University of Birmingham, College of Medical and Dental Sciences, Birmingham, United Kingdom.
University of Birmingham, College of Medical and Dental Sciences, Birmingham, United Kingdom; University of Birmingham, Institute for Mental Health, Birmingham, United Kingdom; Early Intervention Service, Birmingham Womens and Childrens NHS Trust, Birmingham, United Kingdom.
Schizophr Res. 2020 Apr;218:14-27. doi: 10.1016/j.schres.2019.12.011. Epub 2020 Jan 20.
First episode psychosis (FEP) is associated with functional decline. Existing evidence was synthesised to explore the influence of depressive symptoms during FEP on future social, occupational and global functioning.
Medline, Embase, PsychINFO, Cochrane Library, Open Grey, NICE Evidence and Web of Science were searched from inception to May 2018. Longitudinal studies of FEP patients were included. Study quality was assessed using the Downs and Black instrument. Two meta-analyses were performed using random effect models. The first meta-analysis correlates depressive symptoms during FEP with follow-up Global Assessment of Functioning (GAF) scores. The second meta-analysis shows the odds of long-term functional remission if depressive symptoms are present during FEP.
4751 unique abstracts were found. 36 articles were included. The first meta-analysis included 7 studies (932 participants) and showed depressive symptoms during FEP were negatively correlated with follow-up GAF scores (r = -0.16, 95% CI: -0.24 to -0.09, p < 0.001). The second meta-analysis of 9 studies (2265 participants) showed weak evidence of an association between the presence of depressive symptoms in FEP and reduction in functional remission (OR = 0.87, 95% CI: 0.68 to 1.13, p = 0.294).
Depressive symptoms during FEP are associated with poorer long-term global functioning and may be associated with a reduced chance of achieving functional remission. Clinical trials are needed to identify efficacious management of depressive symptoms in early psychosis.
首发精神病与功能下降有关。本研究旨在综合现有证据，探讨首发精神病期间抑郁症状对未来社会、职业和总体功能的影响。
从建库至 2018 年 5 月，检索 Medline、Embase、PsychINFO、Cochrane 图书馆、Open Grey、NICE 证据和 Web of Science 数据库，纳入首发精神病患者的纵向研究。使用 Downs 和 Black 量表评估研究质量。使用随机效应模型进行了两项荟萃分析。第一项荟萃分析将首发精神病期间的抑郁症状与随访时的总体功能评估（GAF）评分相关联。第二项荟萃分析显示首发精神病期间存在抑郁症状时，长期功能缓解的可能性。
共检索到 4751 篇摘要，最终纳入 36 项研究。第一项荟萃分析纳入 7 项研究（932 名参与者），结果显示首发精神病期间的抑郁症状与随访时的 GAF 评分呈负相关（r=-0.16，95%CI：-0.24 至-0.09，p<0.001）。第二项荟萃分析纳入 9 项研究（2265 名参与者），结果显示首发精神病期间抑郁症状的存在与功能缓解减少之间存在弱关联（OR=0.87，95%CI：0.68 至 1.13，p=0.294）。
首发精神病期间的抑郁症状与长期总体功能较差相关，并且可能与功能缓解的机会减少有关。需要开展临床试验，以确定早期精神病中抑郁症状的有效治疗方法。
