Friis Svein, Melle Ingrid, Johannessen Jan Olav, Røssberg Jan Ivar, Barder Helene Eidsmo, Evensen Julie Horgen, Haahr Ulrik, Ten Velden Hegelstad Wenche, Joa Inge, Langeveld Johannes, Larsen Tor Ketil, Opjordsmoen Stein, Rund Bjørn Rishovd, Simonsen Erik, Vaglum Per Wiggen, McGlashan Thomas H
Dr. Friis, Dr. Melle, and Dr. Røssberg are with the Division of Mental Health and Addiction, and Dr. Barder is with the Women and Children's Division, all at Oslo University Hospital, Oslo, Norway (e-mail:
Psychiatr Serv. 2016 Apr 1;67(4):438-43. doi: 10.1176/appi.ps.201400558. Epub 2015 Nov 16.
Identifying patients at risk of poor outcome at an early stage of illness can aid in treatment planning. This study sought to create a best-fit statistical model of known baseline and early-course risk factors to predict time in psychosis during a ten-year follow-up period after a first psychotic episode.
Between 1997 and 2000, 301 patients with DSM-IV nonorganic, nonaffective first-episode psychosis were recruited consecutively from catchment area-based sectors in Norway and Denmark. Specialized mental health personnel evaluated patients at baseline, three months, and one, two, five, and ten years (N=186 at ten years). Time in psychosis was defined as time with scores ≥4 on any of the Positive and Negative Syndrome Scale items P1, P3, P5, P6, and G9. Evaluations were retrospective, based on clinical interviews and all available clinical information. During the first two years, patients were also evaluated by their clinicians at least biweekly. Baseline and early-course predictors of long-term course were identified with linear mixed-model analyses.
Four variables provided significant, additive predictions of longer time in psychosis during the ten-year follow-up: deterioration in premorbid social functioning, duration of untreated psychosis (DUP) of ≥26 weeks, core schizophrenia spectrum disorder, and no remission within three months.
First-episode psychosis patients should be followed carefully after the start of treatment. If symptoms do not remit within three months with adequate treatment, there is a considerable risk of a poor long-term outcome, particularly for patients with a deterioration in premorbid social functioning, a DUP of at least half a year, and a diagnosis within the core schizophrenia spectrum.
在疾病早期识别预后不良风险的患者有助于治疗规划。本研究旨在创建一个由已知基线和病程早期风险因素构成的最佳拟合统计模型，以预测首次精神病发作后十年随访期内的精神病发作时长。
1997年至2000年期间，从挪威和丹麦基于集水区的区域连续招募了301例符合《精神疾病诊断与统计手册》第四版（DSM-IV）标准的非器质性、非情感性首次发作精神病患者。专业心理健康人员在基线、三个月、一年、两年、五年和十年时对患者进行评估（十年时n = 186）。精神病发作时长定义为在阳性与阴性症状量表（PANSS）项目P1、P3、P5、P6和G9中任何一项得分≥4的时长。评估是回顾性的，基于临床访谈和所有可用的临床信息。在最初两年中，临床医生至少每两周对患者进行一次评估。通过线性混合模型分析确定长期病程的基线和病程早期预测因素。
四个变量对十年随访期内更长的精神病发作时长提供了显著的累加预测：病前社会功能恶化、未治疗精神病持续时间（DUP）≥26周、核心精神分裂症谱系障碍以及三个月内未缓解。
首次发作精神病患者在开始治疗后应密切随访。如果经过充分治疗三个月内症状未缓解，则长期预后不良的风险相当大，特别是对于病前社会功能恶化、DUP至少半年且诊断为核心精神分裂症谱系的患者。
