的抑郁症（n=1840）。对这些患者进行了为期五年的随访，以确定后续诊断。通过逻辑回归调查了精神病、社会、家族精神病史、发病前智力水平、头部损伤和产科并发症，以探讨其对精神分裂症或分裂情感性障碍诊断的预测作用。
在随访期间，18%的患者被诊断为精神分裂症或分裂情感性障碍，5%的患者被诊断为双相情感障碍，而 29%的患者未再被收治于精神科诊所。有一级亲属因精神分裂症和/或双相情感障碍住院的患者，后续诊断为精神分裂症或分裂情感性障碍的风险增加（比值比 1.9，95%置信区间 1.1 至 3.0），而先前有严重犯罪行为的患者，其风险降低（比值比 0.5，95%置信区间 0.3 至 0.8）。
首发非精神分裂症和非情感性精神病后，诊断结果各不相同。家族史中有严重精神疾病和以前没有严重犯罪记录是未来发生精神分裂症或分裂情感性障碍的最强危险因素。
