Veru Franz, Jordan Gerald, Joober Ridha, Malla Ashok, Iyer Srividya
Department of Psychiatry, McGill University, Canada; Douglas Mental Health University Institute, Canada; Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Canada.
Department of Psychiatry, McGill University, Canada; Douglas Mental Health University Institute, Canada; Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Canada.
Schizophr Res. 2016 Jul;174(1-3):183-188. doi: 10.1016/j.schres.2016.03.035. Epub 2016 Apr 18.
Adolescent-onset psychosis has traditionally been characterized as a more severe form of psychosis with a poorer prognosis. However, it is still unclear if patients with an adolescent-onset have worse symptom remission outcomes. Symptom remission is the principal clinical outcome known to predict quality of life and social functioning in the long term. The goal of this study is to clarify the influence of age of onset of psychosis on symptom remission in a sample of first-episode psychosis patients.
A total of 246 first-episode psychosis patients were recruited from a specialized early intervention program serving a defined epidemiological catchment area. Age of onset of psychosis (adolescence vs. adulthood) was used as the main predictor, and duration of untreated psychosis (DUP), baseline symptoms, baseline functioning, substance abuse diagnosis, medication adherence and gender were used as covariates in hierarchical regression models predicting the following positive and negative symptom remission outcomes: maximum continuous months in remission and early remission (i.e., occurring in the first three months of follow-up).
After controlling for other variables, onset of psychosis in adulthood and shorter DUP predicted early remission of positive symptoms. This effect was stronger in patients with a diagnosis of a schizophrenia-spectrum disorder. Remission of negative symptoms did not depend on age of onset, and was only predicted by baseline negative symptoms.
Patients with onset of psychosis during adulthood are more likely to achieve early positive symptom remission than those with adolescent onset. This effect might be stronger in patients with a diagnosis of a schizophrenia-spectrum disorder.
青少年期起病的精神病传统上被认为是一种更严重的精神病形式，预后较差。然而，青少年期起病的患者症状缓解情况是否更差仍不清楚。症状缓解是已知的预测长期生活质量和社会功能的主要临床结局。本研究的目的是在首发精神病患者样本中阐明精神病起病年龄对症状缓解的影响。
从一个服务于特定流行病学区域的专门早期干预项目中招募了246名首发精神病患者。将精神病起病年龄（青少年期与成年期）用作主要预测因素，并将未治疗精神病持续时间（DUP）、基线症状、基线功能、物质滥用诊断、药物依从性和性别用作分层回归模型中的协变量，以预测以下阳性和阴性症状缓解结局：缓解的最长连续月数和早期缓解（即在随访的前三个月内出现）。
在控制其他变量后，成年期起病的精神病和较短的DUP预测了阳性症状的早期缓解。这种效应在诊断为精神分裂症谱系障碍的患者中更强。阴性症状的缓解不取决于起病年龄，仅由基线阴性症状预测。
成年期起病的精神病患者比青少年期起病的患者更有可能实现早期阳性症状缓解。这种效应在诊断为精神分裂症谱系障碍的患者中可能更强。
