Cotton S M, Lambert M, Schimmelmann B G, Filia K, Rayner V, Hides L, Foley D L, Ratheesh A, Watson A, Rodger P, McGorry P D, Conus P
Orygen, The National Centre of Excellence in Youth Health, Locked Bag 10 (35 Poplar Road), Parkville, VIC, 3052, Australia.
Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.
Soc Psychiatry Psychiatr Epidemiol. 2017 May;52(5):575-585. doi: 10.1007/s00127-017-1358-0. Epub 2017 Feb 23.
Most patients with first episode psychosis (FEP) are neither studying nor employed (have a poor functional status) when first accessing care. Knowledge of the characteristics of patients with poor functioning and the features influencing functional status over time may pave the way to better treatment.
A medical file audit was used to collect data on premorbid, entry, treatment and 18-month outcome characteristics on 661 FEP patients who consecutively attended the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia, between 1998 and 2000. Functional status was ascertained using the modified vocational status index and was rated at baseline (poor or good) and according to its evolution over the treatment period (stable good, stable poor, deteriorating or improved functional status).
52.0% of patients had a poor functional status at service entry. They were more likely to be male with a non-affective psychosis. They also had lower levels of premorbid global functioning and education, and were more likely to have self-reported histories of learning disability, forensic issues, traumatic experiences and substance use. At service entry, they had more severe symptoms and poorer global functioning. 37% of these patients maintained a poor functional status at discharge, and 18% of those with a good functional status at service entry experienced a decline.
Although psychosocial interventions might assist a young person with FEP with working towards functional goals, for some, the impact of factors such as ongoing substance use and forensic issues on functional status needs to be addressed.
大多数首发精神病（FEP）患者在首次接受治疗时既未上学也未就业（功能状态较差）。了解功能状态较差患者的特征以及随时间影响功能状态的因素，可能为更好的治疗铺平道路。
通过对病历进行审核，收集了1998年至2000年间连续就诊于澳大利亚墨尔本早期精神病预防与干预中心的661例FEP患者的病前、入院、治疗及18个月结局特征的数据。使用改良的职业状态指数确定功能状态，并在基线时（差或好）以及根据其在治疗期间的变化情况（功能状态稳定良好、稳定较差、恶化或改善）进行评定。
52.0%的患者在开始接受服务时功能状态较差。他们更可能是患有非情感性精神病的男性。他们的病前整体功能水平和受教育程度也较低，并且更可能有自我报告的学习障碍、法医问题、创伤经历和物质使用史。在开始接受服务时，他们有更严重的症状和更差的整体功能。这些患者中有37%在出院时功能状态仍较差，而在开始接受服务时功能状态良好的患者中有18%出现了功能下降。
尽管社会心理干预可能有助于患有FEP的年轻人朝着功能目标努力，但对于一些人来说，持续的物质使用和法医问题等因素对功能状态的影响需要得到解决。
