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):469-77. doi: 10.1016/j.schres.2013.08.003. Epub 2013 Aug 23.
Despite the availability of effective long-term treatment strategies in schizophrenia, relapse is still common. Relapse prevention is one of the major treatment objectives, because relapse represents burden and costs for patients, their environment, and society and seems to increase illness progression at the biological level. Valid predictors for relapse are urgently needed to enable more individualized recommendations and treatment decisions to be made.
Mainly recent evidence regarding predictors and early warning signs of relapse in schizophrenia was reviewed. In addition, data from the first-episode (long-term) study (FES; Gaebel et al., 2007, 2011) performed within the German Research Network on Schizophrenia were analyzed.
On the basis of FES data, premorbid adjustment, residual symptoms and some side effects are significant predictors. Although a broad spectrum of potential parameters has been investigated in several other studies, only a few and rather general valid predictors were identified consistently. Data of the FES also indicated that predictive power could be enhanced by considering interacting conjunctions, as suggested by the Vulnerability-Stress-Coping model. Prospective studies, however, are rare. In addition, prodromal symptoms as course-related characteristics likewise investigated in the FES add substantially to early recognition of relapse and may serve as early warning signs, but prognosis nevertheless remains a challenge.
Comprehensive and well-designed studies are needed to identify and confirm valid predictors for relapse in schizophrenia. In this respect, broadly accepted and specifically defined criteria for relapse would greatly facilitate comparison of results across studies.
尽管精神分裂症有有效的长期治疗策略，但复发仍很常见。预防复发是主要的治疗目标之一，因为复发会给患者及其环境和社会带来负担和成本，并且似乎会增加生物学层面的疾病进展。迫切需要有效的预测因素来实现更个体化的建议和治疗决策。
主要回顾了精神分裂症复发的预测因素和早期预警信号的最新证据。此外，还分析了德国精神分裂症研究网络内进行的首发（长期）研究（FES；Gaebel 等人，2007 年，2011 年）的数据。
基于 FES 数据，前驱调整、残留症状和一些副作用是重要的预测因素。尽管其他一些研究已经调查了广泛的潜在参数，但只确定了少数几个一致的、较为普遍的有效预测因素。FES 的数据还表明，通过考虑交互结合，如易感性-应激-应对模型所建议的那样，可以增强预测能力。然而，前瞻性研究很少。此外，FES 中也研究了作为病程相关特征的前驱症状，这同样有助于及早识别复发，并可作为早期预警信号，但预后仍然是一个挑战。
需要进行全面和精心设计的研究，以确定和确认精神分裂症复发的有效预测因素。在这方面，广泛接受和具体定义的复发标准将极大地促进研究结果的比较。
