Bergé Daniel, Mané Anna, Salgado Purificacion, Cortizo Romina, Garnier Carolina, Gomez Laura, Diez-Aja Cristobal, Bulbena Antoni, Pérez Victor
The authors are with the Department of Neurosciences and Psychiatry, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain (e-mail:
Psychiatr Serv. 2016 Feb;67(2):227-33. doi: 10.1176/appi.ps.201400316. Epub 2015 Oct 15.
First-episode psychosis has an annual incidence rate of 24.6 to 40.9 per 100,000 population, and most individuals develop chronic disorders, such as schizophrenia or affective psychosis. The first two to five years are thought to be key determinants of long-term functional and clinical prognosis. This study aimed to determine the two-year course of illness in first-episode psychosis, including diagnosis, relapse, and functioning and factors related to these variables.
A total of 140 patients who experienced a first episode of psychosis were recruited and evaluated between 2008 and 2012 in a first-episode psychosis program in Barcelona, Spain. Regression models were used to determine factors predicting relapse and functioning.
A general trend was noted toward improved functioning and less severe psychotic symptoms. However, after two years, one-third of the patients had a diagnosis of schizophrenia and more than 40% had a diagnosis of affective psychosis. Rates of relapse were 31% after one year and 43% at two years. Cannabis use after illness onset and poor insight were the best predictors of relapse. Being male and severity of negative symptoms at baseline predicted worse functioning at two years.
Patients with first-episode psychosis were found to have high relapse rates during the first years after illness onset. Further studies evaluating treatment strategies focused on reducing cannabis use and improving insight in first-episode psychosis should be encouraged.
首发精神病的年发病率为每10万人24.6至40.9例，且大多数患者会发展为慢性疾病，如精神分裂症或情感性精神病。发病后的头两到五年被认为是长期功能和临床预后的关键决定因素。本研究旨在确定首发精神病患者的两年病程，包括诊断、复发情况、功能状况以及与这些变量相关的因素。
2008年至2012年期间，在西班牙巴塞罗那的一个首发精神病项目中，共招募并评估了140例经历过首次精神病发作的患者。采用回归模型来确定预测复发和功能状况的因素。
观察到功能状况有改善且精神病症状减轻的总体趋势。然而，两年后，三分之一的患者被诊断为精神分裂症，超过40%的患者被诊断为情感性精神病。一年后的复发率为31%，两年后的复发率为43%。发病后使用大麻和自知力差是复发的最佳预测因素。男性以及基线时阴性症状的严重程度预示着两年后的功能状况较差。
首发精神病患者在发病后的头几年复发率较高。应鼓励开展进一步研究，评估旨在减少大麻使用和改善首发精神病患者自知力的治疗策略。
