Institute of Clinical Medicine, KG Jebsen Centre for Psychosis Research, Norwegian Centre for Mental Disorders Research, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway.
Compr Psychiatry. 2018 Oct;86:107-114. doi: 10.1016/j.comppsych.2018.07.014. Epub 2018 Jul 30.
Subjective quality of life (S-QoL) is an important outcome measure in first-episode psychosis, but its associations with clinical predictors may vary across the illness course. In this study we examine the association pattern, including both direct and indirect effects, between specific predefined clinical predictors (insight, depression, positive psychotic symptoms and global functioning) and S-QoL the first ten years after a first-episode psychosis.
Three hundred and one patients with a first-episode psychosis were included at first treatment, and reassessed at 3 months, 1 year, 2 years, 5 years and 10 years after inclusion. At 10-year follow-up 186 participated. S-QoL was assessed with Lehman's Quality of Life Interview. Applying a structural equation model, we investigated cross-sectional association patterns at all assessments between the predefined clinical predictors and S-QoL.
At baseline, only depression was significantly associated with S-QoL. At all follow-up assessments, depression and functioning showed significant associations with S-QoL. Insight was not associated with S-QoL at any of the assessments. Better insight, less depressive symptoms and less positive psychotic symptoms were all associated with higher functioning at all assessments. Functioning seems to mediate a smaller indirect inverse association between positive psychotic symptoms and S-QoL. The association pattern was stable across all follow-up assessments.
Together with depression, functioning seems to be important for S-QoL. Functioning seems to be a mediating factor between positive symptoms and S-QoL. A focus on functional outcome continues to be important.
主观生活质量（S-QoL）是首发精神病的一个重要结果衡量指标，但它与临床预测因子的关联可能因疾病进程而异。本研究旨在考察特定预定义临床预测因子（洞察力、抑郁、阳性精神病症状和整体功能）与首发精神病后 10 年内 S-QoL 之间的关联模式，包括直接和间接效应。
共纳入 310 例首发精神病患者，在首次治疗时纳入，并在 3 个月、1 年、2 年、5 年和 10 年后进行重新评估。在 10 年随访时，有 186 人参加。使用 Lehman 生活质量访谈评估 S-QoL。应用结构方程模型，我们在所有评估中研究了预定义临床预测因子与 S-QoL 之间的横断面关联模式。
在基线时，只有抑郁与 S-QoL 显著相关。在所有随访评估中，抑郁和功能均与 S-QoL 显著相关。洞察力在任何评估中均与 S-QoL 无关。洞察力更好、抑郁症状更少和阳性精神病症状更少与所有评估中的功能更高相关。功能似乎在阳性症状和 S-QoL 之间存在较小的间接负相关中起中介作用。该关联模式在所有随访评估中均保持稳定。
与抑郁一起，功能似乎对 S-QoL 很重要。功能似乎是阳性症状和 S-QoL 之间的中介因素。关注功能结果仍然很重要。
