Lee Jimmy, Fervaha Gagan, Takeuchi Hiroyoshi, Powell Valerie, Remington Gary
From the *Department of General Psychiatry 1, Institute of Mental Health; †Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore; ‡Schizophrenia Division, Centre for Addiction and Mental Health; §Institute of Medical Science, University of Toronto, Toronto, Canada; ∥Department of Neuropsychiatry, School of Medicine, Keio University Tokyo, Japan; and ¶Department of Psychiatry, University of Toronto, Toronto, Canada.
J Clin Psychopharmacol. 2015 Jun;35(3):237-41. doi: 10.1097/JCP.0000000000000310.
Previous investigations on the relationship between global rating measures and symptoms have not considered the additional role of functioning. In this naturalistic study, we examined the relationship between symptom domains and functioning on Clinical Global Impression scales for severity (CGI-S) and improvement (CGI-I) in a sample of patients with schizophrenia assessed to be treatment resistant. Participants were patients with a diagnosis of schizophrenia or schizoaffective disorder who failed 2 prior antipsychotic trials and were considered candidates for clozapine. They were assessed on the 18-item Brief Psychiatric rating Scale (BPRS), Social Occupational Functioning Assessment Scale (SOFAS), and CGI-S at baseline. A subset of patients was followed up at 6 weeks after initiation of clozapine and assessed on the CGI-I. The independent effects of symptom domains and functioning on the CGI scales were examined via multivariate regression models. Brief Psychiatric rating Scale positive factor (P < 0.001) and SOFAS (P < 0.001) scores were significant determinants of CGI-S at baseline. Multivariate models suggested that relative change measures had a better fit for the CGI-I compared to absolute change measures (R = 0.72 vs R = 0.61, respectively). Improvements in BPRS positive (P < 0.001) and affect (P = 0.002) factors and SOFAS (P = 0.030) scores were significant determinants of CGI-I. Ratings of 1 and 2 on the CGI-I corresponded to a mean relative change in the BPRS total of 65% and 41%, respectively. Positive symptoms were a key determinant of clinicians' impression of severity and improvement in this study. Although psychosocial functioning played a large part in determining severity, it was not as significant in the assessment of improvement.
先前关于整体评定指标与症状之间关系的研究并未考虑功能的额外作用。在这项自然主义研究中，我们在一组被评估为治疗抵抗的精神分裂症患者样本中，考察了症状领域与临床总体印象量表中严重程度（CGI-S）及改善程度（CGI-I）方面功能之间的关系。参与者为诊断为精神分裂症或分裂情感性障碍的患者，他们之前两次抗精神病药物试验均失败，被认为是氯氮平治疗的候选者。在基线时，他们接受了18项简明精神病评定量表（BPRS）、社会职业功能评估量表（SOFAS）和CGI-S评估。一部分患者在氯氮平治疗开始6周后进行随访，并接受CGI-I评估。通过多元回归模型检验症状领域和功能对CGI量表的独立影响。基线时，简明精神病评定量表阳性因子（P < 0.001）和SOFAS评分（P < 0.001）是CGI-S的显著决定因素。多元模型表明，与绝对变化量度相比，相对变化量度对CGI-I的拟合度更好（R分别为0.72和0.61）。BPRS阳性（P < 0.001）和情感（P = 0.002）因子以及SOFAS评分（P = 0.030）的改善是CGI-I的显著决定因素。CGI-I评分为1和2分别对应BPRS总分平均相对变化65%和41%。在本研究中，阳性症状是临床医生对严重程度和改善情况印象的关键决定因素。虽然心理社会功能在确定严重程度方面起很大作用，但在改善评估中其重要性不那么显著。
