Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France; University of Paris, Paris, France; CMME (Sainte-Anne Hospital, GHU Paris), Paris, France.
Janssen Cilag, Issy-les-Moulineaux, France.
Psychiatry Res. 2019 Nov;281:112560. doi: 10.1016/j.psychres.2019.112560. Epub 2019 Sep 7.
Functional remission has become a major therapeutic objective in schizophrenia, but the probability of such positive outcome has a large variability, ranging from 15% to 51%. Additionally, how clinical remission constitutes a prerequisite for functional remission also remains unclear.
A prospective observational study was conducted in French schizophrenic patients who initiated treatment with a long-acting injectable (LAI) after an acute episode. Functional and clinical remissions were assessed using the FROGS and the Andreasen criteria, and the role of clinical remission and predictive factors of functional remission was evaluated.
Three hundred three patients with schizophrenia (DSM-IV criteria) were followed for 12 months. At 12 months, 45.1% of the patients reached functional remission while 55.1% obtained clinical remission. Clinical remission facilitated functional remission (OR = 14.74), especially in patients with psychosis for less than 5 years (OR = 23.73). Other predictive factors concerned the family environment, education level, employment status, baseline functioning levels and level of insight.
About half of patients treated with LAI reached functional remission after one year of follow-up. Reduced clinical symptoms and reaching clinical remission largely favored functional remission. These results stress the importance of continuous and appropriate symptomatic treatment to reach functional remission and maximize recovery chances.
功能性缓解已成为精神分裂症的主要治疗目标，但这种积极结果的可能性存在很大的变异性，范围从 15%到 51%。此外，临床缓解如何构成功能性缓解的前提仍不清楚。
对法国精神分裂症患者进行了一项前瞻性观察研究，这些患者在急性发作后开始接受长效注射（LAI）治疗。使用 FROGS 和 Andreasen 标准评估功能和临床缓解，评估临床缓解在功能性缓解中的作用以及功能性缓解的预测因素。
303 名符合 DSM-IV 标准的精神分裂症患者接受了 12 个月的随访。在 12 个月时，45.1%的患者达到了功能缓解，而 55.1%的患者达到了临床缓解。临床缓解促进了功能缓解（OR=14.74），特别是在精神病发作时间少于 5 年的患者中（OR=23.73）。其他预测因素包括家庭环境、教育程度、就业状况、基线功能水平和洞察力水平。
大约一半接受 LAI 治疗的患者在随访一年后达到了功能缓解。临床症状的减轻和达到临床缓解极大地促进了功能缓解。这些结果强调了持续和适当的症状治疗的重要性，以达到功能缓解并最大限度地提高康复机会。
