Chang Wing Chung, Lau Emily Sin Kei, Chiu Shirley Sanyin, Hui Christy Lai Ming, Chan Sherry Kit Wa, Lee Edwin Ho Ming, Chen Eric Yu Hai
Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong.
Department of Psychiatry, Queen Mary Hospital, Hong Kong.
J Affect Disord. 2016 Aug;200:1-5. doi: 10.1016/j.jad.2016.01.050. Epub 2016 Apr 19.
The early course of first-episode mania with psychotic features (FEMP) is under-studied. Accumulating evidence suggests that FEMP is associated with substantial functional impairment. Very few studies were conducted to directly compare clinical and functional outcomes between FEMP and first-episode schizophrenia (FES).
Four-hundred-twenty patients aged 15-25 years who presented with FEMP or FES to a territory-wide early intervention service in Hong Kong from July 2001 to August 2003 and completed 3-year follow-up were studied. Baseline and follow-up variables were collected via systematic medial file review. Functional remission was operationalized as attaining sustained employment, and Social and Occupational Functioning Assessment Scale (SOFAS) score >60 in the last 12 months of follow-up.
At baseline, FEMP patients were younger, more likely to be hospitalized, had shorter duration of untreated psychosis, more severe positive symptoms and lower SOFAS score than FES patients. By the end of 3-year follow-up, FEMP patients had significantly milder positive symptom severity, higher SOFAS score, and higher rates of sustained employment (45.7%) and functional remission (36.9%) than FES patients. Regression analyses showed that diagnostic group membership of FEMP (vs. FES) independently predicted better clinical and functional outcomes.
Our results indicate that FEMP patients had better clinical and functional outcomes than FES patients in the initial 3 years of treatment. Yet, only approximately 37% of FEMP patients attained functional remission at 3 years. This underscores the need to develop specialized early intervention for FEMP populations to promote functional recovery in the early stage of illness.
伴有精神病性特征的首发躁狂症（FEMP）的早期病程研究较少。越来越多的证据表明，FEMP与严重的功能损害有关。很少有研究直接比较FEMP和首发精神分裂症（FES）的临床和功能结局。
对2001年7月至2003年8月在香港一家全地区早期干预服务机构就诊并完成3年随访的420例15 - 25岁的FEMP或FES患者进行研究。通过系统的病历审查收集基线和随访变量。功能缓解定义为实现持续就业，且在随访的最后12个月社会和职业功能评估量表（SOFAS）得分>60。
在基线时，FEMP患者比FES患者更年轻，更有可能住院，未治疗精神病的持续时间更短，阳性症状更严重，SOFAS得分更低。到3年随访结束时，FEMP患者的阳性症状严重程度明显较轻，SOFAS得分更高，持续就业率（45.7%）和功能缓解率（36.9%）高于FES患者。回归分析表明，FEMP（与FES相比）的诊断组成员身份独立预测了更好的临床和功能结局。
我们的结果表明，在治疗的最初3年中，FEMP患者的临床和功能结局比FES患者更好。然而，只有约37%的FEMP患者在3年时实现了功能缓解。这凸显了为FEMP人群开发专门的早期干预措施以促进疾病早期功能恢复的必要性。
