Department of Psychiatry, University of Turku, 70, Kunnallissairaalantie, 20700 Turku, Finland; Psychiatric Clinic, Turku University Central Hospital, Turku, Finland; Turku Psychiatric Clinic, Turku Mental Health Centre, Turku, Finland.
Department of Psychiatry, University of Turku, 70, Kunnallissairaalantie, 20700 Turku, Finland.
Eur Psychiatry. 2014 Aug;29(6):371-80. doi: 10.1016/j.eurpsy.2013.10.003. Epub 2013 Dec 7.
In patients with schizophrenia, premorbid psychosocial adjustment is an important predictor of functional outcome. We studied functional outcome in young clinical high-risk (CHR) patients and how this was predicted by their childhood to adolescence premorbid adjustment.
In all, 245 young help-seeking CHR patients were assessed with the Premorbid Adjustment Scale, the Structured Interview for Prodromal Syndromes (SIPS) and the Schizophrenia Proneness Instrument (SPI-A). The SIPS assesses positive, negative, disorganised, general symptoms, and the Global Assessment of Functioning (GAF), the SPI-A self-experienced basic symptoms; they were carried out at baseline, at 9-month and 18-month follow-up. Transitions to psychosis were identified. In the hierarchical linear model, associations between premorbid adjustment, background data, symptoms, transitions to psychosis and GAF scores were analysed.
During the 18-month follow-up, GAF scores improved significantly, and the proportion of patients with poor functioning decreased from 74% to 37%. Poor premorbid adjustment, single marital status, poor work status, and symptoms were associated with low baseline GAF scores. Low GAF scores were predicted by poor premorbid adjustment, negative, positive and basic symptoms, and poor baseline work status. The association between premorbid adjustment and follow-up GAF scores remained significant, even when baseline GAF and transition to psychosis were included in the model.
A great majority of help-seeking CHR patients suffer from deficits in their functioning. In CHR patients, premorbid psychosocial adjustment, baseline positive, negative, basic symptoms and poor working/schooling situation predict poor short-term functional outcome. These aspects should be taken into account when acute intervention and long-term rehabilitation for improving outcome in CHR patients are carried out.
在精神分裂症患者中，病前心理社会适应是功能结局的重要预测因素。我们研究了年轻临床高危（CHR）患者的功能结局，以及他们的儿童到青春期病前适应情况如何预测这一结局。
共评估了 245 名年轻寻求帮助的 CHR 患者，使用病前适应量表、前驱症状结构化访谈（SIPS）和精神分裂症倾向量表（SPI-A）进行评估。SIPS 评估阳性、阴性、紊乱、一般症状和总体功能评估（GAF），SPI-A 自我体验基本症状；基线、9 个月和 18 个月随访时进行评估。确定向精神病的转变。在分层线性模型中，分析病前适应、背景资料、症状、向精神病转变和 GAF 评分之间的相关性。
在 18 个月的随访期间，GAF 评分显著改善，功能不良的患者比例从 74%下降到 37%。病前适应不良、单身、工作状况差和症状与基线 GAF 评分低有关。低 GAF 评分由病前适应不良、阴性、阳性和基本症状以及较差的基线工作状况预测。即使在基线 GAF 和向精神病转变被纳入模型后，病前适应与随访 GAF 评分之间的关联仍然显著。
大多数寻求帮助的 CHR 患者在功能方面存在缺陷。在 CHR 患者中，病前心理社会适应、基线阳性、阴性、基本症状和较差的工作/学业情况预测短期功能结局较差。在对 CHR 患者进行急性干预和长期康复以改善结局时，应考虑到这些方面。
