Chang W C, Kwong V W Y, Chan G H K, Jim O T T, Lau E S K, Hui C L M, Chan S K W, Lee E H M, Chen E Y H
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, Hong Kong.
Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
Eur Psychiatry. 2017 Mar;41:37-41. doi: 10.1016/j.eurpsy.2016.09.007. Epub 2017 Feb 3.
Amotivation is prevalent in first-episode psychosis (FEP) patients and is a major determinant of functional outcome. Prediction of amotivation in the early stage of psychosis, however, is under-studied. We aimed to prospectively examine predictors of amotivation in FEP patients in a randomized-controlled trial comparing a 1-year extension of early intervention (Extended EI, 3-year EI) with step-down psychiatric care (SC, 2-year EI).
One hundred sixty Chinese patents were recruited from a specialized EI program for FEP in Hong Kong after they have completed this 2-year EI service, randomly allocated to Extended EI or SC, and followed up for 12 months. Assessments on premorbid adjustment, onset profiles, baseline symptom severity and treatment characteristics were conducted. Data analysis was based on 156 subjects who completed follow-up assessments.
Amotivation at 12-month follow-up was associated with premorbid adjustment, allocated treatment condition, and levels of positive symptoms, disorganization, amotivation, diminished expression (DE) and depression at study intake. Hierarchical multiple regression analysis revealed that Extended EI and lower levels of DE independently predicted better outcome on 12-month amotivation.
Our findings indicate a potentially critical therapeutic role of an extended specialized EI on alleviating motivational impairment in FEP patients. The longer-term effect of Extended EI on amotivation merits further investigation.
缺乏动机在首发精神病(FEP)患者中普遍存在,并且是功能转归的主要决定因素。然而,在精神病早期阶段对缺乏动机的预测研究不足。我们旨在通过一项随机对照试验,前瞻性地研究FEP患者缺乏动机的预测因素,该试验比较了早期干预延长1年(延长式早期干预,3年早期干预)与逐步降级精神科护理(SC,2年早期干预)。
160名中国患者在完成香港一项针对FEP的专门早期干预服务后,从该服务中招募而来,随机分配至延长式早期干预组或SC组,并随访12个月。对病前适应、起病情况、基线症状严重程度和治疗特征进行评估。数据分析基于156名完成随访评估的受试者。
12个月随访时的缺乏动机与病前适应、分配的治疗条件以及研究入组时的阳性症状、紊乱、缺乏动机、表情减少(DE)和抑郁水平相关。分层多元回归分析显示,延长式早期干预和较低的DE水平独立预测了12个月时缺乏动机方面更好的转归。
我们的研究结果表明,延长的专门早期干预在减轻FEP患者动机损害方面具有潜在的关键治疗作用。延长式早期干预对缺乏动机的长期影响值得进一步研究。