Yamanaka Hiroshi, Kanahara Nobuhisa, Suzuki Tomotaka, Takase Masayuki, Moriyama Toshihiro, Watanabe Hiroyuki, Hirata Toyoaki, Asano Makoto, Iyo Masaomi
Department of Psychiatry, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan; Department of Psychiatry, Chiba Psychiatric Medical Center, 5 Toyosuna, Mihama-ku, Chiba 261-0024, Japan.
Department of Psychiatry, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan; Division of Medical Treatment and Rehabilitation, Chiba University Center for Forensic Mental Health, 1-8-1 Inohana, Chuou-ku, Chiba 260-8670, Japan.
Schizophr Res. 2016 Feb;170(2-3):252-8. doi: 10.1016/j.schres.2016.01.013. Epub 2016 Jan 13.
Although a variety of factors are known to be significantly related to poor prognosis in schizophrenia, their interactions remain unclear. Dopamine supersensitivity psychosis (DSP) is a clinical concept related to long-term pharmacotherapy and could be one of the key factors contributing to the development of treatment-resistant schizophrenia (TRS). The present study aims to explore the effect of DSP on progression to TRS.
Two-hundreds and sixty-five patients were classified into either a TRS or Non-TRS group based on retrospective survey and direct interview. The key factors related to prognosis, including the presence or absence of DSP episodes, were extracted, and each factor was compared between the two groups.
All parameters except for the duration of untreated psychosis (DUP) were significantly worse in the TRS group compared to the Non-TRS group. In particular, the TRS group presented with a significantly higher rate of DSP episodes than the Non-TRS group. Regression analysis supported the notion that DSP plays a pivotal role in the development of TRS. In addition, deficit syndrome was suggested to be a diagnostic subcategory of TRS.
Our data confirmed that the key predicting factors of poor prognosis which have been established would actually affect somehow the development of TRS. In addition, the occurrence of a DSP episode during pharmacotherapy was shown to promote treatment refractoriness.
尽管已知多种因素与精神分裂症的不良预后显著相关，但其相互作用仍不明确。多巴胺超敏性精神病（DSP）是一个与长期药物治疗相关的临床概念，可能是导致难治性精神分裂症（TRS）发生的关键因素之一。本研究旨在探讨DSP对TRS进展的影响。
通过回顾性调查和直接访谈，将265例患者分为TRS组或非TRS组。提取与预后相关的关键因素，包括是否存在DSP发作，并比较两组之间的每个因素。
与非TRS组相比，TRS组除未治疗精神病持续时间（DUP）外的所有参数均明显更差。特别是，TRS组的DSP发作率明显高于非TRS组。回归分析支持DSP在TRS发生中起关键作用的观点。此外，缺陷综合征被认为是TRS的一个诊断亚类。
我们的数据证实，已确定的不良预后关键预测因素实际上会在某种程度上影响TRS的发展。此外，药物治疗期间DSP发作的发生被证明会促进治疗难治性。
