Kam Shi Mei, Singh Swaran P, Upthegrove Rachel
College of Medical and Dental Sciences, The University of Birmingham.
Birmingham Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham.
Early Interv Psychiatry. 2015 Aug;9(4):279-83. doi: 10.1111/eip.12099. Epub 2013 Nov 20.
As a foundation for considering how gains may be maintained following early intervention in first-episode psychosis (FEP), this study aimed to describe and investigate factors predicting post-discharge relapse and longer term functioning.
An evaluation via case-note review obtained quantitative data on 163 patients sequentially discharged from Birmingham Early Intervention Service (EIS) followed up for a median of 3.6 years. Time to relapse was calculated and hierarchical regression was used to determine predictors of relapse and functioning.
Patients likely to relapse do so within the first year post-discharge; however, over 40% did not relapse during the follow-up period. The number of relapses occurring during EIS care predicted time-to-relapse post-discharge. At discharge from the EIS and study end-point, the proportion with low social and vocational functioning remained high. Predictors of positive 'Not in Education Employment or Training' status at end-point include being in a minority ethnic group, substance misuse and number of relapses.
Increased emphasis on relapse prevention and early post-discharge monitoring may be needed, especially in the first year, for those who have experienced previous relapse. To maintain early outcomes in FEP, targeted interventions to address substance misuse and functional recovery need to be sustained in the long term. EISs should aim to make the first episode of psychosis the last. Services providing care for patients with psychosis post EIS should be designed to deliver care for ongoing need, with continued emphasis on relapse prevention and social recovery.
作为考虑首次发作精神病（FEP）早期干预后如何维持疗效的基础，本研究旨在描述和调查预测出院后复发及长期功能状况的因素。
通过病例记录回顾进行评估，获取了163例依次从伯明翰早期干预服务（EIS）出院患者的定量数据，随访时间中位数为3.6年。计算复发时间，并采用分层回归确定复发和功能状况的预测因素。
可能复发的患者在出院后第一年内复发；然而，超过40%的患者在随访期间未复发。EIS治疗期间的复发次数可预测出院后的复发时间。在从EIS出院时及研究终点，社会和职业功能低下的患者比例仍然很高。终点时“未接受教育、就业或培训”状态为阳性的预测因素包括属于少数族裔、药物滥用和复发次数。
对于既往有复发经历的患者，可能需要更加强调预防复发和出院后早期监测，尤其是在第一年。为维持FEP的早期疗效，需要长期持续进行有针对性的干预，以解决药物滥用和功能恢复问题。EIS应致力于使精神病的首次发作成为最后一次发作。在EIS之后为精神病患者提供护理的服务应设计为满足持续需求，持续强调预防复发和社会康复。
